Section of Medical Toxicology; Department of Emergency Medicine, Washington University School of Medicine, Saint Louis, MO, USA.
Division of Clinical Pharmacology, Department of Medicine/Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
Clin Toxicol (Phila). 2020 Dec;58(12):1281-1283. doi: 10.1080/15563650.2020.1746800. Epub 2020 Apr 7.
Intravenous lipid emulsion (ILE) is a widely accepted treatment for local anesthetic systemic toxicity (LAST), particularly resulting from bupivacaine. The past decade has seen interest in antidotal use of ILE for other poisonings wax and wane. Numerous anecdotes have raised enthusiasm while more rigorous reviews have cast skepticism. The truth may lie between these two poles.We illustrate the recent trends in published reports on ILE. We highlight the gaps in our knowledge and suggest sources of data that may clarify how useful ILE may be for poisonings other than LAST. We offer the example of bupropion, which is hazardous in overdose and which has a Log P (octanol-water partition coefficient) similar to that of bupivacaine.Current data sources including the AAPCC National Poison Data System (NPDS), the ACMT Toxic Investigators Consortium (ToxIC), and a voluntary online registry (www.lipidrescue.org) each give an incomplete view of the problem. We propose analysis of newer NPDS data, which will include ILE as a treatment field code beginning with the 2019 data, and a structured, prospective registry of antidotal use of ILE for poisonings other than LAST.
静脉内脂肪乳剂（ILE）是广泛接受的局部麻醉药全身毒性（LAST）治疗方法，特别是布比卡因引起的 LAST。在过去的十年中，人们对ILE 用于其他中毒的解毒作用的兴趣时高时低。众多传闻引起了人们的热情，而更严格的审查则引起了怀疑。事实可能介于这两个极端之间。我们说明了最近关于 ILE 的已发表报告中的趋势。我们强调了我们知识中的空白，并提出了可能阐明 ILE 对除 LAST 以外的中毒可能有用的数据源。我们以丁丙诺啡为例，它在过量服用时很危险，其 Log P（辛醇-水分配系数）与布比卡因相似。当前的数据源包括 AAPCC 国家毒物数据系统（NPDS）、ACMT 毒理调查员联合会（ToxIC）和一个自愿在线登记处（www.lipidrescue.org），每个数据源都对该问题的看法都不完整。我们建议分析更新的 NPDS 数据，该数据将从 2019 年的数据开始将 ILE 作为治疗领域代码，并对 ILE 用于除 LAST 以外的中毒的解毒作用进行结构化、前瞻性登记。
