intralipidIntravenous infusion of lipids in animals with poisoning can lead to a dramatic improvement in clinical condition, reduce hospitalisation time and save lives. It is a simple, easy-to-administer and cheap treatment.

Intravenous lipid infusion is used in the management of compounds that are lipophilic or cardiotoxic. Most veterinary cases reported involve baclofen, permethrin and macrocyclic lactones (moxidectin, ivermectin), but it has also been used for other drugs (see below). The product normally used is Intralipid® 20% (Fresenius Kabi) but other parenteral lipid products are available.

In most cases the suitability of a compound for treatment with intravenous lipid therapy is determined by two factors: its lipophilicity and half-life. Lipid infusion is suitable for lipophilic compounds with short to moderate half-lives (generally less than 24 hours); it is not suitable for lipophilic compounds with long lives such as vitamin D compounds (e.g. calciferol, calcipotriol) and anticoagulant rodenticides (e.g. brodifacoum, bromadiolone).

The mechanism of action of lipid infusion is not fully understood and there are two main theories: a lipid sink mechanism and a metabolic effect. It is thought that the lipid component formed in the blood acts as a sink for lipophilic drugs making them unavailable to act on their target receptors. In drugs causing cardiotoxicity, lipids may reduce toxic effects by providing a source of energy to the myocardial cells.

The risks of lipid infusion in the context of treatment of drug toxicity (rather than as part of parenteral nutrition) are unknown, but it is generally considered safe. Pancreatitis and extravasation with pain and local swelling have been reported as adverse effects in veterinary cases.

Lipid infusion is increasingly used in the management of poisoning and should be considered for any animal at risk of serious toxicity after exposure to a lipophilic compound.

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Further reading

General articles

  • Gwaltney-Brant S, Meadows I (2012) Use of intravenous lipid emulsions for treating certain poisoning cases in small animals. Vet Clin N Am: Sm Anim Pract 42: 251-262.
  • Jamaty C, Bailey B, Larocque A, Notebaert E, Sanogo K, Chauny JM (2010) Lipid emulsions in the treatment of acute poisoning: a systematic review of human and animal studies. Clin Toxicol 48:1-27.
  • Kaplan A, Whelan M (2012) The use of IV lipid emulsion for lipophilic drug toxicities. J Am Anim Hosp Assoc 48(4): 221-7.

Case reports

  • Bates N, Chatterton J, Robbins C, Wells K, Hughes J, Stone M, Campbell A (2013) Lipid infusion in the management of poisoning: a report of 6 canine cases. Vet Re 172(13):339.
  • Bolfer L, McMichael M, Ngwenyama TR, O’Brien MA. (2014) Treatment of ibuprofen toxicosis in a dog with IV lipid emulsion. J Am Anim Hosp Assoc 50(2):136-40.
  • Brückner M, Schwedes CS (2012) Successful treatment of permethrin toxicosis in two cats with an intravenous lipid administration. Tierarztl Prax Ausg K Kleintiere Heimtiere 40:129-134.
  • Clarke DL, Lee JA, Murphy LA, Reineke EL. 2011 Use of novel intravenous lipid therapy to treat ivermectin toxicosis in a Border collie. J Am Vet Med Assoc 239: 1328-1333.
  • Crandall DE, Weinberg GL. 2009 Moxidectin toxicosis in a puppy successfully treated with intravenous lipids. J Vet Emerg Crit Care 19(2):181-186.
  • DeGroot WD (2014) Intravenous lipid emulsion for treating permethrin toxicosis in a cat. Can Vet J 55(1): 1253-4. Erratum in: Can Vet J (2014) 55(2):106.
  • Edwards P, Shiab N, Scott HW (2014) Treatment of a case of feline baclofen toxicosis with intravenous lipid therapy. Vet Rec Case Rep 2:e000059.
  • Fernandez AL, Lee JA, Rahilly L, Hovda L, Brutlag AG, Engebretsen K (2011) The use of intravenous lipid emulsion as an antidote in veterinary toxicology J Vet Emerg Crit Care 21: 309-320.
  • Gwaltney-Brant S, Dunayer E. 2008 The use of intravenous lipid solution therapy in the treatment of moxidectin overdose in a dog [abstract]. Proc AAVLD 51st Annual Conference, Greensboro, NC, 22-27 October, p118.
  • Gwaltney-Brant S, Meadows I (2012) Use of intravenous lipid emulsions for treating certain poisoning cases in small animals. Vet Clin N Am: Sm Anim Pract 42: 251-262.
  • Haworth MD, Smart, L (2012) Use of intravenous lipid therapy in three cases of feline permethrin toxicosis. J Vet Emerg Crit Care 22(6):697-702.
  • Kidwell JH, Buckley GJ, Allen AE, Bandt C (2014) Use of IV lipid emulsion for treatment of ivermectin toxicosis in a cat. J Am Anim Hosp Assoc 50: 59-61.
  • Kuo K, Odunayo A (2013) Adjunctive therapy with intravenous lipid emulsion and methocarbamol for permethrin toxicity in 2 cats. J Vet Emerg Crit Care 23(4):436-41.
  • Muentener CR, Spicher C, Page SW. 2013 Treating permethrin poisoning in cats. Vet Rec 172(24):643.
  • O’Brien TQ, Clark-Price SC, Evans EE, Di Fazio R, McMichael MA. 2010 Infusion of a lipid emulsion to treat lidocaine intoxication in a cat. J Am Vet Med Assoc 237:1455-1458.
  • Peacock RE, Hosgood G, Swindells KL, Smart L (2013) A randomised controlled clinical trial of an intravenous lipid emulsion for the treatment of permethrin toxicosis in cats [abstract]. J Vet Emerg Crit Care 23 (S1): S25.
  • Pritchard J. 2010 Treating ivermectin toxicity in cats. Vet Rec 166(24):766.
  • Wright HM, Chen AV, Talcott PA, Poppenga RH, Mealey KL. 2011 Intravenous fat emulsion as treatment for ivermectin toxicosis in three dogs homozygous for the ABCB1–1Δ gene mutation. J Vet Emerg Crit Care 21:666-672.