free collaborative open access anaesthesia education

INTRALIPID

CLASS

Lipid emulsion

PRESENTATION

White, opaque fluid

Formulations

  • 250ml bottle; 50g, 20% (200mg/ml)

INDICATIONS & DOSING

Local Anaesthetic Systemic Toxicity (LAST)

  • Adult; 100ml IV bolus
  • Paediatric; 1.5ml/kg IV bolus
  • Infusion; 15mg/kg/hr IV
  • 2 further bolus doses and doubling of the infusion rate recommended at 5 minute intervals until cardiovascular stability is restored
  • Maximum cumulative dose 12mg/kg

PRACTICALITIES

Administration

  • Can be administered via a peripheral vein
  • If not administered immediately, use within 24 hours due to propensity to foster bacterial growth

Incompatibilities

  • In general other drugs should not be co-administered with Intralipid due to incompatibility by its emulsive properties

Practice tips

  • Administration may interfere with pulse oximetry function and some laboratory measurements (Hb, amylase, lipase, Cr, ALT, bili, Mg)
  • Monitoring of serum amylase/lipase should occur for 2 days after Intralipid therapy to detect pancreatitis
  • Clinical use should be reported to www.lipidrescue.org to allow ongoing monitoring of drug efficacy and safety

PHARMACOKINETICS

Onset, duration

Pharmacokinetic studies lacking

Metabolism, elimination

Uncertain, may follow normal physiological pathways of lipid handling

MECHANISM

Mechanism is not fully understood, theories include;

  • Lipid ‘sink’; concentrating local anaesthetic molecules and establishing a concentration gradient with the effect of drawing molecules from cardiac binding sites
  • Lipid supply; supplying cardiac muscle with its preferred energy substrate in the presence of local anaesthetic inhibition of fatty acid oxidation
  • Competitive inhibition of local anaesthetics; at cardiac sodium channel binding sites
  • Cytoprotection
  • Promoting intracellular calcium release in the cardiac myocyte
  • ‘Shunting’ of local anaesthetic molecules to sequestering organs

DESIRED CLINICAL EFFECTS

Cardiovascular

  • Termination of cardiac arrhythmias and collapse secondary to LAST 

Neurological

  • Termination of seizures secondary to LAST

OTHER CLINICAL EFFECTS, ADVERSE EFFECTS & TOXICITIES

Gastrointestinal

  • Hyperlipidaemia and fat overload syndrome; fever, fat infiltration, organ dysfunction, coma
  • Pancreatitis
  • Hepatic dysfunction
  • Refeeding syndrome 

Other

  • Sepsis

CONSIDERATIONS

Precautions

  • Premature and low-birth weight infants (poor lipid clearance resulting in pulmonary accumulation and death)
  • Severe hepatic dysfunction; poor lipid clearance
  • Severely malnourished patients at risk of re-feeding syndrome

Obstetric 
ADEC category C 

Drug interactions

  • Warfarin; Intralipid contains vitamin K1, counteracting the effect of vitamin K epoxide reductase inhibition by warfarin and reducing its efficacy

REFERENCES

Drug information has been compiled from multiple sources including

  • Drugs in Anaesthesia and Intensive Care (Scarth & Smith)
  • Micromedex (IBM)
  • BJA Education (Oxford Academic)
  • Pharmacology for Anaesthesia and Intensive Care (Cambridge)
  • Australian Prescriber (NPS MedicineWise)

Leave a Reply

Close Menu