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Toxicology > 2-Diagnosis and Treatment of Toxicity > Flashcards

2-Diagnosis and Treatment of Toxicity Flashcards

1
Q

Managing the mystery poisoning patient

A

Assess the patient, evaluate for immediate life-threatening problems

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2
Q

Top three chemical toxicants

A

Ethylene Glycol

Rodenticide

Organophophates

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3
Q

Known exposure

A

Owner saw or highly suspects that animal ingested a particular compound

Initial contact often by phone

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4
Q

Uknown exposure

A

Animal presents with symptoms but no known cause

Much more difficult to diagnose and treat

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5
Q

Ass the patient and follow the steps

A

Evaluate for life-threatening problems and treat

  1. CV function and output
  2. Temperature
  3. CNS, seizures
  4. Hemorrhage
  5. Respiration
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6
Q

1) Respiratory maintenance

A

Unconscious, paralyzed, and severe respiratory distress patients are candidates for intubation

  • Anesthetize conscious animals
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7
Q

Ventilation may be needed if

A

Hypoventilation and hypercapnia (PCO2 > 45 mmHg) normal is like 31 I think

Metabolic acidosis (venous pH 7.35) normal is 7.4 tx sodium bicarb

Hypoxia (PaO2<65mmHg) treat with 40% oxygen normal is 90-110

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8
Q

Prevent aspiration of vomitus

A

Head below the body

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9
Q

2) Control CNS activity

Hyperactivity

A

Seizures

  • Diazepam
    • Inc inhibition of GABA Neuro transmitter
    • treatment of choice (0.5 mg/kg IV)
    • repeat every 10 minutes for up to 2 times
  • Phenobarbital (more potent)
    • Barbituates, not GABA specific (compl. inh CNS)
    • (1-5 mg/kg IV to effect) or pentobarbital
  • Methocarbamol
    • (Robaxin 40-200 mg/kg IV from low dose to effect)
    • Skeletal muscle relaxation to control seizures
    • Use in Stichnine poisonings
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10
Q

2) Control CNS activity

Depression

A

Analeptics

  • Can make stabilization difficult

Doxapram

  • Increased respiratory rate (~1-10 mg/kg)
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11
Q

3) Control cardiovascular function

Tacycardia and Arrhythmias

A

Correct Acid-base, electrolyte or fluid disorders

Lidocaine

  • controls arrhythmias
  • (1-2 mg/kg, IV / 40-80 micrograms/kg/min)

Propranolol

  • adrenergic B-2 agonist (beta blocker, slows heart)
  • dogs: 0.1-2 mg/kg PO TID
  • cats: 2.5-5 mg
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12
Q

3) Control cardiovascular function

Hypertension

A

Nitroprusside

  • dialates blood vessels (ex: viagra)
  • constant IV infusion (1-10 microgram/kg/min)

Hydralazine

  • Causes smooth muscle dilation
  • (0.5-1 mg/kg for cats, higher for dogs)
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13
Q

3) Control cardiovascular function

Fluid therapy

A

Balanced electrolyte solution for shock and dehydration

  • monitors kidney function

Monitor urine output (> 1ml/kg/hr)

Inotrpic drugs

  • DOBUTAMINE (pos inotropic)
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14
Q

4) Stabilize the patient

A

Priority in animals presenting with severe clinical signs

  • hyper/hypothermia (do slowly to prevent shocking and seizures)

Obtain venous access and draw for laboratory profile and potential diagnostic testing

  • 3cc EDTA tube
  • 2 serum tubes

Once patient is stable, perform more comprehensive physical exam

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15
Q

5) Obtain complete history

A

Most important/overlooked parts of diagnositc toxicity

Once patient is stable, question owner fully to narrow down causes

Four themes

1) prior health status
2) clinical status/signs
3) environment
4) diet

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16
Q

Health history

What is important

A
  1. Vaccination history
  2. Medications
  3. Previous dz, infectious, genetic, viral, bacterial
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17
Q

Current clinical history

A
  1. How long was the problem present?
  2. When was the animal observed sick?
  3. If animals found dead, when were they healthy?
  4. Size of herd?
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18
Q

Clinical signs

CNS

GI

RENAL

A

CNS

  • ataxia
  • seizures
  • depresseion
  • head pressing

GI

  • vomiting
  • diarrhea
  • rumen stasis
  • gut sounds
  • constipation

Renal

  • hematuria
  • crystalluria
  • polyuria
  • glycosuria
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19
Q

Clinical signs

HEPATIC

CARDIAC

HEMATOPOIETIC

A

Hepatic

  • jaundice

Cardiac

  • arrhythmias
  • tachycardia
  • bradycardia

Hematopoietic

  • hemorrhage
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20
Q

Clinical signs should not…

A

be used to dx a particular toxicosis

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21
Q

History

Environment

A

Indoor only

Indoor/outdoor

Fenced yard vs roaming

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22
Q

Diet

A
  1. New batch, brand, type of diet, confined or roaming
  2. Method of feeding
  3. Presence of moldy or spoiled food
  4. Drinkig water source
  5. Water supply changes
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23
Q

Formulate a rule-out list

A

Populate list of ddx

  • still possible causative agent not a poison
    • infectious
    • metabolic
    • other non-toxic
24
Q

Acute onset of seizures from non-toxicosis

A

Epilepsy

  • rule-out: hx of seizures

Trauma

  • rule out: hx, look for contusions, PE

Hypoglycemia

  • rule out: blood test

Infections

  • rule out: blood test

Hypoxia

25
Q

Ancillary support

General supportive care…

A

Insure adequate urine output

Monitor respiratory, cardiac and neurological status

Manage clinical signs as the develop

Manage secondary hepatic or renal injury

Administer GI protectants/anti-emetic

26
Q

Sympotmatic care

A

Maintain body temp

Alleviate pain

Prevent irritation of skin, membranes with demulcents, milk sucralfate

27
Q

Decontamination measures

A

Emesis

Activated charcoal

Cathartics

  • Things that stimulate movement of GI
  • IE: metamucil
28
Q

Emesis

A

Prevent toxicant absorption

Should be done within 60 minutes of exposure

Contraindications

  • gasoline
  • acidic/basic compounds: DILUTE
  • non-serious toxicoses
29
Q

Emesis rule of thumb

A

1) justified in that specific case

  • ethylene glycol
  • strichnine
  • whole bottle of pills

2) toxic dose is ingested
3) no vomiting has yet occured
4) activated charcoal is not an option
* gas doesn’t bind

*little evidence that emesis improves the clinical outcome in poisoned animals

*save some vomit for analysis

30
Q

Activated charcoal

A

Animal may eat if mixed with food

Earlier=more effective

2-8 g/kg

Give 4-6 hours

Caution in sedated animals without airway protection

Contraindications

  • corrosive agents: toilette bowl cleaner
  • non-polar materials
31
Q

Charcoal rule of thumb

Give charcoal if:

A

1) substance in known/thought to be absorbed
2) ingestion was very recent
3) chemical undergoes enterohepatic circulation
4) substance is sustained release
5) animal can tolerate it
6) no need to admin oral meds within 2 hours of giving charcoal

32
Q

Things charcoal doesn’t bind to

A

acids

alkalis

alcohols/glycols

metals

oils

petroleum

distillates

detergents

33
Q

Cathartics

A

Decrease GI transit time, increase movement of toxins and decreases possible absorption of toxin

Use as adjunct with activated charcoal to reduce transit time

Mineral oil: don’t use with activated charcoal

Saline cathartic:

  • MgSO4 or
  • Na2SO4
  • Can add to charcoal or use later
34
Q

Corrosives technique

(gasoline, acids/bases, emulsants)

A

Use dilution instead of emesis

  • milk
  • water
  • eggs

Lipid infusion

  • organophosphates, ivermectin
  • new treatment
  • off label
35
Q

Summary

Activated charcoal

A

Primary Use:

  • Absorbent material with large surface area
  • Binds most drugs

Limitations/contraindications

  • Some toxins not absorbed
36
Q

Summary

Apomorphine

A

Primary use

  • Emetic agent for dogs, pigs

Limitations/contraindications

  • May cause prolonged vomiting
37
Q

Summary

Xylazine

A

Primary Use

  • Emetic agent for cats

Limitations/contraindications

  • May cause hypotension and bradycardia
38
Q

Summary

Gastric lavage

A

Primary Use

  • Sustained-release products
  • Massive overdoses

Liminations/contraindications

  • Invasive
  • Risk of perforation/rupture
39
Q

Summary

Salt water, hydrogen peroxide

A

Primary use

  • For at-home induction

Limitations/contraindications

  • Might delay treatment from veterinarian
40
Q

Summary

Surgical removal

A

Primary Use

  • Lead, pennies, etc

Limitations/contraindications

  • Invasive
41
Q

Summary

Whole bowel irrigation

A

Primary use

  • Removal of sustained-release pharmaceuticals
  • For toxins not absorbed by activated charcoal

Limitations/contraindications

  • Primarily for small aniamls
  • May cause prolonged diarrhea
  • Safer than gavage
42
Q

Chemical analysis

Blood

A

Test for

  • Heavy metals
  • Anticoagulants
  • antifreeze
  • cholinesterase
  • cyanide
  • chlorinated pesticides

Comments

  • use EDTA or heparin
43
Q

Chemical analysis

Serum

A

Test for

  • some metals (Cu, Nz)
  • nitrate
  • nitrite
  • ammonia

Comments

  • separate clot from serum
44
Q

Chemical analysis

urine

A

Test for

  • alkaloids
  • some metals
  • antibiotics
  • drugs
  • oxalates
  • cantharidin

Comments

  • freeze
  • especially useful for paraquat or diquat
45
Q

Chemical analysis

liver

A

Test for

  • metals
  • aflatoxin M1
  • alkaloids
46
Q

Chemical analysis

vomitus

A

Test for

  • various poisons
  • heavy metals
  • anticoagulants
  • antifreeze
  • pesticides

Comments

  • Indicates recent exposure
47
Q

Chemical analysis

Kidney

A

Test for

  • metals (As, Pb)
  • Phenolic compounds
  • oxalates

Comments

  • freeze
48
Q

Chemical analysis

Brain

A

Test for

  • Chlorinated pesticides
  • pyrethrins
  • cholinesterase
  • metals

Comments

  • freeze
49
Q

Chemical analysis

Fat

A

Test for

  • chlorinated pesticides
  • dioxins
50
Q

Anion gap

Common toxins associated with an increased anion gap

A

Calculation: Na+ + K+ - Cl- + HCO3-

Toxicans associated with an increased anion gap

  • Ethylene glycol
  • Ethanol
  • Iron
  • Methanol
  • Salicylates (aspirin)
  • Strychnine

Normal anion gap 10-12 mEq/L

  • >30mEq/L clinically significant
51
Q

Toxins associated with CNS depression

A

Ivermectin

Cholinesterase inhibitors

Organophosphate insecticides

Carbamate insecticides

Blue-green algae

Slaframine (muscarinic signs only)

Lead

Locoweed

Ethylene glycol

52
Q

Common toxins associated with seizures

A

Bromethalin: mitochondrial inhibitor, reduces ATP production

Chocolate: theobromine

Lead

Organochlorine insecticides

Pyrethrins/pyrethroids

Strychnine

Water deprivation/sodium ion toxicosis

Water hemlock: most dangerous of poisonous N.A. plants

53
Q

Help for Managing Toxicoses

A

ASPCA

National Animal Poison Control Center

College of Veterinary Medicine

Chemical Manufacturer

54
Q

Info from callers

A

Name, phone number

Signalment, breed

What, how much, how long ago

Clinical signs, when did they start

55
Q

Diagnosing unknown toxicity summary

A

1) History

  • Health history
  • Current clinical history
  • Environment
  • Diet

2) Clinical signs
3) Pathology/Necropsy
4) Chemical Analysis

56
Q

Prevent further exposures

A

Change pasture, feed, water

Remove baits, old pesticides

Bathe or flush for cutaneous or ocular exposures

  • use small amount of detergent, rinse well
  • may need to clip animal

Educate your clients

57
Q

Managing poisoned/suspected poisoned patients

SUMMARY

A

Assess ABCs

  • Airway
  • Breathing
  • Circulation

Control seizures, cardia

Metabolic derangements

History

GI decontamination

Supportive and symptomatic care

Toxicology (10 decks)

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