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Toxicology > Diagnosis and Treatment of Toxicity > Flashcards

Diagnosis and Treatment of Toxicity Flashcards

1
Q

5 things to look for and treat immediately

A
  1. heart rate
  2. respiratory rate
  3. temperature
  4. seizure and brain function
  5. hemorrhage
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2
Q

respiratory maintenance

A
  • unconscious, paralyzed, and severe respiratory distress patients are candidates for intubation
  • ventilation may be needed if there is:
    • hypoventilation and hypercapnia
    • metabolic acidosis
    • hypoxia (treat with 40% oxygen)
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3
Q

control CNS activity

A
  • control hyperactivity
    • diazepam, phenobarb, methocarbamol
  • control depression
    • analeptics, doxapram
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4
Q

control CV function

A
  • tachycardia and arrythmias
    • correct acid/base, electrolyte or fluid disorders
    • lidocaine, propanolol
  • hypertension
    • nitroprusside, hydralazine
  • fluid therapy-balanced electrolyte solution for shock and dehydration, monitor urine output, inotropic drugs like dobutamine
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5
Q

stabilize the patient

A
  • priority in animals presenting with severe clinical signs (hyper/hypothermia)
  • obtain venous access and draw for lab profile and potential diagnosis testing (3 cc EDTA, 2 serum)
  • once stable, perform a more comprehensive physical exam
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6
Q

obtain a complete history

A
  • one of the most important and most overlooked parts of diagnosing toxicity
  • once stable, question owner fully in attempt to narrow down possible causes
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7
Q

4 major themes to question owner about

A
  1. health status overall
  2. clinical signs currently
  3. environment at home
  4. diet
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8
Q

questions to ask about current clinical history?

A
  • how long was problem present?
  • when was animal observed sick?
  • if animal was found dead-when were they last seen healthy?
  • size of herd?
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9
Q

systems to cover for clinical signs

A

CNS, GI, renal, hepatic, cardiac, hematopoietic

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10
Q

what to learn about the environment?

A

type of environment where the animal lives

indoor only? fenced yard? roaming?

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11
Q

what to ask about diet?

A

what are they eating?

method of feeding?

presence of moldy or spoiled food?

water source?

water supply changes

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12
Q

general supportive care includes:

A
  • ensuring adequate urine output
  • monitor respiratory, cardiac and neurological status
  • manage clinical signs as they develop
  • manage secondary hepatic or renal injury
  • administer GI protectants/anti-emetic
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13
Q

what is involved in symptomatic care?

A
  • maintain body temperature
    • hypothermia: balnkets, circulating warm water pads-avoid heat lamps!
  • alleviate pain
  • prevent irritation of skin and membranes with demulcents, milk, sucralfate
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14
Q

when to decontaminate?

A

only after animal has been fully stabilized

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15
Q

what are the 2 most common types of decontamination?

A

emesis and activated charcoal

cathartics also used

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16
Q

emesis for decontamination

A
  • potential in clincally normal animals with suspected oral exposure
  • should be induced within 60 minutes of known toxic ingestion
  • intubate, wash stomach 3 times with warm water until fluid is clear
  • possibly save vomitus for possible analysis
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17
Q

when do you induce emesis?

A
  • toxic dose of substance ingested
  • no vomiting has yet occurred
  • activated charcoal is not an option
18
Q

activated charcoal

A
  • prevents toxic absorption
  • animal may eat, can be mixed with baby food
  • earlier given = more effective
  • give repeated doses ever 4-6 hours
  • can give alone or after emesis
  • caution: aspiration potential
19
Q

activated charcoal contraindications

A

corrosive agents

non-polar material

20
Q

4 reasons to give activated charcoal

A
  1. substance is known/thought to be absorbed by it (excluded acids, alkalis, alcohols/glycols, metals, oils, petroleum distillates, detergents)
  2. ingestion was very recent/undergoes eneterohepatic circulation/is sustained release
  3. can tolerate it
  4. no immediate need to administer oral meds (reasonable to wait at least 2 hours between charcoal admin and oral med)
21
Q

cathartics

A
  • decrease GI transit time, increase movement of toxins, or charcoal-toxin complex, and decrease possible absorption of the toxin
  • use as adjunct to activated charcoal therapy to reduce transit time
  • ex: mineral oil, saline cathar
22
Q

how to prevent absorption for corrosives, strong acids and bases:

A
  • use dilution instead of emesis
  • can dilute with milk, water, or eggs
  • (caution: using milk or water may enhance absorption)
23
Q

dermal exposures:

A

may bathe in liquid dish soap, rinse well

24
Q

lipid infusion

A
  • relatively new treatment
  • off label use of IV lipids
  • case reports/case series demonstrates its efficacy and safety
  • promising adjunct to conventional treatments
25
Q

primary use and limitations for activated charcoal

A
  • use: absorbent material with large surface area, bind most drugs
  • limit: some toxins not absorbed
26
Q

primary use and limitations for apomorphine

A
  • use: emetic agent for dogs, pigs
  • limit: may cause prolonged vomiting
27
Q

primary use and limitations for xylazine

A
  • use: emetic agent for cats
  • limit: may cause hypotension and bradycardia
28
Q

primary use and limitations for gastric lavage

A
  • use: sustained release products, massive overdoses
  • limit: invasive! risk of perforation or rupture
29
Q

primary use and limitation for salt water, H2O2

A
  • use: for at home emesis induction
  • limit: might delay treatment for vet
30
Q

primary use and limitation for surgical removal

A
  • use: lead, pennies, etc
  • limit: invasive!
31
Q

primary use and limitation for whole-bowel irrigation

A
  • use: removal of sustained-release pharmaceuticals, for toxins not absorbed by activated charcoal
  • limit: primarily for small animals, may cause prolonged diarrhea, safer than gavage
32
Q

analytic testing

A
  • no one test that will “screen” for all known toxicants
  • multiple test for specific agents can become costly
  • must narrow down general type of agent involved
  • test: blood, serum, urine, liver, vomitus, kidney, brain, fat
33
Q

common toxins associated with an increased anion gap

A

ethylene glycol, ethanol, iron, methanol, salicylates, strychnine

34
Q

normal anion gap

A

10-12 mEq/L

35
Q

clinically significant anion gap

A

> 30 mEq/L suggests metabolic acidosis

36
Q

common toxins associated with CNS depression

A
  • ivermectin
  • cholinesterase in inhibitors
  • organophosphate insecticides
  • carbamate insecticides
  • blue-green algae
  • slaframine
  • lead
  • locoweed
  • ethylene glycol
37
Q

common toxins associated with seizures

A
  • bromethalin
  • chocolate
  • lead
  • organophosphate insecticides
  • pyrethrins/pyrethroids
  • strychnine
  • water deprevation/sodium ion toxicosis
  • water hemlock
38
Q

4 parts to accurately diagnose any toxicity

A
  1. history (health, current clinical hx, environment, diet)
  2. clinical signs
  3. pathology/necropsy
  4. chemical analysis
39
Q

how to prevent further exposure?

A
  • change pasture, feed, water, etc
  • remove baits, old pesticides, etc
  • bathe or flush for cutaneous or ocular exposure
  • EDUCATE
40
Q

summary of how to manage a poisoned patient

A
  1. assess ABC’s
  2. control seizures, cardiac
  3. metabolic derangements
  4. history
  5. GI decontamination
  6. supportive and symptomatic care

Toxicology (8 decks)

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