Segev Gilad, Cowgill Larry D
School of Veterinary Medicine, the Hebrew University of Jerusalem, Israel, Rehovot, Israel.
the Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA 95616.
J Vet Emerg Crit Care (San Antonio). 2018 Mar;28(2):163-167. doi: 10.1111/vec.12694. Epub 2018 Feb 8.
To describe the management of cyclosporine overdose using hemodialysis and hemoperfusion in a dog.
A 6-year-old, spayed female Australian Shepherd was presented for treatment of cyclosporine overdose and acute kidney injury. Five days prior to presentation, the dog had been diagnosed by its referring veterinarian with immune-mediated thrombocytopenia. Treatment was initiated with prednisone, but since no response was noted, azathioprine (50 mg PO q 24 h) and cyclosporine (6 mg/kg IV q 24 h) were added. On day 4, an overdose of cyclosporine (33 mg/kg IV) was administered accidentally. Upon presentation, serum biochemistry panel revealed azotemia [creatinine, 521.6 μmol/L (5.9 mg/dL); BUN, 59.3 mmol/L (166 mg/dL)], increased activities of liver enzymes, and hyperbilirubinemia. Due to the presumed diagnosis cyclosporine overdose and acute kidney injury, a combined hemodialysis and charcoal hemoperfusion treatment was planned. Hemosorba CH-350 charcoal hemoperfusion cartridge was placed in series upstream in the extracorporeal circuit from the hemodialyzer. A 3-hour treatment was performed and a total of 0.74 L/kg of blood was processed. Pretreatment blood cyclosporine concentration was 960 nmol/L (1154 ng/mL) and decreased to 440 nmol/L (529 ng/mL) posttreatment (54% fractional reduction, 18% per hour). Thirty-one hours following treatment, blood cyclosporine concentration was 220 nmol/L (265 ng/mL; 1.5% decrease per hour). Twelve days following presentation to our hospital, the dog was euthanized due to lack of response to medical management.
Combined hemodialysis and charcoal hemoperfusion treatment can significantly reduce blood cyclosporine concentrations following acute intoxication or overdosage, and should be considered as an option for decontamination in such cases.
描述在一只犬中使用血液透析和血液灌流治疗环孢素过量的情况。
一只6岁已绝育的雌性澳大利亚牧羊犬因环孢素过量及急性肾损伤前来就诊。就诊前5天，转诊兽医诊断该犬患有免疫介导性血小板减少症。开始用泼尼松治疗，但未见反应，遂加用硫唑嘌呤（50毫克口服，每24小时一次）和环孢素（6毫克/千克静脉注射，每24小时一次）。在第4天，意外给予了过量的环孢素（33毫克/千克静脉注射）。就诊时，血清生化检查显示氮质血症[肌酐，521.6微摩尔/升（5.9毫克/分升）；尿素氮，59.3毫摩尔/升（166毫克/分升）]、肝酶活性升高及高胆红素血症。由于推测诊断为环孢素过量和急性肾损伤，计划进行血液透析和活性炭血液灌流联合治疗。将Hemosorba CH - 350活性炭血液灌流柱串联置于血液透析器上游的体外循环中。进行了3小时的治疗，共处理了0.74升/千克血液。治疗前血液中环孢素浓度为960纳摩尔/升（1154纳克/毫升），治疗后降至440纳摩尔/升（529纳克/毫升）（分数降低54%，每小时18%）。治疗后31小时，血液中环孢素浓度为220纳摩尔/升（265纳克/毫升；每小时降低1.5%）。在我院就诊12天后，该犬因对药物治疗无反应而实施安乐死。
血液透析和活性炭血液灌流联合治疗可在急性中毒或过量用药后显著降低血液中环孢素浓度，在此类情况下应考虑将其作为一种净化方法。
