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For Feline Permethrin Toxicity, Think ILE

Clinician's Brief (Capsule)

Toxicology

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April 2014

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Permethrin toxicity is diagnosed via history and signs; most cases have a history of toxin exposure (eg, over-the-counter flea sprays, collars, shampoos, spot-on preventives) and present with muscle fasciculations, tremors, ataxia, and possibly seizures. Mydriasis, pyrexia, hypersalivation, and vomiting may also occur.

This study described the treatment of 2 cats diagnosed with severe permethrin toxicity: Both were treated with decontamination, intravenous lipid emulsion (ILE), methocarbamol, and supportive therapy. Each received an ILE bolus followed by an ILE infusion over 30 minutes. Both were bright, alert, and responsive within 24 hours.

ILE, a novel treatment for permethrin toxicity in cats, is a sterile, nonpyrogenic fat emulsion used in parenteral nutrition. ILE may reduce permethrin tissue concentrations, thus improving outcome in permethrin toxicosis. ILE therapy in these 2 cases subjectively reduced hospitalization times and appeared to immediately reduce muscle tremors.

Commentary

ILE has been used in various lipophilic drug intoxications, including local anesthetics and ivermectin. The theory behind its efficacy includes acting as a lipid sink, binding the toxin in the bloodstream and inactivating its effects on tissues. In this report, methocarbamol was administered for muscle tremors. ILE should be considered when treating patients with lipophilic drug toxicities, as adverse effects are minimal, and there is growing evidence that time to resolution of signs is greatly reduced with its use.—Lisa Powell, DVM, DACVECC

Source

Adjunctive therapy with intravenous lipid emulsion and methocarbamol for permethrin toxicity in 2 cats. Kendon K, Odunayo A. JVECC 23:436-441, 2013.

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

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