정맥주사용 지방유제

비경구 영양제; 해독제 (지용성 독소)

**정맥주사용 지방유제(IFE/ILE)**는 정맥 투여를 위해 준비된 무균, 무발열성 지방 유제입니다. 역사적으로 주로 **비경구 칼로리 및 필수 지방산 공급원**으로 사용되었으나, 최근 수의 독성학에서 중요한 **응급 해독제**로 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.

동물 종별 용량

Cats

Parenteral Nutrition (PN) · 25-60% of calories administered. Traditionally not recommended at > 2 g/kg/day for TPN therapy. · IV · CRI · As needed · Consult a veterinary nutritionist.
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 · Extrapolated from general veterinary/human guidelines.

Dogs

Parenteral Nutrition (PN) · 25-60% of calories administered. Traditionally not recommended at > 2 g/kg/day for TPN therapy. · IV · CRI · As needed · Consult a veterinary nutritionist. Keep PPN solutions below 600 mOsm/L.
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 · Do not exceed 8 mL/kg/day generally, though this has been exceeded in acute toxicosis without ill effect.

용량은 면허 수의 전문가를 위한 임상 참고 자료입니다. 항상 최신 라벨과 개별 환자에 대해 확인하십시오.

투여 경로

금기

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

이상반응

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

약물 상호작용

Lipid Soluble Drugs · 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)

과용량

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.

VetSheet 약물 레퍼런스는 면허 수의 전문가를 위한 임상 의사결정 보조 도구이며, 전문적 판단이나 제조사의 최신 라벨을 대신하지 않습니다.