Successful management of acute kidney failure in a dog following calcipotriol ingestion

Abstract

Objective: Calcipotriol intoxication in dogs is quite rare, but it can cause mineralization and necrosis of multiple organs including the kidneys [1]. Calcipotriol is highly toxic to dogs; the acute minimal toxic dose can be as low as 10 μg/kg and acute lethal dose is 65 μg/kg [2]. We report a case of toxic acute kidney failure after ingestion of calcipotriol in a dog, which was successfully treated with intermittent hemodialysis. Case report: A Bedlington terrier, 1-year-old, 9.8 kg chewed and ingested up to 30 g of Daivobet® ointment (containing calcipotriol 50 μg/g and betamethasone 0.5 mg/g). The ingested dose of calcipotriol was therefore up to 1500 μg (153 μg/kg). Emesis was inducted after approximately 2 hours, with a small amount of ointment found in the vomitus. The first symptoms manifested the next day with depression, anorexia, vomiting, and polyuria. The first blood analysis revealed hypercalcemia (3.54 mmol/L, reference 2.2–3.0) and hyperphosphatemia (3.43mmol/L, reference 0.8–2.2). The dog was treated with intravenous fluids, furosemide, and maropitant but its condition deteriorated. Blood analysis (urea 43.4 mmol/L [reference 3–10], creatinine 904 μmol/L [reference 30–140]) and urine specific gravity (1.008) revealed acute kidney failure on the 3rd day. The dog was transferred to a veterinary clinic with hemodialysis facilities and intermittent hemodialysis was started on the same day. Six hemodialysis sessions were performed on the 3rd, 4th, 5th, 6th, 9th, and 11th days. The first two of 0.5 and 1 hour duration were performed with 0.8m2 low-flux dialyzer, and the next four of 1.5 hours duration each, with 0.2m2 high-flux dialyzer. Mannitol infusion was used for disequilibrium syndrome prevention, and heparin for anticoagulation. Blood flow up to 70 mL/min (7 ml/kg/min) was reached without hemodynamic instability. The renal function started to improve from the 12th day and no f. [...]