Ibruprofen ingestion 8mo Cocker

Re: Ibruprofen ingestion 8mo Cocker

Charlie Lyon — Wed, 01 Jul 2015 15:43:57 GMT

for those interested her creatinine went down to 159 and urea 15 on Sunday - after she chewed her iv out (again) thought we would check early. Went home and going to check kidneys next week so so far all good

Re: Ibruprofen ingestion 8mo Cocker

Julian Earl — Sat, 27 Jun 2015 15:51:08 GMT

I make the claim to have brought the risk of Brufen to dogs to the attention of the profession. Way back in about 1983, Polly Taylor of the AHT wrote an In Practice article about NSAIDs for dogs that suggested 30-40mg/kg. Having a very arthritic and normally boisterous Labrador who could not tolerate phenylbutazone, I tried him on some of my Brufen that I had at the time. The response was immediately dramatic and I have a lovely photograph of him playing and chasing a Cavalier Spaniel we met out on a walk, and my dog was now leaping liking a puppy again. He started salivating a lot, vomiting a little and I contacted Boots the manufacturers who told me that their research showed 40-50mg/kg to dogs could cause fatal kidney failure within 48 hours.so gave me a salutary warning abut it. I placed a letter in the Vet Record to this effect, and have always regarded Brufen [though other brands are available!] as highly toxic indeed to dogs. Treatment is as described above, and immediate dosing with copious milk and antacids if possible.

Subsequently my dog coped adequately well for another seven years on soluble aspirin7.5m/kg twice daily dissolved and added to his food twice daily. It was never as dramatic asibuprofen sadly. I wish carprofen had been available in the mid-eighties. I have sometimes wondered if the Cavalier Spaniel survived the vigorous playtime of being chased by a 40kg Labrador?!!

HTH

Re: Ibruprofen ingestion 8mo Cocker

Virginia Campbell — Fri, 26 Jun 2015 20:38:31 GMT

Good luck with the case. I saw a JRT once that got a 60kg dose of metacam instead of 6kg. urea/crea were really quite alarming but she did OK in the end.

Re: Ibruprofen ingestion 8mo Cocker

Charlie Lyon — Fri, 26 Jun 2015 20:10:16 GMT

Thanks for your help everyone. The thing I don't really get is that she is amazingly happy, jumping all over us happy despite the increasing renal values. Passing urine - on her kennel pads which is not useful - and faeces not bloody today. It is written in the notes they were advised ivft and potential gi/renal effects especially as time and quantity of ingestion unknown. Fingers crossed she doesn't go downhill as she is really sweet

Re: Ibruprofen ingestion 8mo Cocker

Virginia Campbell — Fri, 26 Jun 2015 17:49:39 GMT

Is there any point giving misoprostol or is it too late now? (Does this do anything for the kidneys anyway or just GIT lining?)

Re: Ibruprofen ingestion 8mo Cocker

Neil Wheadon — Fri, 26 Jun 2015 15:15:05 GMT

[quote user="Andrew Kent"] I would give decent rates of fluids and ideally have a urinary catheter to monitor outputs[/quote]

1ml/kg/hour is a good guide for urinary output

An ingenious method if you can't catherterise is weigh the vet bed as well as measuring urination outside (if they urinate)

Good luck

Neil

Re: Ibruprofen ingestion 8mo Cocker

Bob Russell — Fri, 26 Jun 2015 15:09:27 GMT

Hopefully it was documented that owners declined IVFT!

The same clients that try to dictate treatment can often be the ones that kick up most fuss if their choices prove wrong! As Shakespeare so brilliantly wrote:

“The empty vessel makes the greatest sound.”

Re: Ibruprofen ingestion 8mo Cocker

Hannah Wynne Richards — Fri, 26 Jun 2015 14:46:20 GMT

Good luck Aren't owners a nuisance at times?

Wynne

Re: Ibruprofen ingestion 8mo Cocker

Andrew Kent — Fri, 26 Jun 2015 13:56:35 GMT

[quote user="Martin Atkinson"]

[quote user="Robin Grimmer"]If the dog had received iv fluid support straight away as recommended then it might have prevented the acute kidney failure. [/quote]Would it?

[/quote]

potentially as the initial nephrotoxic injury is often compounded by the reduced renal perfusion and fluids can help to maintain that. Equally the GI effects causes cause fluid loss which could be corrected through IVFT as this might also contribute to the renal injury.

Andy

Re: Ibruprofen ingestion 8mo Cocker

Joyce Whitehead — Fri, 26 Jun 2015 13:56:12 GMT

N=1 that I have seen, and a few years ago now, but this one presented a few hours post ingestion, and despite very aggressive fluid therapy, gastroprotectants etc, I'm afraid he succumbed to acute renal failure. This was an adult Pharoah hound, so around 25kg dog, and, from memory, ate around 12 ibuprofen tablets. I sincerely hope yours will do better. My feeling is that if the owners had allowed immediate fluids it would have helped, but I don't honestly know if that is right or not!

Re: Ibruprofen ingestion 8mo Cocker

Martin Atkinson — Fri, 26 Jun 2015 13:48:11 GMT

[quote user="Robin Grimmer"]If the dog had received iv fluid support straight away as recommended then it might have prevented the acute kidney failure. [/quote]Would it?

Re: Ibruprofen ingestion 8mo Cocker

Robin Grimmer — Fri, 26 Jun 2015 13:04:15 GMT

Idiots (the owners that is). If the dog had received iv fluid support straight away as recommended then it might have prevented the acute kidney failure.

Re: Ibruprofen ingestion 8mo Cocker

Andrew Kent — Fri, 26 Jun 2015 12:22:21 GMT

But renal hypertension is primarily a complication of chronic rather than acute kidney disease as it is related to the longer term hormonal response. In the acute setting it is mainly reduced renal perfusion that we are contending with and that is what we can worsen with ACE inhibitors.

Andy

Re: Ibruprofen ingestion 8mo Cocker

Martin Atkinson — Fri, 26 Jun 2015 12:17:35 GMT

But is the logic not also that renal hypertension is a vicious cycle so that by reducing this there will be less knock-on damage? I do recall being told not to use Enalapril in dogs because it is part excreted by the kidneys and thus its half life was increased and may lead to relative overdose. Whereas benazepril is excreted almost entirely by the liver so this problem didn't occur.

Re: Ibruprofen ingestion 8mo Cocker

Andrew Kent — Fri, 26 Jun 2015 12:09:55 GMT

No I would say dogs and cats are the same from that respect. ACE inhibitors have repeatedly been shown to be a major risk factor for acute kidney injury in people and they significantly increase the risk of prolonged hospitalisation - this is related directly to their mechanism of action and so there is no reason that it should be different for cats and dogs.

As they cause preferential dilation of the efferent renal arteriole they reduce the glomerular pressures and therefore GFR which could worsen an acute kidney injury. So in people who are on ACEi they would stop them, or significantly reduce the dose, if an acute kidney injury develops.

The only time they might be indicated would be if significant hypertension occurs as part of the disease.

Andy

Re: Ibruprofen ingestion 8mo Cocker

Martin Atkinson — Fri, 26 Jun 2015 11:38:46 GMT

[quote user="Andrew Kent"]I would definitely not use ACEi in an acute kidney injury, they drop glomerular filtration and so could have significant adverse effects, I would only use them when the renal function has stabilised.[/quote]I will take that on board as well Andrew, thank you. But is this different for cats because I have been advised by a specialist in the past to give them to a cat in ARF following NSAID toxicity?

Re: Ibruprofen ingestion 8mo Cocker

Andrew Kent — Fri, 26 Jun 2015 11:33:30 GMT

I would definitely not use ACEi in an acute kidney injury, they drop glomerular filtration and so could have significant adverse effects, I would only use them when the renal function has stabilised.

in terms of managing an acute kidney injury - I would give decent rates of fluids and ideally have a urinary catheter to monitor outputs. If urine production is not appropriate then various pharmacological options exist to improve this.

there are more aggressive options such as haemodialysis or peritoneal dialysis if things are not going well.

ultimately it is a lot about trying to minimise ongoing damage to the kidney and seeing where the kidney function ends up.

Andy

Re: Ibruprofen ingestion 8mo Cocker

Charlie Lyon — Fri, 26 Jun 2015 11:29:03 GMT

Ok well thanks, a urine sample is on the to do list already.

I believe the prognosis can generally be good if treated promptly although have read permanent renal damage can occur?

Re: Ibruprofen ingestion 8mo Cocker

Martin Atkinson — Fri, 26 Jun 2015 10:39:45 GMT

Well first I don't know that IVFT would have made much difference on day 1 anyway. Secondly the raised BUN may be due to the internal bleed as much as renal failure although the Crea is still then a concern. So some urine monitoring for protein & USG may be valuable. If it is really ARF then maybe some ACEi may help albeit it tends not to be used as much in dogs as cats but probably only because we see far less dogs than cats with renal failure.