Outcomes of 434 dogs with non-steroidal anti-inflammatory drug toxicosis treated with fluid therapy, lipid emulsion, or therapeutic plasma exchange
Chalifoux, N.V. et al. (2022) Outcomes of 434 dogs with non‐steroidal anti‐inflammatory drug toxicosis treated with fluid therapy, lipid emulsion, or therapeutic plasma exchange. Journal of Veterinary Internal Medicine.
The primary objective aim of this multicentre retrospective study was to compare outcome of dogs treated with intravenous administration of fluids (IVF) therapy alone or in combination with lipid emulsion (ILE), therapeutic plasma exchange (TPE), or ILE and TPE for the treatment of carprofen, ibuprofen, and naproxen intoxications. Secondary objectives were to evaluate the predictors of outcome for specific drug subgroups and to investigate the sensitivity and specificity of potential thresholds among these predictors.
The medical records of four veterinary teaching hospitals and one emergency and referral hospital in the United States were reviewed to identify dogs with NSAID ingestion treated with IVF alone or in combination with ILE, TPE, or ILE and TPE, between June 2015 and June 2020. Following an initial review of selected cases only dogs that had ingested ibuprofen, carprofen, and naproxen were included in the study.
A total of 434 dogs were included in the study, 225 had presented for ingestion of ibuprofen, 129 for carprofen and 80 for naproxen.
Results showed that in dogs that had consumed any NSAID at a renal- or CNS-toxic dose there was a significant association between TPE usage and severity of clinical signs, with an overrepresentation of neurological disease and underrepresentation of acute kidney injury. Dogs treated with IVF alone had a significantly higher maximal creatine concentration compared with IVF and ILE. Increased maximum time to presentation, higher baseline creatinine, higher baseline PCV were associated with greater clinical severity. Successful induction of emesis was significantly associated with a lower probability of developing clinical signs. Ingestion of Ibuprofen was significantly associated with the development of more severe clinical signs compared to ingestion of carprofen. The overall survival rate was 99% (429/434)
Limitations of the study include the retrospective nature, that the severity of signs may have influenced treatment choice, that none of the NSAID intoxications were confirmed, that none of the cases had serum drug concentrations measured and that the modelling approach used was limited by its inability to account for clinical signs at presentation that persisted throughout the time in hospital.
This study provides an overview of treatment options for NSAID toxicity and highlights the potential usefulness of intralipid therapy in the management of these cases.
The following may also be of interest:
Khan, S.A. and McLean, M.K. (2012) Toxicology of frequently encountered nonsteroidal anti-inflammatory drugs in dogs and cats. Veterinary Clinics of North America: Small Animal Practice, 42 (2), pp. 289-306. https://doi.org/10.1016/j.cvsm.2012.01.003
McLean, M.K. and Khan, S.A. (2018) Toxicology of frequently encountered nonsteroidal anti-inflammatory drugs in dogs and cats: an update. Veterinary Clinics of North America: Small Animal Practice, 48 (6), pp. 969-984 https://doi.org/10.1016/j.cvsm.2018.06.003
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