Hematologic & oncologic: Leukopenia, splenomegaly, thrombocytopenia Gastrointestinal: Cholestasis (central lobular), melanosis (brown fat pigmentation in the reticuloendothelial system) Hepatic: Abnormal hepatic function tests (2% to 10%) Hematologic & oncologic: Hypoproteinemia (2% to 10%) Gastrointestinal: Nausea (≤10%), vomiting (≤10%) The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.Įndocrine and metabolic: Hyperlipidemia (≤10%), hyperglycemia (2% to 10%) Consult drug interactions database for more information. Suggested maximum dose: 10 to 12.5 mL/kg (ACMT 2017 Fettiplace 2015).ĭosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. If instability re-emerges, the infusion rate may be increased to 0.25 mL/kg/minute or the 1.5 mL/kg bolus may be repeated (ACMT 2017). If the patient demonstrates a significant response, the infusion rate may be reduced to 0.025 mL/kg/minute (ie, one-tenth the initial rate). Infants, Children, and Adolescents: Very limited data available, optimal dose not defined: 20% lipid emulsion: IV: 1.5 mL/kg bolus over 2 to 3 minutes followed immediately by a continuous IV infusion at 0.25 mL/kg/minute assess response after 3 minutes of infusion. Serious hemodynamic or other instability secondary to highly lipid soluble substances (including, but not limited to, local anesthetics, calcium channel blockers, tricyclic antidepressants, bupropion, lamotrigine, and quetiapine): Note: Use is reserved for patients not responsive to standard resuscitation measures. Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. (ASRA ).ĭosage adjustment for increased serum triglycerides: Stop infusion and monitor if triglycerides >400 mg/dL restart at a lower dose/infusion rate and advance in smaller increments once triglycerides are 1,000 mg/dL (Mirtallo 2020).ĭosage adjustment for concomitant therapy: For patients receiving other lipid emulsion-based medications (eg, propofol, clevidipine), reduce dosage to avoid fat overload syndrome (Mirtallo 2020). ![]() Consider rebolus or increase the infusion rate to 0.5 mL/kg/minute if hemodynamic instability persists or recurs. If instability re-emerges, the infusion rate may be increased back to 0.25 mL/kg/minute or the bolus may be repeated (ACMT 2017).Īmerican Heart Association recommendations: Continue infusion for 30 to 60 minutes (AHA ).Īmerican Society of Regional Anesthesia and Pain Medicine: Continue infusion for at least 10 minutes after hemodynamic stability has been restored. Maximum suggested dose: 10 to 12 mL/kg over the first 30 to 60 minutes (AHA ASRA ).Īfter administration of the initial bolus and continuous infusion, recommendations regarding the continuous infusion vary significantly:Īmerican College of Medical Toxicology: If after the bolus and continuing the infusion for 3 minutes the patient demonstrates a significant response, the infusion rate may be reduced to 0.025 mL/kg/minute (ie, one-tenth the initial rate). Some suggest dosing based on lean body weight (AHA ASRA ). ![]() Intralipid 20%: IV: 1.5 mL/kg (maximum: 100 mL ASRA ) administered over 1 to 3 minutes, followed immediately by an infusion of 0.25 mL/kg/minute (maximum: 200 to 250 mL ASRA ) (recommended infusion durations vary see below) may repeat the bolus as necessary for persistent cardiovascular collapse or if instability re-emerges (ACMT 2017 AHA ASRA ). Consultation with a clinical toxicologist or poison control center is recommended. Continue chest compressions during administration if patient is in cardiac arrest to circulate the lipid emulsion. ![]() Serious hemodynamic or other instability secondary to highly lipid soluble substances (off-label use): Note: May be considered when the patient does not respond to standard resuscitation measures (eg, fluids, vasopressors, inotropes) (ACMT 2017 AHA ASRA ).
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |