In both cases, the investigators noted the patients may have benefited from more aggressive ILE therapy. Thus, ILE may be an effective treatment for these types of toxicities. Bromethalin is a fat-soluble compound, and organophosphates are lipophilic.
LIPID EMULSION THERAPY PLUS
The second death was due to a suspected ivermectin toxicity that was then compounded when a topical agent containing spinosad plus milbemycin was applied. It’s possible that a delay in treatment contributed to this patient’s death. Treatment following bromethalin ingestion is not generally effective once severe clinical signs are observed. The patient that died due to bromethalin toxicity was not seen by veterinary staff until the day after ingestion.
Numerous additional variables were present in this study, such as patient metabolism, dose and half-life of toxins, drug-drug-interactions, and any comorbidities present prior to hospitalization. The optimal time of ILE administration is not known at this time, but it’s reasonable to assume that administration soon after ingestion of a toxin is likely to be more effective. The times between intoxication and administration of veterinary care, including ILE, varied from case to case. Multiple variables likely affected the patient outcomes in this study, including the 2 deaths recorded. Lipemia was reported in 60% (n = 6) of patients. Amlodipine, baclofen, carbamate, and ivermectin were most responsive to ILE therapy. The two deaths were due to bromethalin rodenticide and an organophosphate pesticide toxicosis. The recommended dose of ILE by the ASPCA Animal Poison Control is a 1.5-mL/kg bolus followed by 0.25 to 0.5 mL/kg/minute constant-rate infusion however, doses administered to patients in this study varied.Īll but 2 patients were alive at discharge. The ILE used in this study was a sterile 20% fat emulsion manufactured by Baxter Healthcare Corporation as a caloric and fatty acid source. Pertinent medical history, clinical signs, details of the intoxications, diagnostic values, and treatments given were collected from medical records, when available.
LIPID EMULSION THERAPY CODE
Over the past 2 decades, lipid emulsions have been used in practice to treat these severe toxicities, although use of lipid emulsions is far from common in most practices. There are multiple hypotheses, including acting as a “lipid sink” where the toxin is sequestered within the intravascular space, enhancing mitochondrial function through increased fatty acids, and providing substrate for cardiomyocytes to enhance function. The mechanism of action of lipid emulsions in these cases is not well understood. It was first reported in 1998 by Weinberg and colleagues that pretreatment with a lipid emulsion, typically used as a parenteral nutritional supplement, could reverse or improve the clinical signs seen in rats following a bupivacaine overdose.
Lipophilic (fat-loving) intoxication cases have always been challenging to treat in the veterinary hospital.
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