LipidRescue™ Resuscitation

Hi. I am a veterinary intern at MVS. I am doing a literature review for my internship and I would love to present the use of intravenous lipids for toxicities. I just saw a post from a vet student about permetherin toxicities and I will try to contact him. My big question is after you create the lipid sink for the lipophillic drugs, how does the body get rid of that sink. In Schnauzers, this could be a problem because they have lipemic serum to begin with. Do you have a reference I could read and use for my presentation? Thanks.

Jennifer Mead, DVM
OSU 09
Staff Dr, MVS

This is a fundamental question to which there is no definitive answer as yet. As long ago as the 1980's it was suggested that the capacity of lipid emulsions to bind lipid soluble drugs was unlikely to to fully account for reversing the drug's effects completely. I believe there is circumstantial evidence to support the notion that lipid may act as a vehicle to facilitate redistribution away from vital organs to peripheral adipose tissue in the acute phase. Thereafter, in the longer term, the drug may be subject to metabolism in the usual way.

From my understanding of the current literature, Nanoparticle lipid technology may provide the opportunity for greater binding affinity with the possible implication of retention within the intravascular compartment and direct transfer to the liver or other organs involved with drug/lipid metabolism.

As you are aware the lipid sink theory is only one of the mechanisms that are thought to be involved. Don't forget Dr Weinberg's and others' excellent work in elucidating intracellular and mitochondrial wall mechanisms.

Of course there may be other as yet unrecognised actions. So there is clearly alot of work to be done!

Thank you for your reply. The more I read about this the more interesting it becomes. There is lots of talk about it on the veterinary circuit especially in certain toxicities that we see in the ER. You mentioned Dr. Weinberg's work in elucidating intracellular and mitochondrial wall mechanisms. To eliminate the toxins or to what are you referring or is there a link to a research article tht you could send me? I have a feeling I will be reading alot about this before my presentation. :)

Jennifer

Here are my recommendations:

Two review articles with comprehensive reference lists that are most likely to answer your question:

1) Intravenous Fat Emulsion: A Potential Novel Antidote. Turner-Lawrence D.E. Kearns II, W. Journal of Medical Toxicology. June 2008 4: 109-114

2) Intravenous Lipid Emulsion as Antidote Beyond Local Anesthetic Toxicity: A systematic Review. Cave G, Harvey M. Academic Emergency Medicine 2009 16: 815-824.