Lipid infusion in the management of poisoning: a report of 6 canine cases

Abstract

Intravenous administration of lipid is a relatively new treatment in the management of toxicity from lipophilic compounds. It is used in human medicine in the treatment of toxicity from lipophilic local anaesthetics and cardiotoxic drugs and can result in dramatic improvement in clinical status. We present six cases of poisoning in dogs successfully treated with lipid infusion after ingestion of ivermectin (3), moxidectin (2) and baclofen (1). The dogs ranged in age from eight weeks to 14 years, and weighed 4–30 kg. Intravenous lipid therapy was started between six and eight hours and 22 hours after ingestion, and all the dogs responded well. In four dogs, there was clinical improvement within one hour; one had improved within two hours and the other within 4.5 hours of lipid administration. The only adverse effect of lipid infusion reported was mild swelling and pain after extravasation in one case which resolved with conservative management. All the dogs were discharged within 24–52 hours after exposure (7–46 hours after the start of lipid administration), and none developed any apparent sequelae.

Poisoning of dogs and cats by drugs intended for human use

“…hypothermia, dyspnoea and respiratory arrest may occur (Campbell and Chapman, 2000;Wismer, 2004). Several cases of intoxication of dogs by baclofen following accidental ingestion of owner's tablets have been reported (Campbell and Chapman, 2000;Wismer, 2004;Scott et al, 2007;Torre et al, 2008;Khorzad et al, 2012;Bates et al, 2013;Caloni et al, 2014). In most cases, dogs develop severe clinical signs, often despite low dosage;~15% died (Campbell and Chapman, 2000).…”

“…In most cases, dogs develop severe clinical signs, often despite low dosage;~15% died (Campbell and Chapman, 2000). Lethal doses for dogs have not been established, but the ASPCA APCC database has reported mortality in dogs at estimated doses of 8-16 mg/kg (Wismer, 2004), while Bates et al (2013) reported a case of poisoning in a dog that ingested a dose of 25 mg/kg. Death was also reported in an 8 week old dog that ingested a dose of 2.3 mg/kg (Table 5), indicating that the amount of baclofen ingested should not be used solely as a predictor of outcome (Khorzad et al, 2012).…”

“…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).…”

Treatment of a case of feline baclofen toxicosis with intravenous lipid therapy

“…ILE has also been used in a single case report of a dog with baclofen toxicosis and provided a rapid improvement in demeanour (Bates and others 2013). It must be noted that the use of ILE does not currently represent an appropriate first-line treatment option for baclofen toxicosis.…”

Lipid infusion in the management of poisoning

“…Adverse effects reported in veterinary cases include pancreatitis (Gwaltney-Brant and Meadows 2012), hyperlipidaemia (Gwaltney-Brant and Meadows 2012), unilateral facial pruritus (Peacock and others 2015), extravasation with pain and local swelling (Bates and others 2013) and prolonged gross lipaemia (lasting more than 48 hours) and suspected corneal lipidosis (Seitz and Burkitt-Creedon 2016). The lipid also interferes with some laboratory analyses (Grunbaum and others 2015).…”