Management of Severe Bromethalin Toxicosis in a Dog, Including the Use of Prolonged Hemodiafiltration Therapy

OBJECTIVE: To describe the management of severe bromethalin intoxication in a dog, including the use of extracorporeal therapies and their effects on serum desmethylbromethalin levels. CASE SUMMARY: A 13-year-old neutered male miniature Australian Shepherd presented after suspected ingestion of bromethalin rodenticide. Despite intravenous fluids and activated charcoal, the dog progressively declined neurologically in a 24-h period, ultimately developing a Cushing reflex. Medical management included hyperosmotic therapies, antiepileptics, intralipids, and warm water enemas. Hemodiafiltration (HDF) was attempted due to the dog's continued decline and a persistently lipemic serum, which precluded repeated doses of intralipids. Serum desmethylbromethalin concentrations were measured before, during, and after HDF, and no clearance was noted across the filter or in the effluent. Regardless, the dog improved with a total hospitalization duration of 5 days and a complete return of neurologic function. NEW OR UNIQUE INFORMATION PROVIDED: This case describes the rapid and successful clinical recovery of a dog with the highest reported levels of desmethylbromethalin, with serum desmethylbromethalin concentrations decreasing faster than the expected half-life. HDF was attempted but was found to be unsuccessful in the clearance of bromethalin.