ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Antidote / Resuscitation Pregnancy: C - use in life-threatening LAST; benefit clearly outweighs risk

Lipid Emulsion 20% (Intralipid)

Brand names: Intralipid 20%, ClinOleic 20%

Adult dose

Dose: Bolus: 1.5 mL/kg IV over 1 min; Infusion: 0.25 mL/kg/min for 30-60 min
Route: IV
Frequency: Repeat bolus x2 at 5-min intervals if cardiovascular collapse persists; max cumulative 10-12 mL/kg
For local anaesthetic systemic toxicity (LAST): give bolus immediately on cardiac arrest. Maintain infusion for at least 10 min after haemodynamic stability achieved.

Paediatric dose

Dose: 1.5 mL/kg
Route: IV
Frequency: Same protocol as adult
Max: 10 mL/kg cumulative
Same weight-based dosing. Monitor for fat overload syndrome.

Dose adjustments

Renal

Not applicable - emergent antidote use.

Paediatric weight-based calculator

Same weight-based dosing. Monitor for fat overload syndrome.

Clinical pearls

  • First-line treatment for local anaesthetic systemic toxicity (LAST): bupivacaine > levobupivacaine > ropivacaine > lidocaine toxicity.
  • Mechanism: 'lipid sink' - sequesters lipophilic local anaesthetic molecules from cardiac and CNS tissue.
  • Also used for toxicity from: tricyclic antidepressants, verapamil, diltiazem, beta-blockers, lamotrigine - off-label but guideline-supported.
  • AAGBI LAST guidelines: have Intralipid available in every area where regional anaesthesia is performed.
  • Do not use propofol as a substitute - insufficient lipid content and cardiorespiratory depression.
  • Continue CPR throughout infusion - lipid works during ongoing resuscitation.

Contraindications

  • Severe egg or soy allergy (soybean oil base) - relative; benefit outweighs risk in cardiac arrest
  • Severe hyperlipidaemia
  • Fat overload syndrome

Side effects

  • Fat overload syndrome (rare at standard doses)
  • Pancreatitis (rare)
  • Interference with blood tests (lipid interference in serum samples)
  • Venous thrombophlebitis at infusion site

Interactions

  • Interferes with pulse oximetry and laboratory results - obtain samples before infusion if possible
  • Propofol: contains lipid - do not confuse with therapeutic agent

Monitoring

  • Continuous ECG
  • BP every 2-5 min
  • Neurological status
  • Serum lipids post-resuscitation
  • Liver function 24-48 h post-use

Reference: BNFc; AAGBI LAST Guidelines 2023; TOXBASE; ACMT Position Statement 2022; BNF 84. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Pathways