Frontiers in Veterinary Science · 4 authors, 3 centres
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This retrospective study of 413 poisoned dogs and cats found that intravenous lipid emulsion (ILE) was associated with clinical improvement in 74% of patients, with an overall survival rate of 96%. Adverse effects occurred in 6% of cases, including neurological signs, bradycardia, and respiratory distress, but were generally transient. The findings support ILE as a safe adjunctive therapy for lipophilic toxicant poisonings, though its use should be individualized due to potential risks.
**Background:** Poisoning is a common emergency in dogs and cats. Intravenous lipid emulsion (ILE) is used to sequester lipophilic toxicants from tissues via the 'lipid sink' or 'lipid shuttle' mechanism, but evidence from large clinical studies in veterinary medicine is limited. This retrospective study aimed to evaluate the effects, adverse effects, dosages, and outcomes of ILE therapy in a large cohort of poisoned dogs and cats over a 5-year period.
**Methods:** Electronic medical records from a transregional veterinary referral center in Germany (2016–2020) were searched for cases of poisoning treated with ILE (Lipofundin MCT/LCT 20%). Inclusion criteria were confirmed or suspected poisoning and ILE administration. Data extracted included demographic information, clinical signs, toxicant (confirmed or suspected), timing of ILE, dosages (bolus and continuous rate infusion [CRI]), clinicopathologic findings, effect of ILE (improved, unchanged, worsened), adverse effects, and outcome. Statistical analyses included Fisher's exact test, Mann–Whitney U test, and Spearman correlation, with significance set at p < 0.05.
**Key Results:** A total of 413 animals (313 dogs, 100 cats) were included. The most common clinical signs at presentation were neurologic (83.3%), altered general behavior (35.4%), cardiovascular/hydration changes (28.8%), altered thermoregulation (21.1%), and gastrointestinal signs (16.5%). The toxicant was unidentified in 48.4% of cases; among identified toxicants, tremorgenic mycotoxins (10.4%), rodenticides (8.0%), recreational drugs (7.3%), and plants (5.5%) were most frequent. ILE was initiated a median of 6.0 hours after poisoning (range 1.0–91.0 h) and a median of 1.0 hour after presentation (range 0.2–23.0 h). Dogs received a median total ILE dose of 8.0 mL/kg (range 1.5–66.6 mL/kg), and cats received 15.8 mL/kg (range 1.8–69.4 mL/kg). A positive effect (improvement or resolution of clinical signs) was observed in 74% of patients (dogs: 74.8%; cats: 54.0%), while 22% showed no change and 4% worsened. Adverse effects occurred in 6% of patients (20 dogs, 4 cats), including temporary loss of consciousness (1.7%), reduced consciousness (0.7%), bradycardia (0.7%), hyperthermia (0.7%), vomiting (0.7%), diarrhea (0.7%), respiratory distress (0.7%), and facial swelling, ataxia, or thrombophlebitis (each 0.2%). Dogs with adverse effects received a higher median total ILE dose (11.7 mL/kg) than those without (7.5 mL/kg; p = 0.042). The overall survival rate was 96% (dogs: 97.1%; cats: 91.0%); 13 patients (3.1%) were euthanized and 6 (1.5%) died. Median time to clinical improvement was 7.0 hours (range 1.0–230.0 h), with dogs recovering faster than cats (median 7.0 vs. 11.0 h; p < 0.001).
**Clinical Implications:** ILE appears to be a safe adjunctive therapy for poisoned dogs and cats, with a low rate of adverse effects (6%) and a high survival rate (96%). However, the lack of a control group and the retrospective design limit causal attribution of clinical improvement to ILE alone. Adverse effects, though generally transient, can occur, and higher total ILE doses were associated with increased risk in dogs. The study underscores the importance of individual risk-benefit assessment, consideration of decontamination prior to ILE, and the need for prospective controlled trials to establish standardized protocols. ILE should not be used routinely but reserved for cases where lipophilic toxicants are suspected or confirmed, particularly when severe neurologic or cardiovascular signs are present.