The use of haemodialysis for the treatment of phenobarbitone intoxication 30 hours after ingestion

Cortellini, Stefano; Greensmith, Thomas; Cole, Laura; Trinder, Richard

Abstract

An 18-month-old male neutered Cocker Spaniel presented with a comatose mentation to his primary care veterinarian following the presumed ingestion of 216mg/kg of phenobarbitone two hours prior. Following a failure to improve with intravenous fluids, lipid emulsion therapy and supportive care, the patient was then referred to a tertiary referral centre for further treatment approximately 30 hours following ingestion. Mechanical ventilation was initiated due to severe hypoventilation (PvCO2 of 69.9mmHg) before the patient underwent a 300-minute prolonged veno-venous hemodiafiltration cycle performed using a continuous haemodialysis-based platform and a high-flux dialyzer. The patient demonstrated rapid neurological improvement being extubated after 4 hours, and becoming responsive and ambulatory 5 hours from initiation of the treatment. Phenobarbitone serum concentrations dramatically reduced from 143µg/ml on presentation to 64µg/ml at the end of the cycle, with no significant rebound redistribution of phenobarbitone documented 24 hours later. The patient was discharged 60 hours following the completion of haemodialysis.
This is the first report in the veterinary literature of the effective use of veno-venous hemodiafiltration to treat phenobarbitone intoxication 30 hours after ingestion using a high-flux dialyser.

Citation

Cortellini, S., Greensmith, T., Cole, L., & Trinder, R. (2022). The use of haemodialysis for the treatment of phenobarbitone intoxication 30 hours after ingestion. Veterinary Record, https://doi.org/10.1002/vrc2.395

• Journal Article Type: Article
• Acceptance Date: Apr 26, 2022
• Publication Date: May 15, 2022
• Deposit Date: Oct 1, 2021
• Publicly Available Date: Jul 14, 2022
• Journal: Veterinary Record case reports
• Print ISSN: 0042-4900
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1002/vrc2.395