Review article: Intravenous lipid emulsion as antidote: A summary of published human experience


  • Grant Cave,

    Corresponding author
    1. Hutt Hospital, Lower Hutt
    2. University of Otago, Wellington School of Medicine and Health Sciences, Wellington
    3. Tamworth Rural Referral Hospital, Tamworth, New South Wales
      Dr Grant Cave, c/- Hutt Hospital, High Street, Lower Hutt, New Zealand. Email:
    Search for more papers by this author
  • Martyn Harvey,

    1. Emergency Department, Waikato Hospital, Hamilton
    2. University of Auckland, Waikato Campus, Auckland, New Zealand
    Search for more papers by this author
  • Andis Graudins

    1. Department of Medicine, Southern Clinical School, Monash University
    2. Southern Health, Monash Medical Centre, Clayton, Victoria, Australia
    Search for more papers by this author

  • Grant Cave, FACEM, FCICM, Emergency Physician, Intensivist, Clinical Senior Lecturer (Hon); Martyn Harvey, FACEM, Emergency Physician, Director Research, Clinical Senior Lecturer (Hon); Andis Graudins, PhD, FACEM, FACMT, Professor of Emergency Medicine Research, Principle Specialist in Emergency Medicine and Clinical Toxicology.

Dr Grant Cave, c/- Hutt Hospital, High Street, Lower Hutt, New Zealand. Email:


Intravenous lipid emulsion (ILE) has been demonstrated to be effective in amelioration of cardiovascular and central nervous system sequelae of local-anaesthetic and non-local-anaesthetic drug toxicity in animal models. Sequestration of lipophilic toxins to an expanded plasma lipid phase is credited as the predominant beneficial mechanism of action of ILE. Systematic review of published human experience is however lacking. We determined to report a comprehensive literature search of all human reports of ILE application in drug poisoning. Forty-two cases of ILE use (19 local-anaesthetic, 23 non-local-anaesthetic) were identified, with anecdotal reports of successful resuscitation from cardiovascular collapse and central nervous system depression associated with ILE administration in lipophilic toxin overdose. Although significant heterogeneity was observed in both agents of intoxication, and reported outcomes; case report data suggest a possible benefit of ILE in potentially life-threatening cardio-toxicity from bupivacaine, mepivacaine, ropivacaine, haloperidol, tricyclic antidepressants, lipophilic beta blockers and calcium channel blockers. Further controlled study and systematic evaluation of human cases is required to define the clinical role of ILE in acute poisonings.