Dr. Jon Cole and colleagues from the Hennepin Regional Poison Center have published a 2-person case series on asystolic cardiac arrest follow administration of intralipid (epub J Medical Toxicology 2014). Both cases involve patients with cardiogenic shock refractory to calcium, vasopressors, and high-dose insulin. Rescue intravenous fat emulsion was given and in both cases the patients had an systolic cardiac arrest in an under 1 minute. Both patients were resuscitated, but ultimately died of multiorgan failure.
The paper is remarkable for several features beyond the very interesting cases. The authors readily acknowledge the limitations of assigning causality. They then retell the cautionary tale of physostigmine. Clinical practice was dramatically altered after a case series of two patients was reported demonstrated a temporal relationship between physostigmine and asystolic cardiac arrest (Pentel, Ann Emerg Med 1980;9(11):588). I appreciated their tempered reporting of a potentially practice changing paper.
It is an interesting read.