Pertinent medical history, clinical signs, details of the intoxications, diagnostic values, and treatments given were collected from medical records, when available. Code Green: The Risk From Toxic Household PlantsĪll cases were selected by the attending veterinarian to receive ILE based on severe clinical signs or a potentially lethal dose of toxin.Patient breeds and ages varied (3 months to 12 years). Intoxications included baclofen alone, baclofen and tadalafil, methomyl, disulfoton, methamphetamine, dextroamphetamine sulfate (Adderall), amlodipine, ivermectin and spinosad plus milbemycin oxime, and bromethalin. This retrospective study examined the medical records of 10 patients, 9 dogs and 1 cat, treated with ILE following severe intoxications between 20. In a study from a private, specialty hospital in the United States, 10 toxicity cases treated with intravenous lipid emulsion (ILE) therapy were evaluated for responses to the treatment given and overall patient outcomes. Over the past 2 decades, lipid emulsions have been used in practice to treat these severe toxicities, although use of lipid emulsions is far from common in most practices. ![]() There are multiple hypotheses, including acting as a “lipid sink” where the toxin is sequestered within the intravascular space, enhancing mitochondrial function through increased fatty acids, and providing substrate for cardiomyocytes to enhance function. The mechanism of action of lipid emulsions in these cases is not well understood. It was first reported in 1998 by Weinberg and colleagues that pretreatment with a lipid emulsion, typically used as a parenteral nutritional supplement, could reverse or improve the clinical signs seen in rats following a bupivacaine overdose. © Veterinary Emergency and Critical Care Society 2015.Lipophilic (fat-loving) intoxication cases have always been challenging to treat in the veterinary hospital. Based on our observations, BCS appears to influence the severity of ivermectin toxicity with a low BCS being associated with more severe signs of ivermectin toxicity.Īvermectins intralipid toxicosis treatment. Our observations also suggest that cats with a low BCS given only a bolus of IVLE treatment were more likely to develop signs of ivermectin intoxication and require a greater amount of IVLE for the resolution of clinical signs. An early bolus followed by a 30-minute constant rate infusion of IVLE appeared to mitigate the signs of ivermectin toxicosis in cats compared to a single treatment bolus. Our series describes the treatment of accidental ivermectin parenteral overdose in 20 cats with early initiation of IVLE therapy. Median (min to max) cumulative dose of IVLE per cat was 4.5 (3.0-4.5) mL/kg for 36 (12-36) hours and 19.5 (7.5-37.5) mL/kg for 96 (72-168) hours for moderately and severely intoxicated cats, respectively. Additional IVLE was administered until clinical resolution was complete. Cats with a low body condition score (BCS) had more severe signs of ivermectin toxicity. ![]() Based on the severity of the clinical signs and their duration (approximately 48 hours), these 6 cats were retrospectively considered either moderately (n = 3) or severely (n = 3) intoxicated by ivermectin. ![]() Six out of the 16 cats that received only the single bolus developed clinical signs of ivermectin intoxication. After admission, two IVLE treatments were initiated in asymptomatic cats: a single bolus (1.5 mL/kg n = 16) versus a bolus followed by a 30-minute constant rate infusion (0.25 mL/kg/min n = 4). Twenty adult cats presented after receiving a 4 mg/kg accidental subcutaneous overdose of ivermectin. To describe the outcome of 20 cats treated with intravenous lipid emulsion (IVLE) after an accidental parenteral ivermectin overdose.
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