We know intravenous injection of lipid emulsion is an effective antidote of some overdoses of lipid-soluble drugs like the local anaesthetics, beta-antagonists, calcium channel blockers and antidepressants. I never thought of it being used as an antidote in cocaine toxicity.
Good thing someone did. In this case report the authors describe the case of the overdosed habitual cocain user who presented in a coma, with seizures, hypotension and supra-ventricular and ventricular tachyarrythmias. His ABGs showed metabolic acidosis, pH 6,8 and a lactate of 9,7.
Despite high doses of norad he became increasingly cardiovascularly unstable and eventually it was decided to inject 1,5 ml/kg Intralipid followed by an infusion of 15 ml/kg/h over 20 minutes.
Within 15 minutes sinus rhythm was restored. 30 minutes after the lipid infusion started the patient didn’t need the noradrenaline infusion anymore. After 24 hours he was extubated and ultimately discharged after two days.
Read about it here.