Post Your Cases > Off Topic : Is there potential for Intralipid use in Propranolol toxicity?

I apologise if this is felt to be too off-topic, but I've been considering this question for a couple of months now.

I have previously been involved with a case of significant propranolol toxicity in a young adult that proved unresponsive to management with glucagon, atropine, isoprenaline, and epinephrine.

There is work to suggest that phosphodiesterase inhibitors may be beneficial, but given that propranolol is highly lipid soluble, I have been questioning whether there may be a role for intralipid.

I have been unable to find anything specific on this via medline (though I will accept that user error may be to blame here), but I have found a couple of references: one via Google, and the other with the help of Professor Weinberg.

Cave G, Harvey M, Castle C. The Role of Fat Emulsion Therapy in a Rodent Model of Propranolol Toxicity : A Preliminary. Medical Journal of Toxicology 2006; volume 2 number 1: 4-7 which can be found at http://jmt.pennpress.org/strands/jmt/toc.htm;?issue=20060201

Bania T, Chu J, Wesolowski M. The Hemodynamic Effect of Intralipid on Propranolol Toxicity. Academic Emergency Medicine 2006; volume 13, supplement 1 109. which can be found at http://www.aemj.org/cgi/content/abstract/13/5_suppl_1/S109-a

To me it suggests that there may some benefit in using intralipid to assist in the management of propranolol toxicity, but clearly there is a lot of work that needs to be done to provide more information.

In the meantime, I would be grateful to find out what others think about this possibility? Is it worth considering?

Additionally, has anyone experience of using intralipid in the management of toxic events for drugs other than local anaesthetics?


Thanks for your time.


Andy
August 30, 2007 | Unregistered CommenterAndy Ody
Andy, thanks very much for the post; it's not the least bit off-topic.first, so sorry to hear of the patient's demise. trying to resuscitate a flaccid heart is somewhere i'd rather never be. you raise an insightful, and i believe a prescient question. in fact there is an outstanding case report in-press (annals of emergency medicine) about the successful lipid resuscitation of a patient with overwhelming bupropion overdose. the amazing thing is that the chest compressions were stopped within 1 minute of lipid infusion. as you point out, there is a nascent literature on the application of lipidrescue to other, non-LA, drugs. these are all animal models, and positive results include chlomiprimine, calcium channel blockers and in less rigorous studies, propranolol and thiopentone.
we're looking forward to further bench and clinical studies of lipidrescue for treating overdoses of these and other lipophilic agents.
September 7, 2007 | Registered Commenter[Guy Weinberg]