General Toxicology treatment Flashcards
When is treatment with a specific antidote recommended?
Only when you have a definitive diagnosis
What should be addressed first in an acute poisoning case?
Control life threatening conditions first - then prn for specific toxicant if a diagnosis is made
What drug can be used to reverse the effects of a neuromuscular blocking toxicant?
Neostigmine
What can owners used as home to induce emesis?
3% hydrogen peroxide: 1-2 ml/kg PO
the patient needs to be BAR and not have active CNS signs - want to prevent aspiration pneumonia in sedate patients
*animals should get to veterinarian asap
________ toxicants will be easily absorbed dermally
Lipophiliic
In the case of a topical exposure, what is something owners can initiate at home to start detoxification?
bathe with water and shampoo very well
owners should be advised to wear gloves
*animals should be in a low stress environment
What products can owners use at home as emuslants and GI protectants if they are warranted?
milk, egg whites, or activated charcoal tablets
What are the 4 basic treatment principles of toxicosis?
- tx symptomatically and supportive first
- Remove the poison
- Specific treatment - antidote
- Observation of the acutely poisoning animal
What drugs may be used to treat respiratory effects of a toxicant?
Bronchodilators (Aminophylline and beta 2 agonists - albuterol - has CV effects) Respiratory analeptics (Doxapram)
**oxygen therapy: nasal canulas, intubation and ventilator, O2 cage, etc
What is the “go to” drug to treat CNS stimulation in the hospital?
Diazepam IV
not always effective - may have to use propofol CRI etc
How might you treat a patient with inadequate circulatory volume?
Fluid therapy
Blood transfusion
Plasma transfusion
depending on the cause of hypovolemia
T/F: LRS and NaCl IVF should be suitable to treat a severe metabolic acidosis
False
Usually will need to add sodium bicarbonate - to get faster results
*important in tx of antifreeze tox
What drugs may be used to treat a hypotensive patient?
Fluid therapy
Epi or nor epi (these are non selective - increased CV effect)
Phenylephrine - selective alpha 1 agnoist (could see reflex bradycardia)
What drugs can be used to treat a metabolic alkalosis?
Ammonium chloride
methianine
What cardiostimulant drugs can be used in tx of toxicosis?
Ca Gluconate - must be given slowly
Glucagon
Digoxin
What are general methods (4) of removing a poison from a patient?
- removal of the suspected source of poisoning (take the source away from the animal or the animal away from the source)
- Removal of the poison from the site of absorption
- Decreasing the rate of absorption
- Enhancing elimination of the poison
What treatments can be used to remove the poison from the site of absorption in the patients body?
Emetics
Gastric lavage (use 5-10ml/kg water to flush)
Enterogastric lavage (stomach tube + high enema)
Rumenotomy (done with L.A. - very effective)
Purgatives (saline or mineral oil - in case of lipid soluble toxins)
Detoxifying bathes
When are emetics contraindicated?
if the p is unconscious Toxicant is a corrosive or petroleum product If the p is dehydrated Animals showing CNS signs Severely ill animals Unknown toxicants
What is the time frame from toxicant ingestion that you should induce emesis in a canine/feline patient?
within 1-2 hours from ingestion
*sometimes done after 3-4 hours - case by case basis
What drug is often used to induce emesis in small animals?
Apomorphine - dogs (central dopamine agonist - stimulates the CRTZ)
can be given IV, IM, SQ, instilled in conjunctival sac
- can have sedative/opioid effect (reversed with noloxone)
- if vo doesn’t stop - metoclopramide will reverse emetic effects
Alpa 2 agonist better for cats - xylazine
What are three general methods of decreased the rate of absorption of toxins?
Precipitation (chemicals bind the toxicant - can be added to gastric lavage)
adsorption
ion trapping
What do adsorption agents do? What common ones are used in vet med?
The physical binding of the toxicant so it can not be absorbed
*Activated charcoal = #1
Plant charcoal is more effective than animal charcoal
What toxicants is activated charcoal NOT effective for?
ammonia cyanide heavy metal salts nitrite fluoride sodium chloride ethanol methanol iodides bleach fertilizer
When is activated charcoal contra-indicated?
If there is a GI perforation or the patient is constipated
*not effective against very small particles
When are multiple doses of activated charcoal recommended?
When the toxicant undergoes enterohepatic circulation
T/F: Ion trapping is very effective in decreasing absorption
FALSE
What treatments cant be used to enhance elimination of a toxicant?
Fluid therapy and diuretics (enhances renal excretion)
Urine pH modifiers
Peritoneal dialysis
Hemodialysis
What urinary acidifiers are used to increase elimination of what type of toxicants?
Ammonium chloride or methionine
enhance renal excretion of weak basic drugs such as alkaloids or amephetamines
What urinary alkalinizers are used to increase elimination fo what type of toxicants?
Sodium bicarbonate
enhances renal excretion of weak acidic drugs such as NSAIDs or phenobarbital
When would perotoneal dialyis be used?
When the patient is suffering from oliguria or anuria so elimination via the kidneys can not be used
When is lipid emulsion therapy used?
Only when all other treatments of the toxicant fail and the patient will die without this treatment (since the treatment itself could potentially kill the patient)
Response will depend on the lipid solubility of the toxicant
When is pepto bismol contra-indicated?
Whenever there is evidence of GI bleeding or ulcers
