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J Med Toxicol. 2008 June; 4(2): 71–76.
PMCID: PMC3550140

Intralipid infusion ameliorates propranolol-induced hypotension in rabbits



Recent case reports of successful amelioration of lipid-soluble drug toxidromes with Intralipid infusion have prompted interest in the scope of lipid emulsions as antidotal therapy. Propranolol is a highly lipid-soluble, nonselective beta-blocker with additional local-anaesthetic properties. We explored the hypothesis that propranolol toxicity may be similarly attenuated by Intralipid infusion in a rabbit model.


Twenty sedated, invasively monitored, and mechanically ventilated New Zealand White rabbits underwent propranolol infusion at 4.2 mg/min to a target mean arterial pressure (MAP) of 60% baseline MAP. Animals subsequently received 6 ml/kg 20% Intralipid, or 6 ml/kg 0.9% saline solution over a 4-minute period. Pulse rate and MAP were recorded at 2.5-minute intervals to 15 minutes.


MAP was greatest in the Intralipid group (median 69 mmHg, interquartile range [IQR] 17.5 mmHg Intralipid vs. median 53 mmHg, IQR 12.75 mmHg saline;p = 0.029) at 15 minutes. No difference was observed in first derivative of MAP, or pulse rate between groups.


Propranolol-induced hypotension is ameliorated by Intralipid infusion in this intact rabbit model. The mechanism of action remains to be elucidated.

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Selected References

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1. Reith D, Dawson A, Epid D, Whyte I, Buckley N, Sayer G. Relative toxicity of beta blockers in overdose. J Toxicol/Clin Toxicol. 1996;34(3):273–278. [PubMed]
2. Mansell P. Glucagon in the management of deliberate self-poisoning with propranolol. Arch Emerg Med. 1990;7(3):238–240. [PMC free article] [PubMed]
3. Brimacombe J, Scully M, Swainston R. Propranolol overdose—a dramatic response to calcium chloride. Med J Aust. 1991;155(4):267–268. [PubMed]
4. Sandroni C, Cavallaro F, Caricato A, Scapigiati A, Fenci P. Antonelli M. Enoximone in cardiac arrest caused by propranolol: two case reports. Acta Anaesthesiol Scand. 2006;50(6):759–761. doi: 10.1111/j.1399-6576.2006.01026.x. [PubMed] [Cross Ref]
5. Holger J, Engebretsen K, Fritzlar S, Patten L, Harris C, Flottemesch T. Insulin versus vasopressin and epinephrine to treat beta-blocker toxicity. Clin Toxicol. 2007;45(5):396–401. doi: 10.1080/15563650701285412. [PubMed] [Cross Ref]
6. Lane A, Woodward A, Goldman M. Massive propranolol overdose poorly responsive to pharmacologic therapy: use of the intra-aortic balloon pump. Ann Emerg Med. 1987;16(12):1381–1383. doi: 10.1016/S0196-0644(87)80425-0. [PubMed] [Cross Ref]
7. McVey F, Corke C. Extracorporeal circulation in the management of massive propranolol overdose. Anaesthesia. 1991;46(9):744–746. doi: 10.1111/j.1365-2044.1991.tb09770.x. [PubMed] [Cross Ref]
8. Rosenblatt M, Abel M, Fischer G, Itkovich C, Eisenkraft J. Successful use of a 20% lipid emulsion to resuscitate a patient after a presumed bupivacaine-related cardiac arrest. Anaesthesiology. 2006;105:217–218. doi: 10.1097/00000542-200607000-00033. [PubMed] [Cross Ref]
9. Litz R, Popp M, Stehr S, Koch T. Successful resuscitation of a patient with ropivacaine-induced asystole after axillary plexus block using lipid infusion. Anaesthesia. 2006;61(8):800–801. doi: 10.1111/j.1365-2044.2006.04740.x. [PubMed] [Cross Ref]
10. Sirianni A, Osterhoudt K, Calello D, et al. Use of Intralipid in the resuscitation of a patient with prolonged cardiovascular collapse after overdose of bupropion and lamotrigine.Ann Emerg Med2007; epub ahead of print. [PubMed]
11. Weinberg GL, VadeBoncouer T, Ramaraju GA, Garcia-Amaro M, Cwik M. Pretreatment or resuscitation with a lipid infusion shifts the dose-response to bupivacaine-induced asystole in rats. Anaesthesiology. 1998;88(4):1071–1075. doi: 10.1097/00000542-199804000-00028. [PubMed] [Cross Ref]
12. Weinberg G, Ripper R, Feinstein DL, Hoffman W. Lipid emulsion infusion rescues dogs from bupivacaine induced cardiac toxicity. Reg Anesth Pain Med. 2003;28(3):198–202. [PubMed]
13. Cave G, Harvey M, Castle C. Intralipid ameliorates thiopentone induced respiratory depression in rats: investigative pilot study [letter] Emerg Med Australas. 2005;17:180–181. doi: 10.1111/j.1742-6723.2005.00714.x. [PubMed] [Cross Ref]
14. Tebbutt S, Harvey M, Nicholson T, Cave G. Intralipid prolongs survival in a rat model of verapamil toxicity. Acad Emerg Med. 2006;13(2):134–139. doi: 10.1111/j.1553-2712.2006.tb01661.x. [PubMed] [Cross Ref]
15. Harvey M, Cave G. Intralipid outperforms sodium bicarbonate in a rabbit model of clomipramine toxicity. Ann Emerg Med. 2007;49(2):178–185. doi: 10.1016/j.annemergmed.2006.07.016. [PubMed] [Cross Ref]
16. Cave G, Harvey M, Castle C. The role of fat emulsion therapy in a rodent model of propranolol toxicity: a preliminary study. J Med Toxicol. 2006;2(1):4–7. doi: 10.1007/BF03161005. [PMC free article] [PubMed] [Cross Ref]
17. Weinberg G. Lipid rescue resuscitation from local anaesthetic cardiac toxicity. Toxicol Rev. 2006;25(3):139–145. doi: 10.2165/00139709-200625030-00001. [PubMed] [Cross Ref]
18. Van der Vusse G, van Bilsen M, Glatz J. Cardiac fatty acid uptake and transport in health and disease. Cardiovasc Res. 2000;45:279–293. doi: 10.1016/S0008-6363(99)00263-1. [PubMed] [Cross Ref]
19. Weinberg G. Reply to Drs. Goor, Groban and Butterworth—Lipid rescue: Caveats and recommendations for the ‘silver bullet’ [letter] Reg Anaesth Pain Med. 2004;29:74–74.
20. Abel R, Fisch D, Grossman M. Hemodynamic effects of intravenous 20% soy oil emulsion following coronary bypass surgery. J Parenter Enteral Nutr. 1983;7:534–540. doi: 10.1177/0148607183007006534. [PubMed] [Cross Ref]
21. Nava-Ocampo A, Bello-Ramirez A. Lipophilicity affects the pharmacokinetics and toxicity of local anaesthetic agents administered by caudal block. Clin Exp Pharmacol Physiol. 2004;31(1-2):116–118. doi: 10.1111/j.1440-1681.2004.03961.x. [PubMed] [Cross Ref]
22. Ishizarki J, Yokogawa K, Nakashima E, et al. Prediction of changes in the clinical pharmacokinetics of basic drugs on the basis of octanol water partition coefficients. J Pharm Pharmacol. 1997;49:762–767. [PubMed]
23. Pang D, Sperelakis N. Uptake of calcium antagonistic drugs into muscles as related to their lipid solubilities. Biochem Pharmacol. 1984;33(5):821–826. doi: 10.1016/0006-2952(84)90468-4. [PubMed] [Cross Ref]
24. Weinberg G, Ripper R, Murphy P, et al. Lipid infusion accelerates removal of bupivacaine and recovery from bupivacaine toxicity in the isolated rat heart. Reg Anesth Pain Med. 2006;31(4):296–303. [PubMed]
25. Gilman AG, Rall TW, Nies AS, Taylor P. The Pharmacological Basis of Therapeutics. 8th ed. New York: McGraw-Hill Inc: Macmillan Publishing Company; 1993.
26. Van de Velde M, Woutens PF, Rolf N, Van Aken H, Flameng W, Vandermeersch E. Long-chain triglycerides improve recovery from myocardial stunning in conscious dogs. Cardiovasc Res. 1996;32:1008–1015. doi: 10.1016/S0008-6363(96)00165-4. [PubMed] [Cross Ref]
27. Van de Velde M, DeWolff M, Leather H, Wouters P. Effects of lipids on the functional and metabolic recovery from global myocardial stunning in isolated rabbit hearts. Cardiovasc Res. 2000;48(1):129–137. doi: 10.1016/S0008-6363(00)00151-6. [PubMed] [Cross Ref]
28. Jones J, Tibbs D, McDonald M, Lowe R, Hewitt R. 10% soybean oil emulsion as a myocardial energy substrate after ischemic arrest. Surg Forum. 1977;28:284–285. [PubMed]
29. Liedtke A, DeMaison L, Eggleston A, Cohen L, Nellis S. Changes in substrate metabolism and effects of excess fatty acids in reperfused myocardium. Circ Res. 1988;62(3):535–542. [PubMed]
30. Mickle D, del Nido P, Wilson G. Exogenous substrate preference of the post-ischaemic myocardium. Cardiovasc Res. 1986;20(4):256–263. doi: 10.1093/cvr/20.4.256. [PubMed] [Cross Ref]
31. Stehr S, Ziegeler J, Pexa A. The effects of lipid infusion on myocardial function and bioenergetics in l-bupivacaine toxicity in the isolated rat heart. Anesth Analg. 2007;104:186–192. doi: 10.1213/01.ane.0000248220.01320.58. [PubMed] [Cross Ref]

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