Background: The prescription and use of antipsychotic medications have rapidly increased over the last two decades. Acute poisoning by antipsychotics could result in various life-threatening toxic effects mainly on cardiovascular and central nervous systems. As acute antipsychotics overdose lacks specific antidote, the primary goal in treatment is aggressive supportive therapy. Despite the increased concern for utilizing intravenous lipid emulsion (ILE) therapy in the treatment of lipophilic drugs toxicity including antipsychotics, there is a paucity of data, with low-quality evidence.
Aim of the study: This study is a randomized controlled clinical trial aimed to assess the adjuvant therapeutic role of lipid administration in improving the level of consciousness of acutely poisoned comatose patients by antipsychotic drugs presented to the Poison Control Center of Ain Shams University hospitals (PCC-ASUH).
Methods: We conducted a randomized controlled clinical trial starting from October 2020 to March 2021. Forty patients with acute antipsychotics poisoning were randomly assigned into two equal groups. The standard therapy was administered to the control group while ILE was given to the second group in addition to the standard therapy.
Results: Intravenous lipid emulsion therapy was effective in improving level of consciousness via the assessment of Alert, Voice, Pain and Unresponsive (AVPU) score and Glasgow Coma Scale (GCS). The median GCS and median AVPU scale assessed 12 hours after admission were significantly higher in the intervention group compared to the control group. Corrected QT interval (QTc) measured 12 hours after admission in addition to the length of hospital and intensive care unit (ICU) stay were significantly shorter in the intervention group compared to the control group.
Conclusion: It was concluded that ILE was an effective therapy in improving level of consciousness and correcting ECG abnormalities as prolonged QTc in acute antipsychotic poisoning, in addition to decreasing length of ICU and hospital stay.