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July/August 2014 Today's Veterinary Practice 27 TheraPeuTic uPdaTes in VeTerinary Toxicology | tvpjournal.com use of a potent antiemetic and administration of SC fluids (approx- imately 40–50 mL/kg of a balanced, isotonic crystalloid) prevents addi- tional free water loss and replaces any fluid deficit, thereby helping to prevent hypernatremia and allow- ing rapid return to a hydrated state. ROLE OF INTRAVENOUS LIpID EMULSION Intravenous lipid emulsions (ILE), also known as intravenous fat emulsions (IFE), have been used in human and veterinary medicine as part of total or partial paren- teral nutrition for several decades. ILE also has been used as a vehi- cle for drug delivery for emulsions (eg, propofol) and, more recent- ly, it has been recommended as a potential antidote for lipophilic drug toxicosis. The precise mechanism of action through which ILE increases the rate of recovery and reduces the severity of clinical signs in lipophil- ic drug toxicosis is unknown. See Table 4 for hypotheses regarding how ILE works. In the Literature A state-of-the-art review by Fernan- dez, et al, 5 was recently published, introducing the first recommenda- tions for use of ILE in veterinary medicine. Table 5 (page 28) lists the toxicants for which ILE therapy is thought to be helpful. Indications ILE therapy is generally consid- ered relatively safe; however, its use for treatment of toxicities is considered extra-label, and rare side effects can occur, including fat-overload syndrome, cholester- ol deposits into the cornea, and coagulopathy. Keep in mind that the use of ILE in human medicine is typically reserved for severe tox- icosis and life-threatening clinical signs when conventional therapies have failed. Current human medicine guide- lines recommend that infusion of ILE should only be: • Attempted in patients who have suf fered cardiac arrest • Used when standard resusci- tation protocols have failed to establish adequate return to spontaneous circulation. • Cardiopulmonar y resuscita- tion should continue during ILE administration. In veterinary medicine, ILE is generally initiated earlier in the course of treatment, and is war- ranted: • For toxicities associated with lip- id-soluble compounds in which a high morbidity has been report- ed • In patients with clinical signs of toxicosis • When traditional therapies have failed or are cost-prohibitive. Table 4. hypotheses: how ile addresses Fat- soluble Toxicants 5 1. Provides myocytes with energy substrates, thereby augmenting cardiac performance. 2. restores myocardial function by increasing intracellular calcium concentration, which increases contractility of the heart. 3. increases overall fatty acid pool, which overcomes inhibition of mitochondrial fatty acid metabolism (eg, bupivacaine toxicosis). 4. acts as a lipid sink by sequestration of lipophilic compounds into the newly created intravascular lipid compartment (a lipid or pharmacologic sink), resulting in decreased free drug concentration available to the tissues. O C E A N F I S H # 1 I N G R E D I E N T ©2014 Hill's Pet Nutrition, Inc. ®/™ Trademarks owned by Hill's Pet Nutrition, Inc. Go to HillsVet.com for more information. NEW great tasting Ocean Fish