Successful Outcome Following Intravenous Lipid Emulsion Rescue Therapy in a Patient with Cardiac Arrest Due to Amitriptyline Overdose

The incidence of toxic effects of drugs leading to emergency department visits has increased in the United States in the past several years. Most of these patients can be adequately managed by supportive care alone. However, pharmacological antidotes may be necessary, particularly in patients with hemodynamic instability. In severe cases refractory to conventional antidote therapy, rescue therapy with intravenous lipid emulsion (ILE) may be necessary. Traditionally, ILE has been used as an antidote of choice in treating toxic effects of local anesthetics. But data continue to emerge on the successful use of ILE to treat overdoses of drugs other than local anesthetics, particularly lipophilic medications. The recommended ILE dose is a 1.5 mL/kg bolus followed by infusion of 15 mL/kg per hour, with repeat dosing permissible for continued hemodynamic instability. Use of ILE should be considered early as a rescue therapy in the settings of lipophilic medication overdoses when cardiovascular compromise or cardiac arrest is present.

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Survival following massive amitriptyline overdose: The use of intravenous lipid emulsion therapy and the occurrence of acute respiratory distress

Journal of the Intensive Care Society ◽

10.1177/1751143714568630 ◽

2015 ◽

Vol 16 (2) ◽

pp. 181-182 ◽

Cited By ~ 3

Author(s):

David Radley ◽

Sarah Droog ◽

John Barragry ◽

Colin Bigham

Keyword(s):

Respiratory Distress ◽

Lipid Emulsion ◽

Intravenous Lipid Emulsion ◽

Amitriptyline Overdose

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Severe Venlafaxine Intoxication with Refractory Pulseless Electrical Activity Cardiac Arrest Successfully Treated with Intravenous Lipid Emulsion

International Journal of Critical Care and Emergency Medicine ◽

10.23937/2474-3674/1510044 ◽

2018 ◽

Vol 4 (2) ◽

Author(s):

Blixt John ◽

Raheem Shazia ◽

Bujarski Stephen

Keyword(s):

Cardiac Arrest ◽

Electrical Activity ◽

Lipid Emulsion ◽

Pulseless Electrical Activity ◽

Intravenous Lipid Emulsion

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Chewing the fat: A case report on intravenous lipid emulsion to reverse cardiotoxicity from intentional amitriptyline overdose.

African Journal of Emergency Medicine ◽

10.1016/j.afjem.2012.06.001 ◽

2012 ◽

Vol 2 (4) ◽

pp. 159-162 ◽

Cited By ~ 8

Author(s):

J. Hellig ◽

I. Von Watzdorf ◽

S. Lahri ◽

K. Vallabh ◽

R.L. Allgaier

Keyword(s):

Case Report ◽

Lipid Emulsion ◽

Intravenous Lipid Emulsion ◽

Amitriptyline Overdose

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Cardiac Arrest after Local Anaesthetic Toxicity in a Paediatric Patient

Case Reports in Anesthesiology ◽

10.1155/2016/7826280 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Liana Maria Torres de Araújo Azi ◽

Diego Grimaldi Figueroa ◽

Ana Amélia Souza Simas

Keyword(s):

Cardiac Arrest ◽

Early Diagnosis ◽

Paediatric Patient ◽

Local Anaesthetic ◽

Lipid Emulsion ◽

Local Anaesthetics ◽

Favourable Outcome ◽

Intravenous Lipid Emulsion ◽

Intraosseous Injection

We report a case of a paediatric patient undergoing urological procedure in which a possible inadvertent intravascular or intraosseous injection of bupivacaine with adrenaline in usual doses caused subsequent cardiac arrest, completely reversed after administration of 20% intravenous lipid emulsion. Early diagnosis of local anaesthetics toxicity and adequate cardiovascular resuscitation manoeuvres contribute to the favourable outcome.

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