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Poisoning Information for the Public & Health Care Professionals
Last updated: 01/2020

Fat Emulsion

Lipid emulsion, Intralipid 20%

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Fat Emulsion

Lipid emulsion, Intralipid 20%

WARNING: Warning: Evidence for the use of lipid emulsion therapy in the pediatric population for reversal of drug toxicity is limited.


  • Local anesthetic toxicity/cardiac arrest unresponsive to conventional resuscitation.
  • Rescue therapy for cardiac arrest or severe hemodynamic compromise due to lipid-soluble and sodium channel blocking drug toxicity unresponsive to conventional resuscitation (e.g., bupropion, lipid soluble beta-blockers and calcium channel blockers, tricyclic antidepressants, etc).


PEDIATRIC DOSING NOT ESTABLISHED. Current recommendations follow the same dosing regimen as in adults:

Local Anesthetic Systemic Toxicity

  • IV Direct: 1.5 mL/kg (300 mg/kg) lipid emulsion 20% over 1 to 3 minutes.
  • Infusion: Follow immediately with 0.25 mL/kg/minute (50 mg/kg/minute) for 30 - 60 minutes. Dose can be increased to 0.5ml/kg/minute based on response.

Non-local Anesthetic Drug Toxicity

  • IV Direct: 1.5 mL/kg (300 mg/kg) lipid emulsion 20% over 1 to 3 minutes. Bolus dose can be repeated 1-2 times at 5-minute intervals based on response.
  • Infusion: Insufficient evidence to support infusions for this indication.


IV Direct: Administer undiluted over 1 to 3 minutes.

Infusion: 0.25 mL/kg/minute undiluted for 30 – 60 minutes. Rates as high as 0.5 mL/kg/minute have been used for life-threatening toxicity.

Therapeutic Endpoint: Intravenous lipid emulsion therapy should be discontinued once hemodynamic stability is achieved.

  • A maximum of 10-12 mL/kg can be administered every 24 hours. 
  • If the dose exceeds a pump’s maximum infusion rate, administer the lipid infusion at the pump’s maximum infusion rate. Two pumps are not required. 
  • If infusions longer than 60 minutes appear necessary, consult the poison centre for direction.
  • Lipid emulsion may be infused via peripheral, central, or intraosseous lines.
  • DEHP-free tubing is not required, and the absence of this tubing should not delay therapy

Compatibility, Stability

  • Do not add other drugs or intravenous nutrients to the lipid emulsion bag.
  • Partially used containers of lipid emulsion must be discarded and should not be stored for later use.
  • Lipid emulsion may be stored at room temperature. DO NOT FREEZE.
  • In-line filters should not be used for the administration of lipid emulsion.
  • Lipid emulsion should not be administered directly into an extracorporeal membrane oxygenation (ECMO) circuit. Separate IV line should be used.
  • The integrity indicator (Oxalert) should be inspected before removing the lipid emulsion from the over-wrap. If the indicator is black the product should be discarded.

Potential Hazards of Administration

Relative contraindications:

  • Allergy to eggs or soybeans, lipid metabolism and lipid storage disorders, severe sepsis, severe liver disease, acute pancreatitis, and acute myocardial infarction.

Adverse events in the rescue setting include

  • Lab interferences: transient disruption of lab values has been noted from the resulting hypertriglyceridemia, lasting 6-12 hours. All critical blood work should be drawn prior to lipid emulsion initiation.
  • Fat overload syndrome: hypertriglyceridemia, fever, organomegaly, coagulopathy, altered mental status, and seizures
  • Veno-occlusive: venous thromboembolism, priapism
  • Cardiorespiratory: arrhythmia, acute lung injury, ARDS
  • Gastrointestinal: pancreatitis, hepatic steatosis, acute renal failure
  • Miscellaneous: sepsis, hyperphosphatemia


  • Lipid emulsion contains approximately 15 mmol/L of phosphate and 300 microgram/L Vitamin K.
  • Lipid emulsion is a category C substance in pregnancy; no safety data is available in this population. However, in refractory hemodynamic instability following toxicity from a lipid-soluble drug, lipid emulsion therapy can be considered as a rescue intervention