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Ann Emerg Med. 2014 Jul;64(1):32-7. doi: 10.1016/j.annemergmed.2013.11.017. Epub 2013 Dec 15.

Pretreatment with intravenous lipid emulsion reduces mortality from cocaine toxicity in a rat model.

Author information

1
Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI. Electronic address: stephanie.carreiro@umassmemorial.org.
2
Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI.
3
Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI; Division of Medical Toxicology, Alpert Medical School of Brown University, Providence, RI.

Abstract

STUDY OBJECTIVE:

We compare the effects of intravenous lipid emulsion and normal saline solution pretreatment on mortality and hemodynamic changes in a rat model of cocaine toxicity. We hypothesize that intravenous lipid emulsion will decrease mortality and hemodynamic changes caused by cocaine administration compared with saline solution.

METHODS:

Twenty male Sprague-Dawley rats were sedated and randomized to receive intravenous lipid emulsion or normal saline solution, followed by a 10 mg/kg bolus of intravenous cocaine. Continuous monitoring included intra-arterial blood pressure, pulse rate and ECG tracing. Endpoints included a sustained undetectable mean arterial pressure (MAP) or return to baseline MAP for 5 minutes. The log-rank test was used to compare mortality. A mixed-effect repeated-measures ANOVA was used to estimate the effects of group (intravenous lipid emulsion versus saline solution), time, and survival on change in MAP, pulse rate, or pulse pressure.

RESULTS:

In the normal saline solution group, 7 of 10 animals died compared with 2 of 10 in the intravenous lipid emulsion group. The survival rate of 80% (95% confidence interval 55% to 100%) for the intravenous lipid emulsion rats and 30% (95% confidence interval 0.2% to 58%) for the normal saline solution group was statistically significant (P=.045).

CONCLUSION:

Intravenous lipid emulsion pretreatment decreased cocaine-induced cardiovascular collapse and blunted hypotensive effects compared with normal saline solution in this rat model of acute lethal cocaine intoxication. Intravenous lipid emulsion should be investigated further as a potential adjunct in the treatment of severe cocaine toxicity.

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