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A cohort study of unstable overdose patients treated with intravenous lipid emulsion therapy

  • Shazma Mithani (a1) (a2), Kathryn Dong (a1) (a2), Ashlea Wilmott (a3), Heather Podmoroff (a4), Nadim Lalani (a5), Rhonda J. Rosychuk (a6), Ryan Chuang (a3) (a7) (a4) and Mark C. Yarema (a1) (a3) (a8)...

Abstract

Objectives

Intravenous lipid emulsion (ILE) has been used increasingly over the last decade for a range of drug overdoses. Although the use of ILE in local anesthetic toxicity (LAST) is well established, the hemodynamic effectiveness of ILE in non-LAST poisonings is still unclear. Thus, the primary objective of this study was to examine a cohort of poisoned patients in whom ILE was administered.

Methods

Consecutive patients were identified by calls to a regional poison center from May 1, 2012 to May 30, 2014. Patients were enrolled if they ingested a drug, developed hemodynamic instability, failed conventional treatment, and received ILE therapy. Data were collected by medical record review. The primary outcome was the change in mean arterial pressure (MAP) in the first hour after ILE administration. Secondary outcomes included survival, length of stay, and the effect of drug class on patient outcome.

Results

Thirty-six patients were enrolled. Agents ingested included calcium channel blockers and beta blockers (10/36, 27.8%), tricyclic antidepressants (5/36, 13.9%), bupropion (3/36, 8.3%), and antiepileptic agents (1/36, 2.8%). Seventeen patients (47.2%) ingested multiple agents. Twenty-five patients survived (69.0%). Overall, MAP increased by 13.79 mm Hg (95% CI 1.43–26.15); this did not meet our a priori definition of clinical significance.

Conclusions

Our study did not find a clinically important improvement in MAP after ILE administration. Until future research is done to more definitively study its efficacy, ILE should remain a potential treatment option for hemodynamically unstable overdose patients only after conventional therapy has failed.

Objectif

Le recours à l’émulsion lipidique intraveineuse (ELI) a connu une augmentation au cours de la dernière décennie dans le traitement de divers types de surdosage. Si l’utilisation de l’ELI dans le traitement de la toxicité des anesthésiques locaux est bien établie, l’efficacité hémodynamique de l’ELI dans les cas d’intoxication causée par d’autres substances que les anesthésiques locaux, elle, est incertaine. L’étude décrite ici avait donc pour objectif principal d’examiner une cohorte de patients intoxiqués, traités par une ELI.

Méthode

Le repérage des patients consécutifs s’est fait à l’aide des appels reçus dans un centre antipoisons régional, du 1er mai 2012 au 30 mai 2014. Ont été retenus ceux qui avaient pris des médicaments, présentaient de l’instabilité hémodynamique, n’avaient pas réagi au traitement habituel et avaient été traités par une ELI. La collecte de données a été réalisée à l’aide des dossiers médicaux. Le principal critère d’évaluation consistait en la mesure des variations de la pression artérielle moyenne (PAM) au cours de la première heure suivant l’administration de l’ELI; les critères secondaires d’évaluation comprenaient la survie, la durée du séjour et l’effet de la classe de médicaments sur l’évolution de l’état de santé.

Résultats

Ont participle à l’étude 36 patients. Différents types de médicaments avaient été avalés, notamment des inhibiteurs calciques et des bêta-bloquants (10/36; 27,8 %), des antidépresseurs tricycliques (5/36; 13,9 %), du bupropion (3/36; 8,3 %) et des antiépileptiques (1/36; 2,8 %). Dix-sept patients (47,2 %) avaient pris un mélange de médicaments. Vingt-cinq patients ont survécu (69,0 %) au surdosage. La PAM a augmenté, dans l’ensemble, de 13,79 mm Hg (IC à 95 % : 1,43 - 26,15), mais l’écart ne respectait la définition de portée clinique, établie avant l’étude.

Conclusions

Les résultats de l’étude ne permettent pas de conclure à une amélioration importante de la PAM sur le plan clinique après l’administration de l’ELI. Aussi le traitement devrait-il rester une solution de rechange possible dans les seuls cas de surdosage accompagnés d’instabilité hémodynamique, après l’échec du traitement courant, jusqu’à ce que des recherches ultérieures examinent davantage en profondeur la question de l’efficacité de l’ELI.

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Copyright

Corresponding author

Correspondence to: Dr. Shazma Mithani, Department of Emergency Medicine, Royal Alexandra Hospital, 10240 Kingsway Avenue, Community Services Building, Room 541, Edmonton, AB, Canada, T5H 3V9; email: smithani@ualberta.ca

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Keywords

A cohort study of unstable overdose patients treated with intravenous lipid emulsion therapy

  • Shazma Mithani (a1) (a2), Kathryn Dong (a1) (a2), Ashlea Wilmott (a3), Heather Podmoroff (a4), Nadim Lalani (a5), Rhonda J. Rosychuk (a6), Ryan Chuang (a3) (a7) (a4) and Mark C. Yarema (a1) (a3) (a8)...

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