LipidRescue™ Resuscitation

As anesthesiologist on call,I was called to Code 99 for a 56 yr old man who had presumably taken an overdose of mirtazepine and quetiapine, unknown amount at an unknown time but thought to be about 7 hours prior to being found unresponsive in his hospital bed (he was hospitalized for intoxication and passing out in a snowbank). He was intubated and in the ICU and 20% intralipid 60cc slowly times two was given without any effect so far; now access is hampered by procedures but I will try a further dose to see if there is any response; BP has been quite low and he is tachycardic but at no time was there complete asystole to my knowledge.

Like Guy, I too would be interested to know how this case was managed following your post, and also the outcome. Were you able to take blood to establish the plasma concentrations of the drugs understood to have been taken in overdose? With reference to our posted case we gave a total of 500ml intralipid as described in the 'getting started' section which also appears in the AAGBI guidelines.

Just to put my two pence in! Am awaiting hopefully the printing of a letter we have submitted to Anaesthesia relating to a similar case where we used intralipid for a large quetiapine overdose (4.3mg). Essentially the patient made a full recovery but it was slow due to concomitant overdose of benzodiazepines and iron. Whether the intralipid helped is impossible to say. However, we did encounter a problem with our lab as the subsequent blood samples were unanalyseable due to profound lipaemia. We were fortunate enought to be able to track serum lipids for 24 hours (permission obtained afterwards) and found that samples only became analyseable for U+E after about 10 hours. It appears that the lab needs an ultracentrifuge, which ours doesn't. Could have implications if you're not aware of it in advance.