LipidRescue™ Resuscitation

A 57-year-old female (65 Kg) was brought to our ED with a history of consumption of unknown amount of diltiazem (SR). Her Bp was 65/40 mmHg, heart rate of 52/min, respiratory rate 20/min, and oxygen saturation no trace seen. She was alert and oriented other physical examination was unremarkable. Her ECG showed sinus bradycardia without any ischemic changes and her ABG showed metabolic acidosis with elevated lactate level. She received activated charcoal, 2 liters of 0.9% saline, 2 g of calcium chloride and started on dopamine and noradrenaline. However, there was no significant improvement in her haemodynamic status, the doses of inotropes were increased but she developed chest pain and her ECG showed ST depression in anterior leads. She was intubated and intravenous lipid emulsion was started with 20% SMOF lipid (she was loaded with 1.5 ml/kg). There was rapid improvement in her BP, so an infusion of 0.25 ml/kg/min for a total of 8 ml/kg was started. After two hours of infusion, she become more unstable with severe hypotension and drop in pao2. We changed the SMOF lipid to Intralipid surprisingly, her haemodynamics and oxygen status improved. She discharged home on 6th day without any sequelae. Is there any difference in the type of lipid emulsion? What is the optimal formulation of lipid emulsion to be used?
Kindly enlighten me about this.
Warm regards,
S.Senthilkumaran,

Clinical Toxicology (2011) 49, 340–344
J Sep Sci. 2012 Nov;35(22):3106-12.
most of studies have been carried out with intralipid.
other lipids have been used with inconsitent results.
the composition of the lipid emulsion plays a role but it doesnt mean intralipid is the best.
im sorry theres no clear answer at this point.
my best wishes and please publish your case.