Overdose of low molecular weight heparin in an infant with stage 5 chronic kidney disease treated with hemofiltration.

Low molecular weight heparin (LMWH) is widely used for the treatment and prevention of many venous thromboembolic disorders. LMWH acts through its ability to potentiate inhibition of factor Xa. LMWH undergoes primary renal excretion and therefore its elimination can be severely impacted by kidney disease. We report on the case of an infant with stage 5 chronic kidney disease (CKD) who received a prolonged accidental overdose of dalteparin. The infant was symptomatic with a falling haemoglobin, perinephric hematoma, and oozing venipuncture sites. Given the inability to predict drug clearance in this infant and her significant risk of bleeding, she underwent a successful trial of continuous veno-venous hemofiltration (CVVH) for the treatment of LMWH overdose. Whilst on CVVH, a steady downward trend in anti-Xa levels over 24 h was observed.