Iv lipid emulsion therapy indications8/31/2023 ![]() ![]() The ILE infusion was continued (100 ml/h) for an additional 4 h after the PE therapy. The patient's blood pressure started to improve. Following this procedure, the ECG returned to sinus rhythm and the QT interval shortened to 541 ms (fig. One hour later PE therapy (1 plasma volume) was carried out. Because the patient exhibited persistent hypotension despite vasoconstrictor therapy and her metabolic condition did not improve, intravenous lipid emulsion (ILE) therapy (Smoflipid Fresenius Kabi, Bad Homburg, Germany) was started at a rate of 100 ml/h via the central venous catheter. An infusion of sodium bicarbonate (20 mEq/h) was initiated due to acidosis in the blood gas report and potassium replacement was also started. All other electrolytes, creatinine, blood urea nitrogen, glucose, hepatic transaminases, troponin and coagulation study results were within normal ranges. ![]() Her partial pressure of carbon dioxide was 30.7 mm Hg, partial pressure of oxygen was 70.3 mm Hg, bicarbonate was 12.9 mmol/l and lactate was 7.0 mmol/l. Initial laboratory data revealed a sodium level of 133 mmol/l, potassium level of 2.8 mmol/l, and an arterial blood gas analysis revealed a pH of 7.22. The patient was then taken urgently to the emergency critical care unit. Gastric irrigation was performed and activated charcoal (1 g/kg) was administered. An infusion of dopamine and norepinephrine was started because of persistent hypotension despite the rapid infusion of normal saline. The patient became agitated and her respiratory condition deteriorated, hence she was sedated and intubated 10 min following her arrival. Flumazenil (0.1 mg i.v.) was administered because diazepam was the likely cause of her respiratory depression. The patient was monitored and fluid replacement was commenced. Her oxygen saturation was 79% using pulse oximetry and her pulse was 110 beats/min. 1a), in addition to profound hypotension and severe depression of the central nervous and respiratory systems. Upon arrival, she exhibited signs of cardiotoxicity, including QT interval prolongation and atrial fibrillation (fig. She arrived at the emergency department in a critical condition approximately 2 h after the ingestion. Based on information from the patient's family, the ingested drugs were amisulpride (28 g), diazepam (250 mg), valsartan (2,240 mg), aripiprazole (45 mg) and paliperidone (21 mg). IVLE should be used with conventional therapies for permethrin toxicosis, and owners should be advised of its off-label use.A 45-year-old woman who attempted suicide by ingesting large quantities of antipsychotic, benzodiazepine and antihypertensive drugs was taken to the hospital of Adnan Menderes University School of Medicine in a critical condition. Additional doses can be administered after 6–8 hours if signs have not resolved and the serum is not grossly lipemic. The recommended dose of 20% intralipid is a 1.5 mL/kg IV bolus over 30 minutes then 0.25 mL/kg/min IV over 30–60 minutes through a dedicated IV set. The exact mechanism of action is unknown, but one theory suggests that an intralipid pulls lipophilic molecules out of the interstitium. The goal of IVLE in permethrin toxicity is to reduce permethrin tissue concentrations, thereby decreasing hospitalization time and mortality rates. IVLE, a new treatment for toxicities that are lipophilic (eg, permethrins), is a sterile, nonpyrogenic fat emulsion used in parenteral nutrition. ![]() Treatment usually includes controlling tremors, supportive care, decontamination, and promoting excretion. Permethrin toxicity produces a prolonged opening of sodium channels causing tremors, ataxia, hyperesthesia, mydriasis, pyrexia, hypersalivation, vomiting, and seizures. Feline permethrin toxicosis occurs most often when canine flea preventive is applied to a cat. All cases showed marked improvement of muscle tremors after IVLE administration. ![]() This study described 3 cases of feline permethrin toxicity treated with IV lipid emulsion (IVLE) as one component of therapy. ![]()
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