After the initial report of treatment of bupropion and lamotrigine overdose by intravenous lipid emulsion, additional case reports have asserted the usefulness of lipid emulsion for enteral poisonings. In accordance with these and other reports, the American College of Medical Toxicology offered interim guidelines on lipid resuscitation therapy; they recommended a bolus of 1.5 mL/kg, followed by an infusion of 0.25 mL/kg/min of intravenous lipid emulsion if toxicity persists. This recommendation was based on guidelines for treatment of local anesthetic toxicity, in which absorption is quick and toxicity short lived. In contrast to local anesthetic toxicity, prolonged absorption during enteral overdose can result in extended toxicity, with a need for continuing medical support, including a protracted infusion of lipid emulsion. Guidelines for lipid resuscitation therapy in local anesthetic toxicity set an upper limit of 10 to 12 mL/kg during the first half hour, but because of the aforementioned nature of oral overdoses, the American College of Medical Toxicology did not provide a limit on total lipid infusion volume or duration of infusion. In the absence of limits, an increasing number of cases have reported the use of large volumes of lipid to treat oral overdose. However, until definitive studies can be conducted, there is a need for rational volume limits to prevent undisciplined use of intravenous lipid emulsion.

Related American College of Medical Toxicology Position Statement