11/29/2023 0 Comments Intralipid iv![]() According to 2016 INS Standards of Practice and a 2014 ASPEN guidelines document, a 0.22-micron filter is needed for the 2-in-1 PN solution due to particulates from the compounding process and microorganisms that could enter the system. There are several options for configuring the filters. Now the IVFE requires a 1.2-micron filter regardless of where it is infused. IVFE was piggybacked below the filter or given through a separate catheter with no filtration. ![]() What about filtration for a 2-in-1 solution containing protein, carbohydrates, and other additives? The practice has been to use a 0.2-micron filter on this solution to ensure removal of all particulate matter and microorganisms. The concern was and still is cracking the fat emulsion, possibly resulting in a fat embolism. IVFE will not pass through filters with a smaller pore size. When all components are admixed together in one solution container (ie, 3-in-1 or Total Nutrient Admixture), the recommendation has always been to use an in-line 1.2-micron filter for infusion. This brings up several questions about the most appropriate filtration for infusing all parenteral nutrition solutions. Previous instructions were not as specific, stating that filters were not recommended or that a filter of less than 1.2-micron pore size was not to be used. fat emulsion (e.g., Intralipid, Nutrilipid) states to use a 1.2-micron filter for all infusion. In the patient in the present report, ILE was used successfully to treat ivermectin toxicosis, and results of serial measurement of serum ivermectin concentration supported the proposed lipid sink mechanism of action.The instructions have recently changed. Novel ILE treatment has been shown to be effective in human patients with lipid-soluble drug toxicoses, although the exact mechanism is unknown. This is particularly true in dogs affected by the ATP-binding cassette polymorphism. Ivermectin toxicosis in veterinary patients can result in death without aggressive treatment, and severe toxicosis often requires mechanical ventilation and intensive supportive care. Further diagnostic evaluation subsequently revealed that this dog was unaffected by the multidrug resistance gene (MDR-1) deletion, known as the ATP-binding cassette polymorphism. The dog was discharged from the hospital 48 hours after admission and was clinically normal within 4 days after ivermectin ingestion. An initial bolus of 1.5 mL/kg (0.68 mL/lb) of a 20% sterile lipid solution was administered IV over 10 minutes, followed by a constant rate infusion of 0.25 mL/kg/min (0.11 mL/lb/min) over 60 minutes that was administered twice to treat clinical signs of ivermectin toxicosis. The use of ILE treatment was initiated in this patient on the basis of previous clinical and experimental evidence supporting its use for toxicosis resulting from lipid-soluble agents. The dog was treated with ILE in addition to supportive care with IV fluid therapy and cardiovascular, respiratory, and neurologic monitoring. Results of CBC, serum biochemical analysis, venous blood gas analysis, and measurement of plasma lactate concentration were also within reference limits. ![]() The remaining physical examination findings were unremarkable. Neurologic evaluation revealed that the dog was ataxic and had mydriasis with bilaterally absent menace responses and pupillary light reflexes. On initial examination, the dog had stable cardiovascular signs but had diffuse muscle tremors and was hyperthermic. A 2-year-old spayed female Border Collie was treated with IV lipid emulsion (ILE) after ingesting 6 mg/kg (2.73 mg/lb) of an equine ivermectin anthelmintic paste 8 hours prior to examination.
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