Successful multimodal treatment of extreme hypertriglyceridemia in a juvenile diabetic dog

J Vet Emerg Crit Care (San Antonio). 2022 Dec 27. doi: 10.1111/vec.13275. Online ahead of print.

Abstract

Objective: To describe the therapeutic protocol used to normalize severe hypertriglyceridemia in a dog.

Case summary: A 7-month-old, 1.2-kg female Pomeranian presented with acute polyuria, polydipsia, and ocular discoloration. Diagnoses included diabetic ketosis, severe hypertriglyceridemia (>225 mmol/L [>20,000 mg/dl]), lipemia retinalis, and bilateral uveitis. The triglyceride concentration was near normal within 2 days of initiating treatment with fenofibrate, regular insulin constant rate infusion (CRI), manual therapeutic plasma exchange (TPE), and a low-fat diet. All clinical signs resolved. The dog has had no relapse of hypertriglyceridemia at the time of writing the manuscript, 6 months later, with continued treatment of diabetes mellitus.

New or unique information provided: This is the first case report documenting the combination of fenofibrate, insulin CRI, and manual TPE for treatment of severe hyperlipidemia in a dog. Detailed protocols for manual TPE and a novel insulin CRI are provided. A discussion of multiple spurious biochemical and hematologic errors associated with the severe hypertriglyceridemia is also provided.

Keywords: fenofibrate; glargine U300; insulin constant rate infusion; lipemia retinalis; manual therapeutic plasma exchange.

Publication types

  • Case Reports