Approach to a Poisoned Pet

Question 1

What are the top 10 toxins?

Answer 1

OTC meds
Food
Human prescription meds
Chocolate
Plants
Household toxins
Veterinary products
Rodenticides
Insecticides
Recreational Drugs

Question 2

5 main areas of acute management of intoxication

Answer 2

ABCDs (airway, breathing, circulatory)
Control hemorrhage, seizures and muscle tremors
Assess metabolic and medical abnorms/ plan for tx
GI contamination
Supportive care

Question 3

Decontamination

Answer 3

Ocular decontamination (flush with water)
Dermal decon (PPE, soap)
GI decon
Ion exchange resins
Cathartics
Activated charcoal

Question 4

GI contamination

Answer 4

Purpose: ↓ absorption
Emesis, gastric lavage and whole bowel irrigation

Question 5

Contraindications to emesis

Answer 5

Going up hurts like going down
Oil/ petroleum
↑ chance of aspiration
Seizing, sedated animal

Question 6

Home use emetics

Answer 6

7% syrup Ipecac
3% peroxide (NOT CATS)
Table salt
Liquid dishwashing liquids

Question 7

Veterinary use emetics

Answer 7

Apomorphine (conjunctiva)→ reversal: naloxone
Xylazine (limited effectiveness in cats)
Dexmetatomidine (cats) → reversal: atipamazole
Ropinirole

Question 8

Gastric lavage

Answer 8

For large quantities of toxins that sit on the stomach (kitty litter) or have a narrow safety index (organophosphate, seizures, comatose)
15-20 L of fluid

Question 9

Whole bowel irrigation

Answer 9

Indication: sustained release tablets
Clears the entire GI
Contra: obstruction

Question 10

Ion exchange resins

Answer 10

Binds toxin to carrier → traps in stool → excretion
Ex: cholestyramine

Question 11

Osmotic cathartics

Answer 11

↓ the time allowed for toxin to absorb (speed transit time)
Two forms: saline (Na sulfate, Mg sulfate, Mg citrate) and saccharide (sorbitol)

Question 12

Activated charcoal

Answer 12

Universal antidote that absorbs the toxin
Used with cathartic (sorbitol)
Enterohepatic circulation
Hydration and multiple doses

Question 13

Contraindications for activated charcoal

Answer 13

Toxicants that don’t bind: EG, xylitol and heavy metals
Hypernatremia, Gi obstruction/ perforation, CNS depression

Question 14

Other forms of decontamination

Answer 14

Forced diuresis
Ion trapping (changes in urine pH)
Lipid emulsion (lipid sink- fat soluble compounds- ivermectins, weed, permethrin)

Question 15

Therapeutic plasma exchange (TPE)

Answer 15

Apheresis tx
Plasma component of blood removed and replaced with solution (crystalloid/ colloid)

Question 16

What is TPE used for?

Answer 16

Drugs with small volumes of distribution and highly protein bound
Ex: NSAIDs