Household Toxins

Question 1

Xylitol toxicity MOA

Answer 1

release of insulin → hypoglycemia
hepatobiliary system main effects (necrosis, elevated enzymes, icterus, coagulopathy, hepatic encephalopathy)

Question 2

Methylxanthines (theophylline, caffeine, theobromine) toxicity MOA

Answer 2

blocks adenosine binding to purinergic receptors increasing intracellular Ca2+ levels → inhibit phosphodiesterase → increasing cAMP

Question 3

acid toxicity MOA

Answer 3

sour taste, high ingestion unlikely
coagulative necrosis followed by thick eschar formation

Question 4

base toxicity MOA

Answer 4

no taste, high ingestion likely
liquefactive necrosis followed by edema and inflammation; triglycerides are saponified

Question 5

essential oils/potpourri toxicity MOA
what species is more sensitive? why?

Answer 5

absorbed rapidly through mucous membranes and skin → primarily hepatobiliary effects
Cats more sensitive due to decreased glucuronidation

Question 6

lithium disk battery toxicity MOA

Answer 6

tissue damage/perforation due to esophagus being basic on cathode side and acidic on anode side
absorption of lithium is rare
stomach acid doesn’t affect casing
usually passed unchanged in feces

Question 7

dry cell battery toxicity MOA

Answer 7

K or Na hydroxide results in damage
rupture battery can leak acid or alkaline components
little systemic absorption
heavy metal toxicosis possible if left lodged in GI

Question 8

what are the majority of household batteries

Answer 8

alkaline dry cell batteries

Question 9

fertilizer toxicity MOA

Answer 9

low exposure, low level toxicity due to poor GI/dermal absorption

Question 10

ethylene glycol toxicity MOA
what species is the most sensitive? why?

Answer 10

rapid absorption
rapid metabolism by alcohol dehydrogenase
oxalic acid causes calcium oxalate crystals in kidneys
cats due to high baseline oxalic acid production

Question 11

diethylene glycol toxicity MOA

Answer 11

rapid absorption
rapid metabolism by alcohol dehydrogenase
diglycolic acid causes kidney dysfunction

Question 12

propylene glycol toxicity MOA

Answer 12

safer antifreeze; NOT metabolized by alcohol dehydrogenase

Question 13

xylitol toxicity treatment

Answer 13

early decontamination – emesis w/in 1-2 hours
BG monitoring & dextrose for hypoglycemia
hepatic monitoring & support (SAMe, silymarin, NAC)

Question 14

acids and bases toxicity treatment

Answer 14

large volumes of H2O or saline for decontamination of skin/oral membranes
tap water for eyewash
IV drugs
gastroprotection (sucralfate, histamine blockers, PPI)
fluids
analgesia for pain
NO neutralization/GI decontamination/PO drugs

Question 15

Methylxanthines (theophylline, caffeine, theobromine) toxicity treatment
- when should you induce emesis for caffeine? chocolate?
- what is good for large ingestion?
- why would you want to repeat activated charcoal?
- what would you do because 10% excretion via urine
- supportive care for sedation?
- supportive care for seizures?
- what would you give for tachycardia?
- what could you give for ventricular arrhythmias?
- purpose of IV fluids?

Answer 15

Decontamination: emesis for caffeine within 1-2 hours if asymptomatic, emesis for chocolate within 6 hours esp with large ingestion/bloat, gastric lavage with large ingestion, activated charcoal + cathartic then repeated AC due to enterohepatic recirculation, urinary catheterization or frequent urination

Supportive Care: acepromazine or butorphanol for sedation, diazepam or midazolam for seizures, propranolol for tachycardia, lidocaine for ventricular arrhythmias, IV fluids for hydration/perfusion/urinary elimination

Question 16

Essential Oils/Potpourri toxicity treatment

Answer 16

wash with hand/dishwashing detergent for dermal exposure
copious amounts of water for ocular exposure
if non-caustic induce emesis followed by AC
if caustic use milk or water to dilute and NO GI decontamination
antiemetics
hepatoprotectives (silymarin, NAC, SAMe) due to clinical signs primarily hepatobiliary

Question 17

common gastroprotectants

Answer 17

sucralfate
misoprostol
PPI
histamine blockers

Question 18

common liver protectants

Answer 18

NAC
SAMe
silymarin

Question 19

battery toxicity treatment

Answer 19

small amounts of water to dilute
endoscopic or surgical removal
GI protectants and antacids
antimicrobials or analgesics if necessary

Question 20

fertilizer toxicity treatment

Answer 20

emesis within 2 hours of consumption
if fertilizer is not corrosive, supportive care

Question 21

ethylene glycol or diethylene glycol toxicity treatment

Answer 21

antidote (Fomepizole) or ethanol
correct acid-base and electrolyte derangement (calcium gluconate for severe hypocalcemia, bicarb for pH < 7)
isotonic fluids
hemodialysis or extracorporeal blood purification
supportive care for AKI (antiemetics, GI protectants, phosphate binders)
GI decontamination NOT effective - too rapid of absorption & metabolism

Question 22

propylene glycol toxicity treatment

Answer 22

supportive care
acid-base monitoring
GI decontamination NOT effective

Question 23

physical exam early after exposure (1-2hrs) of what toxin may be WNL

Answer 23

methylxanthines