Use of therapeutic plasma exchange to treat nonsteroidal anti-inflammatory drug overdose in dogs

Abstract

Background: Therapeutic plasma exchange (TPE) may be an effective technique for treatment of accidental nonsteroidal anti-inflammatory drug (NSAID) overdose, but information regarding the use of this technique in veterinary medicine is currently limited. Objectives: To evaluate the overall outcome for dogs with NSAID overdose treated with TPE and to determine if any presenting factors can predict or influence overall outcome. Secondary objectives included investigating TPE complications as well as the utility of other adjunctive treatments. Animals: Eleven client-owned dogs presented for NSAID overdose that received TPE. All patients also received additional supportive treatment including IV lipid infusion. Methods: Retrospective review of medical records. Results: Eleven cases were included in the study. Of these, the NSAID ingested was ibuprofen in 6 (54.5%), naproxen in 4 (36.4%), and deracoxib in 1 (9.1%). All dogs survived to discharge with 3 (27.3%) developing acute kidney injury during hospitalization. A larger initial dose of NSAID ingested was associated with a higher maximum serum creatinine concentration during hospitalization (P =.04) and larger change in serum creatinine concentration from baseline (P =.02). Six dogs (54.5%) developed complications associated with TPE. The use of other treatments did not affect the overall outcome. Conclusions and Clinical Importance: We identified TPE as an effective treatment for NSAID overdose with good outcomes despite high doses of NSAID ingestion in dogs treated with a single TPE treatment. Complications were common but did not affect the final outcome. Therapeutic plasma exchange should be considered in patients presenting for high-dose NSAID ingestion.