LipidRescue™ Resuscitation

Addition to the list of cases of successful resuscitation of drug overdoses using intralipid 20%. 38 year old lady,with history of overdose of quetiapine 400 mg, 20 tablets(8g), presented to A&E ,at 15:45, GCS 13/15.

Background history of depression- on treatment with Quetiapine and Olanzapine, previous history of drug overdose, once in the past.

No haemodynamic instability except for tachycardia of 114/min, ECG- QTc of 510 ms.
Over the next 2 hours gradual deterioration in GCS to 9/15 at 17:45. Anaesthetic input requested at this time. GCS- 9/15, Airway- maintained, on 100 % O2 by mask, stable haemodynamics, on iv fluids
Decision to try Intralipid 20% based on previous case reports of its successful use. Bolus dose 100 ml followed by an infusion of 400 ml over next 45 mins. Gradual improvement in GCS to 13/15 at 21:15. Observed overnight in ICU. Sleepy for most of the time overnight, but easily arousable. Discharged home after 48 hours. Successful use, i suppose , considering the fact that we didnt have to do tracheal intubation and ventilation.
Details to follow

I'm interested in the additional details you've promised.

Do you have serial 12 lead ecg recordings documenting any further QTc changes? Is there any other explanation for the prolonged QTc other than o/d?

It seems the lipid was given sufficiently early to perhaps attenuate the GCS fall that might have been expected from this dose.