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Guarino AL, Cagle LA, Ehrhardt CM, Beatty SSK, Stern JK, Gilor C, Specht AJ, Londoño LA. Successful multimodal treatment of extreme hypertriglyceridemia in a juvenile diabetic dog. J Vet Emerg Crit Care (San Antonio) 2023; 33:247-256. [PMID: 36573353 DOI: 10.1111/vec.13275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To describe the therapeutic protocol used to normalize severe hypertriglyceridemia in a dog. CASE SUMMARY A 7-month-old, 1.2-kg female Pomeranian presented with acute polyuria, polydipsia, and ocular discoloration. Diagnoses included diabetic ketosis, severe hypertriglyceridemia (>225 mmol/L [>20,000 mg/dl]), lipemia retinalis, and bilateral uveitis. The triglyceride concentration was near normal within 2 days of initiating treatment with fenofibrate, regular insulin constant rate infusion (CRI), manual therapeutic plasma exchange (TPE), and a low-fat diet. All clinical signs resolved. The dog has had no relapse of hypertriglyceridemia at the time of writing the manuscript, 6 months later, with continued treatment of diabetes mellitus. NEW OR UNIQUE INFORMATION PROVIDED This is the first case report documenting the combination of fenofibrate, insulin CRI, and manual TPE for treatment of severe hyperlipidemia in a dog. Detailed protocols for manual TPE and a novel insulin CRI are provided. A discussion of multiple spurious biochemical and hematologic errors associated with the severe hypertriglyceridemia is also provided.
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Affiliation(s)
- Aria L Guarino
- Blue Pearl Veterinary Partners, Rockville, Maryland, USA
- Small Animal Hospital, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Laura A Cagle
- Diagnostic Laboratories, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Caryn M Ehrhardt
- Small Animal Hospital, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Sarah S K Beatty
- Diagnostic Laboratories, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
- Antech Diagnostics, Fountain Valley, California, USA
| | - Jere K Stern
- Diagnostic Laboratories, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
- Auburn University Clinical Pathology Laboratory, College of Veterinary Medicine, Auburn University, Auburn, Alabama, USA
| | - Chen Gilor
- Small Animal Hospital, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Andrew J Specht
- Small Animal Hospital, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Leo A Londoño
- Small Animal Hospital, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
- Capital Veterinary Specialists, Jacksonville, Florida, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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