Post Your Cases > Intralipid works again

57 y/o female, accidental lidocaine toxicity due to excessive subcut lidocaine during permacath placement, presented to our ICU after nurse noticed muscle twitching, altered sensorium, no witnessed seizures. On presentation, obtunded, hypotensive with cardiovascular collapse and MAP in the 40s. Levophed started intralipid quickly initiated with impressive response and weaning off of levophed, return of sensorium. Of note, unusual presentation because of cardiovascular collapse much more impressive than neurological symptoms in this case of lidoacine toxicity.
October 7, 2013 | Unregistered CommenterVikram Mukherjee, MD
Hi Vikram, thanks for posting this interesting example of lipid rescue reversing lidocaine toxicity. Such cases are important since some believe that because of its lower lipid solubility, lidocaine toxicity is less susceptible to reversal with lipid than bupivacaine. However, there are several cases known (some published, others I've heard from practitioners) now including yours that show even severe lidocaiune toxicity can be reversed with lipid infusion. You might consider writing this one up!
G
November 25, 2013 | Registered Commenter[Guy Weinberg]