Clinical outcomes and prognostic factors associated with nonsteroidal anti‐inflammatory drug overdose in dogs presented to an emergency room

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.

Outcomes of 434 dogs with non‐steroidal anti‐inflammatory drug toxicosis treated with fluid therapy, lipid emulsion, or therapeutic plasma exchange

“…With regards to outcome analysis, the high survival rate of 99% means there was insufficient power to evaluate for associations with death, and lack of true drug exposure might have contributed to this finding. This is similar to the previous reported survival rate of 96% for NSAID overdose in dogs 28 …”

“…However, broad size group categories in this study and relatively low power might have introduced bias and potential type II error 27 . Similarly, no association between weight and survival, AKI, or GI ulceration was identified in a more recent retrospective evaluation of 125 dogs with NSAID overdose 28 …”

“…A similar association exists between a longer time from ingestion to intervention with a greater risk of GI ulceration and severe AKI in dogs treated conservatively for ibuprofen toxicosis 27 . While a recent study failed to identify an association between outcome and maximum time to presentation after multivariate analysis, increasing time from ingestion to admission was associated with the development of both AKI and suspected GI ulceration at the univariate level 28 …”

“…Dogs diagnosed with an acute kidney injury at presentation were not excluded from the ROC analysis was associated with the development of both AKI and suspected GI ulceration at the univariate level. 28 Packed cell volume has been associated with the duration of hospitalization in dogs undergoing TPE for NSAID overdoses, where dogs with lower PCV had longer hospitalization times. 18 Low PCV might indicate hemorrhage secondary to GI ulceration or be associated with circuit loss as a complication of TPE.…”

“…This is similar to the previous reported survival rate of 96% for NSAID overdose in dogs. 28 Non-steroidal anti-inflammatory drug toxicosis generally carries an excellent prognosis in dogs and despite similar overall outcomes, ILE and TPE should be considered in the management of severe NSAID toxicosis.…”