Peer-reviewed veterinary case report
Plasma exchange to treat lipid overdose in dog with baclofen poisoning
By Epstein, Steven E et al.·Published in Journal of the American Veterinary Medical Association·2022·View original on PubMed →
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Original publication title: Manual plasma exchange to treat an accidental overdose of intravenous lipid emulsion in a dog with baclofen toxicosis.
- Species:
- dog
Plain-English summary
A 2-year-old male German Shorthair Pointer was brought in after showing severe symptoms from baclofen poisoning, including a lack of gag reflex and stupor. The dog had received a high dose of intravenous lipid emulsion, which led to dangerously high triglyceride levels and other serious health issues. To treat this, veterinarians performed a procedure called therapeutic plasma exchange, which successfully lowered the triglyceride levels and improved the dog's heart function. Unfortunately, the dog later developed aspiration pneumonia and, after discussion with the owner, was euthanized.
People also search for: dog baclofen poisoning treatment · German Shorthair Pointer triglyceride levels · intravenous lipid emulsion overdose in dogs
Abstract
CASE DESCRIPTION: An approximately 2-year-old sexually intact male German Shorthair Pointer was presented for treatment of baclofen toxicosis. CLINICAL FINDINGS: The dog had signs of severe baclofen toxicosis (no gag reflex, intermittent vocalization, and stupor) and received intravenous lipid emulsion (142 mL/kg) as a constant rate infusion over 11 hours. Severe hypertriglyceridemia (29,221 mg/dL; reference interval, 19 to 133 mg/dL) developed, followed by cardiovascular depression (poor peripheral perfusion, hyperlactatemia, and hypertension), severe hypoglycemia (26 mg/dL), acute kidney injury (serum creatinine, 3.6 mg/dL), intravascular hemolysis, and coagulopathy (hypocoagulable thromboelastogram and marked bilateral epistaxis). TREATMENT AND OUTCOME: Therapeutic plasma exchange was performed in 4 stages to treat the hypertriglyceridemia. For each stage, an approximately 500-mL aliquot of blood (22 mL/kg) was removed and centrifuged, and the patient's RBCs and allogenic fresh-frozen plasma were returned to the dog. Approximately 1.2 times the dog's plasma volume was exchanged, reducing the serum triglyceride concentration to 1,349 mg/dL and improving the dog's cardiovascular function and coagulation. Hours after the procedure was completed, the dog regurgitated and developed acute respiratory distress as a result of presumptive aspiration pneumonia, and the owner elected to have the dog euthanized. CLINICAL RELEVANCE: Veterinarians should be aware of possible complications associated with administration of intravenous lipid emulsion, and veterinary-specific guidelines for the maximum dose of intravenous lipid emulsion should be developed to help prevent adverse effects. TPE appears to be an effective method for treating iatrogenic hypertriglyceridemia in dogs.
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Search related cases →Original publication on PubMed: https://pubmed.ncbi.nlm.nih.gov/35066487/