脂肪乳劑
靜脈注射脂肪乳劑 (ILE) 主要用於**腸胃外營養**，提供高密度的熱量與必需脂肪酸。在獸醫急診醫學中，越來越常被用作親脂性藥物中毒（如阿維菌素類、布比卡因等局部麻醉劑）的**解毒劑**。 > **臨床警告：** 對於有胰島素阻抗（如糖尿病）或有胰臟炎風險的病患，應極度謹慎使用。必須嚴格遵守無菌操作，因為乳劑極易滋生細菌。 **臨床小提示：** 使用 ILE 治療中毒通常被稱為「脂肪救援 (Lipid Rescue)」療法。
作用機制: 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.
各物種劑量
- 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.
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
給藥途徑
禁忌症
- Insulin resistance (e.g., diabetes mellitus)
- Hyperlipidaemia
- Disrupted fat metabolism
不良反應
- 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)
藥物相互作用
- 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
監測
- Plasma clearance (visual lipaemia or serum triglycerides daily)
- Blood glucose
- Pancreatic enzymes
- Coagulation profile (if prolonged use)
過量
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 藥物參考供持牌獸醫專業人員作臨床決策輔助之用,不能取代專業判斷或廠方最新藥品說明書。