Canis ISSN: 2398-2942

Intravenous lipid infusion

Synonym(s): Lipid rescue

Contributor(s): Nicola Bates, Alexander Campbell

Introduction

  • Lipid infusion has been used successfully with poisoning from lipophilic compounds in dogs (Baker, 2008; Gwaltney-Brant and Dunayer, 2008, Crandall and Weinberg, 2009; Lee, 2010; Clarke et al, 2011; Bates et al, 2013) and cats (O'Brien et al,2010, Pritchard, 2010; Bruckner and Schwedes, 2012; Howarth and Smart, 2012).
  • Administration of intravenous lipids may result in rapid improvement in neurological status.
  • This is an experimental procedure in humans and it is only recommended in severe, potentially fatal cases of toxicity but this is generally not the case in veterinary medicine where it is reportedly used earlier in the course of therapy (Fernandez et al, 2011; Bruckner and Schwedes 2012).
  • Note that there are case reports of ivermectin toxicity Ivermectin toxicity where lipid infusion has failed. It has been suggested that lack of effect may have been due to the presence of high brain concentrations of ivermectin Ivermectin and that these were not significantly affected by lipid administration (Wright et al, 2011). This may indicate a need to institute lipid therapy as soon as possible in susceptible breeds before the brain concentration of the offending toxin is too high.
  • The use of lipid infusion in veterinary medicine has also been the subject of recent reviews (Fernandez et al, 2011; Gwaltney-Brant and Meadows, 2012; Kaplan and Whelan, 2012).
  • Consider in the management of toxicity from macrocyclic lactones (eg ivermectin, moxidectin Moxidectin ), local anesthetics, permethrin Permethrin , baclofen and some calcium channel blockers (eg diltiazem Diltiazem verapamil Verapamil ).

Cautions and contradictions

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Risks

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Mechanism

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Method

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Further Reading

Publications

Refereed papers
  • Recent references fromPubMed.
  • Bates N, Chatterton J, Robbins C, Wells K, Hughes J, Stone M, Campbell A (2013)Lipid infusion in the management of poisoning: a report of 6 canine cases. Vet Rec172(13), 339PubMed.
  • Bruckner M, Schwedes C S (2012)Successful treatment of permethrin toxicosis in two cats with an intravenous lipid administration. Tierarztl Prax Ausg K Kleintiere Heimtiere40(2), 129-34.
  • Gwaltney-Brant S, Meadows I (2012)Use of intravenous lipid emulsions for treating certain poisoning cases in small animals. Vet Clin N Am: Sm Anim Pract42, 251-262PubMed.
  • Haworth M D, Smart L (2012)Use of intravenous lipid therapy in three cases of feline permethrin toxicosis. J Vet Emerg Crit Care22(6), 697-702.
  • Kaplan A, Whelan M (2012)The use of IV lipid emulsion for lipophilic drug toxicities. J Am Anim Hosp Assoc48(4), 221-227.
  • Clarke D L, Lee J A, Murphy L A, Reineke E L (2011)Use of intravenous lipid emulsion to treat ivermectin toxicosis in a border collie. J Am Vet Med Assoc239(10), 1328-1333PubMed.
  • Fernandez A L, Lee J A, Rahilly L, Hovda L, Brutlag A G, Engebretsen K (2011)The use of intravenous lipid emulsion as an antidote in veterinary toxicology. J Vet Emerg Crit Care21, 309-320PubMed.
  • McAllister R K, Tutt C D, Colvin C S (2011)Lipid 20% emulsion ameliorates the symptoms of olanzapine toxicity in a 4-year-old. Am J Emerg Med30(6), 1012.e1-2PubMed.
  • Wright H M, Chen A V, Talcott P A, Poppenga R H, Mealey K L (2011)Intravenous fat emulsion as treatment for ivermectin toxicosis in three dogs homozygous for the ABCB11 gene mutation. J Vet Emerg Crit Care21, 666-672PubMed.
  • O'Brien T Q, Clark-Price S C, Evans E E, Di Fazio R, McMichael M A (2010)Infusion of a lipid emulsion to treat lidocaine intoxication in a cat. J Am Vet Med Assoc237, 1455-1458.
  • Pritchard J (2010)Treating ivermectin toxicity in cats [letter]. Vet Rec166(24), 766.
  • Crandall D E, Weinberg G L (2009)Moxidectin toxicosis in a puppy successful treated with intravenous lipids. J Vet Emerg Crit Care19(2), 181-186PubMed.
  • Harvey M, Cave G, Kazemi A (2009)Intralipid infusion diminishes return of spontaneous circulation after hypoxic cardiac arrest in rabbits. Anesthesia & Analgesia108, 1163-1168.
  • Marwick P C, Levin A I, Coetzee A R (2009)Recurrence of cardiotoxicity after lipid rescue from bupivacaine-induced cardiac arrest. Anesthesia & Analgesia108, 1163-1168.
  • Van de Velde M, Wouters P F, Rolf N, Van Aken H, Flameng W, Vandermeersch E (1996)Long-chain triglycerides improve recovery from myocardial stunning in conscious dogs. Cardiovasc Res32 (6), 1008-1015.

Other sources of information

  • Lee J A (2010)Advances in toxicology: the use of intra-lipid therapy & high-dextrose insulin therapy. ACVIM Proceedings, Anaheim, California, June 9-12.
  • Baker L (2008)Lipid emulsion treatment of ivermectin in a dog.www.lipidrescue.squarespace.com/post-your-cases/post/510768
  • Gwaltney-Brant, Dunayer E (2008)The use of intravenous lipid solution therapy in the treatment of moxidectin overdose in a dog [abstract]. Proc AAVLD 51st Annual Conference, Greensboro, NC, 22-27 October, p 118.


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