Lipid emulsion for xenobiotic overdose: PRO.

Infusion of lipid emulsion for drug overdose arose as a treatment for local anesthetic systemic toxicity (LAST) initially based on laboratory results in animal models with the subsequent support of favorable case reports. Following successful translation to the clinic, practitioners also incorporated lipid emulsion as a treatment for non-local anesthetic toxicities, but without formal clinical trials. Recent clinical trials demonstrate a benefit of lipid emulsion in antipsychotic, pesticide, metoprolol and trazodone overdoses. Formal trials of lipid emulsion in LAST may never occur, but alternative analytic tools indicate strong support for its efficacy in this indication; for example, lipid emulsion has obviated the need for cardiopulmonary bypass in most cases of LAST. Herein we describe the pre-clinical support for lipid emulsion, evaluate the most recent clinical studies of lipid emulsion for toxicity, identify a possible dose-based requirement for efficacy and discuss the limitations to uncontrolled studies in the field.