Lipid emulsion in acute poisonings: Still no convincing demonstration for its use in non-local anesthetic drug poisoning without life-Threatening presentation

摘要

We read with interest the article reporting Glasgow coma score (GCS) improvement in poisonings six hours after presentation, when using lipid emulsion (LE)1.The authors should be congratulated for this randomized investigation. However, we wish to comment on their findings.If considered as "antidote" for non-local aesthetic drug poisoning lacking cardiovascular impairment, LE should be a drug whose mechanisms of action have been determined, which is able to modify either poison's toxicokinetics or toxicodynamics and whose administration reliably induces significant benefits.LE most reliable mechanism of action, called "lipid sink"3, is causing drugs with high lipid solubility to be absorbed out of the serum, away from targets while possibly enhancing excretion. Guidelines stated that clinicians should consider using LE for overdoses involving drugs with high-degree of lipid solubility4. LE extraction efficiency is dependent upon the drug's lipid partition constant.