포메피졸

해독제 - 알코올 탈수소효소 억제제

**포메피졸**(4-메틸피라졸 또는 4-MP로도 알려짐)은 주로 개와 고양이의 **에틸렌 글리콜(부동액) 중독**을 치료하는 데 사용되는 합성 해독제입니다. 주요 임상 포인트: * **시간의 중요성**: 개의 경우 섭취 후 8시간 이내에 투여하면 매우 효과적입니다. 고양이의 경우 훨씬 더 높은 용량이 필요하며, 치명적인 신장 손상을 방지하기 위해 섭취 후 3시간 이내에 투여해야 합니다. * **작용 기전**: 원래의 화합물을 제거하는 것이 아니라 독성 대사 산물의 형성을 방지합니다. * **임상 팁**: 질소혈증(신장 수치 상승)이 발생하면 예후가 급격히 떨어지지만, 혈액 투석과 같은 보존적 치료를 시작하는 동안 추가 손상을 막기 위해 섭취 후 최대 36시간까지 포메피졸을 투여할 수 있습니다. * **비용 및 가용성**: 특히 대형견의 경우 치료 비용이 매우 비쌀 수 있으며, 응급 상황에서 약물의 신속한 확보가 제한 요소가 되는 경우가 많습니다.

작용 기전: Fomepizole acts as a potent, competitive inhibitor of **alcohol dehydrogenase (ADH)**, the primary enzyme responsible for the initial metabolism of ethylene glycol. **The Toxic Pathway:** Ethylene Glycol → (via **ADH**) → Glycoaldehyde → Glycolate → Glyoxalic Acid → Oxalic Acid. *Note: Oxalic acid binds with systemic calcium to form calcium oxalate crystals, which precipitate in the renal tubules causing acute tubular necrosis and severe metabolic acidosis.* **Fomepizole's Action:** By competitively binding to **ADH** with an affinity roughly 8,000 times greater than that of ethylene glycol, fomepizole effectively blocks the first step of this cascade. * Ethylene glycol remains unmetabolized in the bloodstream. * The parent compound (which is only mildly CNS-depressant) is then safely and slowly excreted unchanged in the urine. * This prevents the life-threatening metabolic acidosis and acute kidney injury associated with the toxic metabolites.

동물 종별 용량

Cats

For treatment of ethylene glycol toxicity · Initially, 125 mg/kg slow IV ; at 12, 24, 36 hours give 31.25 mg/kg IV . · IV · Specific intervals (0, 12, 24, 36 hours) · 36 hours · Cats must be treated within 3 hours of ingestion. Treat supportively with supplemental fluids. Cats whose treatment began 4 hours post ethylene glycol had 100% mortality.

Dogs

For treatment of ethylene glycol toxicity · Initially load at 20 mg/kg IV ; at 12 hours post initial dose give 15 mg/kg IV ; at 24 hours post initial dose give another 15 mg/kg IV and at 36 hours after initial dose give 5 mg/kg; may give additional 5 mg/kg doses as necessary · IV · Specific intervals (0, 12, 24, 36 hours) · 36+ hours · May give additional 5 mg/kg doses as necessary if animal has not recovered or has additional ethylene glycol in blood.

용량은 면허 수의 전문가를 위한 임상 참고 자료입니다. 항상 최신 라벨과 개별 환자에 대해 확인하십시오.

투여 경로

금기

No labeled contraindications, but use with caution if the patient is already receiving ethanol therapy.

이상반응

Vein irritation and phlebosclerosis (if given rapidly or undiluted)
Anaphylaxis (rare)
Mild sedation (particularly in cats)

약물 상호작용

Ethanol · Fomepizole inhibits alcohol dehydrogenase; ethanol metabolism is reduced significantly and alcohol poisoning (CNS depression, coma, death) can occur. Concurrent use is generally not recommended. If used together, mandatory monitoring of ethanol blood levels is required.

모니터링

Ethylene glycol blood levels (to document diagnosis and determine if therapy can be discontinued after 36 hours)
Blood gases (acid-base status)
Serum electrolytes
Hydration status
Renal function tests (Urine output, urinalysis, BUN, serum creatinine)
Body temperature (especially in cats)

과용량

Overdosage may cause significant **CNS depression**. There is no specific antidote or treatment recommended for fomepizole overdose; provide supportive care as needed.

VetSheet 약물 레퍼런스는 면허 수의 전문가를 위한 임상 의사결정 보조 도구이며, 전문적 판단이나 제조사의 최신 라벨을 대신하지 않습니다.