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TOXICOLOGIC EMERGENCIES
• Signs will vary depending on character of toxic compound• Toxicity can result from exposure via many routes
• Ingestion• Inhalation• Skin contact• Injection
Toxicologic Emergencies
• Top 10 Toxicoses (2005)– Human medication (ibuprofen, acetominophen, anti-depressants)– Insecticides—flea and tick– Rodenticides—anticoagulants– Veterinary medication– Household cleaners—bleach, detergents– Plants—sago palm, lily, azalea– Herbicides– Chocolate—highest in food category– Home improvement products—solvents, adhesives, paint, wood glue– Fertilizers
Toxicologic Emergencies
• HISTORY• ASSESS• STABILIZE
– Administer oxygen– Control seizures– Correct cardiovascular abnormalities
• DECONTAMINATION– Emetics– Activated charcoal– Gastointestinal protectants
• CONTROL CLINICAL SIGNS• GOOD NURSING CARE• PREVENT FURTHER EXPOSURE
Toxicologic Emergencies
• Ocular exposure• Rinse eyes with copious saline for 20-30 min• Chemical burns treated with lubricating ointment and suture lids
closed• Use corticosteroids only if corneal epithelium is
intact• Skin exposure
• Bathe with mild detergent (liquid dish soap)• Bather should wear protective clothing (gloves, goggles)
Toxicologic Emergencies: external exposure
• Ingestion • Induce vomiting—if chemical not caustic; animal conscious, not seizing
• Syrup of ipecac, apomorphine, Xylazine, H2O2 (not reliable), salt (not recommmended)• Dilute caustic substances with milk, water• Gastric lavage—large bore stomach tube; light anesthesia w/ endotracheal tube• Administer absorbents—activated charcoal inhibits GI absorption
• Give orally or via stom tube• Enemas/cathartics to eliminate toxins more rapidly
Toxicologic Emergencies
Toxicological Emergencies
ACTIVATED CHARCOAL WITH OR WITHOUT A CATHARTIC
• Methylxanthines (caffeine, theobromine, theophylline
• Found in: coffee, tea, chocolate, other stimulants• Toxic Dose of caffeine and theobromine in dogs:
100-200 mg/kg; (other sources: 250-500mg)• Milk Chocolate—44-60 mg/oz
Dark chocolate-150 mg/ozBaking Chocolate—390-450 mg/oz
Toxicologic Emergencies
• Clinical signs of methylxanthine/chocolate toxicosis (caffeine, theobromine)
– Increased HR, RR– Anxiety– Vomiting/diarrhea– Seizures, coma– Cardiac arrhythmias
• Treatment– Induce vomiting– Activated charcoal– Control seizues– Fluid therapy
Toxicologic Emergencies
• Rodenticides1. Anticoagulants
(warfarin, pindone, bromadiolone, brodifacoum)
• Work by binding Vit K, which inhibits synthesis of factors II, VI, IX, X
• This effect occurs within 6-40 h in a dog; effect may last 1-4 wk
Toxicologic Emergencies
• Clinical signs (occur after depletion of clotting factors)– Lethargy– Vom/dia with blood; melena– Anorexia– Ataxia– Dyspnea – Epistaxis, scleral hemorrhage, pale mm
• Treatment– Vit K: 3-5 mg/kg PO for up to 21 d depending on anticoagulant used– Induce vomiting; activated charcoal– Whole blood transfusion if anemic
Toxicological Emergencies
– Rodenticides2. Cholecalciferol—Vit D3; used in Quintox, rampage, Rat-Be-Gone
-causes Ca++ reabsorption from bone, intestine, kidneys causing hypercalcemia (>11.5 mg/dl) and cardiotoxicity
• Clinical signs (12-36 h after ingestion)– Kidney failure
» Anorexia» Vomiting» Tissue mineralization
– Cardiovascular abnormalities» Muscle weakness» arrhythmias
Toxicologic Emergencies
• Diagnosis– Hx of exposure– Usually discovered on routine Chem panel (↑blood Ca++)
• Treatment– Induce vom/activated charcoal if ingestion occurred with 2 h– Furosemide x 2-4 wk; increases Ca++ excretion in urine– Prednisone x 2-4 wk; decreases Ca++ reabsorption from bones/intesine– Calcitonin to lower blood Ca++ concentration
Toxicological Emergencies
– Rodenticides3. Bromethalin
-uncoupler of oxidative phosphorylation in CNS (stops production of ATP)-Causes cerebral edema-found in Assault, Vengence, Trounce-Toxic Dose Dog: 4.7 mg/kg
Cats: 1.8 mg/kg
Clinical signs (>24 h after ingestion of high dose; 1-5 d--low dose)– Excitement, tremors, seizures– Depression, ataxia
• Rx (will take 2-3 wk to know if animal will survive)– Purge GI tract if exposure recent– Reduce cerebral edema with Mannitol and glucocorticoids– Seizure control with Diazepam and Phenobarbital
Toxicologic Emergencies
• Acetaminophen• Common OTC drug for analgesia• Toxic dose: Dog—160-600 mg/kg
Cat—50-60 mg/kg (2 doses in 24 h is almost always fatal)• Clinical signs (starts within 1-2 h of ingestion)
– Vomiting, salivation– Facial and paw edema– Depression– Dyspnea– Pale mm– Cyanosis due to methemoglobinemia
• Px—poor• Rx
– Induce vom/activated charcoal– Antidote: N-Acetylcysteine (loading dose of140-280 mg/kg PO, IV, then at 70 mg/kg PO, IV QID x
2-3 d
Toxicologic Emergencies
Toxicological Emergencies
– Metals• Lead toxicity more common in dogs than cats
– Source» Lead paint (prior to 1970’s) is primary source» Batteries, linoleum, plumbing supplies, ceramic containers, lead pipes, fishing sinkers,
shotgun pellets– Clinical signs (Usually involves signs of GI and nervous systems)
» Anorexia» Vom/dir» Abd pain-CNS signs do not show initially» Blindness, seizures, ataxia, tremors, unusual behavior
Toxicologic Emergencies
–Metals• Lead toxicity
– Dx» Large # nucleated RBC’s; basophilic stipling » Blood lead conc >35 μg/ml
– Rx» Remove lead from GI tract (cathartic, Sx)» Chelators (to bind the Pb in blood stream and hasten its removal)
-Calcium EDTA (ethylene diamine tetra acetic acid)-Penicillamine
» IV fluids for dehydration and to speed removal via kidneys» Diazepam, Phenobarbital to control seizures
Toxicologic Emergencies
– Metals• Zinc Toxicosis
– Usually from ingested pennies, galvanized metal, zinc oxide ointment
• Clinical signs– Vomiting– CNS depression– Lethargy
• Dx– Hx of exposure– Clinical signs
• Rx– Remove metal objects endoscopically or
surgically– IV fluid therapy– Ca EDTA chelation
Toxicologic Emergencies
• Ethylene Glycol (antifreeze; sweet taste)• Lethal dose: Cat—1.5 ml/kg
Dog—6.6 ml/kg• Signs (onset within 12 h of ingestion)
– CNS depression, ataxia (may appear intoxicated)– Vomiting– PD/PU– Seizures, coma, death– Acute renal failure
• Dx– Hx, signs– Ethylene Glycol Poison Test—an 8 min test used in cats and dogs– Calcium oxalate crystals
• Rx– Emesis, adsorbents if ingestion within 3 h of presentation– IV fluids, NaBicarb for acidosis– Ethanol inhibits ethylene glycol metabolism Dogs (Cats): 20% ethanol—5.5 (5.0) ml/kg q6h x 5, then q8h x 4 – 4-methylpyrazole has been shown to be effective
Toxicologic Emergencies
Toxicological Emergencies
THE PROBLEMTHE SOLUTION
• Snail Bait (Metaldehyde, methiocarb)– Metaldehyde mechanism unknown– Methiocarb is a carbamate and parasympathomimetic
• Signs– Hypersalivation– Incoordination– Muscle fasciculations– Hyperesthesia– Tachycardia– Seizures
• Rx– Emesis and absorbents– Pentobarbital, muscle relaxants to control CNS hyperactivity
Toxicologic Emergencies
• Garbage Toxicity– Common in dogs; not in cats– Enterotoxin-producing bacteria include
Strep, Salmonella, Bacillus• Signs (within min to h after ingestion)
– Anorexia, lethargy– Vom/dia– Ataxia, tremors– Enterotoxic shock can cause death
• Rx– IV Fluid therapy– Broad-spec antibiotics– Intestinal protectants– Muscle relaxers or Valium may be needed to control tremors– Corticosteroids to counter endotoxic shock
Toxicologic Emergencies
• Insecticides• Pyrethrins, Pyrethroids, Permethrins
– Common ingredients of flea/tick sprays, dips, shampoos, etc– If used according to instructions, toxicity rarely occurs; if overused, toxicity can result
• Signs– Hypersalivation– Vom/dia– Tremors, hyperexcitability or lethargy– Later, dyspnea, tremors, seizures can occur
• Rx– Bathe animal to remove excess– Induce vomiting/charcoal/cathartics for ingestion– Diazepam may be necessary for mild tremors– Methocarbamol, a muscle relaxer, for moderate-severe tremors– Atropine for hypersalivation and bradycardia
Toxicologic Emergencies
– Insecticides• Organophosphates and Carbamates
– Inhibit cholinesterase activity (break down of Ach is inhibited)– Highly fat-soluble; easily absorbed from skin and GI tract– Found in dips, sprays, dusts, etc for fleas and ticks, and flys
• Signs– Salivation– Lacrimation– Urinary incontinence– Diarrhea– Dyspnea– Emesis, gastrointestinal cramping-May progress to – Seizures, coma, resp depression, death
• Rx– Bathe animal– Charcoal if ingested– Atropine (0.2-0.4 mg/kg; half IV, half IM or SQ)– Praloxime chloride (20 mg/kg BID till signs subside)—reactivates cholinesterase
Toxicologic Emergencies
• Plant Toxicity– Most common in confined and juvenile animals– Usually from ornamental, indoor plants– Severity varies with plants– ID scientific plant name (florist, greenhouse)
• Araceae family (most from this family) – Dumb cane, split-leaf philodendron– Contain calcium oxalate crystals
• Signs– Hypersalivation, oral mucosal edema, local pruritis-Large amount of plant may cause:– Vomiting, dysphagia, dyspnea, abd pain, vocalization, hemorrhage
• Rx– Rinse mouth with milk or water to remove Ca Oxalate crystals– GI decontamination (protectants) may be needed
Toxicologic Emergencies
Dumb Cane (Dieffenbachia)• aka Mother-in-law’s tongue• Oral irritation; intense burning,
excess salivation
Split Leaf Philodendron• Oxalate crystals like Dieffenbachia• Oral irritation; intense burning, excess salivation
Lily of the Valley• Contains cardiac glycosides• Cardiac arrythmias, death
Azalea (Rhododendron) • Hypotension, cardiovascular collapse, death
Sago Palm
• ALL PARTS OF THE PLANT ARE TOXIC• Coagulopathy• Liver failure
• Phone advice to give owners (legal issues)• Protect yourself from exposure before handling animal
• Gloves, protective clothing• Protect yourself from animal because poisoned animals may act strangely• Protect animal from further exposure by removing pet from source• Bring sample of vomit, feces, urine• Bring container/package that toxin was in and a sample of the toxin (plant
material, rat bait, etc)
Toxicologic Emergencies