Now that this modality is available it can really save lives, but should be used appropriately. We had more risk in the past than we have now with this newer technology, but we also need clinical experience. These guidelines are based on these first five years we've been using this. They're going to be updated as we acquire more and more experience.
Dr. Emmanuelle Butty Publishes Guidelines on Emerging Treatment Options for Pets with Toxicities
Hemoperfusion can clear the blood of selected toxins quickly and more safely with new technologies
Among the very first class of diplomates from the new American College of Veterinary Nephrology and Urology (ACVNU), Dr. Emmanuelle Butty (she/her) is hitting the ground running as the lead author of a study detailing standard-of-care guidelines and best practices for treating veterinary toxicity cases with blood purifying hemoperfusion.
Published in the February 2026 edition of The Veterinary Journal, the study titled “Hemoperfusion for veterinary toxicities: International renal interest society best practices consensus guidelines,” is based on veterinarians’ clinical experiences treating patients with hemoperfusion, a therapy gaining ground after new technological advances.
“Working with colleagues at different universities and figuring out best practices is wonderful, to not only help the patients we are treating, but hopefully by creating these guidelines, helping animals all over the world,” says Butty, assistant clinical professor in the Department of Small Animal Clinical Sciences at Cummings School of Veterinary Medicine at Tufts University. Butty is part of the Internal Medicine service at Henry and Lois Foster Hospital for Small Animals (FHSA).
Over the past five years, Butty and the extracorporeal therapy team at FHSA have treated hundreds of cases of dogs and cats that ingested poison or a toxic dose of medication.
“We see it way too often, about a case every seven to ten days on average,” says Butty. “Toxic dose of a medication is by far what we see the most. The dog is looking for a treat, ends up in a jar of medication, and can have this massive overdose.”
Hemoperfusion is a type of extracorporeal therapy (ECT) that treats blood outside of the body to remove toxins. ECTs have started to figure more prominently in emergency medicine and critical care to treat toxicities. During hemoperfusion, the patient’s blood is pumped out of the body through a catheter in the jugular vein and runs through an adsorptive device to clear the blood of toxins before returning the clean blood back into the patient. Originally, charcoal was used in hemoperfusion to clear toxins, but it led to complications because charcoal also binds to other blood components (such as platelets and blood sugar), which can cause severe complications.
“Now we have new technologies that allow us to create devices that are more selective and bind to what we want and let the rest stay in the blood,” says Butty.
Two new adsorptive devices were introduced several years ago that have significantly reduced the risks of hemoperfusion. Because the technology is relatively new, literature on best practices for hemoperfusion is limited, and no clinical guidelines exist.
The International Renal Interest Society (IRIS) set out to establish guidelines for ECT modalities and reached out to veterinarians across the country regularly treating patients with hemoperfusion. A team of clinicians with the most experience on the new devices worked together for three years to develop the IRIS Hemoperfusion Study Group Guidelines. The authors included Butty and several other specialists in emergency medicine and critical care, internal medicine, and urology, from North Carolina State University, the University of California, San Diego, and the University of Pennsylvania. Butty has also contributed to a number of published studies on treating drug toxicity with therapeutic plasma exchange.
The group conducted extensive data collection on patients they treated with hemoperfusion—tracking toxin levels at various stages of treatment and effectiveness based on the toxin. They studied available literature on hemoperfusion in human and veterinary medicine, and worked closely with developers of the two devices to make improvements.
In the study, the authors describe four modalities of extracorporeal decontamination to treat toxicity: high-efficiency intermittent hemodialysis, continuous renal replacement therapy, therapeutic plasma exchange, and hemoperfusion. The paper outlines the advantages and disadvantages of each based on the type and quantity of toxin ingested. The study identifies situations in which hemoperfusion is the optimal treatment, when more than one treatment should be considered, best practices and safety guidelines in administering hemoperfusion, the importance of proper training, recommendations for medical management, and associated risks of hemoperfusion.
“Now that this modality is available, it can really save lives, but should be used appropriately,” says Butty. “We had more risk in the past than we have now with this newer technology, but we also need clinical experience. These guidelines are based on the first five years we've been using this. They're going to be updated as we acquire more and more experience.”
Last fall, a Boston Terrier that overdosed on ibuprofen arrived at FHSA, unable to walk and nonresponsive. Ibuprofen at toxic levels can severely alter the brain and neurological system. After four hours of hemoperfusion, the dog trotted out with his owner. The blood samples collected during the session confirmed that the hemoperfusion treatment markedly decreased the drug levels.
“He was lateral, not responding, and suddenly we have a happy dog. That's extremely rewarding,” says Butty. “When it is safe for the patient, and we have the owner’s approval, we are collecting blood samples to understand better the impact we are making and when this type of therapy should be recommended.”
Ibuprofen is the most common toxicity; the extracorporeal therapy team at FHSA has treated more than 50 of these patients.
“Prevention is the best medicine—put medications away,” says Butty. “For all accidental toxin ingestions, the faster we intervene, the better the outcome. We are always running against time. Don’t take the ‘watch and see’ approach.”
Extracorporeal therapies can only have a direct impact on toxins present in the blood, not once toxins reach the tissues. Butty stresses that with any toxicity, pet owners should seek treatment immediately.
A 10-year-old Golden Retriever arrived at FHSA this winter after ingesting rat poison (bromethalin) two days earlier. FHSA clinicians have seen an influx of pets eating rat poison, which can cause neurologic disease and death. While most of these patients were treated with hemoperfusion soon after ingesting the rat poison, and the treatments showed improvement after analyzing toxin levels, this was FHSA’s first case using hemoperfusion to treat a patient so severely affected with the toxin in his system for such a long duration. Hemoperfusion seems to have impacted the outcome, but toxin levels are still pending to better understand its impact.
“This dog is doing fantastic today, so that's wonderful,” says Butty.
Raising awareness of hemoperfusion to treat toxicity is paramount. Now that the guidelines are published, Butty and team will advise ECT centers on integrating hemoperfusion into their modality options and animal poison control centers on communicating ECTs as options to pet owners. The study was published in The Veterinary Journal as an open article, so that all clinicians can access and follow the guidelines.