Evaluation of the in vitro efficacy of hemodialysis, hemoperfusion, and the combined approach on the removal of metaldehyde from canine plasma

Objective To describe the efficacy of in‐series hemoperfusion and hemodialysis in 2 dogs with carprofen overdose. Case Summary This report describes the treatment of 2 dogs following accidental carprofen overdoses who underwent a single in‐series hemoperfusion and hemodialysis session. Serial serum carprofen concentrations were measured before, during, and after the session. The first patient's session lasted 5 hours, with the largest decrease in serum carprofen concentrations occurring during the first hour of treatment. The carprofen clearance during the following 4 hours of treatment decreased substantially compared to the first hour and was not different from the patient's intrinsic clearance of carprofen after the session was completed. Based on the findings from the first case, the second patient was treated with a 1 hour single hemoperfusion and hemodialysis session. Our results support the hypothesis that carprofen is not effectively removed by conventional hemodialysis and the efficacy of hemoperfusion is short lived due to rapid saturation of the charcoal filter. Once filter saturation occurs, the extracorporeal session is no longer efficacious. Using in‐series hemoperfusion and hemodialysis is of benefit to correct the side effects seen with hemoperfusion alone, and hourly charcoal filter replacement may extend the efficacy of treatment in removing carprofen. New or Unique Information Provided This is the first published report of in‐series hemoperfusion and hemodialysis being used to treat carprofen overdose in a dog. In these 2 cases, the intrinsic clearances of the patients were shown to be equivalent to that of standard hemodialysis alone, indicating that hemodialysis does not produce any advantage in carprofen clearance. In this limited report, we suggest that the efficacy of hemoperfusion in removing carprofen is short‐lived, and extending the treatment beyond the first hour does not produce any therapeutic benefit. In order to extend the efficacy of hemoperfusion, hourly replacement of the charcoal filter should be considered.

Section: Introductionmentioning

confidence: 99%

Efficacy of a single session in‐series hemoperfusion and hemodialysis in the management of carprofen overdose in two dogs

Fick

Messenger

Vigani

2020

“…Drug removal by HD relies on diffusion and convection (solute drag) of the molecules across a semipermeable membrane. Diffusion of the drug molecules occurs down a concentration gradient between the blood (high concentration) and the dialysate (low concentration), whereas convection represents the drag of the molecules by water moving across the semipermeable membrane . An ideal drug to be removed effectively with HD has a small molecular weight (<500 Da), a low apparent volume of distribution (<1 L/kg), and low plasma protein binding (<80%) .…”

Section: Discussionmentioning

confidence: 99%

“…Diffusion of the drug molecules occurs down a concentration gradient between the blood (high concentration) and the dialysate (low concentration), whereas convection represents the drag of the molecules by water moving across the semipermeable membrane . An ideal drug to be removed effectively with HD has a small molecular weight (<500 Da), a low apparent volume of distribution (<1 L/kg), and low plasma protein binding (<80%) . Long‐acting barbiturates, such as phenobarbital, have pharmacokinetics that meet these criteria and allow them to be removed via HD .…”

Section: Discussionmentioning

confidence: 99%

Treatment of phenobarbital intoxication using hemodialysis in two dogs

Basile¹,

Vigani²

2020

Objective To describe the use of hemodialysis in 2 dogs with severe clinical signs from phenobarbital intoxication. Series Summary Two dogs ingested a toxic dose of phenobarbital, leading to severe neurological dysfunction and a comatose state. Both dogs received a 3‐hour session of hemodialysis with complete resolution of clinical signs and returned to normal mentation by the end of the therapy. No negative side effects occurred and phenobarbital concentrations returned to therapeutic range during treatment. New Information Provided This is the first report on the utility and safety of using hemodialysis for phenobarbital intoxication in dogs.

“…In one patient, blood samples were collected immediately prior to HD and after 15, 20, 30, 60, 110, and 180 minutes of treatment. Serum was stored at ‐80°C and shipped on dry ice to an external laboratory ††† for quantitative metaldehyde analysis via gas chromatography–mass spectrometry using a previously reported methodology 21 …”

Section: Methodsmentioning

confidence: 99%

“…There is limited information about the utility of HD in the treatment of metaldehyde intoxication. A recent study evaluated the effect of different blood purification techniques on metaldehyde concentration in canine plasma 21 . In this in vitro study, metaldehyde was removed effectively from canine plasma using combined charcoal hemoperfusion and HD as well as using HD alone.…”

Section: Introductionmentioning

confidence: 99%

Retrospective evaluation of the use of hemodialysis in dogs with suspected metaldehyde poisoning (2012–2017): 11 cases

Teichmann‐Knorrn

Doerfelt

2020

Self Cite

Objective To evaluate dogs treated with hemodialysis for severe metaldehyde intoxication and to compare them with conventionally‐managed patients. Design Retrospective study (2012–2017). Setting University teaching hospital. Animals Data from 18 dogs with severe metaldehyde intoxication were analyzed. Eleven dogs were treated with intermittent hemodialysis and 7 managed conventionally. Interventions None. Measurement and main results Metaldehyde poisoning was diagnosed based on clinical signs and toxicological analysis or presence of turquoise material in the gastrointestinal content. Clinical signs, additional treatments, dialysis prescription, duration of anesthesia and hospitalization, complications, and outcome were documented. Results were analyzed by t‐test, Mann–Whitney U‐test, and Chi‐square test. P < 0.05 was considered significant. Dialysis was performed for median (range) 180 min (150–420 min) with median of 2.28 L/kg (1.66–4.48 L/kg) blood volume processed. In the hemodialysis group, anesthesia was discontinued at a median of 3.0 hours (1.5–6.7 h) after starting dialysis. The conventional‐group received general anesthesia for a median of 17.5 hours (7.0–30.5 h). No further anticonvulsive treatment was necessary for the hemodialysis group. Time to hospital discharge was shorter in dialyzed dogs (median 18 h; 15–41 h) compared to conventionally treated dogs (median 89 h; 61–168 h; P = 0.0014). Aspiration pneumonia was reported in 5 conventionally treated dogs and none of the dialyzed dogs (P = 0.001). Five dialyzed dogs developed hematoma at the dialysis catheter site. One dog in each group was euthanized. Conclusion Hemodialysis significantly decreases the requirement for anesthesia and length of hospitalization in dogs with metaldehyde intoxication. Aspiration pneumonia occurred less often in dialyzed patients. Prospective studies are warranted to confirm the clinical utility of hemodialysis in dogs with metaldehyde poisoning.