Intravenous Lipid Emulsions in Veterinary Toxicology: Silver Bullet or Snake Oil?

摘要

The perfect antidote is the Holy Grail of toxicology. In other words, a substance that can neutralize a poison and bring the poisoned patient back to health. A perfect antidote would work against all poisons (i.e., universal antidote), be easy to administer, be readily available, be of relatively low cost, and be of low toxicity. Of course, the concept of a universal antidote is unachievable due to the various mechanisms by which poisons enter and exert their damage on the host, so the perfect antidote is an unreachable goal. However, recently the world of veterinary clinical toxicology has been intrigued by the development of a new potential antidote that appears to fill many of the other criteria of a perfect antidote and whose origin could not have been more surprising: intravenous lipid emulsions (ILE) marketed for total parenteral nutrition (TPN).Intravenous lipid emulsions provide free fatty acids and triglycerides to patients unable to maintain normal nutritional status via the enteral route. ILE are composed of lipids derived from various plant and/or animal sources, the most common being soyand eggs. These solutions have been used for TPN for decades in both human and veterinary medicine and have stellar track records for safety, with few adverse effects being reported when ILE are used as TPN components.