정맥주사용 지방유제
Intravenous Fat Emulsion
Intravenous Lipid Emulsion
다른 이름: Intralipid · Liposyn III · IFE · ILE · Intravenous Lipid Emulsion · Lipid Rescue
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
동물 종별 용량
🌎 NA — North America🌍 EU — Europe
개
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Parenteral Nutrition (PN) | 25-60% of calories administered. Traditionally not recommended at > 2 g/kg/day for TPN therapy. | IV | CRI | As needed | 🌎 NA |
| Rescue agent for fat-soluble drug/toxin intoxication | IFE 20% via a sterile, peripheral IV catheter as a 1.5 mL/kg bolus over 1-3 minutes, then 0.25-0.5 mL/kg/min for 30-60 min. The bolus could be repeated in case of cardiac arrest. If symptomatic after traditional dosing, consider additional doses of 1.5 mL/kg IV over 30 min q4-6h for 24-36 hours until clinical signs resolve, or maintaining a CRI of 0.5 mL/kg/hour until clinical signs resolve. | IV | Bolus followed by CRI | Until clinical signs resolve | 🌎 NA |
- Parenteral Nutrition (PN): Consult a veterinary nutritionist. Keep PPN solutions below 600 mOsm/L.
- Rescue agent for fat-soluble drug/toxin intoxication: Do not exceed 8 mL/kg/day generally, though this has been exceeded in acute toxicosis without ill effect.
고양이
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| Parenteral Nutrition (PN) | 25-60% of calories administered. Traditionally not recommended at > 2 g/kg/day for TPN therapy. | IV | CRI | As needed | 🌎 NA |
| Rescue agent for fat-soluble drug/toxin intoxication | IFE 20% via a sterile, peripheral IV catheter as a 1.5 mL/kg bolus over 1-3 minutes, then 0.25-0.5 mL/kg/min for 30-60 min. The bolus could be repeated in case of cardiac arrest. If symptomatic after traditional dosing, consider additional doses of 1.5 mL/kg IV over 30 min q4-6h for 24-36 hours until clinical signs resolve, or maintaining a CRI of 0.5 mL/kg/hour until clinical signs resolve. | IV | Bolus followed by CRI | Until clinical signs resolve | 🌎 NA |
- Parenteral Nutrition (PN): Consult a veterinary nutritionist.
- Rescue agent for fat-soluble drug/toxin intoxication: Extrapolated from general veterinary/human guidelines.
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
정맥주사용 지방유제(IFE/ILE)는 정맥 투여를 위해 준비된 무균, 무발열성 지방 유제입니다.
역사적으로 주로 비경구 칼로리 및 필수 지방산 공급원으로 사용되었으나, 최근 수의 독성학에서 중요한 응급 해독제로 부상했습니다. 기존 치료법이 실패했을 때 고지용성 약물로 인한 생명 위협적인 독성을 치료하는 데 매우 효과적입니다.
주요 임상 적용:
- 독성학 응급 처치: 국소 마취제(부피바카인, 리도카인), 대크로라이드계(이버멕틴, 목시덱틴), 칼슘 채널 차단제(암로디핀), 베타 차단제 및 특정 항우울제/항정신병 약물.
- 비경구 영양(PN): 고밀도 칼로리를 제공합니다(20% 용액의 경우 약 2 kCal/mL). 참고: 잠재적인 면역 억제 및 감염 위험 때문에 중증 환자의 영양 공급을 위한 사용은 논란의 여지가 있습니다.
작용 기전
Toxicologic Mechanism (Antidote):
- "Lipid Sink" Theory: IFE creates an expanded intravascular lipid phase. Highly lipophilic toxins partition out of target tissues (e.g., myocardium, CNS) and into this "lipid sink" within the plasma, reducing the free (active) drug concentration at receptor sites.
- Metabolic/Cardiac Enhancement: Provides a direct energy substrate (free fatty acids) to the myocardium, overcoming mitochondrial lipid metabolism blockade (e.g., by bupivacaine) and increasing intracellular calcium to improve cardiac contractility.
Nutritional Mechanism:
- Provides a dense source of calories and essential fatty acids (linoleic, linolenic acids) necessary for cellular integrity and metabolism.
안전성·주의사항
금기사항
- Severe egg yolk allergies
- Abnormal fat metabolism
- Premature and low-birth weight infants (human black box warning)
- Blood coagulation disorders
- Pulmonary disease
- Renal impairment
- Severe liver damage
- Patients at high risk for fat emboli
부작용
- Sepsis or thrombophlebitis (secondary to IV catheterization)
- Fat overload syndrome (hyperlipidemia, hepatomegaly, icterus, splenomegaly, fat embolism, thrombocytopenia, hemolysis, prolonged clotting times)
- Pulmonary toxicity (temporary)
- GI effects
- Somnolence
- Headache
- Flushing
- Pancreatitis
- Hypercoagulability
- Hypersensitivity
주의
Strict aseptic technique and excellent IV catheter care are imperative to prevent sepsis. When used alone, IFE may be given via a peripheral line; when combined with amino acids/dextrose as Total Parenteral Nutrition (TPN), a dedicated central line is required due to hypertonicity. Use with caution in critically ill animals due to potential immunosuppression, exacerbation of pulmonary pathology, and increased infection rates. Blood samples for diagnostics should be drawn prior to administration to avoid severe lipemia artifacts (falsely high hemoglobin, MCH, MCHC, and altered bilirubin).
약물 상호작용
IFE may act as a 'lipid sink', reducing the free circulating levels and clinical efficacy of concurrently administered lipophilic medications.
모니터링
- Serum/plasma drug levels (for toxicology tracking)
- Blood glucose
- Serum triglycerides and gross lipemia
- PCV and Total Protein
- IV catheter site status (phlebitis/sepsis)
- Hydration status and vital signs (temp, HR, RR)
- Serum electrolytes (including phosphorus)
- Renal and liver function tests
- CBC
- Coagulation times (if using heparin)
약동학
흡수
Administered intravenously; 100% bioavailable.
분포
Removed from the blood stream about as rapidly as chylomicrons.
대사
Requires prior lipolysis of IFE into free fatty acids. Clearance seems to be increased with heparin-activated lipoprotein lipase.
배설
Elimination half-life in humans is about 30 minutes.
과다투여
In the event of inadvertent overdose or severe fat overload, stop the infusion until the lipid has cleared from the plasma. Clearance can be evaluated visually (inspecting hematocrit tubes for lipemia) or via laboratory methods (triglyceride concentrations, nephelometry).
If severe hyperlipidemia occurs during toxicity treatment, heparin therapy (75-250 Units/kg SQ q6h) may be considered to increase lipid clearance via lipoprotein lipase activation. However, weigh risks carefully, as heparin may alter the antidote mechanism. Monitor PTT; if PTT exceeds 2-2.5X normal, lower heparin dose (75 Units/kg SQ q6-8h) or discontinue.
제품
제형
- Intravenous injection (10%, 20%, 30% emulsions)
인용의약품
- Fat Emulsion, Intravenous 10%, 20%, 30% in 50 mL, 100 mL, 200 mL, 250 mL, & 500 mL bottles or bags (Intralipid, Liposyn II, Liposyn III)
규제 현황
규제 데이터 없음: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
Store unopened products at room temperature (not above 25°C / 77°F). Do not freeze; discard if accidentally frozen. Once opened, store the remaining product in the refrigerator (2-8°C) and discard after 24 hours. A new bag/vial must be used every 24 hours. Admixtures must be used promptly or stored under refrigeration for 24 hours or less.
보호자 정보
정맥주사용 지방유제(IFE)는 병원에서만 사용하는 전문 치료제입니다.
- 중독의 경우: 혈류에서 '스펀지' 역할을 하여 특정 심각하고 생명을 위협하는 독소(심장약, 국소 마취제 또는 특정 구충제 등)를 흡수합니다. 표준 치료가 실패할 때 생명을 구하는 응급 요법이 될 수 있습니다.
- 영양 공급의 경우: 음식을 먹을 수 없어 정맥 영양 공급이 필요한 반려동물에게 필수 칼로리와 지방을 제공합니다.
- 정맥으로 직접 투여되기 때문에 반려동물은 입원하여 정맥 카테터를 장착해야 하며, 감염이나 혈중 지방 과부하 징후가 없는지 수의료진의 면밀한 모니터링이 필요합니다.
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