The primary triglycerides include linoleic, linolenic, oleic, palmitic, and stearic acids. The 20% IV fat emulsion is made up of 20% soybean oil, 1.2% egg yolk phospholipids, 2.25% glycerin, and water for injection. Intralipid®, or intravenous fat emulsion, is the most commonly reported ILE used for drug toxicity and is composed of two types of lipids: triglycerides and phospholipids. ILE therapy has also been used in life-threatening overdose from lipophilic medications, including but not limited to, calcium channel blockers, beta-blockers, and cyclic antidepressants. Toxicity may occur after an overdose, an intravascular injection, or inadvertent systemic absorption of a local anesthetic. Systemic toxicity from local anesthetics is a rare but potentially fatal complication of regional anesthesia and occurs in approximately 1 out of every 1000 peripheral nerve blocks. ILE is commonly used as a source of calories and essential fatty acids for patients requiring parenteral nutrition and, in recent years, has gained steam for the management of LAST and various other life-threatening overdoses due to lipophilic (fat-soluble) medications. The ED physician suspects that the cardiac arrest may be due to local anesthetic systemic toxicity (LAST) and immediately requests for intravenous lipid emulsion (ILE) therapy. EMS states that the patient received an unknown amount of a local anesthetic prior to the cardiac arrest. A 33-year-old female presents to the emergency department (ED) in cardiac arrest from an outpatient cosmetic procedure.
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