dvm360: Hemoperfusion for Acute Toxin Ingestion

Extracorporeal therapy (ECT) is a method of blood purification performed to remove a pathogenic substance, or solute, from the body. In this procedure, blood is removed from the patient and circulated through an extracorporeal circuit, which purifies the blood before it is returned to the patient.

Hemoperfusion (HP) is a type of extracorporeal blood purification therapy aimed at removing exogenous or endogenous toxins from the bloodstream. Other common types of ECT include renal replacement therapy (hemodialysis [HD], hemofiltration) and therapeutic plasma exchange.(1) Advanced procedures are especially beneficial when traditional decontamination techniques fall short.

Acute toxin exposure is a common and potentially life-threatening emergency in dogs and cats. Traditional decontamination techniques include induction of emesis, gastric lavage, activated charcoal, cathartic or intravenous (IV) lipid emulsion (ILE) administration, IV fluid therapy, and antidote administration, if applicable.(2) Few toxins have a specific antidote available, so therapy is predominantly aimed at decreasing gastrointestinal absorption of the toxin. If the protein is heavily lipophilic, then ILE administration may be considered to reduce clinical signs associated with intoxication and enhance the clearance of the toxin. IV fluid therapy is often employed for patients presenting with acute toxin ingestion, often at high rates, to encourage diuresis and more rapid clearance of the toxin. However, there is limited evidence to support the theory that IV fluid diuresis enhances toxin clearance, and for highly protein-bound toxins such as nonsteroidal anti-inflammatory drugs (NSAIDs), it has minimal positive effects.

Organ damage and life-threatening clinical signs may still develop despite traditional decontamination techniques because of the high ingested dose, rapid absorption of many toxins, and the inherent delay that precedes presentation for veterinary care.(2) Extracorporeal toxin removal (ECTR) provides a vital bridge whereby the toxin can be removed from the blood after it has undergone partial or complete absorption through the gastrointestinal tract, but often before it has had time to cause significant organ damage. This can reduce the morbidity and mortality related to acute toxin exposure and shorten the time required in the hospital for acute decontamination and monitoring.

This article originally appeared on dvm360.com on January 24, 2025, as part of Thrive Pet Healthcare's Strategic Alliance with dvm360.

Spillane graduated from the University of Queensland, Australia, with a degree in veterinary medicine. After a small animal rotating internship in Queensland, she completed an emergency and critical care residency at the University of Illinois. In 2022, she achieved diplomate status with the American College of Veterinary Emergency and Critical Care. Spillane then completed a fellowship at The Ohio State University in extracorporeal therapies, where she developed a deep passion for nephrology. Currently, she is advancing her specialization as one of the inaugural residents with the American College of Veterinary Nephrology & Urology. In October 2023, Spillane joined ACCESS Los Angeles, a Thrive Pet Healthcare partner, to lead the nephrology and extracorporeal therapies department.