Fatty Infusions: A Potential Antidote for Drug Toxicity

Intravenous lipid emulsions (ILE) were first introduced in 1998 to treat cardiac arrest caused by bupivacaine. Since then, their application has broadened significantly to include poisonings by various lipophilic — or fat-loving — substances, such as tricyclic antidepressants and calcium channel blockers. A 2025 narrative review examines the mechanisms behind this therapy, specifically the 'lipid sink' and 'shuttle' theories, which suggest the emulsion traps drug molecules to reduce their toxicity.

beyond simply scavenging toxins, ILE appears to offer cardiotonic effects, including membrane stabilisation and mitochondrial support. While recent data suggests benefits in cases involving tramadol, clozapine, and organophosphates, the evidence is currently limited by inconsistent study methods. Consequently, mortality reduction remains unproven.

Current guidelines recommend ILE as a first-line treatment specifically for local anaesthetic systemic toxicity, but only as a second-line option for other life-threatening poisonings. With rare risks such as acute pancreatitis and fat overload syndrome, researchers emphasise the need for high-quality, multicentre studies to firmly establish safety and dosing protocols.