Title: Intravenous Lipid Emulsion Therapy (ILE) – EmergencyPedia
Headings: 
Intravenous Lipid Emulsion Therapy (ILE)
Intravenous Lipid Emulsion (ILE) Therapy – A Brief Review
Case Study (Fictitious)
What other specific therapies may be useful in these circumstances?
Intralipid Emulsion (ILE)
What is Intralipid?
How is Intralipid Administered in an Emergency?

Content: Intravenous Lipid Emulsion Therapy (ILE) – EmergencyPedia
Intravenous Lipid Emulsion Therapy (ILE)
Posted on June 20, 2013
June 20, 2013
by Andrew Coggins
Intravenous Lipid Emulsion (ILE) Therapy – A Brief Review
Case Study (Fictitious)
Patient – Mr John Harper
75 year old man living in a rural area
John fell over on the front porch of his house – this was witnessed by his daughter and she called the emergency services and an ambulance arrived soon after
He was unable to get up afterwards and has an obvious deformity of his right leg
On arrival in the Emergency Department (ED) the patient complains of leg pain and has shortening of his right leg. There are no other apparent injuries
Shortly after arrival the following x-ray is taken
This x-ray is interpreted as a right femoral shaft fracture
The patient is noted to have significant thigh and groin pain
John receives Morphine and Paracetamol IV but still has persistent pain
The local doctor places a femoral block using Marcaine® (Bupivicaine) 20mls
In doing so they use a ‘landmark’ technique with aspiration every 5mls infiltrated
A few moments later the patient becomes unresponsive and CPR is started
The patient’s rhythm is Asystole
The medical team begins CPR using the following algorithim
What other specific therapies may be useful in these circumstances? John received continued CPR with 1.5mls/kg of intralipid as well as 50mls of 8.4% Sodium Bicarbonate. After 8 minutes of effective CPR he regains a cardiac output and begins to bite the Endotracheal tube that has been placed during resuscitation. The picture described above is highly suggestive of acute local anaesthetic cardiac toxicity. This is due to sodium channel blockade
In most circumstances (assuming the maximal dose in mg per kg is no grossly exceeded acute toxicity is due to inadvertent intravenous (IV) administration
Cardiovascular collapse from accidental local anesthetic toxicity while rare is a potential disasterous complication of regional anaesthesia. It is well described particularly in the anaesthetic literature and many anaethetic departments have had protocols for the management of this emergency for many years
Sodium bicarbonate has often been described as standard therapy for sodium channel blockade toxicity from drugs such as tricyclic antidepressants but in this case Intralipid Therapy should also be considered at an early stage because of the increasing evidence of its effectiveness in this situation. Intralipid Emulsion (ILE)
Intravenous lipid Emulsion (ILE) or Intralipid is emerging as a first line therapy for treating the cardiotoxic effects of Local Anaesthetic toxicity and other refractory toxicological emergencies
It was first used in medicine as artificial nutrition in the 1960s
The use of ILE for Local Anaesthetic toxicity was first discussed in the 1990s
Evidence has emerged for use of ILE in the form of Human Case Reports , Animal Data and a number of recent Review Articles and Case Series
What is Intralipid? ILE is an oil and water Micro Emulsion
It is extracted from Soya Beans
The pH of ILE is 8.0
How does it work? The Mechanism of Action of Intralipid is poorly understood but thought to be related to the following factors: