Lipid emulsion improves Glasgow Coma Scale and decreases blood glucose level in the setting of acute non-local drug poisoning – a randomized controlled trial

F. Taftachi, H. Sanaei-Zadeh, B. Sepehrian, N. Zamani

Department of Forensic Medicine and Toxicology, Tehran University of Medical Sciences, Hazrat Rasoul Akram Hospital, Tehran (Iran)

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• Emergency Medicine

Background: To date, no study has been performed to evaluate the antidotal effect of intravenous lipid emulsion on the poisoned patients’ level of consciousness and routine metabolic profile tests in non-local anesthetic overdoses.

Objectives: Our aim was to evaluate the effect of intravenous intralipid administration as an antidote on the poisoned patients’ Glasgow Coma Scale (GCS), hemodynamic parameters, arterial blood gas analysis, and routine metabolic profile tests (i.e. urea, glucose, sodium, and potassium) in the setting of non-local anesthetic drug overdose.

Material and Methods: In this randomized controlled trial, a total of 30 patients with non-local anesthetic drug intoxication were enrolled and randomly assigned into case (n=15) and control (n=15) groups. In the case group, all patients received 10 cc/kg intralipid 10% infusion. The patients in the control group just received the supportive care. Patients’ demographic and clinical characteristics and results of their laboratory tests were evaluated at presentation and 6 hours after that.

Results: Mean age was 23±5 and 28±11 years in cases and controls, respectively. There were no significant statistical differences between these two groups regarding age, gender, elapsed time between intubation and extubation, and need for intubation and/or mechanical ventilation (p = 0.70 and p = 1.00, respectively). Also, systolic blood pressure, pulse rate, mean rate pressure product, respiratory rate, results of acid-base gas, serum sodium, potassium, urea, and creatinine on presentation and six hours later were not statistically significantly different between the two study groups. However, a significant difference was found between the two groups in terms of GCS difference (p = 0.048) and blood glucose six hours after presentation (p = 0.04).

Conclusions: In the setting of non-local anesthetic drug overdose, intravenous intralipid infusion can increase GCS and interestingly, decrease the blood glucose.

Corresponding Author: Hossein Sanaei-Zadeh, MD; e-mail: h-sanaiezadeh@tums.ac.ir