Post Your Cases > Historical Intralipid 'rescue' for barbiturate overdose
In 1978-79 - heavens knows exactly when, I was a first year SHO in medicine (first year resident?). We admitted a male patient in his 60’s I guess, who had taken a large overdose of barbiturate. I think it was phenobarbitone. He was asleep for two days (on the open ward – no HDU then!) as I recall, and I was worrying about his calorie intake. We had hydrated him of course, but I was unkeen to place a central line at that stage for proper nutrition, so I gave a bottle of Intralipid via a peripheral vein. No idea of the rate, but it was not particularly fast. To our astonishment he woke up about an hour or so later. And never looked back, as I recall. Remember this is a long time ago! I wondered if it was a coincidence, but I could not help thinking that there was a possibility that I had introduced a further compartment into his pharmacokinetics, and had ‘sucked’ the barbiturates, very lipid soluble of course, out of his CNS into the Intralipid. I day-dreamed for weeks about animal experiments with barbiturate poisoned rats treated with Intralipid, and then human studies. Of course it came to nothing as I had to pass my postgraduate exams, and then went into cardiology research after completing general internal medical training. The story however stayed with me, and indeed with my physician wife, who remembered it well, and remembered my postulating a mechanism and suggesting experimental validation (which validated my memory fortunately). A few weeks ago, some 33years later, I was chatting to a young intensivist friend of mine. We were musing, I think, about the lipid solubility of different betablockers, and I mentioned my experience. His reaction was of fascination, as he knew all about this site, and the increasing use of Intralipid to treat toxicity with lipid soluble drugs. I thought it was worth my posting this case, although of course it is rather anecdotal, and would be very difficult to verify now. But perhaps barbiturates should join the list of lipid soluble drugs that, in overdose, may be treated by Intralipid infusion!
To our astonishment he woke up about an hour or so later. And never looked back, as I recall. Remember this is a long time ago!
I wondered if it was a coincidence, but I could not help thinking that there was a possibility that I had introduced a further compartment into his pharmacokinetics, and had ‘sucked’ the barbiturates, very lipid soluble of course, out of his CNS into the Intralipid. I day-dreamed for weeks about animal experiments with barbiturate poisoned rats treated with Intralipid, and then human studies.
Of course it came to nothing as I had to pass my postgraduate exams, and then went into cardiology research after completing general internal medical training. The story however stayed with me, and indeed with my physician wife, who remembered it well, and remembered my postulating a mechanism and suggesting experimental validation (which validated my memory fortunately).
A few weeks ago, some 33years later, I was chatting to a young intensivist friend of mine. We were musing, I think, about the lipid solubility of different betablockers, and I mentioned my experience.
His reaction was of fascination, as he knew all about this site, and the increasing use of Intralipid to treat toxicity with lipid soluble drugs.
I thought it was worth my posting this case, although of course it is rather anecdotal, and would be very difficult to verify now. But perhaps barbiturates should join the list of lipid soluble drugs that, in overdose, may be treated by Intralipid infusion!