NACCT Platform Abstracts 2012 - The American Academy of Clinical ...

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238 ASSESSING THE PREVALENCE OF PANCREATITIS FOLLOWING RESUSCITATIVE USE OF INTRAVENOUS LIPID EMULSION Michael Levine 1 , Aaron Skolnik 1 , Rachel Levitan 1 , Anthony F Pizon 2 1 Banner Good Samaritan Medical Center, Phoenix AZ 2 University of Pittsburgh, Pittsburgh PA USA BACKGROUND: Intravenous (IV) lipid emulsion has long been part of total parenteral nutrition (TPN) regimens. Recently, the use of IV lipid emulsion (ILE) therapy for drug toxicity has become popular. The amount of lipid given per unit time is typically much greater in antidotal use than in TPN. Complications from use of ILE as an antidote, including pancreatitis (PANC), have only recently been described. The purpose of this pilot study is to determine the frequency by which patients develop pancreatitis following ILE therapy. METHODS: A retrospective review of all patients admitted between 1/1/2005 to 12/31/2011 and treated with ILE at 2 inpatient toxicology services. Patients who expired within 24 hours of admission were excluded. Data were abstracted using standardized chart review methods. Descriptive analysis was performed. PANC was defined a priori as an elevated lipase with symptoms of epigastric pain or nausea/vomiting RESULTS: Seven patients received ILE. One patient was excluded (expired < 24 hours). Mean age was 27.4 years (range 13-48); 50% were male. Five patients received ILE for dysrhythmias (WCT/VT=2, asystole=2), while 1 each received ILE for refractory hypotension or seizures. Three patients developed PANC. The 1st case was a 13 y.o. treated for amitriptyline toxicity with 2 boluses of ILE (1.5 mL/kg each), followed by 0.25 mL/kg/min for 30 minutes. Lipase and triglycerides peaked at 1849 IU/L and 8611 IU/L, respectively. The 2nd case was a 20 year old with doxepin toxicity treated with 2 doses of ILE 2hapart (each dose 1.5 mL/kg, followed by 0.25 mL/kg/min for 30 minutes). Lipase and triglycerides peaked at 2951 IU/L and 3648 IU/L, respectively. The 3rd case involved a 20 year old with bupivacaine toxicity who received 1.7 mL/kg bolus, followed by 0.26 mL/kg/min for 3h. The patient complained of epigastric pain and vomiting following resuscitation. A lipase was checked on hospital day 13, as the patient's symptoms were improving, and was 185 IU/L. Two of the 3 patients who developed pancreatitis received 2 boluses and one received a prolonged infusion. The 3 patients who did not develop PANC had 1 bolus each; 2 had no maintenance infusion and 1 had a 60 min infusion. CONCLUSION: PANC is common among patients who are treated with antidotal doses of ILE and survive their drug toxicity. PANC appears more common in those who received multiple doses or prolonged infusion of ILE. Due to the small number of patients included, firm conclusions should not be drawn from these data. However, this pilot study suggests toxicity is possible from antidotal use of ILE. Until further information is available, it is prudent to restrict use of ILE rescue to lifethreatening toxicity.
Page 1 and 2: 1 Comprehensive Drug Analysis of "B
Page 3 and 4: 3 DIGLYCOLIC ACID, THE NEPHROTOXIC
Page 5 and 6: 5 Poison center consultation and ho
Page 7 and 8: 7 Massive acetaminophen overdose tr
Page 9 and 10: 82 Clonidine For Cuties: The Quick
Page 11 and 12: 84 Adjunct Ketamine Use in the Mana
Page 13 and 14: 159 A Spoonful of Cinnamon: The "Ci
Page 15 and 16: Conclusion: The majority of deaths
Page 17 and 18: 162 Review of Eastern Coral Snake (
Page 19: 237 Intentional and Unintentional P

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