Today's Veterinary Practice

JUL-AUG 2014

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| TheraPeuTic uPdaTes in VeTerinary Toxicology Today's Veterinary Practice July/August 2014 28 tvpjournal.com ac = activated charcoal; bWkg = body weight in kg; crTZ = chemoreceptor trigger zone; gi = gastrointes- tinal; iFe = intravenous fat emulsion; ile = intravenous lipid emulsion; ld 50 = lethal dose (dose required to kill 50% of the test population); PcV = packed cell vol- ume; Ts = total solids; usg = urine specific gravity References 1. lee JA. decontamination of the poisoned patient. in osweiler gd, Hovda lr, Brutlag Ag, lee JA, (eds): Blackwell's Five-Minute Veterinary Consult Clinical Companion: Small Animal Toxicology, 1st ed. iowa city: wiley-Blackwell, 2010, pp 5-19. 2. Peterson Me. Toxicological decontamination. in Peterson Me, Talcott PA (eds): Small Animal Toxicology, 2nd ed. St. louis: elsevier Saunders, 2006, pp 127-141. 3. Benson Be, Hoppu K, Troutman wg, et al. Position paper update: gastric lavage for gastrointestinal decontamination. Clin Toxicol 2013; 51(3):140-146. 4. Personal communication, Justine lee, dVM, diplomate AcVecc & ABT. 5. Fernandez Al, lee JA, rahilly l, et al. The use of intravenous lipid emulsion as an antidote in veterinary toxicology. J Vet Emerg Crit Care 2011; 21(4):309-320. 6. crandell de, weinberg gl. Moxidectin toxicosis in a puppy successfully treated with intravenous lipids. J Vet Emerg Crit Care 2009; 19(2):181-186. 7. wright HM, chen AV, Talcott PA, et al. intravenous fat emulsion as treatment for ivermectin toxicosis in three dogs homozygous for the ABcB1-1delta gene mutation. J Vet Emerg Crit Care 2011; 21(6):666-672. 8. clarke dl, lee JA, Murphy lA, reineke el. Use of novel intravenous lipid therapy to treat ivermectin toxicosis in a border collie. JAVMA 2011; 239(10):1328-1333. 9. Bruenisholz H, Kupper J, Muentener cr, et al. Treatment of ivermectin overdose in a miniature Shetland pony using intravenous administration of a lipid emulsion. J Vet Intern Med 2012; 26(2):407-411. 10. o'Brien TQ, clark-Price Sc, evans ee, et al. infusion of a lipid emulsion to treat lidocaine intoxication in a cat. JAVMA 2010; 237(12):1455-1458. 11. Baton Bl, Simmonds ee, lee JA, Alwood AJ. The use of high-dose insulin therapy and intravenous lipid emulsion to treat severe, refractory diltiazem toxicosis in a dog. J Vet Emerg Crit Care 2013; 23(3):321-327. 12. Haworth Md, Smart l. Use of intravenous lipid therapy in three cases of feline permethrin toxicosis. J Vet Emerg Crit Care 2012; 22(6):697-702. 13. Bolfer l, McMichael M, ngwenyama Tr, o'Brien MA. Treatment of ibuprofen toxicosis in a dog with iV lipid emulsion. JAAHA 2014; 50(2):136-140. Justine A. Lee, DVM, Diplomate ACVECC & ABT, is the CEO and founder of VetGirl (vetgirlontherun .com), a subscription-based podcast and webinar service that offers RACE-approved veterinary continuing education. She recently received the NAVC Speaker of the Year Award, and is the author and editor of several veterinary textbooks, book chapters, and scientific publications. She completed her veterinary training at Cornell University, Angell Animal Medical Center (Boston), and University of Pennsylvania. Administration ILE (eg, Intralipid, baxter.com; Liposyn III, hospira.com) can be delivered through a sterile, peripheral catheter, and does not require placement of a central line for administration. ILE has a long storage half-life, and can be stored at room temperature until it is opened. Once opened, asep- tic handling is imperative and refrigeration necessary; the remaining product should be discarded after 24 hours. For additional information about ILE, including cur- rent dosing recommendations in veterinary medicine, see Table 6. CONCLUSION The use of new and updated approaches to therapy in veterinary toxicology may dramatically improve the overall outcome in toxicities that have been previously associated with a high morbidity, mortality, and cost. However, extra-label use should be judicious, and appro- priate case selection, along with continuous supportive care, is imperative in critically ill, poisoned patients. Table 6. suggested dosing for ile in dogs & cats 5 1. using a 20% solution, bolus 1.5–4 mL/kg iV over 1 minute, followed by a constant rate infusion of 0.25 mL/kg/min for 30–60 min. 2. if clinical signs are ongoing, continue: » intermittent bolus dosing, 1.5 mL/kg Q 4–6 h for 24 h, or » constant rate infusion, 0.5 mL/kg/H, until clinical signs improve. 3. if clinical signs do not improve after 24 h, discontinue ile. Table 5. Toxicants That have been successfully Treated with ile Therapy 4,6-13 • baclofen † • beta blockers † • calcium channel blockers • cholecalciferol † • ibuprofen • lidocaine • Macrocyclic lactones ‡ • Pyrethrins † The ASPcA Animal Poison control center has recommended ile for these fat-soluble toxicants with a narrow safety margin. ‡ in one case report, ile was not found to be beneficial for macrocyclic lactone toxicosis in multidrug resistant (Mdr), also known as ABcB1-1delta, gene mutation dogs.

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