Top 10 Facts about Intravenous Lipid Emulsion FAT being PHAT!
By Dr. Garret Pachtinger, DACVECC
Let’s first define “FAT.” FAT in the context of this blog is referring to is intravenous lipid emulsion (ILE).
ILE is used for two primarily reasons in modern medicine.
1) ILE can be used to provide nutritional support.
2) ILE can also be used in cases of certain toxicities. In fact, in the late 1990s and early 2000s, ILE was used to treat local anesthetic toxicity in human patients.
Then what is PHAT? Well…according to kids these days (and Wikipedia), Phat is the wiktionary slang term for “cool” or “awesome”.
So…yes….ILE is FAT and PHAT!
Let’s get to our top 10 facts about FAT being PHAT!
1. ILE can be used as an antidote for fat-soluble toxins.
2. The most common toxicities ILE is used for in veterinary medicine include ivermectin, moxidectin, and baclofen. Other toxins that are considered ILE-worthy include cholecalciferol, beta-blockers, calcium channel blockers, buproprion, and local anesthetics (e.g., lidocaine, bupivicaine, etc.)
3. While the mechanism of action (MOA) is not completely understand, one of the most compelling thoughts is that ILE acts as a lipid “sink.”
4. While we always recommend contacting a veterinary poison control service for the most up-to-date information on toxicities and dosing, a common dose recommendation for ILE use is:
1.5 ml/kg of 20% ILE, IV over 1 minute, followed by 0.25 ml/kg/min X 30-60 minutes.
5. If necessary, you can repeat the dose with 8 ml/kg/day being a common “max dose” per 24 hours (although that is debated).
6. Before giving a repeat dose, it is recommended to check the patient’s serum. If the patient is already grossly lipemic, a repeat dose may not have great effect.
7. As compared to other super osmotic parenteral medications, ILE can be given through a standard peripheral intravenous catheter. Ideally, this should be a new, dedicated IV catheter (where no other drugs are being given).
8. Although not an exhaustive list, complications of ILE to be aware of include fat overload syndrome, fat/pulmonary embolism, bacterial contamination, hepatopathy, thrombophlebitis, hyperlipidemia, and pancreatitis.
9. Clinical improvement is often rapid, typically within 30 – 60 minutes following administration although in some cases it can take up to 24 hours to see improvement.
10. A great website to get more information on ILE is lipidrescue.org.
For a clinical case discussion, check out this VETgirl video of a 10-year-old, male neutered, Domestic Long Hair presented to the ER for ivermectin toxicity that received ILE therapy!