Emergency treatment with intermittent hemodialysis for amikacin overdose in a cat

OBJECTIVE To describe the safety and use of intermittent hemodialysis (IHD) for the emergency treatment of a cat with an amikacin overdose. CASE SUMMARY A cat was accidentally administered 400 mg (97.5 mg/kg, IV) of amikacin. Four hours after the time of the overdose, a single emergency IHD session to remove amikacin was performed. The 4-hour IHD treatment allowed for the active removal of approximately 110 mg of amikacin. The plasma concentration of amikacin from the beginning to the end of the session decreased from approximately 160 μg/mL to a nontoxic concentration of 10 μg/mL. Following IHD treatment, the cat developed an International Renal Interest Society (IRIS) grade IV acute kidney injury (AKI) with a peak creatinine of 486 μmol/L (5.5 mg/dL) and was hospitalized for 4 days for supportive management of AKI. At the time of discharge, 4 days following the overdose, the AKI had resolved. NEW OR UNIQUE INFORMATION PROVIDED This is the first report describing the use and safety of using IHD for emergency removal of amikacin overdose in a cat.