Use of Intralipid Therapy and Therapeutic Plasma Exchange in the Management of Cholecalciferol Rodenticide Exposure in a Dog: A Case Report.

TPE may serve as a rescue therapy for refractory hypercalcemia in cholecalciferol rodenticide toxicosis when standard treatments fail.

This case report describes the management of suspected cholecalciferol rodenticide intoxication in a 3-year-old neutered female crossbreed dog presenting with acute vomiting and lethargy. Severe hypercalcemia was confirmed without other identifiable etiologies. Standard hypercalcemia therapy was initiated but proved insufficient due to persistent rebound hypercalcemia. Intralipid emulsion (ILE) therapy was trialed as an adjunctive treatment and showed initial promise; however, rebound hypercalcemia continued. Therapeutic plasma exchange (TPE) was subsequently employed as a novel intervention and successfully reduced serum concentrations of vitamin D metabolites, ultimately achieving normocalcemia. Despite metabolic stabilization, the dog developed infective endocarditis that progressed to congestive heart failure, resulting in death. Blood cultures identified Serratia marcescens as the causative organism, representing only the second reported case of S. marcescens endocarditis in a dog. This report is notable as the first published case describing combined use of both ILE and TPE for cholecalciferol rodenticide toxicosis in a dog. The findings suggest TPE may be a viable rescue therapy when conventional treatments and ILE fail to maintain normocalcemia in severe cholecalciferol intoxication, though infectious complications remain a significant concern in critically ill patients undergoing intensive interventions.

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