Department of Clinical Sciences & Advanced Medicine, University of Pennsylvania, School of Veterinary Medicine, Philadelphia, Pennsylvania, USA.
Department of Clinical Sciences, Tufts University, Cummings School of Veterinary Medicine, Foster Hospital for Small Animals, North Grafton, Massachusetts, USA.
J Vet Intern Med. 2023 Jan;37(1):161-172. doi: 10.1111/jvim.16603. Epub 2022 Dec 1.
Traditional management of non-steroidal anti-inflammatory drug (NSAID) intoxication includes gastrointestinal decontamination, intravenous administration of fluids (IVF), and gastroprotection. Intravenous administration of lipid emulsion (ILE) and therapeutic plasma exchange (TPE) are popular novel therapeutic strategies.
Compare outcomes of dogs treated with IVF, ILE, and TPE for NSAID intoxications and evaluate outcome predictors for drug subgroups.
Four hundred thirty-four dogs with NSAID intoxications (2015-2020).
Multicenter retrospective study of ibuprofen, carprofen, and naproxen intoxication. An ordinal outcome was defined as mild gastrointestinal, moderate kidney, or signs of severe central nervous system disease.
Signs of neurological disease were overrepresented and acute kidney injury underrepresented in the TPE group among dogs exposed to kidney- or CNS-toxic doses (P = .05), though all TPE dogs with signs of neurological disease had evidence of neurotoxicity at presentation. Dogs treated with IVF had a higher maximal creatinine concentration (median, 1.1 mg/dL; range, 0.4-8.44 mg/dL) compared with IVF + ILE (median, 0.9 mg/dL; range, 0.4-6.2 mg/dL; P = .01). Increased maximum time to presentation (P < .001), higher baseline creatinine (P < .001) and PCV (P = .007), and absence of induced emesis (P < .001) were associated with greater clinical severity. Ibuprofen toxicosis was associated with more severe clinical signs compared with carprofen (P = .03). Overall survival rate was 99%.
NSAID toxicosis generally carries an excellent prognosis in dogs. Despite similar outcomes of lower incidence of AKI in the TPE group, and slightly lower maximal creatinine concentration in dogs treated with ILE vs IVF alone, ILE and TPE should be considered in the management of severe NSAID toxicosis.
传统的非甾体抗炎药（NSAID）中毒管理包括胃肠道去污、静脉补液（IVF）和胃保护。静脉注射脂肪乳剂（ILE）和治疗性血浆置换（TPE）是流行的新型治疗策略。
比较接受 IVF、ILE 和 TPE 治疗的 NSAID 中毒犬的结果，并评估药物亚组的预后预测因素。
434 只 NSAID 中毒犬（2015-2020 年）。
多中心回顾性研究，包括布洛芬、卡洛芬和萘普生中毒。将轻度胃肠道、中度肾脏或严重中枢神经系统疾病的迹象定义为序贯结果。
在接受肾毒性或 CNS 毒性剂量的 TPE 组中，神经系统疾病的迹象过多，而急性肾损伤过少（P=0.05），尽管所有有神经系统疾病迹象的 TPE 犬在就诊时均有神经毒性的证据。与 IVF+ILE 组（中位数 0.9mg/dL；范围 0.4-6.2mg/dL；P=0.01）相比，接受 IVF 治疗的犬的最大肌酐浓度更高（中位数 1.1mg/dL；范围 0.4-8.44mg/dL）。就诊时间延长（P<0.001）、基线肌酐升高（P<0.001）和 PCV 升高（P=0.007）以及无诱导性呕吐（P<0.001）与更严重的临床严重程度相关。与卡洛芬相比，布洛芬中毒与更严重的临床体征相关（P=0.03）。总体存活率为 99%。
犬 NSAID 中毒通常预后良好。尽管 TPE 组 AKI 的发生率较低，且单独接受 ILE 治疗的犬的最大肌酐浓度略低，但在严重 NSAID 中毒的治疗中应考虑使用 ILE 和 TPE。
