Overdose of low molecular weight heparin in an infant with stage 5 chronic kidney disease treated with hemofiltration.
Beejal Patel, Matko Marlais, Mary Mathias et al.
✦ AI-curated · Sources linked
Case in brief
An infant with stage 5 chronic kidney disease received a prolonged accidental overdose of dalteparin, a low molecular weight heparin cleared primarily by the kidneys. She developed a falling haemoglobin, a perinephric hematoma, and oozing at venipuncture sites. Because drug clearance was difficult to predict and bleeding risk was significant, continuous veno-venous hemofiltration (CVVH) was used. During CVVH, anti-Xa levels showed a steady downward trend over 24 hours, and the treatment was reported as successful.
What made this case unusual
The case describes CVVH as a successful approach to LMWH overdose in an infant with stage 5 CKD, where impaired renal clearance made dalteparin elimination difficult to predict.
Diagnostic / clinical pearl
In severe kidney disease, LMWH clearance may be substantially impaired; a bleeding presentation after overdose should be considered alongside anti-Xa monitoring.