![]() ![]() Hepatic: Fat overload syndrome, hepatomegaly, increased liver enzymes 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. ![]() 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 ). 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. ![]()
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