LAUSR

sulted. Upon discussion with the toxicologist, the patient received 20% lipid emulsion (IntralipidR , Fresenius Kabi) to prevent further seizure activity and worsening mental status. The patient received a 1.5mL/kg IV bolus of 20% lipid emulsion over three minutes (36.5mL), followed by an infusion at 0.025mL/kg/minute for a total of six hours (255.2mL or 10.5mg/kg total). The patient experienced an increase in his triglyceride concentration from 44mg/dL to 306mg/dL. These concentrations subsequently declined after cessation of ILE. After the infusion was started the patient had a marked improvement in mental status and upon completion had returned to baseline, and was transferred out of the intensive care unit. There was no recurrence of seizure activity. The etiology of the itching on the patient’s foot was never determined. Ivermectin is neurotoxic in overdose, in particular, in overdose when P-glycoprotein efflux pumps are saturated [6,7]. In a recent pharmacovigilance case series of 40 patients who were using ivermectin to treat a SARS-CoV-2 infection, 50% of the patients experienced CNS depression and 10% experienced seizure [7]. The recent prominence of ivermectin in the media and its relative ease of accessibility have led to preventable exposures and toxicity, such as the case discussed in this report. Ivermectin’s high lipophilicity (LogP 4.1), along with animal case reports and case reports of other neurotoxic medication overdoses being treated with ILE, support ILE as a treatment option in cases of toxicity [1–5,8]. This case supports the need for further investigation especially given its controversial endorsement and use by some for SARS-CoV-2 infections.