Diagnosis and Care of the Intoxicated Patient

Question 1

what is the flow of diagnosis and care of the intoxicated patient?

Answer 1

1. identify patient
2. determine patient status: PROVIDE EMERGENCY CARE IF NEEDED (this is an immediate and primary goal before you even figure out what to toxicant could be)
3. history, physical exam
4. if toxicant exposure is suspected, determine source/exposure
5. initiate treatment: prevent further exposure/absorption, give specific antidotes if available, and enhance elimination of absorbed toxicant`

Question 2

what are the 4 aspects of the INITIAL assessment of the intoxicated patient?

Answer 2

1. who is the patient?
2. how many animals?
3. status of all animals?
4. suspected exposure to toxicants? +/- known or suspected source?

DO NOT ASSUME intoxication just because the owner thinks it!!

Question 3

what are the 3 aspects of the diagnostic assessment of the intoxicated patient?

Answer 3

1. clinical signs: how acute? determine time of onset of signs, duration, and early versus late signs
2. environment: pasture, roaming animal, food/water source, pesticide management new plants in home
3. medical history: predisposing conditions contribution to severity of toxicity

Question 4

what is the rule for care of the intoxicated patient? what are the 5 goals in order of importance?

Answer 4

treat the ANIMAL, not the toxicant!!

goals:
1. emergency support
2. maintain vital organ function
3. decontamination to prevent further absorption
4. antidotes (if available)
5. enhance elimination

Question 5

what are the 5 aspects of emergency care of the intoxicated patient? what do you do once the patient is stabilized?

Answer 5

1. establish patent airway
2. assist ventilation if needed
3. maintain or correct fluid and electrolyte balances
4. control arrhythmias and seizures
5. maintain body temp

once stabilized: estimate dose and prevent further exposure

Question 6

describe the physical exam of an intoxicated patient (4)

Answer 6

1. quick but thorough
2. update patient status via triage
3. know that fever is NOT a rule out for toxicants (ROS can uncouple OxPhos and lead to fever)
4. handle with care

Question 7

what are the 3 diagnostic confirmations of the intoxicated patient?

Answer 7

1. lab evaluations
2. recovery of toxicant
3. response to therapy

due to short half-lives of some toxicants, 1 and 2 can be hard, so may just need to diagnose based on response to therapy; do NOT make diagnosis based on clinical signs alone

Question 8

describe decontamination (5)

Answer 8

1. emesis
2. gastric lavage: if patient present unconscious or anesthetized; intubate to protect airway!
3. adsorbents:
   -activated charcoal: best for neutral, large particles, does NOT work for heavy metals, hydrocarbons, alcohols, or strong acids or bases
   -multiple dose activated charcoal: may repeat in presence of enterohepatic recycling, high dose exposure, or toxicants with long half-lives
   -other adsorbents: clay based for herbicides, novasil for mycotoxins
   -using emesis or gastric lavage is questionable in benefit bc won’t usually see patient until at least an hour post exposure, so being rec’d to skip straight to adsorbents
4. for dermal or ocular exposure: bathe in mild soap and water or ocular irrigation
5. cathartics to promote GI tract emptying: osmotics are good, but bulks and oily cathartics are too slow or irritating

Question 9

what are the 5 types of antidotes?

Answer 9

1. chemical
2. functional
3. competitive
4. non-competitive
5. intravenous lipid/fat emulsion

Question 10

how do we promote renal excretion? (3)

Answer 10

1. controlled fluid therapy
2. diuretics
3. ion trapping: urinary alkalinization or acidification

Question 11

what are the 2 rules of emetics use?

Answer 11

1. patient must be able to protect airway so gag reflex must be intact
2. do not use if patient is unconscious, CNS depressed, seizuring, in resp distress, when the compounds are suspected to be caustic, corrosive, or volatile, or in species that don’t vomit effectively (horses, ruminants, rodents)

Question 12

what are the 3 rules for giving adsorbents and cathartics?

Answer 12

1. cannot give the drugs orally
2. do not give cathartics to animals with diarrhea
3. do not give cathartics more than once

Question 13

what are 4 complications of forced fluid therapy?

Answer 13

1. cerebral edema
2. pulmonary edema
3. metabolic acidosis or alkalosis
4. electrolyte imbalances