脂肪乳剤
静注用脂肪乳剤（ILE）は、主に**静脈内栄養**として高カロリーおよび必須脂肪酸を供給するために使用されます。獣医救急医療では、脂溶性薬物（アベルメクチン類、ブピバカインなどの局所麻酔薬など）の中毒に対する**解毒剤**としての利用が増加しています。 > **臨床上の警告：** インスリン抵抗性（糖尿病など）のある患者や膵炎のリスクがある患者には極めて慎重に使用してください。乳剤は細菌の増殖を促進するため、厳格な無菌操作が必須です。 **臨床のポイント：** 中毒に対するILEの使用は、しばしば「リピッドレスキュー（Lipid Rescue）」療法と呼ばれます。
作用機序: As a nutritional supplement, lipid emulsions provide **triglycerides** which are hydrolyzed by **lipoprotein lipase** into free fatty acids and glycerol, entering cellular metabolism via **beta-oxidation** to produce ATP. As an antidote, the primary mechanism is the **'lipid sink' theory**: the infusion creates an expanded intravascular lipid phase that sequesters highly lipophilic toxins (e.g., bupivacaine, ivermectin) away from target organs (brain, heart) → reducing clinical toxicity.
動物種別の用量
- Parenteral nutrition · Supply 30% (partial peripheral) to 40-60% of energy requirements · IV · continuous · As required · Amount governed by physiological status
- Treatment of lipid-soluble toxicosis (e.g., ivermectin, moxidectin) · 1.5-5 ml/kg of 20% lipid solution as bolus, followed by 0.25-0.50 ml/kg/min infusion. Boluses of 1.5 ml/kg can be repeated. · IV · bolus followed by continuous infusion · Infusion for 30-60 min (maximum 24 hours) · Infusions of 0.5 ml/kg/min can be administered for a maximum of 24 hours.
- Parenteral nutrition · Supply 40-60% of energy requirements · IV · continuous · As required · Generally used as an energy source in a nutrient admixture for infusion through central venous access (total parenteral nutrition).
- Treatment of lipid-soluble toxicosis (e.g., ivermectin, moxidectin) · 1.5-5 ml/kg of 20% lipid solution as bolus, followed by 0.25-0.50 ml/kg/min infusion. Boluses of 1.5 ml/kg can be repeated. · IV · bolus followed by continuous infusion · Infusion for 30-60 min (maximum 24 hours) · Infusions of 0.5 ml/kg/min can be administered for a maximum of 24 hours.
用量は獣医療従事者向けの臨床リファレンスです。必ず最新の添付文書と個々の患者で確認してください。
投与経路
禁忌
- Insulin resistance (e.g., diabetes mellitus)
- Hyperlipidaemia
- Disrupted fat metabolism
有害事象
- Febrile episodes (mainly with 20% emulsions)
- Vasculitis
- Thrombosis
- Anaphylaxis (rare)
- Hepatic failure (with prolonged treatment)
- Pancreatitis (with prolonged treatment)
- Cardiac arrest (with prolonged treatment)
- Thrombocytopenia (with prolonged treatment)
薬物相互作用
- Other IV medications · Physical incompatibility; requires dedicated IV line for parenteral feeding · major
- Biochemical assays · Lipaemia interferes with blood gas and calcium measurements if samples are taken before fat is cleared · moderate
モニタリング
- Plasma clearance (visual lipaemia or serum triglycerides daily)
- Blood glucose
- Pancreatic enzymes
- Coagulation profile (if prolonged use)
過量投与
Overdosage or failure to clear lipids can lead to **fat overload syndrome**, characterized by hyperlipidaemia, fever, jaundice, hepatosplenomegaly, and coagulopathy. Treatment involves immediate cessation of the infusion and supportive care.
VetSheet の薬剤リファレンスは、獣医療従事者向けの臨床意思決定支援を目的としており、専門的判断やメーカーの最新添付文書に代わるものではありません。