Anticoagulant Toxicity - Dog - VIN Flashcards
These are derivatives of _______
Dicoumarol, a mycotoxin
AR inhibit which enzyme?
Vitamin K epoxide reductase
It stops recycling of vitamin K
How many generations ?
First and second
Which generation is more harmful and more common in toxicosis cases?
2 nd
Most common concentration is ?
0.0025 to 0.25 %
Name the vitamin k dependent factors
2,7,9,10
How long after infestion of toxic dose does coagulopathy develop?
3-7 days
Does PT become prolonged first or PTT
PT
Clinical hemorrhage not seen until both PT and PTT are SIGNIFICANTLY elevated
What dose merits veterinary management?
1st gen = >0.5 mg/kg
Others > 0.02 mg/kg
Can transdermal exposure cause coagulopathy?
No
Can ingestion of single poisoned rodent cause toxicosis?
UNLIKELY
possible if regular consumption ie barn cats
Whats limitation of measuring coagulation paramters?
Might not be accurate if pet has SEVERE liver disease
Does fdp increase in all cases?
50 percent only
Immediate rx?
- stabilise life threatening signs first
- decontamination
Some info about stabilizing life threatening signs?
- rx seizures if present
- provide o2
- provide blood replacement as needed(whole blood or FFP)
What does decontamination include?
- emesis within 4-6 hrs
- activated charcoal after emesis
Specific rx?
Vitamin K1
Oral route preferred
Other option is SQ
Can give injectable sol as oral in small patients
Can we give vitamin k 3?
No
Only vitamin k1
Dose of vitamin k1?
2.5-5 mg/kg PO/SQ SID or divided BID
- don’t give IV → anaphylactic shock*
Takes 6-12 hr for new clotting factors to form
give with fatty meal
Duration of initial rx with vit k1?
Warfarin 2 w
Bromadiolome 3 w
Others 1 m
Rx beyond this time frame might be needed if large dose infested.
Supportive care?
- avoid exercise for 1 week after therapy ended
- avoid IM inj
- avoid highly protein bound durgs such as nsaids
- avoid other drugs such as metronidazole, neomycin, cimetidine, salicyclates
When to recheck pt?
2-3 d post stopping k1
What if pt still high on recheck?
R/o reexposure and continue it for 1-2 weeks more then again recheck 2-3 days post stopping
Prognosis?
Good if prompt dx and rx
Otherwise it is second most common toxin causing death in comapnion animals
Differentials ?
Liver failure Other causes of vit k deficiency Dic Coagulation factor deficiency Thrombocytopathia Vw disease
Initial signs are vague; later on it depends on the location of bleeding
T/F
T
most common presentation is DYSPNEA
-eg: brain → seizure
- Bloody vomit and diarrhea are least common presentation
Most common presentation in ACR toxicity is ?
DYSPNEA
How long does if take for clotting factors to form after vitamin K1 ?
6-12 hr
So if active bleeding then pet needs direct clotting factors i.e. whole blood,fresh plasma,FFP
What if pet ingested non toxic dose of ACR?
- close observation
- check PT in 48 hrs
- if PT normal → no Rx needed
- if PT high → follow Rx protocol
5 most common symptoms in ACR toxicity?
• Lethargy
• Anorexia
• Increased RR/RE(dyspnea)
• Hemoptysis
• Lameness
Initial signs are vague; later signs depend on location of bleeding; bloody vomit and diarrhea are least common symptoms
Most common symptom is DYSPNEA
Dose of FFP and whole blood if needed in case of acute bleeding in ACR toxicity?
FFP = 10-20 ml/kg IV over 1-2 h
WB = 20-40 ml/kg
If anemia then (FFP + pRBC) or WB can be chosen
If no anemia then FFP can be chosen
