4b – Management of Poisoned Animal

Question 1

Dermal decontamination

Answer 1

• Prevent transdermal absorption or prevent secondary exposure through self grooming (cats)
• Proper PPE for medical staff
• *washing with a gentle degreasing liquid dish soap
• Caustic materials: be extremely gentle
• Clip hair if needed
• Monitor temperature
• E-collar (cats)
• Avoid: high pressure and temperatures, aggressive scrubbing and soaps with essential oils

Question 2

Ocular decontamination

Answer 2

• To prevent corneal damage or damage to deeper structures
• Examination of eye should be performed to check for damage
• *rinse eye with tepid water (tap, saline or distilled) for 20-30mins
  o May need sedation
  o Owner can start at home
• Do NOT use contact lens solution
• Flush medial to lateral to prevent exposure to other eye

Question 3

Inhalation decontamination

Answer 3

• Multiple mechanisms: irritation, increased secretions, pulmonary edema, aspiration
• Can be complex mixtures (Ex. smoke from fire)
• *MOVE TO FRESH AIR: ensure adequate ventilation
• Occupational hazard: zinc phosphide exposures

Question 4

Enhanced elimination examples:

Answer 4

• Ion trapping
• Dialysis
• Forced diuresis

Question 5

Ion trapping

Answer 5

• Unknown for real world applicability
• Alter ionization status to prevent reabsorption
• Acidification for weak bases: urine
• Alkalinization for weak acids: urine

Question 6

Dialysis

Answer 6

• Blood is filtered externally and returned to patient
  o Availability depends on hospital

Question 7

Forced diuresis

Answer 7

• Promote excretion of renally-eliminated toxic agents
  o Risk of fluid overload

Question 8

What are some important considerations for antidotes?

Answer 8

• Most toxic ones do NOT have specific antidotes
• Certain ones only work within a certain time window
  o Ex. 4-MP for ethylene glycol needs to be administered before it is bioactivated to nephrotoxic metabolites
• Can have side effects
• May not be readily available
• Can be expensive
• Not a guarantee of success

Question 9

Managing the CNS symptoms

Answer 9

• Seizures: diazepam
• Tremors: methocarbamol (if just anxious=acepromazine)
• Agitation/hyperexcitable: sedation (ace or butorphanol)
• Hypoglycemic: IV dextrose (min 50% dilution)
• Cerebral edema
• *monitor mentation, blood gas for acid/base abnormalities, blood glucose, evidence of aspiration and signs of intracranial pressure

Question 10

Managing the CV and respiratory system

Answer 10

• Low BP: fluids
• Blood products
• Antiarrhythmics
• Oxygen
• Intubation
• Acid base and electrolyte abnormalities (hyperkalemia or hypercalcemia)
• *monitor HR/RR, oxygenation, ventilation, ECG, BP, electrolytes, acid/base status

Question 11

Managing the gastrointestinal

Answer 11

• Vomiting: anti-emetic, fluids
• Diarrhea: fluids, electrolytes
• Gastroprotectants
• GI bleed
• Monitoring PCV, CBC, chemistry, UA

Question 12

Managing the liver

Answer 12

• Hepatoprotectants
• Dietary change: reduce protein
• Dextrose
• Vitamin K
• Fluids with colloids (hold fluid in vascular space)
• Lactulose: preventative to change metabolism to decrease ammonia in blood
• Ascites
• Monitor chemistry panel, mentation, MM/plasma colour

Question 13

*what are some hepatoprotectants in vet med? (don’t need to know the mechanism): most of them are antioxidants

Answer 13

• N-acetylcysteine (NAC)
• S-adenosyl-L-methionine (SAMe)
• Silymarin (milk thistle)
• Ursodexycholic acid
• Vitamin E

Question 14

Managing the kidney

Answer 14

• Fluids: diuresis
• BP support
• Dialysis
• Dietary change
• No ‘nephroprotectants’
• Monitor chem panel: GFR (urea, creatinine, electrolytes), urinalysis

Question 15

What are some other systems and considerations for managing a patient

Answer 15

• Temperature: hypo or hyperthermia
• Pain management
• General nursing care
  o Bladder management
  o Nutritional support
  o Rotating patient
  o Catheter care
  o Handling/environment that minimizes stress and fear
  o TLC!!

Question 16

Intravenous lipid emulsion (IVLE)

Answer 16

• Developed to treat lidocaine overdose in humans
• Act as nutritional + energy support
• *acts as a sink for LIPOPHILIC DRUGS=prevents absorption of drugs from blood stream
  o Ex. ivermectin, baclofen, lidocaine, marijuana
• Monitor patient for lipemia

Question 17

IVLE side effects: considered safe with RARE side effects

Answer 17

• Fat overload syndrome
  o High administration rates
  o Excessive volume
• Fat embolism
• Hyperlipidemia
• Pancreatitis
• Contamination of lipid solution

Question 18

Cholestyramine

Answer 18

• Questran: anti-lipemic, bile acid sequestrant
• May be useful for lipophilic poisons with a high degree of enterohepatic circulation
• *combines with bile acids in intestines to form a complex that is excreted in feces
• Mix powder with water or canned wet food
• *side effect (humans): constipation

Question 19

What are the contraindications with cholestyramine?

Answer 19

• Pregnant/lactating animals
• Biliary obstruction

Question 20

What are some cautions with cholestyramine?

Answer 20

• Interferes with absorption of fat-soluble vitamins
• Interferes with absorption of oral medications
• Patients with kidney problems, hypovolemia
• *can overdose