Lipid emulsion therapy is a hot topic these days in both veterinary and human medicine. It has great potential, and when it works seems nearly miraculous.
But like all things in medicine, it does not always work like we want it to and side effects do occur. Knowing the basics about lipid therapy and when to use it will increase the chances it will be successful for you and your patient.
1) The toxin is lipid soluble. Knowing that one of the suspected mechanisms of action is the lipid sink theory, this one is pretty obvious. Remember that lipid sink is not the only proposed mechanism for lipids; the role lipids may play with cardiovascular effects is being researched as well.
2) The therapeutic interventions are NOT lipid soluble. Remember that lipid emulsion therapy is not selective: it can affect lipid soluble therapeutic medications along with the toxic exposure.
3) You’ve tried everything else, and the patient's condition continues to decline. Coma, respiratory depression, intractable cardiac arrhythmias: These are the types of symptoms APCC uses lipids for—cases that have gone through all the standard treatments unsuccessfully. Remember that while some times lipids seem to do miraculous things, they don’t always work.
4) Significant clinical signs are present. Lipids were not designed to prevent signs; they were designed to treat signs. There is no current evidence to show using them prior to signs developing that they will help and it is possible they may increase absorption of the toxin from the gut. Remember: Lipids are not selective!