Introduction

• Lipid infusion has been used successfully with poisoning from lipophilic compounds in dogs (Baker, 2008; Gwaltney-Brant and Dunayer, 2008, Crandall and Weinberg, 2009; Lee, 2010; Clarke et al, 2011; Bates et al, 2013) and cats (O'Brien et al,2010, Pritchard, 2010; Bruckner and Schwedes, 2012; Howarth and Smart, 2012).
• Administration of intravenous lipids may result in rapid improvement in neurological status.
• This is an experimental procedure in humans and it is only recommended in severe, potentially fatal cases of toxicity but this is generally not the case in veterinary medicine where it is reportedly used earlier in the course of therapy (Fernandez et al, 2011; Bruckner and Schwedes 2012).
• Note that there are case reports of ivermectin toxicity Ivermectin toxicity where lipid infusion has failed. It has been suggested that lack of effect may have been due to the presence of high brain concentrations of ivermectin Ivermectin and that these were not significantly affected by lipid administration (Wright et al, 2011). This may indicate a need to institute lipid therapy as soon as possible in susceptible breeds before the brain concentration of the offending toxin is too high.
• The use of lipid infusion in veterinary medicine has also been the subject of recent reviews (Fernandez et al, 2011; Gwaltney-Brant and Meadows, 2012; Kaplan and Whelan, 2012).
• Consider in the management of toxicity from macrocyclic lactones (eg ivermectin, moxidectin Moxidectin ), local anesthetics, permethrin Permethrin , baclofen and some calcium channel blockers (eg diltiazem Diltiazem verapamil Verapamil ).

Cautions and contradictions

Risks

Mechanism

Method

Further Reading

Publications

Refereed papers

• Recent references from PubMed and VetMedResource.
• Bates N, Chatterton J, Robbins C et al (2013) Lipid infusion in the management of poisoning: a report of 6 canine cases. Vet Rec 172 (13), 339 PubMed.
• Brückner M, Schwedes C S (2012) Successful treatment of permethrin toxicosis in two cats with an intravenous lipid administration. Tierarztl Prax Ausg K Kleintiere Heimtiere 40 (2), 129-34 PubMed.
• Gwaltney-Brant S, Meadows I (2012) Use of intravenous lipid emulsions for treating certain poisoning cases in small animals. Vet Clin N Am Sm Anim Pract 42 (2), 251-262 PubMed.
• Haworth M D, Smart L (2012) Use of intravenous lipid therapy in three cases of feline permethrin toxicosis. J Vet Emerg Crit Care 22 (6), 697-702 PubMed.
• Kaplan A, Whelan M (2012) The use of IV lipid emulsion for lipophilic drug toxicities. J Am Anim Hosp Assoc 48 (4), 221-227 PubMed.
• Clarke D L, Lee J A, Murphy L A et al (2011) Use of intravenous lipid emulsion to treat ivermectin toxicosis in a Border Collie. J Am Vet Med Assoc 239 (10), 1328-1333 PubMed.
• Fernandez A L, Lee J A, Rahilly L et al (2011) The use of intravenous lipid emulsion as an antidote in veterinary toxicology. J Vet Emerg Crit Care 21 (4), 309-320 PubMed.
• McAllister R K, Tutt C D, Colvin C S (2011) Lipid 20% emulsion ameliorates the symptoms of olanzapine toxicity in a 4-year-old. Am J Emerg Med 30 (6), 1012.e1-2 PubMed.
• Wright H M, Chen A V, Talcott P A et al (2011) Intravenous fat emulsion as treatment for ivermectin toxicosis in three dogs homozygous for the ABCB1-1Δ​ gene mutation. J Vet Emerg Crit Care 21 (6), 666-672 VetMedResource.
• O'Brien T Q, Clark-Price S C, Evans E E et al (2010) Infusion of a lipid emulsion to treat lidocaine intoxication in a cat. J Am Vet Med Assoc 237 (12), 1455-1458 PubMed.
• Pritchard J (2010) Treating ivermectin toxicity in cats. Vet Rec 166 (24), 766 PubMed.
• Crandall D E, Weinberg G L (2009) Moxidectin toxicosis in a puppy successful treated with intravenous lipids. J Vet Emerg Crit Care 19 (2), 181-186 PubMed.
• Harvey M, Cave G, Kazemi A (2009) Intralipid infusion diminishes return of spontaneous circulation after hypoxic cardiac arrest in rabbits. Anesthesia & Analgesia 108 (4), 1163-1168 PubMed.
• Marwick P C, Levin A I, Coetzee A R (2009) Recurrence of cardiotoxicity after lipid rescue from bupivacaine-induced cardiac arrest. Anesthesia & Analgesia 108 (4), 1344-6 PubMed.
• Van de Velde M, Wouters P F, Rolf N et al (1996) Long-chain triglycerides improve recovery from myocardial stunning in conscious dogs. Cardiovasc Res 32 (6), 1008-1015 PubMed.

Other sources of information

• Lee J A (2010) Advances in toxicology: the use of intra-lipid therapy & high-dextrose insulin therapy. ACVIM Proceedings, Anaheim, California, June 9-12.
• Baker L (2008) Lipid emulsion treatment of ivermectin in a dog. www.lipidrescue.squarespace.com/post-your-cases/post/510768
• Gwaltney-Brant, Dunayer E (2008) The use of intravenous lipid solution therapy in the treatment of moxidectin overdose in a dog [abstract]. Proc AAVLD 51st Annual Conference, Greensboro, NC, 22-27 October, p 118.