Treatment of ibuprofen toxicity with serial charcoal hemoperfusion and hemodialysis in a dog

Tauk, Barbara S.; Foster, Jonathan D.

doi:10.1111/vec.12544

Cited by 14 publications

(14 citation statements)

References 8 publications

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“…In-series HP/HD is a therapeutic option for patients with severe This report demonstrates that the efficacy of carprofen removal by HP is short lived due to presumed rapid saturation (within 1 h) of the adsorptive capacity of the charcoal filter. 7,9,18 This may drastically limit the therapeutic utility of this technique for drug removal in cases of severe intoxication, where a large amount of carprofen may still remain in the body once filter saturation has occurred. The therapeutic efficacy of HP may be improved with hourly charcoal filter exchanges to prevent saturation.…”

Section: Discussionmentioning

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

J Vet Emergen Crit Care

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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.

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Section: Discussionmentioning

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

J Vet Emergen Crit Care

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“…The information available to veterinarians regarding NSAID toxicosis in dogs is diverse and includes clinical review articles, 1,3 case reports, 4,5 pharmacokinetic data, 6,7 safety studies and clinical trials, 8,9 and reports evaluating treatment and decontamination 10–14 . Additionally, a systematic review examining safety studies in dogs 15 and an analysis of the frequency of adverse effects of veterinary NSAIDs in dogs and cats in the United Kingdom 16 have been published, evaluating adverse events in animals given appropriate prescribed dosages.…”

Section: Introductionmentioning

confidence: 99%

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

Steele

Stefanovski

Rondeau

2021

J Vet Emergen Crit Care

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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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“…Recently, 3 case reports about the use of TPE for the treatment of overdoses of meloxicam, ibuprofen, and carprofen have been published. Also, the use of charcoal hemoperfusion and hemodialysis for ibuprofen toxicity in a dog has been reported. Nonsteroidal anti‐inflammatory medications are highly protein bound (98%‐99%) and have a small V d, which makes them difficult to remove by hemodialysis alone, but are ideal candidates for TPE or charcoal hemoperfusion techniques.…”

Section: Introductionmentioning

confidence: 99%

Use of therapeutic plasma exchange to treat nonsteroidal anti‐inflammatory drug overdose in dogs

Rosenthal¹,

Labato

2019

Veterinary Internal Medicne

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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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Treatment of ibuprofen toxicity with serial charcoal hemoperfusion and hemodialysis in a dog

Abstract: This report details the technique for extracorporeal extraction of ibuprofen, a methodology that could be employed for other toxicities due to substances with similar pharmacokinetics. Complications and limitations (eg, saturation of the charcoal cartridge) of the therapy are discussed.

Cited by 14 publications

References 8 publications

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

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

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

Use of therapeutic plasma exchange to treat nonsteroidal anti‐inflammatory drug overdose in dogs

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