Treatment of Ibuprofen Toxicosis in a Dog with IV Lipid Emulsion

Abstract

A 3 yr old spayed female mixed-breed dog weighing 19.4 kg was evaluated for ingestion of 1,856 mg/kg (180 tablets) of ibuprofen, a human formulated nonsteroidal anti-inflammatory drug (NSAID). At the time of presentation, the patient was alert and hypersalivating, but her mental status rapidly declined to obtunded, stuporous, and then comatose within 30 min of presentation. Initial treatment included supportive therapy with prostaglandin analogs and antiemetics. An IV lipid emulsion (ILE) was administered as a bolus, followed by a constant rate infusion. Clinical signs began to improve approximately 3 hr after completion of the lipid infusion. The patient required supportive care for 3 days before discharge. This case report demonstrates the use of ILE for treatment of ibuprofen toxicosis in a dog. ILE infusion may be a therapeutic option for patients with toxicosis due to lipid-soluble drugs.

Poisoning of dogs and cats by drugs intended for human use

“…Chemical structure References Acetyl salicylic acid Salycilates Jones et al, 1992;Giuliano Albo and Nebbia, 2004;Cope et al, 2006;Berny et al, 2010;Khan and McLean, 2012;Mahdi and Van der Merwe, 2013;Caloni et al, 2014 Diclofenac Phenylacetic acids Campbell and Chapman, 2000;Khan and McLean, 2012;Caloni et al, 2014 Ibuprofen Proprionic acids Spyridakis et al, 1986;Jones et al, 1992;Poortinga and Hungerford, 1998;Campbell and Chapman, 2000;Giuliano Albo and Nebbia, 2004;Cope et al, 2006;Monaghan and Sutton, 2008;Berny et al, 2010;Khan and McLean, 2012;Mahdi and Van der Merwe, 2013;Bolfer et al, 2014;Caloni et al, 2014 Indomethacin Indole acetic acids Jones et al, 1992;Campbell and Chapman, 2000;Khan and McLean, 2012;Caloni et al, 2014 Meloxicam Oxicams Khan and McLean, 2012;Caloni et al, 2014 Naproxen Proprionic acids Campbell and Chapman, 2000;Cope et al, 2006;Khan and McLean, 2012;Caloni et al, 2014Nimesulide Sulphonamides Borku et al, 2008Caloni et al, 2014 Table 2 Cases of paracetamol (acetaminophen) ingestion reported in dogs and cats. Schlesinger, 1995;Richardson, 2000;Mariani and Fulton, 2001;…”

“…The use of intravenous lipid emulsion (ILE) has become popular in recent years as an antidote in cases of lipophilic human and veterinary drug toxicosis (Crandell and Weinberg, 2009;O'Brient et al, 2010;Clarke et al, 2011;Haworth and Smart, 2012;Bates et al, 2013;Maton et al, 2013) and has been used to treat ibuprofen toxicity in a dog (Bolfer et al, 2014). The benefits of ILE therapy are thought to be related to improvements in cardiac function and a 'lipid sink' effect, which relies on the formation of a lipid compartment that traps lipophilic drugs (Fernandez et al, 2011).…”

Past, Present, and Future of Lipid Resuscitation Therapy

“…In particular, Peacock et al 171 conducted a randomized trial of lipid emulsion in permethrin toxicosis in felines and found a robust rescue effect of the lipid emulsion in comparison to saline. Beyond that, a number of other overdoses with potential translational relevance have been reported as effectively managed with ILE, including moxidectin, 172 ibuprofen, 173 carbamazepine, 106 , 119 and baclofen 106 . Baclofen is interesting in particular because it is nonlipophilic and may serve as a good model of how lipid can be used to treat nonlipophilic drug overdose.…”

Nonsteroidal Anti-Inflammatory Drug Toxicity in Children

“…66 Intravenous lipid emulsion for management of NSAID toxicity has been reported in canine subjects, but its use in humans requires further investigation. 67,68 Given the questionable effectiveness of these elimination strategies, their use is not routinely recommended.…”