Cross Species - Top 20 Toxicosis Part 2 Flashcards
what companion animals are most often affected by raisin, grape, chocolate, & xylitol toxicosis?
dogs
what organs are affected by grapes/raisin toxicosis?
kidneys
what clinical signs are seen with raisin/grape toxicosis?
vomiting, diarrhea, abdominal pain, weakness, tremors, polydipsia, & anuria
what organs are affected by chocolate toxicosis?
gi, heart, & CNS
what clinical signs are seen with chcocolate toxicosis?
cardiac arrhythmias, cns dysfunction (restlessness, ataxia, tremors, seizures), pu/pd, vomiting, diarrhea, & abdominal distension
what organs/body systems are affected by xylitol toxicosis?
endocrine & liver
what clinical signs are seen with xylitol toxicosis?
vomiting, weakness, depression, ataxia, seizures, coma, icterus, & potentially coagulopathy
what is the toxic principle of raisins/grapes? how is it diagnosed?
unknown - history, clinical signs, & azotemia
what is the toxic principle of chocolate? how is it diagnosed?
methylxanthines (theobromine & caffeine)
what is the toxic principle of xylitol? how is it diagnosed?
essentially acts as a huge dose of insulin - profound hypoglycemia (monitor every 1-2 hours), bilirubinemia, thrombocytopenia, & hyperphosphatemia
how is raisin/grape toxicosis treated?
decontamination, IV fluid diuresis, & promote urination with dopamine or furosemide
how is chocolate toxicosis treated?
decontamination (gastric emesis/lavage, activated charcoal), methocarbamol, diazepam, & barbiturates, treat arrthymias, & other supportive care
how is xylitol toxicosis treated?
emesis at a hospital, IV dextrose, & liver support with SAMe & n-acetylcsteine
why does activated charcoal not work for xylitol toxicosis?
it won’t bind to it
what is the prognosis of raisin/grape toxicosis?
guarded
how are the kidneys damaged by raisins/grapes?
toxin damages proximal renal tubular epithelium
T/F: for dogs, some are resistant to raisin/grape toxicosis while others develop acute renal failure after just a few raisins or grapes
TRUE
how is chocolate toxicity characterized by severity?
higher cocoa percentage - white chocolate is the least toxic while dark chocolate/baker’s chocolate is most toxic
what is the pathophysiology of how methylxanthines damage the body?
inhibit cellular adenosine receptors, increase intracellular calcium, & increase cyclic AMP levels
how long can signs persist from chocolate toxicosis?
72 hours
why do dogs typically die from chocolate toxicosis?
cardiac arrhythmias, hyperthermia, & respiartory failure
T/F: chocolate toxicosis rarely affects cats
TRUE
what is xylitol?
sugar free sweetener
what is the pathophysiology of xylitol? what are poor prognostic indicators?
stimulates a profound, rapid, dose-dependent insulin release - liver disease & hyperphosphatemia usually mean a poor prognosis
what human medications are often implicated in companion animal toxicity cases?
acetaminophen, SSRIs, methylphenidate, & sleep aids
what does acetaminophen affect in the body?
affects erythropoiesis, liver, & kidneys
what clinical signs are seen with acetaminophen toxicity?
muddy mucus membranes, hyperpnea, tachycardia, weakness/depression, & death
what in the body is affected by SSRI toxicity?
CNS & heart
what clinical signs are seen with SSRI toxicosis?
mydriasis, vomiting/diarrhea, lethargy, fever, ataxia, seizures, hyperactivity, vocalization, & increased or decreased heart rate
what body system does methylphenidate affect?
CNS only
what clinical signs are seen with methylphenidate toxicity?
hyperactivity, aggression, hyperthermia, tremors/ataxia/circling, tachycardia, hypertension, mydriasis, & death
how do sleep aids affect the body in toxicity cases?
affect the CNS
what clinical signs are seen in sleep aid toxicosis?
marked sedation & paradoxical excitement
how is acetaminophen toxicosis diagnosed?
methemoglobinemia & then heinz bodies & abnormal liver values
how is methylphenidate toxicosis diagnosed?
measure levels in gastric contents/urine - can use over the counter test kits
how is acetaminophen toxicosis treated?
decontamination, n-acetylcysteine slowly iv, ascorbic acid, iv fluids, & blood transfusions
how is SSRI toxicosis treated?
decontamination, cyproheptadine, phenothiazines, diazepam, & beta blockers - DO NOT USE ATROPINE
how is methylphenidate toxicosis treated?
phenothiazines & acidify urine to increase excretion
how is sleep aid toxicosis treated? what drug is contraindicated for use in these cases?
if mild, keep animal quiet, decontamination, phenothiazines, flumazenil if severe - NO DIAZEPAM
what is the pathophysiology of acetaminophen toxicosis?
oxidizing toxic metabolites lead to methemoglobin formation with heinz bodies
why are cats uniquely sensitize to acetaminophen toxicosis?
they lack glucuronyl transferase
what other condition may dogs develop with acetaminophen toxicosis?
KCS
what is the pathophysiology of SSRI toxicosis?
block the presynaptic serotonin receptors
T/F: serotonin syndrome can occur with any drug that increases free serotonin levels
TRUE
what is the pathophysiology of methylphenidate toxicosis?
amphetamiens cause release of norepinephrine & other catecholamines
methylphenidate toxicosis is difficult to differentiate from what other toxicosis?
cocaine
what is the pathophysiology of sleep aid toxicosis?
binds to GABA receptors
what household hazards are most often implicated in toxicity cases?
alcohol, chlorine bleach, & dish washer packets
what animals are most often affected by household hazards? why?
dogs - indiscriminate eating habits
what body systems are affected by alcohol toxicosis?
gi & CNS
what clinical signs are seen with alcohol toxicosis?
vomiting, diarrhea, ataxia, disorientation, tremors, dyspnea/respiratory failure, hypothermia, & death
what body systems are affected by chlorine bleach toxicosis?
gi, eyes, skin, & respiratory
what clinical signs are seen with chlorine bleach toxicosis due to ingestion?
vomiting, diarrhea, & hypersalivation
what clinical signs are seen with chlorine bleach toxicosis due to inhalation?
caged birds at highest risk of respiratory exposure due to unique respiratory anatomy - gogging, coughing, & sneezing
what clinical signs are seen with chlorine bleach toxicosis due to ocular contact?
epiphora & ulceration
what clinical signs are seen with chlorine bleach toxicosis due to dermal contact?
ulceration
what body system is affected by dishwasher packets?
gi tract
what clinical signs are seen with dishwasher packet toxicity?
vocalization, hypersalivation, vomiting (bloody), & gi pain
how is alcohol toxicosis diagnosed?
blood alcohol level, hypoglycemia, & metabolic acidosis
how is chlorine bleach toxicosis diagnosed?
metabolic acidosis & pulmonary edema if inhalation exposure seen on rads
how is dishwasher packet toxicosis diagnosed?
endoscopy to determine degree of necrosis
T/F: activated charcoal does not work for treating alcohol toxicosis
TRUE
how is alcohol toxicosis treated?
induce emesis, treat CV & acid base status, diazepam, & yohimbine
how is chlorine bleach toxicosis treated for all of the different exposures?
treat metabolic acidosis - treat inhalation/pulmonary edema, treat dermal exposure by bathing, & treat ocular with irrigation
what should not be done for dishwasher packet toxicosis?
do NOT induce emesis or activated charcoal
what treatment is used for dishwasher packet toxicosis?
dilute with milk/water, supportive care, & potentially an esophagostomy tube
what is the pathophysiology of alcohol toxicosis?
gi irritation, cns depressant, stimulates catecholamine release, & metabolic acidosis
what alcohols are most often involved in toxicity cases?
ethanol, methanol, isopropanol
what is the pathophysiology of chlorine bleach toxicosis?
irritant - if pH is greater than 11 or less than 3.5, can cause corrosive injury - risk depends on concentration pH - bleach and ammonia produce a toxic gas that causes pulmonary edema
what is the pathophysiology of dishwasher packet toxicosis?
alkaline corrosive (pH is higher than 11) - causes liquefactive penetrating necrosis
what are the common rodenticides involved in toxicity cases?
anticoagulant, bromethalin, cholecalciferol, & zinc phosphide
when do clinical signs start in anticoagulant toxicosis cases?
5-7 days after ingestion
what clinical signs are seen in anticoagulant toxicosis cases?
hemorrhage (affects coagulation cascade) anemia, weakness, lameness if hemorrhage in a joint, hematomas, melena, hematuria, etc
what acute clinical signs are seen with bromethalin toxicosis?
hyperexcitability, muscle tremors, seizures, hyperthermia, & death
what subacute/chronic clinical signs are seen with bromethalin toxicosis?
pelvic limb weakness, paralysis, & ataxia
what body systems are affected by cholecalciferol toxicity?
affects kidneys, CV, & CNS
what clinical signs are seen with cholecalciferol toxicity?
depression, anorexia, pu/pd, vomiting, hematemesis, & hypertension
what body systems are affected by zinc phosphide toxicity?
affects respiratory system, liver, & kidneys
what clinical signs are seen with zinc phosphide toxicity?
vomiting, tachypnea, ataxia, trembling, collapse, seizures, & death
how is anticoagulant rodenticide toxicity diagnosed?
measure in serum/plasma/stomach contents - prolonged PT, aPTT, & ACT
how is bromethalin toxicity diagnosed?
measure levels in liver, kidney, fat, & brain
how is cholecalciferol toxicity diagnosed?
hypercalcemia then hyperphosphatemia
how is anticoagulant rodenticide toxicity treated?
vitamin k PO for 3-4 weeks until PT is normal 72 hours after last dose, plasma/whole blood transfusion, & oxygen
how is bromethalin toxicity treated?
decontamination & diazepam
how is cholecalciferol toxicity treated?
decontamination, cholestyramine, calciuresis (normal saline, furosemide, & prednisolone), aluminum hydroxyide, & pamidronate
how is zinc phosphide toxicity treated?
decontamination, decrease gastric acid, n-acetylcysteine, SAMe, & diazepam
what is the pathophysiology of anticoagulant toxicity?
vitamin k antagonist by inhibiting vitamin k epoxide reductase causing abnormal coagulation
what are the vitamin k dependent clotting factors?
I, II, VII, IX, & X
what are the 1st & 2nd generations anticoagulants? how are they different?
1st: warfarin & 2nd: brodifacoum - warfarin needs multiple doses for toxicity & brodifacoum only needs one
what is the pathophysiology of bromethalin toxicity?
uncouples oxidative phosphorylation causing demyelination & cerebral edema
what animals are especially sensitive to bromethalin toxicity?
cats & young dogs
T/F: subacute/chronic toxicity can be seen from bromethalin up to 7 days after exposure
TRUE
what is the pathophysiology of cholecalciferol toxicity?
vitamin d3 causes increased calcium & phosphorus
why does calciuresis initiated prior to hypercalcemia worsen disease?
stimulates osteoclasts
what products have zinc phosphide?
gopher/mole/ground squirrel bait
what is the pathophysiology of zinc phosphide toxicity?
phosphide + low gastric ph produces a toxic phosphine gas (careful with emesis as personnel can inhale this toxic gas which causes noncardiogenic pulmonary edema) & after absorption, blocks cytochrome c oxidase producing reactive oxygen compounds which cause tissue damage
T/F: zinc phosphide toxicity is worse in animals that can’t vomit
TRUE
T/F: phosphine gas is a public health hazard that smells like fish or garlic
TRUE
what animals are most often affected by ethylene glycol toxicity?
dogs & cats
what clinical signs are seen with ethylene glycol toxicosis?
kidneys & neuro signs - stupor, ataxia, knuckling, poor withdrawal & righting reflexes
what is seen in phase 1 of ethylene glycol toxicosis?
vomiting & pu/pd
what is seen in phase 2 of ethylene glycol toxicosis?
oliguric renal failure
how is ethylene glycol toxicosis diagnosed?
normochloremic metabolic acidosis with increased anion gap & osmolar gap, calcium oxalate crystalluria, & commercial ethylene glycol tests
T/F: it is best to treat dogs within 8-12 hours & cats within 2 hours for ethylene glycol toxicosis
TRUE
how is ethylene glycol toxicosis treated?
if no neuro signs - induce vomiting & gastric lavage, 4-MP, fomipizole, or ethanol to inactivate alcohol dehydrogenase, & sodium bicarbonate for acidosis
what is the pathophysiology of ethylene glycol toxicosis?
toxic metabolites of ethylene glycol that cause renal tubular damage & lead to a metabolic acidosis
T/F: the prognosis becomes poor for ethylene glycol toxicosis once the animal is in acute renal failure
TRUE
T/F: ethylene glycol (anti-freeze) is always dyed a bright color like yellow-green and has a sweet flavor, so it has a small lethal dose
TRUE
what type of urinary crystals are seen with ethylene glycol toxicosis?
calcium oxalate monohydrate crystals - dumb bell shaped
