Use of haemodiafiltration in the treatment of massive caffeine intoxication in a dog

The objective of this case report is to describe the use of extracorporeal therapy, specifically hemodialfiltration, for the treatment of caffeine intoxication. A 12 year old Border Terrier consumed up to 1440 mg/kg of caffeine and rapidly developed clinical signs of tachycardia and tremors. Hemodiafiltration was instituted, using an M60 PrismaFlex cartridge using blood to prime the system due to patient size. Treatment with 11.25 L of therapy fluid (83% dialysate, 17% replacement fluid), or 1.8 L/kg, was provided over 6 h. Pre‐treatment serum caffeine concentration of 233 µg/mL was decreased by 89% to 25 µg/nL by the end of treatment. Despite prompt institution of extracorporeal toxin removal therapy, ventricular ectopy developed necessitating sotolol treatment for the following week. Caffeine is efficiently removed via hemodialysis, as predicted by small size, small volume of distribution, and minimal protein binding. A CRRT platform can be used to provide adequate clearance.