Lipid Emulsion 20%
Intralipid
Lipid resuscitation agent
Theory: 'Lipid sink' sequesters lipophilic drugs (especially LAs), shifts to better Ca²⁺ handling, fatty acid metabolic support.
Indications
- •LAST (cardiotoxicity from local anesthetic)
- •Lipophilic drug overdose (TCA, calcium-channel blocker, β-blocker, bupropion — controversial)
Dosing
| Context | Adult | Pediatric |
|---|---|---|
| LAST bolus | 1.5 mL/kg IV over 1 min, repeat 1–2× if no response | — |
| LAST infusion | 0.25 mL/kg/min for 10 min after stability; max ~12 mL/kg total | — |
Pharmacokinetics
Onset 1–3 min.
Side effects
- !Pancreatitis (high cumulative dose)
- !Fat overload syndrome (rare with single resuscitation event)
- !Lab interference (lipemic samples)
- !ECMO circuit fouling (use only if no alternatives)
Contraindications
- ×Severe egg allergy (formulation contains egg phospholipid)
Clinical pearls
- ★ASRA recommends earliest lipid use, before resuscitation seems failing.
- ★Document via LipidRescue.org registry.
- ★Don't substitute propofol — too dilute (1% lipid) and has cardiac depression.
Education only — confirm against current package inserts and institutional protocols. Doses assume normal organ function unless otherwise noted.