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Haire LE, Vitalo AD, Gonçalves RP, Lanaux TM. Case report: Manual carbon hemoperfusion for the treatment of meloxicam toxicity in a cat and suspected ibuprofen toxicity in a dog. Front Vet Sci 2024; 11:1395967. [PMID: 39359392 PMCID: PMC11445753 DOI: 10.3389/fvets.2024.1395967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 08/19/2024] [Indexed: 10/04/2024] Open
Abstract
Extracorporeal blood purification (ECBP) has become a popular treatment option for non-steroidal anti-inflammatory drug (NSAID) toxicity in small animals. However, challenges arise when using ECBP for small dogs and cats because the priming volume required by most machine-based ECBP platforms might be excessive, leading to cardiovascular instability if a blood prime is not used. This report describes the successful use of manual carbon hemoperfusion (MCHP) to reduce plasma meloxicam levels in a cat following an inadvertent overdose and its use in a dog following suspected ibuprofen ingestion. In both animals, MCHP reduced the circuit volume needed for ECBP from 125 mL with a machine-based therapeutic plasma exchange or 104 mL with an in-series carbon hemoperfusion on an intermittent hemodialysis platform to just 40-50 mL. In the cat, MCHP reduced plasma meloxicam levels by 44%, and in both animals, the use of MCHP in these pets was well-tolerated and safe. Due to pre-existing anemia, the cat required a blood transfusion but the dog did not. MCHP is technically simple and can be performed at any hospital with access to carbon filters and blood bank resources. This technique may represent a reasonable alternative to treat NSAID toxicities in animals that are too small for conventional extracorporeal decontamination methods using either machine-based platforms without using a blood prime or in locations where these machines are unavailable.
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Affiliation(s)
| | | | - Ronald P. Gonçalves
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, FL, United States
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Akyol BA, Gokbulut C. The effect of intravenous lipid emulsion (ILE) on the pharmacokinetic/toxicokinetic dispositions of ivermectin and carprofen in rabbits. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:1841-1852. [PMID: 37768375 DOI: 10.1007/s00210-023-02738-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023]
Abstract
Intravenous lipid emulsion (ILE) has been widely used as an effective antidote in both veterinary and human medicine for the treatment of acute intoxications caused by drugs and pesticides with high lipid solubility. This study was conducted to investigate the effect of ILE co-administration on the kinetic dispositions of ivermectin (IVM) and carprofen (CRP) following intravenous bolus administration at subtoxic doses in rabbits.Twenty-four male New Zealand rabbits weighing 2.78 ± 0.2 kg were used in this study. Rabbits were divided into four groups (Group 1: IVM and Group 2: IVM + ILE or Group 3: CRP and Group 4: CRP + ILE), each group consisting of 6 animals. In the IVM study, Group 1 received IVM (0.6 mg/kg) alone while Group 2 received IVM (0.6 mg/kg) and ILE (2.5 ml/kg). In the CRP study, Group 3 received CRP (12 mg/kg) alone while Group 4 received CRP (12 mg/kg) and ILE (2.5 ml/kg). In both drug groups, ILE was administered 3 times as an i.v. bolus at the 10th min and repeated 4th and 8th h after the drug administration. Blood samples were collected from the auricular vein at various times after drug administration. The drug concentrations in plasma samples were determined by high-pressure liquid chromatography. Kinetic parameters were calculated using a non-compartmental model for both CRP and IVM.The C0 and area under the concentration-time curve from zero up to ∞ (AUC0-∞) values were significantly greater with ILE co-administration (2136 ng/ml and 360.84 ng.d/ml) compared to the IVM alone (1340.63 ng/ml and 206 ng.d/ml), respectively. Moreover, the volume of distribution (Vdss) and clearance (Cl) of IVM were reduced by approximately 42% and 46% with ILE co-administration compared to IVM alone resulting in a reduction of the distribution and slower elimination, respectively. Similar differences in C0, and Vdss values were also observed in CRP with ILE co-administration compared to CRP alone. ILE co-administration changed significantly the kinetic profile of both IVM and CRP in rabbits, supporting the lipid sink theory in which highly lipid-soluble compounds are absorbed into the lipid phase of plasma from peripheral organs such as the heart and brain affected by the acute toxicity of the compounds.
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Affiliation(s)
- Busra Aslan Akyol
- Department of Veterinary Pharmacology and Toxicology, Institute of Health Sciences, Balikesir University, CoHE 100/2000 Scholarship Holder, University Rectorate Çağış Campus 17. Km, Bigadiç Caddesi, 10145, Balikesir, Turkey
| | - Cengiz Gokbulut
- Department of Medical Pharmacology, Faculty of Medicine, Balikesir University, University Rectorate Çağış Campus 17. Km, Bigadiç Caddesi, 10145, Balikesir, Turkey.
- Department of Veterinary Pharmacology and Toxicology, Institute of Health Sciences, Balikesir University, University Rectorate Çağış Campus 17. Km, Bigadiç Caddesi, 10145, Balikesir, Turkey.
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3
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Chalifoux NV, Butty EM, Mauro KD, Moyle RB, Ehrhardt CM, Robertson JB, Labato MA, Culler CA, Londoño LA, Vigani A, Ueda Y, Suter SE, Lynch AM. Outcomes of 434 dogs with non-steroidal anti-inflammatory drug toxicosis treated with fluid therapy, lipid emulsion, or therapeutic plasma exchange. Vet Med (Auckl) 2022; 37:161-172. [PMID: 36453531 PMCID: PMC9889694 DOI: 10.1111/jvim.16603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 11/23/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Traditional management of non-steroidal anti-inflammatory drug (NSAID) intoxication includes gastrointestinal decontamination, intravenous administration of fluids (IVF), and gastroprotection. Intravenous administration of lipid emulsion (ILE) and therapeutic plasma exchange (TPE) are popular novel therapeutic strategies. HYPOTHESIS Compare outcomes of dogs treated with IVF, ILE, and TPE for NSAID intoxications and evaluate outcome predictors for drug subgroups. ANIMALS Four hundred thirty-four dogs with NSAID intoxications (2015-2020). METHODS Multicenter retrospective study of ibuprofen, carprofen, and naproxen intoxication. An ordinal outcome was defined as mild gastrointestinal, moderate kidney, or signs of severe central nervous system disease. RESULTS Signs of neurological disease were overrepresented and acute kidney injury underrepresented in the TPE group among dogs exposed to kidney- or CNS-toxic doses (P = .05), though all TPE dogs with signs of neurological disease had evidence of neurotoxicity at presentation. Dogs treated with IVF had a higher maximal creatinine concentration (median, 1.1 mg/dL; range, 0.4-8.44 mg/dL) compared with IVF + ILE (median, 0.9 mg/dL; range, 0.4-6.2 mg/dL; P = .01). Increased maximum time to presentation (P < .001), higher baseline creatinine (P < .001) and PCV (P = .007), and absence of induced emesis (P < .001) were associated with greater clinical severity. Ibuprofen toxicosis was associated with more severe clinical signs compared with carprofen (P = .03). Overall survival rate was 99%. CONCLUSIONS AND CLINICAL IMPORTANCE NSAID toxicosis generally carries an excellent prognosis in dogs. Despite similar outcomes of lower incidence of AKI in the TPE group, and slightly lower maximal creatinine concentration in dogs treated with ILE vs IVF alone, ILE and TPE should be considered in the management of severe NSAID toxicosis.
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Affiliation(s)
- Nolan V. Chalifoux
- Department of Clinical Sciences & Advanced MedicineUniversity of Pennsylvania, School of Veterinary MedicinePhiladelphiaPennsylvaniaUSA
| | - Emmanuelle M. Butty
- Department of Clinical SciencesTufts University, Cummings School of Veterinary Medicine, Foster Hospital for Small AnimalsNorth GraftonMassachusettsUSA
| | - Katie D. Mauro
- Small Animal Clinical SciencesMichigan State University, College of Veterinary MedicineEast LansingMichiganUSA
| | | | - Caryn M. Ehrhardt
- Department of Small Animal Clinical SciencesUniversity of Florida, College of Veterinary MedicineGainesvilleFloridaUSA
| | - James B. Robertson
- Department of Clinical SciencesNorth Carolina State University, College of Veterinary MedicineRaleighNorth CarolinaUSA
| | - Mary A. Labato
- Department of Clinical SciencesTufts University, Cummings School of Veterinary Medicine, Foster Hospital for Small AnimalsNorth GraftonMassachusettsUSA
| | | | | | - Alessio Vigani
- Clinic for Small Animal Medicine, Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
| | - Yu Ueda
- Department of Clinical SciencesNorth Carolina State University, College of Veterinary MedicineRaleighNorth CarolinaUSA
| | - Steven E. Suter
- Department of Clinical SciencesNorth Carolina State University, College of Veterinary MedicineRaleighNorth CarolinaUSA
| | - Alex M. Lynch
- Department of Clinical SciencesNorth Carolina State University, College of Veterinary MedicineRaleighNorth CarolinaUSA
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Sohn JT. Commentary: Case report: Successful intravenous lipid emulsion therapy for canine amphetamine toxicosis. Front Vet Sci 2022; 9:1011210. [PMID: 36187822 PMCID: PMC9525104 DOI: 10.3389/fvets.2022.1011210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ju-Tae Sohn
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University College of Medicine, Gyeongsang National University Hospital, Jinju-si, South Korea
- Institute of Health Sciences, Gyeongsang National University, Jinju-si, South Korea
- *Correspondence: Ju-Tae Sohn
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Butty EM, Suter SE, Chalifoux NV, Lynch AM, Mauro KD, Moyle RB, Ehrhardt CM, Robertson JB, Culler CA, Londoño LA, Vigani A, Ueda Y, Labato MA. Outcomes of nonsteroidal anti-inflammatory drug toxicosis treated with therapeutic plasma exchange in 62 dogs. J Vet Intern Med 2022; 36:1641-1647. [PMID: 35930372 PMCID: PMC9511067 DOI: 10.1111/jvim.16507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/19/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Therapeutic plasma exchange (TPE) is gaining popularity for the management of nonsteroidal anti-inflammatory drug (NSAID) overdose in dogs. HYPOTHESIS/OBJECTIVES Describe a population of dogs treated with TPE for NSAID overdose. ANIMALS Sixty-two dogs with NSAID overdose treated with TPE. METHODS Multicenter retrospective study of dogs treated with TPE for ibuprofen, carprofen, or naproxen overdose. RESULTS The median dose of ibuprofen, carprofen or naproxen ingested was 533 mg/kg (range, 36-4857 mg/kg), 217 mg/kg (range, 88-625 mg/kg) and 138 mg/kg (range, 26-3000 mg/kg), respectively. Based on previously established toxic ranges for each NSAID, 2 (3.2%), 14 (22.6%), and 46 (74.2%) dogs ingested a gastrointestinal, renal, and neurological toxic dose, respectively. The median time between ingestion and presentation was 4 hours (range, 1-20 hours). The median number of plasma volumes processed was 1.6 (range, 0.4-2.2). The median TPE session duration was 2 hours (range, 1-4.5 hours). Circuit clotting developed during 8 (12.9%) sessions. Patient adverse events reported during 21 (33.8%) sessions consisted of urticaria (12.9%), asymptomatic hypocalcemia (9.6%), and hypotension (9.6%). The median duration of hospitalization was 2.25 days (range, 1-11 days). Sixty-one (98.4%) dogs survived to discharge, and none were rehospitalized. Thirty-one (91.1%) of the 34 dogs with at least 1 follow-up visit were not azotemic at the time of reevaluation. CONCLUSIONS AND CLINICAL IMPORTANCE This population of dogs managed with TPE had excellent outcomes, even in cases of high NSAID dose ingestion. When TPE is available and the time frame is appropriate, this extracorporeal modality should be considered for the management of NSAID overdose.
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Affiliation(s)
- Emmanuelle M Butty
- Department of Clinical Sciences, Tufts University, Cummings School of Veterinary Medicine, Foster Hospital for Small Animals, N. Grafton, Massachusetts, USA
| | - Steven E Suter
- Department of Clinical Sciences, North Carolina State University, College of Veterinary Medicine, Raleigh, North Carolina, USA
| | - Nolan V Chalifoux
- Department of Clinical Sciences & Advanced Medicine, University of Pennsylvania, School of Veterinary Medicine, Philadelphia, Pennsylvania, USA
| | - Alex M Lynch
- Department of Clinical Sciences, North Carolina State University, College of Veterinary Medicine, Raleigh, North Carolina, USA
| | - Katie D Mauro
- Department of Clinical Sciences & Advanced Medicine, University of Pennsylvania, School of Veterinary Medicine, Philadelphia, Pennsylvania, USA
| | | | - Caryn M Ehrhardt
- Department of Small Animal Clinical Sciences, University of Florida, College of Veterinary Medicine, Gainesville, Florida, USA
| | - James B Robertson
- Department of Clinical Sciences, North Carolina State University, College of Veterinary Medicine, Raleigh, North Carolina, USA
| | | | - Leonel A Londoño
- Department of Small Animal Clinical Sciences, University of Florida, College of Veterinary Medicine, Gainesville, Florida, USA
| | - Alessio Vigani
- Clinic for Small Animal Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Yu Ueda
- Department of Clinical Sciences, North Carolina State University, College of Veterinary Medicine, Raleigh, North Carolina, USA
| | - Mary A Labato
- Department of Clinical Sciences, Tufts University, Cummings School of Veterinary Medicine, Foster Hospital for Small Animals, N. Grafton, Massachusetts, USA
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Harris S, McMichael MA, Harmon R, Boothe D. Case Report: Successful Intravenous Lipid Emulsion Therapy for Canine Amphetamine Toxicosis. Front Vet Sci 2022; 9:938021. [PMID: 35903141 PMCID: PMC9315424 DOI: 10.3389/fvets.2022.938021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/24/2022] [Indexed: 11/27/2022] Open
Abstract
A 4-year-old, female-spayed, mixed breed dog, weighing 24.2 kg, was presented for acute ingestion of ~12.3 mg/kg of Adderall XRⓇ, an extended-release amphetamine medication. In dogs, the oral median lethal dose for amphetamines ranges anywhere from 9–11 mg/kg to 20–27 mg/kg. On presentation, the patient was agitated, tachycardic and hypertensive. Initial treatment was instituted with intravenous lipid emulsion (IVLE) therapy, and baseline and post-treatment amphetamine concentrations were quantified in serum and plasma. In both serum and plasma, post-IVLE concentrations of amphetamine were lower 1 h after treatment and IVLE was the only treatment instituted during this time. The dog improved significantly while in hospital and was discharged <24 h after presentation. This is the first known reported use of IVLE for treatment of amphetamine toxicosis with documented decreases in both serum and plasma amphetamine levels shortly after administration of IVLE.
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Affiliation(s)
- Stephanie Harris
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, AL, United States
| | - Maureen A. McMichael
- Department of Clinical Sciences, Auburn University College of Veterinary Medicine, Auburn, AL, United States
- *Correspondence: Maureen A. McMichael
| | - Roy Harmon
- Department of Anatomy, Physiology and Pharmacology, Auburn University College of Veterinary Medicine, Auburn, AL, United States
| | - Dawn Boothe
- Department of Anatomy, Physiology and Pharmacology, Auburn University College of Veterinary Medicine, Auburn, AL, United States
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Buseman M, Blong AE, Walton RAL. Successful management of severe carprofen toxicity with manual therapeutic plasma exchange in a dog. J Vet Emerg Crit Care (San Antonio) 2022; 32:675-679. [PMID: 35527394 PMCID: PMC9790471 DOI: 10.1111/vec.13203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 01/14/2021] [Accepted: 02/04/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To report the use of manual therapeutic plasma exchange (TPE) in a dog with severe carprofen toxicity. SUMMARY A 12-year-old neutered female Pembroke Welsh Corgi weighing 20 kg was evaluated after ingesting 223 mg/kg of carprofen. Emesis was attempted with apomorphine at the primary care veterinarian but was unsuccessful, and a dose of activated charcoal with sorbitol was administered. On presentation to the referral center, approximately 8 hours after ingestion, the dog's physical examination revealed mild abdominal discomfort but was otherwise unremarkable. Treatment consisted of a combination of supportive care including activated charcoal with sorbitol, cholestyramine, IV lipid emulsion, and manual TPE. Blood samples were collected prior to the initiation of manual TPE and at the completion of 12 exchange cycles. Carprofen levels were determined by high-pressure liquid chromatography. A 57% decrease in carprofen levels was achieved with the combination of activated charcoal, cholestyramine, IV lipid emulsion, and manual TPE. The dog did not develop organ dysfunction secondary to toxicity and was discharged 4 days after ingestion. NEW OR UNIQUE INFORMATION PROVIDED This report describes the successful decrease of plasma carprofen in a dog with the combination of decontamination techniques and manual TPE. While TPE has been previously reported as a successful therapeutic in dogs with nonsteroidal anti-inflammatory toxicity, including carprofen, equipment and expertise of this platform is not readily available. Manual TPE is technically simple and can be performed in any hospital with a large blood centrifuge.
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Affiliation(s)
- Miranda Buseman
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineIowa State UniversityAmesIowaUSA
| | - April E. Blong
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineIowa State UniversityAmesIowaUSA
| | - Rebecca A. L. Walton
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineIowa State UniversityAmesIowaUSA
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8
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Spillane AM, Haraschak JL, McMichael MA. Resolution of Severe Neurologic Signs Following Intravenous Lipid Emulsion Therapy in a Young Dog With a Portosystemic Shunt: Case Report. Front Vet Sci 2021; 8:798198. [PMID: 34957288 PMCID: PMC8694260 DOI: 10.3389/fvets.2021.798198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
A 5-month-old male intact Great Pyrenees was presented for an acute onset of severe neurologic signs (stupor, absent menace, intermittent head turn to the left). The patient's history included possible naproxen ingestion with a maximum ingested dose of 59 mg/kg, exceeding the reported dose of >50 mg/kg known to cause neurologic signs. Blood sampling for baseline bloodwork was performed, and intravenous lipid emulsion (ILE) was subsequently administered, for treatment of the suspected toxicosis. Due to severe and life-threatening neurologic signs, other methods of decontamination were contraindicated and unlikely to be effective; extracorporeal therapy was also unavailable. Complete resolution of neurologic signs occurred 30 min after completion of ILE therapy. At this time, the owners found the missing naproxen tablets after returning home and the bloodwork results returned revealing findings consistent with hepatic encephalopathy. The fasted blood ammonia concentration immediately prior to ILE administration was 702.1 μg/dL (reference interval, RI: 24–36 μg/dL) and decreased to 194.1 μg/dL 24 h later. In the first 24 h, the patient also received three doses of lactulose, N-acetylcysteine, and intravenous fluids. The patient was subsequently diagnosed with a single, large intrahepatic portosystemic shunt via computed tomography and underwent an endovascular coil embolization procedure. Given the rapid and dramatic improvement in severe neurologic signs after ILE therapy alone, it is strongly suspected that this treatment resulted in improvement of hepatic encephalopathy.
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Affiliation(s)
- Amanda M Spillane
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Jenica L Haraschak
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Maureen A McMichael
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, United States
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Lubian E, Capitelli R, Nappi S, Semenza Esposito R, Russo RP, Lodi G, Ravasio G, Bardi E. Use of intralipid emulsion therapy to treat suspected oleander toxicosis in a domestic goose (Anser anser domesticus). J Exot Pet Med 2021. [DOI: 10.1053/j.jepm.2021.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Steele C, Stefanovski D, Rondeau MP. Clinical outcomes and prognostic factors associated with nonsteroidal anti-inflammatory drug overdose in dogs presented to an emergency room. J Vet Emerg Crit Care (San Antonio) 2021; 31:638-646. [PMID: 34297883 DOI: 10.1111/vec.13096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/19/2019] [Accepted: 01/04/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe case presentations, clinical signs, and outcomes following nonsteroidal anti-inflammatory drug (NSAID) overdose in a clinical population of dogs and to identify factors associated with various outcomes including death or euthanasia, acute kidney injury, and suspected gastrointestinal ulceration (GIU). DESIGN Retrospective study. SETTING University teaching hospital. ANIMALS One hundred twenty-five client-owned dogs presenting to an emergency room for NSAID overdose between January 2006 and December 2017. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Vomiting was the most common clinical sign, seen in 46 of 125 dogs (36.8%). Acute kidney injury and suspected GIU were seen in 17 (13.6%) and 16 dogs (12.8%), respectively. Thirty-two dogs (25.6%) ingested veterinary-formulated NSAIDs and 93 (74.4%) ingested human-formulated NSAIDs. No difference in any outcomes was seen between these two groups. One hundred twenty dogs (96%) survived to discharge. In multivariable analysis, the only significant finding was of the number of days of anorexia increased the risk of death or euthanasia with an odds ratio of 2.7 (95% confidence interval [1.14-6.5], P = 0.02). CONCLUSIONS Acute kidney injury and suspected GIU were seen less frequently than vomiting. Similar outcomes were seen for dogs ingesting veterinary- versus human-formulated NSAIDs. Owners presenting dogs with a longer duration of anorexia may be more apt to euthanize. As this was a clinical population of dogs presenting to an emergency room, findings may be more broadly applicable to the general population than prior studies utilizing poison control center data.
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Affiliation(s)
- Cara Steele
- Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, USA
| | - Darko Stefanovski
- Department of Clinical Studies - New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, USA
| | - Mark P Rondeau
- Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, USA
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Dixon CE, Kelley D, Froehlich JM, Gruntman A, Oura T, Mazan MR, Labato MA. Therapeutic plasma exchange to mitigate flunixin meglumine overdose in a cria. J Vet Emerg Crit Care (San Antonio) 2021; 31:521-524. [PMID: 33955631 DOI: 10.1111/vec.13071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 09/04/2019] [Accepted: 09/21/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the use of therapeutic plasma exchange (TPE) in the treatment of flunixin meglumine overdose in a cria. CASE SUMMARY A 3-day-old alpaca cria was diagnosed with ureteral obstruction and agenesis resulting in severe bilateral hydronephrosis. During hospitalization, the cria inadvertently received a flunixin meglumine overdose of >65 mg/kg. Here, we report the use of lipid emulsion and TPE to mitigate flunixin meglumine toxicosis. TPE appeared to prevent any flunixin-induced kidney or gastrointestinal injury, even in a patient with congenital defects of the urinary tract. NEW INFORMATION PROVIDED This is the first report of the use of TPE in a cria.
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Affiliation(s)
- Claire E Dixon
- Department of Clinical Sciences, Tufts Cummings Veterinary Medical Center, North Grafton, Massachusetts, USA.,Present address: Claire E. Dixon, School of Veterinary Medicine, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Denise Kelley
- Friendship Hospital for Animals, Washington, D.C., USA
| | - Jacob Michael Froehlich
- Department of Clinical Sciences, Tufts Cummings Veterinary Medical Center, North Grafton, Massachusetts, USA
| | - Alisha Gruntman
- Department of Clinical Sciences, Tufts Cummings Veterinary Medical Center, North Grafton, Massachusetts, USA
| | - Trisha Oura
- Veterinary Specialty Hospital, San Diego, California, USA
| | - Melissa R Mazan
- Department of Clinical Sciences, Tufts Cummings Veterinary Medical Center, North Grafton, Massachusetts, USA
| | - Mary Anna Labato
- Department of Clinical Sciences, Tufts Cummings Veterinary Medical Center, North Grafton, Massachusetts, USA
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12
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Butty EM, McKinney CA, Prisk AJ. Treatment of a flunixin meglumine overdose with intravenous administration of lipid emulsion and therapeutic plasma exchange in a Nigerian dwarf buck kid (Capra aegagrus hircus). J Vet Intern Med 2021; 35:1626-1630. [PMID: 33934401 PMCID: PMC8163127 DOI: 10.1111/jvim.16124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 12/30/2022] Open
Abstract
A 12 week‐old Nigerian dwarf (Capra aegagrus hircus) buck kid was hospitalized for management of obstructive urolithiasis. Postoperatively, he was inadvertently administered 16‐times greater than his calculated dose of a nonsteroidal anti‐inflammatory drug (NSAID; 17.5 mg/kg flunixin meglumine, IV). The goat was treated with intravenous administration of lipid emulsion (ILE) prior to membrane‐based therapeutic plasma exchange (mTPE) under general anesthesia. The increased coagulability inherent to small ruminants in comparison with dogs and cats warranted specific adjustments in the prescription of anticoagulation, blood flow, and filtration fraction to avoid circuit clotting during mTPE. Serum flunixin meglumine concentration measured before, during, and after mTPE revealed marked reduction in drug concentration. After the combined treatments, no clinical evidence of NSAID gastrointestinal or renal toxicosis was detected. This case report describes successful management of flunixin meglumine overdose in a small ruminant using combined ILE and mTPE.
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Affiliation(s)
- Emmanuelle Marie Butty
- Department of Clinical Sciences, Small Animal Internal Medicine, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, USA
| | - Caroline Ann McKinney
- Department of Clinical Sciences, Large Animal Internal Medicine, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, USA
| | - Amanda Jane Prisk
- Department of Clinical Sciences, Large Animal Surgery, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, USA
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13
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Cook S, Greensmith T. Supporting the intoxicated patient: toxicants affecting the gastrointestinal and hepatobiliary systems. IN PRACTICE 2020. [DOI: 10.1136/inp.m3152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kopke MA, Yozova ID. Management of presumptive canine permethrin toxicosis using intravenous lipid emulsion as an adjunctive therapy. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2019-001041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Matthew A Kopke
- School of Veterinary ScienceMassey UniversityPalmerston NorthNew Zealand
| | - Ivayla D Yozova
- School of Veterinary ScienceMassey UniversityPalmerston NorthNew Zealand
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Chumbler NS, Schildt JC, Mawby DI, Papich MG. Use of intravenous lipid therapy in a cat with carprofen overdose. Clin Case Rep 2020; 8:653-657. [PMID: 32274029 PMCID: PMC7141744 DOI: 10.1002/ccr3.2772] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 12/08/2019] [Accepted: 12/18/2019] [Indexed: 11/06/2022] Open
Abstract
Intravenous lipid emulsion (ILE) was administered to a cat with no adverse effects. This case report postulates that ILE can be used for the treatment of carprofen toxicity in cats and supports the lipid sink theory as the main mechanism of action.
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Affiliation(s)
- Nathan S Chumbler
- University of Tennessee College of Veterinary Medicine Knoxville TN USA
| | - Julie C Schildt
- University of Tennessee College of Veterinary Medicine Knoxville TN USA
| | - Diane I Mawby
- University of Tennessee College of Veterinary Medicine Knoxville TN USA
| | - Mark G Papich
- North Carolina State University College of Veterinary Medicine Raleigh NC USA
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16
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Yamindago A, Lee N, Woo S, Yum S. Transcriptomic profiling of Hydra magnipapillata after exposure to naproxen. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2019; 71:103215. [PMID: 31301532 DOI: 10.1016/j.etap.2019.103215] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/12/2019] [Accepted: 06/23/2019] [Indexed: 06/10/2023]
Abstract
The extensive use in humans and animals of nonsteroidal anti-inflammatory drugs (NSAIDs) increases their possible impact on aquatic organisms. In the present study, we investigated acute toxicity, morphological responses, and potential physiological and metabolic impacts of naproxen exposure on Hydra magnipapillata. The median lethal concentrations (LC50) of naproxen in H. magnipapillata were 51.999 mg/L, 44.935 mg/L, and 42.500 mg/L after exposure for 24, 48, and 72 h, respectively. Morphological observation of the exposed Hydra showed that 40 mg/L naproxen stimulated the contraction of body column and tentacles after 24 h. A KEGG pathway analysis of the genes differentially expressed in the Hydra after exposure to naproxen for 6, 24, or 48 h demonstrated various cellular and metabolic effects, including protein processing in the endoplasmic reticulum, Wnt signaling, and tryptophan metabolism. These results suggest that exposure to naproxen affects the genetic material, inflammatory processes, and metabolic processes of aquatic organisms.
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Affiliation(s)
- Ade Yamindago
- Ecological Risk Research Division, Korea Institute of Ocean Science and Technology (KIOST), Geoje, 53201, Republic of Korea; The Faculty of Applied Ocean Science, University of Science and Technology (UST), Geoje, 53201, Republic of Korea; Faculty of Fisheries and Marine Science, Brawijaya University, Malang, 65145, Indonesia
| | - Nayun Lee
- Ecological Risk Research Division, Korea Institute of Ocean Science and Technology (KIOST), Geoje, 53201, Republic of Korea
| | - Seonock Woo
- Marine Biotechnology Research Center, Korea Institute of Ocean Science and Technology (KIOST), Busan, 49111, Republic of Korea
| | - Seungshic Yum
- Ecological Risk Research Division, Korea Institute of Ocean Science and Technology (KIOST), Geoje, 53201, Republic of Korea; The Faculty of Applied Ocean Science, University of Science and Technology (UST), Geoje, 53201, Republic of Korea.
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17
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Yousefsani BS, Mohajeri SA, Moshiri M, Jafarian AH, Hosseinzadeh H. Effect of Intravenous Lipid Emulsion on Clozapine Acute Toxicity in Rats. J Pharmacopuncture 2019; 22:147-153. [PMID: 31673444 PMCID: PMC6820469 DOI: 10.3831/kpi.2019.22.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/15/2019] [Accepted: 05/31/2019] [Indexed: 11/30/2022] Open
Abstract
Objectives Many studies have been reported the efficacy of intravenous lipid emulsion (ILE) as an antidote on acute lipophilic drug toxicity. Clozapine, highly lipophilic dibenzodiazepine neuroleptics, is an important medication in the schizophrenia therapy regimen. Acute intoxication with antipsychotics is one of the main reasons for the referral of poisoned patients to the hospital. We expected that ILE could be used for the therapy of acute clozapine intoxicated patients. Methods We used two groups of consisting of six male rats. Both groups received a toxic dose of clozapine (40 mg/kg) intravenously, via the tail vein. After 15 minutes, they were treated with intravenous infusion of 18.6 mg/kg normal saline (NS group), or 18.6 mg/kg ILE 20% (ILE group). We evaluated blood pressure (BP) and heart rate by power lab apparatus through the tail artery, ataxia by a rat rotary circle, seizure scores and death in multiple times after starting clozapine administration. For biochemical and pathological evaluations the samples of tissue and blood were taken. Results Our results demonstrated that ILE 20% could return hypotension-induced clozapine better than normal saline. Furthermore, ataxia and seizure have rectified more rapidly and deaths reduced. Clozapine administration causes pancreatitis and lung injury but fat emulsion did not show an optimal effect on tissue damages caused by clozapine toxicity. Conclusion In conclusion, ILE can remove toxic signs of clozapine same as other lipophilic medicines, however, clinical uses of ILE for this intention requires more appraisement to determine the precise implication and safety.
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Affiliation(s)
- Bahareh Sadat Yousefsani
- Research Institute for Islamic and Complementary Medicine, Iran University of Medical Sciences, Tehran, Iran.,School of Persian Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Ahmad Mohajeri
- Department of Pharmacodynamy and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Moshiri
- Department of Pharmacodynamy and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Hossein Jafarian
- Cancer Molecular Pathology Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Hosseinzadeh
- Department of Pharmacodynamy and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.,Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
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18
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Kicera‐Temple K, Londoño L, Lanaux TM, Buckley GJ. Treatment of a massive naproxen overdose with therapeutic plasma exchange in a dog. Clin Case Rep 2019; 7:1529-1533. [PMID: 31428382 PMCID: PMC6692984 DOI: 10.1002/ccr3.2277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/02/2019] [Accepted: 05/16/2019] [Indexed: 01/16/2023] Open
Abstract
In comparison with other over-the-counter anti-inflammatory drugs, naproxen has a longer half-life in dogs and can lead to severe morbidity and mortality. This report describes the successful use of membrane-based therapeutic plasma exchange after a massive ingestion of naproxen by a dog resulting in 86% reduction in plasma concentration.
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Affiliation(s)
| | - Leonel Londoño
- Department of Small Animal Clinical SciencesUniversity of FloridaGainesvilleFloridaUSA
| | - Travis M. Lanaux
- Department of Small Animal Clinical SciencesUniversity of FloridaGainesvilleFloridaUSA
| | - Gareth J. Buckley
- Department of Small Animal Clinical SciencesUniversity of FloridaGainesvilleFloridaUSA
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19
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Rosenthal MG, Labato MA. Use of therapeutic plasma exchange to treat nonsteroidal anti-inflammatory drug overdose in dogs. J Vet Intern Med 2019; 33:596-602. [PMID: 30698297 PMCID: PMC6430928 DOI: 10.1111/jvim.15420] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 01/08/2019] [Indexed: 12/02/2022] Open
Abstract
Background Therapeutic plasma exchange (TPE) may be an effective technique for treatment of accidental nonsteroidal anti‐inflammatory drug (NSAID) overdose, but information regarding the use of this technique in veterinary medicine is currently limited. Objectives To evaluate the overall outcome for dogs with NSAID overdose treated with TPE and to determine if any presenting factors can predict or influence overall outcome. Secondary objectives included investigating TPE complications as well as the utility of other adjunctive treatments. Animals Eleven client‐owned dogs presented for NSAID overdose that received TPE. All patients also received additional supportive treatment including IV lipid infusion. Methods Retrospective review of medical records. Results Eleven cases were included in the study. Of these, the NSAID ingested was ibuprofen in 6 (54.5%), naproxen in 4 (36.4%), and deracoxib in 1 (9.1%). All dogs survived to discharge with 3 (27.3%) developing acute kidney injury during hospitalization. A larger initial dose of NSAID ingested was associated with a higher maximum serum creatinine concentration during hospitalization (P = .04) and larger change in serum creatinine concentration from baseline (P = .02). Six dogs (54.5%) developed complications associated with TPE. The use of other treatments did not affect the overall outcome. Conclusions and Clinical Importance We identified TPE as an effective treatment for NSAID overdose with good outcomes despite high doses of NSAID ingestion in dogs treated with a single TPE treatment. Complications were common but did not affect the final outcome. Therapeutic plasma exchange should be considered in patients presenting for high‐dose NSAID ingestion.
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Affiliation(s)
- Melisa G Rosenthal
- Department of Internal Medicine, BluePearl Veterinary Partners, Waltham, Massachusetts
| | - Mary A Labato
- Department of Clinical Sciences, Tufts University, Cummings School of Veterinary Medicine, North Grafton, Massachusetts
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20
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Gwaltney-Brant S, Meadows I. Intravenous Lipid Emulsions in Veterinary Clinical Toxicology. Vet Clin North Am Small Anim Pract 2018; 48:933-942. [PMID: 30115370 DOI: 10.1016/j.cvsm.2018.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Use of intravenous lipid emulsion (ILE) as an antidote for severe cardiotoxicity and neurotoxicity has expanded in the veterinary world in the past decade. Despite advances in understanding of potential mechanisms of action of antidotal ILE, knowledge gaps remain in efficacy, appropriate dosing rates for various toxicants, and potential adverse reactions. Use of ILE in management of toxicoses of veterinary patients should be considered investigational, and should not be first-line treatment of most toxicoses, especially where established treatment protocols have good likelihood of positive outcomes. Use of ILE in veterinary toxicology cases requires judicious assessment of individual cases and proper informed consent of clients.
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Affiliation(s)
| | - Irina Meadows
- ASPCA Animal Poison Control Center, 1717 South Philo Road, Suite 36, Urbana, IL 61802, USA
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21
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Behling-Kelly EL, Wakshlag J. A commercial soy-based phospholipid emulsion accelerates clot formation in normal canine whole blood and induces hemolysis in whole blood from normal and dogs with inflammatory leukograms. J Vet Emerg Crit Care (San Antonio) 2018; 28:252-260. [PMID: 29631333 DOI: 10.1111/vec.12716] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 10/07/2016] [Accepted: 12/14/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To compare lipid emulsion-induced hemolysis in blood from dogs with inflammatory leukograms to blood from healthy dogs, and determine the impact of a prototypical soy-based phospholipid emulsion on coagulation in whole blood from healthy dogs. DESIGN Ex vivo study using EDTA and citrated whole blood from healthy dogs and EDTA anticoagulated whole blood from dogs with inflammatory leukograms. SETTING University research laboratory. ANIMALS Healthy dogs (total of 16, 9 for hemolysis assays and 6 for thromboelastography) included student- and staff-owned animals. Blood samples from dogs with inflammatory leukograms (8) were obtained from the clinical pathology laboratory after the complete blood count was performed as part of patient care. For the purposes of this study, an inflammatory leukogram was defined as a neutrophilia with a left-shift (minimum of 3% band neutrophils) and evidence of toxic change. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Hemolysis was measured via spectrophotometric quantification of released hemoglobin and expressed as a percent of a water-lysed control. The soy emulsion caused hemolysis in blood from healthy dogs, ranging from 3.6% to 16.4% as the dose increased, and 4.1% to 25.0% in blood from dogs with inflammatory leukograms. Hemolysis between these patient groups was significantly different at the highest dose. Coagulation was assessed by native thromboelastography. Treatment of whole blood with the lipid emulsion caused a significant decrease in the time to clot formation (R) and a shorter time to reach a clot amplitude of 20 mm (K). CONCLUSIONS Soy-based lipid emulsions cause hemolysis that is more severe in blood from dogs with inflammatory leukograms and accelerate clot formation in canine blood. The in vivo significance of these findings is not clear at this time, but warrants additional investigation given the use of these emulsions in clinical practice.
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Affiliation(s)
- Erica L Behling-Kelly
- Departments of Population Medicine and Diagnostic Sciences (Behling-Kelly) and Department of Clinical Sciences (Wakshlag), Cornell University, Ithaca, 14853, NY
| | - Joseph Wakshlag
- Departments of Population Medicine and Diagnostic Sciences (Behling-Kelly) and Department of Clinical Sciences (Wakshlag), Cornell University, Ithaca, 14853, NY
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22
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Gosselin S, Hoegberg LCG, Hoffman RS, Graudins A, Stork CM, Thomas SHL, Stellpflug SJ, Hayes BD, Levine M, Morris M, Nesbitt-Miller A, Turgeon AF, Bailey B, Calello DP, Chuang R, Bania TC, Mégarbane B, Bhalla A, Lavergne V. Evidence-based recommendations on the use of intravenous lipid emulsion therapy in poisoning. Clin Toxicol (Phila) 2016; 54:899-923. [DOI: 10.1080/15563650.2016.1214275] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Sophie Gosselin
- Department of Emergency Medicine, McGill University Health Centre, Montréal, Québec, Canada
- Centre Antipoison du Québec, Montréal, Québec, Canada
- Province of Alberta Drug Information Services, Calgary, Alberta, Canada
| | - Lotte C. G. Hoegberg
- Danish Poisons Information Centre, Anaesthesiology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Robert. S. Hoffman
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, NY, USA
| | - Andis Graudins
- Monash Clinical Toxicology Service, Program of Emergency Medicine, Monash Health and School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Christine M. Stork
- Upstate NY Poison Center, Syracuse, NY, USA
- Department of Emergency Medicine, Upstate Medical University, Syracuse, New York, USA
| | - Simon H. L. Thomas
- National Poisons Information Service (Newcastle) and Medical Toxicology Centre, Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | | | - Bryan D. Hayes
- Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD, USA
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael Levine
- Department of Emergency Medicine, Section of Medical Toxicology, University of Southern California, Los Angeles, CA, USA
| | - Martin Morris
- Schulich Library of Science and Engineering, McGill University, Montréal, Québec, Canada
| | - Andrea Nesbitt-Miller
- Schulich Library of Science and Engineering, McGill University, Montréal, Québec, Canada
| | - Alexis F. Turgeon
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, and CHU de Québec, Université Laval Research Center, Population Health and Optimal Health Practices Unit, Université Laval, Québec City, Québec, Canada
| | - Benoit Bailey
- Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Montréal, Québec, Canada
- Centre Antipoison du Québec, Quebec, Canada
| | - Diane P. Calello
- Medical Toxicology, Department of Emergency Medicine, Morristown Medical Center, Emergency Medical Associates, Morristown, NJ, USA
| | - Ryan Chuang
- Department of Emergency Medicine, Division of Clinical Pharmacology and Toxicology, University of Calgary, Poison and Drug Information Service, Calgary, Alberta, Canada
| | | | - Bruno Mégarbane
- Department of Medical and Toxicological Intensive Care, Lariboisière Hospital, Paris-Diderot University, INSERM UMRS1144, Paris, France
| | - Ashish Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Valéry Lavergne
- Department of Medical Biology, Sacré-Coeur Hospital, University of Montréal, Montréal, Québec, Canada
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23
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Chan DL. Chewing the fat on veterinary toxicology: The path to discovery. J Vet Emerg Crit Care (San Antonio) 2016; 25:591-3. [PMID: 26460527 DOI: 10.1111/vec.12408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Daniel L Chan
- Professor of Emergency and Critical Care Medicine and Clinical Nutrition, Section of Emergency and Critical Care, Department of Clinical Science and Services, The Royal Veterinary College, University of, London, UK
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24
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Bayldon W, Carter JE, Beths T, Warne LN, Whittem T, Martinez L, Bauquier SH. Accidental alfaxalone overdose in a mature cat undergoing anaesthesia for magnetic resonance imaging. JFMS Open Rep 2016; 2:2055116916647740. [PMID: 28491424 DOI: 10.1177/2055116916647740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2016] [Indexed: 12/25/2022] Open
Abstract
Case summary This case report describes the clinical signs and treatment of an alfaxalone 10 times overdose in a 12-year-old cat undergoing anaesthesia for MRI. The cat was discharged from hospital following a prolonged recovery including obtunded mentation and cardiorespiratory depression for several hours following cessation of anaesthesia. The cat received supportive therapy that included supplemental oxygen via a face mask, intravenous crystalloid fluids and active rewarming. The benefits of using alfaxalone for maintenance of anaesthesia, its pharmacokinetics and previously reported lethal doses are discussed. Strategies for reducing the incidence of medication errors are presented. Relevance and novel information An unintentional overdose of alfaxalone by continuous rate infusion has not been reported previously in a cat. Treatment is supportive and directed towards maintenance of the cardiorespiratory systems. Whenever possible, smart pumps that have been designed to reduce human error should be used to help prevent medication errors associated with continuous rate infusions.
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Affiliation(s)
- Wendy Bayldon
- Translational Research and Animal Clinical Trials (TRACTs), Veterinary Hospital, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Werribee, VIC 3030, Australia
| | - Jennifer E Carter
- Translational Research and Animal Clinical Trials (TRACTs), Veterinary Hospital, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Werribee, VIC 3030, Australia
| | - Thierry Beths
- Translational Research and Animal Clinical Trials (TRACTs), Veterinary Hospital, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Werribee, VIC 3030, Australia
| | - Leon N Warne
- Translational Research and Animal Clinical Trials (TRACTs), Veterinary Hospital, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Werribee, VIC 3030, Australia
| | - Ted Whittem
- Translational Research and Animal Clinical Trials (TRACTs), Veterinary Hospital, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Werribee, VIC 3030, Australia
| | - Lorena Martinez
- Translational Research and Animal Clinical Trials (TRACTs), Veterinary Hospital, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Werribee, VIC 3030, Australia
| | - Sébastien H Bauquier
- Translational Research and Animal Clinical Trials (TRACTs), Veterinary Hospital, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Werribee, VIC 3030, Australia
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25
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Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most widely used classes of medications in children. Despite a reported positive safety profile, NSAIDs have been associated with toxicities in both overdose and routine use. Most children with NSAID overdoses are asymptomatic and should be managed conservatively, whereas a small number may present with severe symptoms. We review NSAID exposures in children and strategies for their clinical evaluation and management.
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26
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Stein DG. Lost in translation: understanding the failure of the progesterone/traumatic brain injury Phase III trials. FUTURE NEUROLOGY 2016. [DOI: 10.2217/fnl.15.49] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Donald G Stein
- Department of Emergency Medicine, Emory University, 1365 B Clifton Road NE, Suite 5100, Atlanta, GA 30322, USA
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