The kidneys are not tiny toilets you can flush – approach to nephrotoxin exposure
Exposure to potentially nephrotoxic substances is a common reason for dogs and cats to be presented to emergency practices. Common examples include NSAIDs (for both species), lilies (for cats), and grapes (for dogs). In addition to gastrointestinal decontamination, most veterinary textbooks and review articles recommend admission to hospital for administration of intravenous fluid therapy at greater than calculated maintenance requirements (usually two to three times) for several days (usually 48-72 hours). The stated rationale is that this will induce a diuresis, which results in more rapid renal excretion of the toxin and/or prevention of processes causing acute kidney injury (AKI) in the response to the toxin. This assertion is not supported by clinical evidence and does not have a strong physiologic rationale. This session will suggest review what is known about nephrotoxins, and the effects of IV fluids on urine output, and suggest an alternative approach to these cases.
At the end of this lecture attendees will be able to:
- Recall common nephrotoxins and relevant toxic mechanisms / pharmacology (eg. protein binding, lipid solubility, metabolism, excretion).
- Explain why intravenous fluid therapy provided at greater than maintenance rates may not be beneficial and may cause harm in animals exposed to nephrotoxins.
- Describe the key steps in management of nephrotoxin exposure including appropriate decontamination, administration of antidotes where available, supportive care and monitoring.
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