Intravenous Lipid Emulsion (ILE): veterinary dose and monograph

At a glance

Drug class

Veterinary drug

Also known as

ILE, 20% Intralipid, Lipid rescue, IV fat emulsion

Species with doses

Dogs and Cats

Routes

IV

Last reviewed

1 October 2026

Indications

• Local-anaesthetic systemic toxicity (bupivacaine/lidocaine cardiotoxicity) — the original indication
• Lipophilic toxicoses: permethrin (cats), ivermectin/moxidectin (macrocyclic lactones), baclofen, calcium-channel blockers, some NSAIDs, antidepressants and other fat-soluble drugs
• Adjunct rescue in severe lipophilic-drug overdose unresponsive to standard care

Intravenous Lipid Emulsion (ILE) dose by species

Doses are per administration unless stated. mg/kg doses scale with body weight; per-animal, per-quarter and infusion-rate doses are shown as the reference writes them.

Dogs

• Lipophilic toxicosis (lipid rescue): Plumb’s (Fat Emulsion, Intravenous): regimen extrapolated from human medicine (Jamaty 2010), aiming not to exceed 8 mL/kg/day; if signs persist, 1.5 mL/kg IV over 30 min q4–6h for 24–36 h or a CRI of 0.5 mL/kg/h (Lee 2010). Papich 5e (ivermectin toxicosis): 1.5 mL/kg bolus of 20% emulsion. Use a dedicated sterile catheter; check for lipaemia before repeating. Adjunct to decontamination and supportive care.

Cats

• Permethrin / lipophilic toxicosis (lipid rescue): Plumb’s (Fat Emulsion, Intravenous): general regimen, not cat-specific; aim not to exceed 8 mL/kg/day. Adjunct to methocarbamol, decontamination (bathing) and supportive care in permethrin toxicosis.

Contraindications

Known hypersensitivity to egg/soy components. Fat-overload conditions; severe lipaemia-sensitive conditions (e.g. pancreatitis — relative). Use as a substitute for standard decontamination/supportive care (it is an ADJUNCT). Total doses beyond recommended (fat-overload syndrome). Use only for lipophilic toxins (no benefit for water-soluble poisons).

Species-specific warnings

Cats: A valuable adjunct in severe/refractory permethrin toxicosis — combine with decontamination, methocarbamol, cooling and supportive care; monitor for lipaemia/fat overload.

Adverse effects

• Usually well tolerated
• Fat-overload syndrome with repeated/large doses (lipaemia, haemolysis, organ dysfunction)
• Hypersensitivity (egg/soy); interference with some lab assays (lipaemic sample)
• Theoretical worsening of pancreatitis; phlebitis

Drug interactions

• Lipophilic drugs: sequestered (the therapeutic effect) — but this can also sequester concurrently needed lipophilic drugs (e.g. reduce efficacy of lipophilic medications)
• Laboratory assays: lipaemic samples interfere with many tests
• No specific adverse pharmacologic interactions

Pregnancy and lactation

Used in life-threatening toxicosis when needed (it is a nutritional lipid product); maternal benefit prioritised.

Monitoring

• Clinical response of the toxicosis (cardiac/neurologic signs)
• Serum lipaemia clearance before any repeat dose; PCV (haemolysis)
• Total lipid dose (avoid fat overload)
• Continue standard decontamination/supportive care alongside

Toxicity and overdose

Generally safe; the main concern is FAT-OVERLOAD SYNDROME with excessive/repeated dosing — hyperlipaemia, haemolysis, hepatosplenomegaly, coagulopathy and organ dysfunction. Hypersensitivity (egg/soy), phlebitis, and interference with laboratory assays can occur. There is theoretical concern about precipitating/worsening pancreatitis.

Management: Stop further lipid; supportive care. For fat-overload syndrome, discontinue and provide supportive treatment (monitor lipaemia clearance, PCV for haemolysis, organ function). Limit total dose and do not re-bolus until the serum has cleared of visible lipaemia.

Clinical pearls

• A genuine "lipid rescue" for LIPOPHILIC poisonings — the original use is local-anaesthetic (bupivacaine) cardiotoxicity, but it is now a key adjunct for permethrin (cats), ivermectin/moxidectin, baclofen, calcium-channel blockers and other fat-soluble toxins
• Give a bolus then a CRI; only repeat once the serum has cleared of lipaemia, and don't exceed recommended total doses (fat overload)
• It is an ADJUNCT — keep doing decontamination, methocarbamol (for tremors), and full supportive care
• It can also sequester lipophilic medications you want to work — bear that in mind in mixed scenarios

Mechanism of action

The leading explanation is the "lipid sink": the infused intravascular lipid phase sequesters highly lipophilic drug molecules, pulling them out of target tissues (heart, brain) and lowering the free, active concentration. Additional proposed mechanisms include providing fatty-acid energy substrate to the myocardium and direct positive cardiotonic/membrane effects. The net effect is reduced toxicity from fat-soluble drugs as the toxin partitions into the emulsion and is redistributed/eliminated.

Formulations and products

• 20% lipid emulsion (Intralipid/Lipofundin) — 200 mg/mL
• Intralipid / Lipofundin 20% — 20% (200 mg/mL) emulsion, IV emulsion (human-label)

Storage

Emulsion: 15–25 °C (some refrigerated), do not freeze; discard if the emulsion has cracked/separated (oil droplets). Use aseptically; dedicated line.

Before you use this dose

Reference doses for veterinary professionals. Confirm the dose against the product label, the patient’s condition, current guidance and local regulations before use; the attending veterinarian remains responsible for every clinical decision.

Other hormones, emergency drugs, supplements and other drugs

• Hydroxyzine
• Hypertonic Saline (7.2–7.5% NaCl)
• Imepitoin
• Insulin
• Iron Dextran
• Leflunomide
• Leucovorin (Folinic Acid)
• Levetiracetam

Frequently asked questions