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Answers and Discussion

Case #13 -- Ibuprofen Toxicity

Answers and Discussions to the Questions:

What emergency treatments would you institute for "Thompson"?

If it has been less than 4 hours since the animal ingested the ibuprofen, start by inducing vomiting or using gastric lavage. Activated charcoal should also be used. Vomiting can be induced with apomorphine at the clinic. If the client is at home and calls you to report their dog just ate ibuprofen, you can have the client induce vomiting with household products such as salt (teaspoon), dry mustard (teaspoon) or hydrogen peroxide (few tablespoons). Then begin fluid therapy (see question 3).

What GI problems would you expect in this case and how would you treat them?

You should expect gastric ulcers and hemorrhage, vomiting and tarry stools. This is due to reduced prostaglandin synthesis via inhibition of prostaglandin synthetase. NSAID toxicity will also decrease the cytoprotective effects of prostaglandins, especially in the stomach. Treat with sucralfate 0.5-1 gm/dog PO TID; either ranitidine 2 mg/kg IV SLOWLY or SQ, BID or TID OR famotidine 0.5-1 mg/kg PO, SQ or IV daily or BID; metoclopramide 1-2 mg/kg/day IV CRI or 0.2-0.4 mg/kg SQ QID; misoprostol 2-4 mcg/kg PO TID or QID.

What kidney problem would you expect in this case and how would you treat it?

You should expect acute renal failure. Fluids should be run at 1.5-2 times maintenance [ (30 x body wt in kg) + 70]. Monitor for signs of overhydration (chemosis, pulmonary congestion, increased CVP). Typically, 0.9% saline is used since most patients have hyperkalemia (although "Thompson" did not). Urine output should exceed 1 ml/kg/hr. If output is low, lasix (2-3 mg/kg every 6-8 hours) or dopamine (1-5 mg/kg/min IV CRI) can be used to increase it.

Follow-Up: "Thompson" remained in the critical care unit for 3 days, receiving GI protectants and being diuresed. His blood values never became abnormal and vomiting/diarrhea stopped. He was then released.

Ibuprofen Toxicity Pearls

If the dog ingested ibuprofen recently, induce vomiting or perform gastric lavage, then give activated charcoal.
Prepare for GI ulcers and hemorrhage by using protectants like sucralfate, zantac, pepcid or misoprostol.
Prepare for renal damage by diuresing.