title: Intravenous lipid emulsion therapy in 20 cats accidentally overdosed with ivermectin.
abstract: OBJECTIVE
  To describe the outcome of 20 cats treated with intravenous lipid emulsion (IVLE) after an accidental parenteral ivermectin overdose.
  
  
  METHODS
  Twenty adult cats presented after receiving a 4 mg/kg accidental subcutaneous overdose of ivermectin. After admission, two IVLE treatments were initiated in asymptomatic cats: a single bolus (1.5 mL/kg; n = 16) versus a bolus followed by a 30-minute constant rate infusion (0.25 mL/kg/min; n = 4). Six out of the 16 cats that received only the single bolus developed clinical signs of ivermectin intoxication. Based on the severity of the clinical signs and their duration (approximately 48 hours), these 6 cats were retrospectively considered either moderately (n = 3) or severely (n = 3) intoxicated by ivermectin. Cats with a low body condition score (BCS) had more severe signs of ivermectin toxicity. Additional IVLE was administered until clinical resolution was complete. Median (min to max) cumulative dose of IVLE per cat was 4.5 (3.0-4.5) mL/kg for 36 (12-36) hours and 19.5 (7.5-37.5) mL/kg for 96 (72-168) hours for moderately and severely intoxicated cats, respectively.
  
  
  CONCLUSIONS
  Our series describes the treatment of accidental ivermectin parenteral overdose in 20 cats with early initiation of IVLE therapy. An early bolus followed by a 30-minute constant rate infusion of IVLE appeared to mitigate the signs of ivermectin toxicosis in cats compared to a single treatment bolus. Our observations also suggest that cats with a low BCS given only a bolus of IVLE treatment were more likely to develop signs of ivermectin intoxication and require a greater amount of IVLE for the resolution of clinical signs. Based on our observations, BCS appears to influence the severity of ivermectin toxicity with a low BCS being associated with more severe signs of ivermectin toxicity.
authors.affiliation: Critical and Intensive Care, Anesthesia Unit, Toulouse National Veterinary School, Toulouse, France.
authors.forename: Geraldine
authors.initials: G
authors.lastname: Jourdan
authors.affiliation: Critical and Intensive Care, Anesthesia Unit, Toulouse National Veterinary School, Toulouse, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Boyer
authors.affiliation: the Anatomy, Pathology Unit, Toulouse National Veterinary School, Toulouse, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Raymond-Letron
authors.affiliation: the Parasitology-Dermatology Unit, Toulouse National Veterinary School, Toulouse, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Bouhsira
authors.affiliation: the Emergency, Critical and Intensive Care Unit, Alfort National Veterinary School, Maisons-Alfort, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Bedel
authors.affiliation: Critical and Intensive Care, Anesthesia Unit, Toulouse National Veterinary School, Toulouse, France.|the Emergency, Critical and Intensive Care Unit, Alfort National Veterinary School, Maisons-Alfort, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Verwaerde
mesh_terms: D000818:Animals; D000977:Antiparasitic Agents / Q000008:administration & dosage / Q000633:toxicity*; D002371:Cat Diseases / Q000139:chemically induced* / Q000188:drug therapy; D002415:Cats; D062787:Drug Overdose / Q000188:drug therapy / Q000662:veterinary*; D005217:Fat Emulsions, Intravenous / Q000627:therapeutic use*; D007559:Ivermectin / Q000008:administration & dosage / Q000633:toxicity*
chemical_list: D000977:Antiparasitic Agents; D005217:Fat Emulsions, Intravenous; D007559:Ivermectin
keywords: avermectins; intralipid; toxicosis; treatment