Suspected ketorolac toxicosis in a dog

ABSTRACT

Non-steroidal anti-inflammatory drugs (NSAIDs) also have analgesic and anti-pyretic properties. Ketorolac tromethamine (ketorolac) is a potent NSAID which is used mainly for its analgesic properties in humans. Ketorolac is also available as a registered veterinary pharmaceutical product in Trinidad. Off-label use of NSAIDs in dogs has been documented and is occasionally used in small animal practice in Trinidad. Six days after the treatment with ketorolac tablets (5 milligram) once daily for five days, a 20 kilogram (kg) mixed breed female dog was presented to the Veterinary Hospital, School of Veterinary Medicine, Trinidad. A grave prognosis was given based on the clinical signs of anorexia, hematemesis, very pale mucous membranes, melanoma and lateral recumbency. The animal was euthanised and submitted for necroscopy. Severe hemorrhage (140 millilitres) from gastric ulcerations, and multi-focal hepatic necrosis was found on necroscopy. Histopathology reinforced the hypothesis of ketorolac toxicosis causing gastric ulceration. Also noteworthy was a predominantly lymphoplasmacytic infiltrate accompanying a peri-acinar hepatic necrosis. Ketorolac is conjugated by the liver to an inactive metabolite and excreted by the kidney. Data from human and canine studies have consistently recorded gastric ulcerations as a side effect of this drug. Concurrent hepatic disease may have prolonged its duration of activity, thereby increasing the incidence and/or the severity of side effects. Contra-indications for the use of this drug in humans and animals include renal disease, cardiac disease, concurrent gastro-intestinal ulceration, dehydration and shock, but not hepatic disease/insufficiency (AU)