Successful Treatment of a Dog With Polyethylene Glycol Electrolyte and Activated Charcoal Solution Aspiration Pneumonitis With Bronchoalveolar Lavage and Mechanical Ventilation.

BAL and mechanical ventilation can successfully resolve iatrogenic PEG-AC aspiration pneumonitis in dogs.

This case report describes the successful management of aspiration pneumonitis in a young female Chihuahua-Pomeranian crossbreed following inadvertent administration of a polyethylene glycol (PEG) electrolyte and activated charcoal (AC) solution into the airways. The dog initially presented to a primary care clinician for constipation and was sedated for nasoesophageal tube placement. Misplacement of the tube resulted in delivery of the solution into the airway, causing acute respiratory distress and coughing. Initial intervention included bronchoscopic suction, bronchoalveolar lavage (BAL), and medical support with antimicrobials and a bronchodilator. Progressive hypoxemia and increased respiratory effort necessitated mechanical ventilation (MV) using pressure-controlled synchronized intermittent mandatory ventilation (PC-SIMV), a mode permitting both spontaneous and mandatory breaths. Two notable complications arose during MV: hyperkalemia of unknown origin, managed with glucose, calcium gluconate, insulin, and terbutaline; and severe clogging of heat-moisture exchanger (HME) filters by the PEG and AC solution, leading to hypercapnia. Vigilant monitoring and timely filter replacement were critical. After four days, the dog was successfully weaned from the ventilator and achieved full recovery. To the authors' knowledge, this represents the first documented case of successful BAL and MV for this specific iatrogenic complication in a dog, highlighting important considerations for sedated tube placement and post-procedural monitoring in small animal practice.

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