FTK 4: Toxicosis Treatment Flashcards
4 things we should do as providers for toxicosis TREATMENT assessment?
- POISONING or MEDICAL CONDITION?
–> how likely is it that this is from a poison, or is it something else? - do we know EXACT PRODUCT that was ingested?
–> try to access EXACT product/box that it was in - MAXIMUM dose that could’ve been ingested?
–> if we don’t know, ASSUME THE WORST - NON-toxic exposure? or toxic at small doses?
–> if NON-TOXIC, then likely SELF-LIMITING GI UPSET, can cross GI decontamination off of list
OUTCOMES of ingestion of HIGHLY TOXIC SUBSTANCES will depend on… (4)
- timing
- treatment
- SIZE of animal
- FORMULATION (sustained or immediate release)
ABCD steps for treating poisoned patient?
A = AIRWAY
B = BREATHING
C = CIRCULATION
D = DECONTAMINATION, DEXTROSE, DRUGS
NON-TOXIC exposures in small animals? (9)
- POINSETTA
- SOAPS/SHAMPOO/CONDITIONER
- LOTIONS
- BALLPOINT PEN
- ACRYLIC/WATER COLOR/LATEX PAINT
- RUST
- PLASTER
- ANTACIDS
- CAT LITTER
TOXIC at SMALL DOSES in small animals (6 main)
- TOXIC ALCOHOLS (methanol & ethylene glycol)
- CAMPHOR (Vik’s Vapo Rub) –> CAUSES SEIZURES, so DO NOT USE EMESIS
- BENZOCAINE (Orakel & dental products)
- OPIOIDS
- LOMOTIL
- CA-CHANNEL BLOCKERS
4 toxic exposures in LARGE ANIMALS?
- VENOMOUS snakes
- MYCOTOXINS
- LEAD (from contaminated soil or paint chips)
- PLANTS
–> pyrazolidine alkaloids
–> CARDIAC GLYCOSIDE-containing or DIGOXIN-containing plants
4 main TREATMENT goals?
- assess RISK of EXPOSURE
- SUPPORTIVE/SYMPTOMATIC care
- PREVENTION of further absorption
- ANTIDOTE (if available/indicated)
gastric decontamination
= definition
3 goals?
should you always do this?
4 overall options?
= any technique that PREVENTS absorption of a CHEMICAL/DRUG
3 goals?
1. to DECREASE CONCENTRATION of toxin in BLOODSTREAM
2. to DECREASE AMOUNT of toxin going to BLOOD AND TISSUES
3. to REDUCE SEVERITY of poisoning to as little as possible
SOMETIMES CAN MAKE THINGS WORSE, DO NOT ALWAYS DO THIS
4 overall options?
1. emetics
2. gastric lavage
3. activated charcoal
4. cathartics
emetics
what 2 things must be present for HIGHEST efficacy?
emetics for DOGS? (2)
emetics for CATS? (4, one controversial)
contraindications? (7)
= use if FOOD IN STOMACH & RECENT ingestion (within 4 hours for dog, 2 hours for cat)
in DOGS…
1. 3% HYDROGEN PEROXIDE (fresh), should see BUBBLING ON SKIN
2. APOMORPHINE
in CATS…
1. 3% hydrogen peroxide can cause HEMORRHAGIC GASTRITIS
2. XYLAZINE
3. DEXMEDETOMIDINE
4. MIDAZOLAM/HYDROMORPHONE
contraindications?
1. SPECIES THAT CANNOT VOMIT = RUMINANTS, HORSES, RABBITS, RODENTS
2. if CNS depression or SEIZURES likely
3. if animal has ALREADY VOMITED
4. CAUSTIC substances
5. SHARP foreign bodies
6. BUTTON batteries –> can cause OBSTRUCTION
7. substances that RISK ASPIRATION (petroleum products like kerosene, gasoline, pine oil, motor oil, lamp oil)
gastric lavage
what 2 things must be true to perform this?
allows for what process when we can’t do what?
contraindications? (3)
complications? (3) how common are they?
2 things?
1. AIRWAY must be PROTECTED
2. ANESTHETIZED
allows for GASTRIC EMPTYING when we can’t do EMESIS
contraindications?
1. want to avoid things that can get PAST TUBE and GET TO LUNGS
2. CAUSTICS
3. substances that cause ASPIRATION PNEUMONIA (petroleum-based, kerosene, gasoline, motor oil, lamp oil, pine oil)
complications? (RARE)
1. esophageal perforation
2. fluid/electrolyte imbalances
3. aspiration pneumonia
activated charcoal
what 2 kinds of substances DOES it bind?
what 5 things DOESN’T it bind?
ratio & formulation?
what other medication can we use this with? 2 concerns?
contraindications? (2) & common reason
2 substances?
binds NONPOLAR, LARGE molecules
DOES NOT bind…
1. alcohols
2. hydrocarbon/petroleum-based products
3. metals
4. inorganic minerals
5. caustics
ratio/formulation?
10:1 charcoal:medication ratio, formulated at 1 gm/kg of POWDERED mixed AC and water
other medication?
can use with SORBITOL (cathartic)
1. DON’T USE MINERAL OIL because it can INTERFERE WITH ABSORPTION
2. DON’T use sorbitol if MULTIPLE DOSES OF AC –> electrolyte disturbances
contraindications?
1. CAUSTICS
2. AGENTS with HIGH RISK OF ASPIRATION PNEUMONIA
**AC INCREASES RISK OF EMESIS
whole bowel irrigation
what does it aim to do?
indications? (2)
dose it’s given/what substance/via what route?
how do we know when to stop?
aim?
GASTRIC EMPTYING
indications?
1. SUSTAINED-RELEASE medications
2. agents NOT ABSORBED IN AC (alcohols, metals, inorganic materials)
dose = 500 mL/hour
substance = POLYETHYLENE GLYCOL in ISOTONIC SOLUTION
route = NASOGASTRIC TUBE
continue until RECTAL EFFLUENT IS CLEAR
lipid emulsion therapy
= definition
used for what 2 kinds of toxins?
= IV lipid emulsion will SEQUESTER lipophilic toxicants in a LIPID-SINK that will eventually be ELIMINATED BY BODY
2 toxins?
1. neurotoxins
2. cardiotoxins
antidotes in small animals
= definition
what 3 things can they do?
= a REMEDY that COUNTERACTS the effects of poison
3 things?
1. PREVENT action of toxin
2. PREVENT FORMATION of metabolite
3. BIND & INACTIVATE toxin
difference between antidotes in FOOD ANIMAL vs. other species?
must be SPECIFICALLY approved for use
N-acetylcysteine
use? species?
when should we give it?
what 2 routes?
adverse effects? (2)
for ACETAMINOPHEN POISONING in DOGS/CATS
when should we give it?
WITHIN 8 HOURS
PO or IV
adverse effects?
–> PO = GI UPSET
–> IV = BRONCHOSPASM
fomepizole
use? species?
route?
when should we give it?
adverse effects?
used for ETHYLENE GLYCOL & METHANOL poisoning in DOGS ONLY
IV ONLY
give WITHIN 3-6 HOURS, if given 8+ HOURS AFTER then might need HEMODIALYSIS
adverse effects?
–> at EXCESSIVELY HIGH DOSES, CNS DEPRESSION
ethanol
use? species?
route?
when should we give it? special consideration?
adverse effects? (2)
used for ETHYLENE GLYCOL & METHANOL poisoning in CATS ONLY
IV BOLUSES or CRI
give within 3-6 HOURS and KEEP BLOOD ALCOHOL AT .10 TO MAINTAIN ANTIDOTE ABILITIES
adverse effects?
1. HYPOGLYCEMIA
2. CNS DEPRESSION
vitamin K1
should we give prophylactically?
use? species?
2 routes? what route should we NOT use?
NO, can prevent us from knowing when to STOP administration
used for SYMPTOMATIC animals following ingestion of ANTICOAGULANT RODENTICIDE in DOGS/CATS
given PO or SQ
**DO NOT GIVE IV BECAUSE IT HAS EMULSOR OIL IN IT that can cause ANAPHYLACTOID REACTIONS
deferoxamine
use? species?
route?
what’s the limit on the amount of time we can give it? why?
why must we give it SLOWLY?
used for SIGNIFICANT IRON POISONING in DOGS ONLY
IV
can only give for 24 HOURS or FATAL PULMONARY TOXICITY
need to give SLOWLY to avoid ANAPHYLACTOID REACTION or HYPOTENSION
