Successful treatment of metaldehyde toxicosis with intravenous lipid emulsion in a dog

Abstract

The aim of the present report is to describe a novel successful treatment approach for metaldehyde poisoning in a dog: intravenous lipid emulsion therapy (ILE). A 2.5-month-old female Labrador Retriever was referred to the Emergency Department following deliberate ingestion of a metaldehyde-containing granular bait. Severe continuous tonic-clonic activity, muscle tremors, loss of consciousness, diffuse congestion of the oral mucosa, tachycardia, tachypnoea and nystagmus were observed upon admission. Additional intravenous administration of a 20% lipid emulsion resulted in normalization of the vital signs and complete neurological recovery. To the authors' knowledge, this is the first report describing ILE in the treatment of canine metaldehyde intoxication and the first description of a case of metaldehyde poisoning in a dog in Romania. Considering the severity of the neurological signs and the fact that no specific antidote is known, treatment can be significantly challenging to the veterinary practitioner. This finding should be included in metaldehyde poisoning therapy protocols, especially when severe clinical signs fail to respond to symptomatic treatment.

Conventional treatment of a metaldehyde-intoxicated cat with additional use of low-dose intravenous lipid emulsion

“…To our knowledge, this is the first report to describe an emergency approach to metaldehyde toxicosis in a cat and the additional use of low-dose ILE as supporting therapy, as carried out previously in dogs. 12 The effectiveness of ILE therapy in our case is unclear because it was necessary to use multiple drugs to control the clinical signs. Further studies are needed to evaluate the possible effectiveness of ILE therapy in metaldehyde intoxication in cats.…”

“…Despite the low lipophilicity of metaldehyde (LogP = 1.1), 11 a potential application of the scavenging effect of ILE appeared effective in a case report of a dog with metaldehyde toxicosis. 12 The elimination half-life of metaldehyde is reported to be around 27 h in humans and is associated with prolonged intensive care support. 26 No toxicokinetic data are described in small animals; however, a potential impact of the use of ILE on recovery times and mortality might be considered in companion animals with metaldehyde toxicosis.…”

“…4,7,10 Metaldehyde lipophilicity is low (LogP = 1.1), 11 but it easily crosses the blood-brain barrier and exerts its toxicity on the central nervous system. In the literature, successful use of ILE infusion in the treatment of metaldehyde toxicosis was described in a dog, 12 but no data exist for cats.…”

Fatal metaldehyde poisoning in a dog confirmed by gas chromatography

“…The main goals of the treatment include prevention of metaldehyde absorption, patient stabilization, management of the neurological signs and supportive care provision [3]. More recently, lipid emulsion therapy has shown potential in reverting severe clinical signs [13]. In the present case, conventional therapy was installed, but the gravity of the case and evolution of clinical signs impaired the success of the treatment.…”

Management of presumptive canine permethrin toxicosis using intravenous lipid emulsion as an adjunctive therapy

“…Stemming from this understanding of lipophilicity, is the use of ILE, which has formed part of the successful management for several cases of feline permethrin toxicosis 14–19. In dogs, ILE has been used as part of the management for amlodipine, baclofen, bromethalin, carbamate, dextroamphetamine sulphate, diltiazem, ibuprofen, ivermectin, lamotrigine, metaldehyde, methamphetamine, moxidectin, naproxen, organophosphate and vitamin D toxicities, along with suspected tremorgenic mycotoxicosis, and experimentally in rescuing dogs from bupivacaine‐induced cardiac toxicity, as well as verapamil toxicity 20–35. However, there are currently no reports of canine permethrin toxicosis, where ILE was used as part of a successful case management.…”