Use of 20% intravenous lipid emulsion for the treatment of loperamide toxicosis in a Collie homozygous for the ABCB1-1∆ mutation

Abstract

Objective: To describe the successful treatment of loperamide toxicosis in a dog using intravenous lipid emulsion (ILE).

Case summary: An 8-month-old male neutered Rough Collie weighing 20.0 kg was given a total dose of 0.75 mg/kg loperamide over 3 days as treatment for diarrhea. The dog was subsequently evaluated for signs of dull mentation, anxiety, ptyalism and ataxia, thought to be a result of loperamide intoxication. The dog was treated with a 1.5 mL/kg IV bolus of 20% ILE solution followed by 0.25 mL/kg/min of the same solution for 2 hours. The dog's mentation improved rapidly following ILE infusion, and he was neurologically normal 3 hours after initiation of ILE treatment. The dog was subsequently found to be homozygous for the ATP-binding cassette (ABC) transporter gene (ABCB1-1∆) mutation. There were no adverse effects noted during or following ILE infusion.

New or unique information provided: ILE was successful in the treatment of loperamide toxicosis in a Collie with the ABCB1-1∆ mutation. ILE may be of benefit for treatment of other intoxications in dogs with ABCB1-1Δ mutations.

Keywords: P-glycoprotein; antidote; central nervous system; mutation; neurotoxicosis.