Safety and efficacy of high-dose fomepizole compared with ethanol as therapy for ethylene glycol intoxication in cats

Connally, Heather E.; Thrall, Mary Anna; Hamar, Dwayne W.

doi:10.1111/j.1476-4431.2009.00492.x

Cited by 36 publications

(39 citation statements)

References 29 publications

(35 reference statements)

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“…A recent study by Connally and others (2010) showed that high doses of 4-MP were safe and effective at preventing fatal renal failure when given to cats within three hours of ingestion. Unfortunately, 4-MP requires a licence to be imported into the UK, which can be difficult to obtain.…”

Section: Specific Therapiesmentioning

confidence: 99%

Acute kidney injury in dogs and cats 2. Management, treatment and outcome

Li¹,

Mugford²,

Humm³

2013

In Practice

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Acute kidney injury (AKI) is a commonly encountered emergency in small animal practice. Dogs and cats with AKI are mostly presented in the maintenance phase of the disease, by which point renal function has been severely compromised and clinical signs are apparent. The first article in this two-part series, which was published in the May issue of In Practice discussed the pathogenesis and diagnosis of AKI. This article considers both specific therapy and general supportive treatment in dogs and cats.

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Section: Specific Therapiesmentioning

confidence: 99%

Acute kidney injury in dogs and cats 2. Management, treatment and outcome

Li¹,

Mugford²,

Humm³

2013

In Practice

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“…18 Similar to ethanol, fomepizole is associated with CNS depression, especially at the doses required for treatment in cats, but other side effects have not been documented with its use. 18 While this drug is available in the US, that may not be the case in many other countries and alternative treatment options must be considered.…”

Section: 19mentioning

confidence: 99%

“…21 However, ethanol is associated with increased side effects such as worsened CNS depression, metabolic acidosis and hyperosmolality. 18 …”

Section: Ethanolmentioning

confidence: 99%

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Feline acute kidney injury

Monaghan

Nolan²,

Labato

2012

Journal of Feline Medicine and Surgery

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Practical relevance: Acute kidney injury (AKI) is a frequently recognized disease process in cats that requires immediate and aggressive intervention. A thorough understanding of the pathophysiologic processes underlying AKI and familiarity with the most common etiologies are essential for providing the most effective and timely therapy. Possessing this knowledge will also allow a more accurate prognosis to be given, and afford the best chance of a favorable outcome. Clinical challenges:Feline patients often present with vague signs of AKI, which may delay treatment and adversely affect the prognosis. Their response to injury and treatment is often different to that of other species.Audience: This two-part review article is directed at small animal practitioners as well as specialists. Part 1 reviews mechanisms underlying AKI in the cat, as well as etiologies and treatments related to some specific causes of AKI. New terminology -and a new emphasisAcute kidney injury (AKI) is a relatively new term in the nephrology literature that largely replaces the use of 'acute renal failure' (ARF). Originally introduced in the human literature, AKI allows for greater stratification of cases with regard to severity and prognosis. By suggesting that a patient has injury, rather than failure, one can recognize the potential for earlier treatment and recovery. In human medicine, the older term 'ARF' refers only to patients requiring renal replacement therapy (RRT). Additionally, the more common term 'kidney', rather than 'renal', facilitates communication with and understanding by clients of AKI. The incidence of AKI in cats is not known, but it is not uncommon and can be caused by a variety of different insults. A uniform definition for AKI does not exist in the veterinary literature and varies among publications. Generally accepted criteria include an abrupt reduction in kidney function resulting in alterations in glomerular filtration, urine production and tubular function. These alterations result in an inability to maintain fluid, electrolyte and acid-base balance, and may lead to azotemia. PathophysiologyThe pathophysiology of AKI is complex, but can be described by four stages: initiation, extension, maintenance and recovery.

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“…11 In dogs, the peak serum concentration is 2 hr and the half-life is 3.4 hr. 9 The published minimum lethal dose in cats is 1.4 ml/kg and in dogs is 4.4-6.6 ml/kg of body weight 4 ; death is usually a result of acute renal failure. Mortality after ingestion of EG is 96-100% in cats and 59-70% in dogs.…”

Section: Introductionmentioning

confidence: 99%

Preliminary evaluation of a quantitative ethylene glycol test in dogs and cats

Scherk¹,

Brainard

Collicutt

et al. 2013

J VET Diagn Invest

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Abstract. Ethylene glycol (EG) toxicity is commonly encountered in dogs and cats. The purpose of the current study was to determine if the Catachem test kit (Catachem Inc., Oxford, Connecticut) could precisely and accurately detect the presence of EG added to serum and plasma from 6 dogs and 4 cats. Serum and plasma samples were spiked at various concentrations of EG (0, 20, 60, and 100 mg/dl) and analyzed using the Catachem kit. Twenty randomly selected samples were also submitted for gas chromatography-mass spectroscopy (GC-MS) analysis of EG concentration, which was considered the gold standard. Inter-and intra-assay coefficients of variation (CVs) were calculated. Bland-Altman analysis was performed to compare the Catachem results to the GC-MS analyses. Analysis of serum samples showed a bias of 8.48 mg/dl (95% limits of agreement: 17.8 to -0.9 mg/dl) while spiked plasma samples had a bias of 7.32 mg/dl (18.1 to -3.5 mg/dl). Intra-assay CV was 0.7%. Interassay CV ranged from 1.2% to 2.0%. For all samples, the Catachem kit read higher than GC-MS values and slightly overestimated in vitro concentrations. The Catachem test kit is an accurate quantitative test for EG in dogs and cats that may aid in timely recognition of EG exposure. Because of the positive bias in all samples, some pets may receive treatment unnecessarily. However, animals with blood EG concentrations at or above the published lethal serum or plasma concentration will be readily identified so that treatment may be initiated.

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Safety and efficacy of high-dose fomepizole compared with ethanol as therapy for ethylene glycol intoxication in cats

Abstract: Fomepizole is safe when administered to cats in high doses, prevents EG-induced fatal ARF when therapy is instituted within 3 hours of EG ingestion, and is more effective than treatment with EtOH.

Cited by 36 publications

References 29 publications

Acute kidney injury in dogs and cats 2. Management, treatment and outcome

Acute kidney injury in dogs and cats 2. Management, treatment and outcome

Feline acute kidney injury

Preliminary evaluation of a quantitative ethylene glycol test in dogs and cats

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