靜脈注射脂肪乳劑
**靜脈注射脂肪乳劑 (IFE/ILE)** 是一種無菌、無熱原的靜脈注射用脂肪乳劑。 過去主要作為**腸胃外熱量與必需脂肪酸來源**，現已成為獸醫毒理學中關鍵的**急救解毒劑**。當傳統療法失效時，它對於治療由高脂溶性藥物引起的危及生命的毒性反應非常有效。 **主要臨床應用：** * **毒理學急救：** 局部麻醉劑（布比卡因、利多卡因）、大環內酯類（伊維菌素、莫昔克丁）、鈣離子通道阻斷劑（氨氯地平）、β-受體阻斷劑及某些抗憂鬱/抗精神病藥物。 * **腸胃外營養 (PN)：** 提供高密度熱量（20% 溶液約 2 kCal/mL）。*注意：由於潛在的免疫抑制和感染風險，其在重症患者營養支持中的使用存在爭議。*
作用機制: **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.
各物種劑量
- 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.
- 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.
劑量為合格獸醫專業人員的臨床參考。請務必對照最新藥品仿單及個別病患確認。
給藥途徑
禁忌症
- 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
不良反應
- 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
藥物相互作用
- Lipid Soluble Drugs · IFE may act as a 'lipid sink', reducing the free circulating levels and clinical efficacy of concurrently administered lipophilic medications.
監測
- 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)
過量
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 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。