Levine Michael, Skolnik Aaron B, Ruha Anne-Michelle, Bosak Adam, Menke Nathan, Pizon Anthony F
Department of Emergency Medicine, Section of Medical Toxicology, University of Southern California, 1200 North State Street, #1011, Los Angeles, CA, 90033, USA,
J Med Toxicol. 2014 Mar;10(1):10-4. doi: 10.1007/s13181-013-0356-1.
The primary objective is to identify and describe the complications associated with the use of intravenous lipid emulsion (ILE) therapy as an antidote for lipophilic drug toxicity. This study is a retrospective chart review of patients treated with ILE at two academic medical centers between 2005 and 2012. Based on previously reported complications, we hypothesized that pancreatitis, ARDS, and lipemia-induced laboratory interference might occur. Clinical definitions of these complications were defined a priori. Subjects treated with ILE who did not develop at least one complication were excluded. A total of nine patients were treated with ILE during the study period, six of whom experienced potential complications as a result of the ILE. Two patients developed pancreatitis, and four patients had lipemia-induced interference of interpretation of laboratory studies, despite ultracentrifugation. Laboratory interference precluded one patient from being an organ donor. Three patients developed ARDS; although temporally associated, a causal relationship between ILE and the development of ARDS cannot be clearly established. As ILE is increasingly used for less severe cases of drug toxicity, clinicians should be aware of potential complications associated with its use. A risk-benefit assessment for the use of ILE should be implemented on a case-by-case basis.
主要目的是识别和描述与使用静脉注射脂质乳剂（ILE）治疗作为亲脂性药物中毒解毒剂相关的并发症。本研究是对2005年至2012年期间在两个学术医学中心接受ILE治疗的患者进行的回顾性病历审查。基于先前报道的并发症，我们推测可能会发生胰腺炎、急性呼吸窘迫综合征（ARDS）和脂血症引起的实验室干扰。这些并发症的临床定义是预先确定的。未发生至少一种并发症的接受ILE治疗的受试者被排除。在研究期间共有9例患者接受了ILE治疗，其中6例因ILE出现了潜在并发症。2例患者发生了胰腺炎，4例患者尽管进行了超速离心，但仍出现了脂血症引起的实验室检查结果解读干扰。实验室干扰使1例患者无法成为器官捐献者。3例患者发生了ARDS；尽管在时间上相关，但ILE与ARDS发生之间的因果关系尚不能明确确立。由于ILE越来越多地用于不太严重的药物中毒病例，临床医生应意识到其使用相关的潜在并发症。应逐案进行ILE使用的风险效益评估。
