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The Intralipid Genie is Out of the Bottle—Spin and Wishful Thinking

Intralipid has recently become a widely accepted treatment for intravenous local anaesthetic toxicity. There is some reasonable animal evidence and a clear rationale for this indication, although controlled human studies have not been conducted to quantify the extent to which this translates into clinical benefits. However, over the last decade many enthusiasts have uncritically extrapolated the use of intralipid to oral overdose of several unrelated drugs, reporting a favourable outcome in unstructured case reports (containing limited detail) as if these provided evidence of effectiveness. These reports may provide ‘food for thought’ but are at best lowlevel evidence and their use to justify wider adoption of such treatments is clearly poor science. Worse, it may also be poor medicine and put patients’ lives at risk in some situations. The suggested use of intralipid in tricyclic antidepressant (TCA) overdose provides a good example to illustrate these concerns. This relates to interpretation of case reports given the natural history, the expected effect of intralipid on bioavailability, clearance and distribution of TCAs, and the (lack of) evidence that should logically have preceded any use in patients for this indication.