Intoxications (Corrie) Flashcards
1
Q
Good history
A
- What
- How much
- Active ingrediant
- When
- Species, breed, weight
- treatment so far
- symptoms, changes
- pre-existing conditions
2
Q
Poison control centers
A
- case number!
3
Q
Tox at clinic
A
- FRONT OF LINE
- multi-pet
- whos the naughty one?
- make all vomit
- put in separate cages
- Assess
- exam, bloodwork (IV cath) EKG
- Stabilize if necessary
- respiratory distress - tube if necessary
- seizures
- obtunded/comotose
- INTUBATE IF NEEDED
- Don’t forget to do full physical
4
Q
Testing
A
- Min database
- CBC
- Chem
- U/A: SG and sediment
- Coagulation testing
- Imaging
- Specific drug testing
5
Q
Decontamination
A
- Prevent further absorption
- Speed up removal
- excretion
- elimination
- Tme limits
- Extended decontamination
- long acting and sustained release
- enterohepatic circulation
6
Q
Ocular decon
A
- no time limit
- flush for 20-30 min
- medial to lateral
- stain corneas
- and stain next day
- lubricate
- even if negative stain
7
Q
Topical decon
A
- No time limit
- Bath
- repeatedly
- mild dishwashing detergent
- be conscientious about lowering body temp
- young/old
- debilitated
8
Q
Oral decon dos
A
- Things that you make vomit
- Recent or unknown exposure
- prefer less than 2 hours
- slow movement through stomach
- large meal
- substance that stays in stomach
- asymptomatic patient
- Recent or unknown exposure
9
Q
oral decon don’ts
A
- Don’t make vomit
- corrosive agent
- hydrocarbon toxicant: oils
- symptomatic/unstable patient
- medical and/or physical contraindications
- brachycephatics
- megaesophagus
- emetic agents non-gratis (DON’T USE THESE)
- syrup of ipecac
- salt, mustard, dish detergent, milk, etc
10
Q
Decon
Oral at home considerations
A
- communicate that there are contraindications (DOCUMENT)
- stable enough
- Contraindications in hx
- distance from hospital
- financial concerns
- species
- marijauna - antiemetic properties
- nothing safe for cats at home
- Informed decision-document
11
Q
Oral decon
hydrogen peroxide
A
- Use the 3%
- no higher concentrations
- 1-5 mls/kg, 1 tsp, 1 tsp = 5 mls
- can repeat 1 x wait 10-15 minutes
- cats bad-ish
- 10 mls/cat
- don’t admin with explosives
12
Q
Oral decon
Apomorphine
A
- Apomorphine
- dopamine receptor stimulation in CRTZ
- not recommended for cats
- 0.03-0.04 mg/kg IV, IM, SQ
- can go higher
- must be filtered
- use in conjunctival sac
- rinse copiously
- anti-emetic after emesis
- Naloxone if deleterious sides effects
- 0.04 mg/kg IV, IM, SQ
13
Q
Decon oral
Cats
A
- xylazine (20mg/ml)
- 0.44 mg/kg IM
- be careful of 100 mg/ml
- dexmedetomidine
- 5 mcg/kg SQ
14
Q
Decon
Gastric lavage
A
- Why
- if emesis doesn’t work
- large amounts of material
- bezoar, concretions, foreign body
- when aspiration a concern
- underlying medical/physical contraindication
- toxicants with narrow margin safety
- caustic and petroleum distillates
- avoid with concurrent sharp FB
15
Q
Decon
Gastric lavage: technique
A
- Labor intensive and costly
- IV cath, sedation/gen anesth, intubation
- multiple lavages
- activated charcoal
- recovery and suportive care
16
Q
Decon
activated charcoal
about
A
- Binds instead of absorbs
- Negative charge
- Large surface area
- indigestible
17
Q
charcoal reliabel for
A
reliable
- organic compounds
- pesticides
- mercury
- fertilizer
- many pharm drugs
- NSAIDS
- illegal drugs
18
Q
Charcoal unreliable for
A
- Unreliable
- strong acid and bases
- heavy metals
- xylitol
- alcohols
- sodium
- arsenic
- iodine
- boric acid
- hydrocarbons
19
Q
Charcoal
A
- first time use with sorbitol
- Timing
- within an hour
- 6 hour cutoff….?
- long acting medication
- enterohepatic circulation
- Combination with cathartic
- speed through GI
- palatability
- usually only first dosing
- can cause probs
20
Q
sorbitol contraindicated
A
- dehyrdation
- diabetes mellitus
- diabetes insipidus
21
Q
Decontamination
Activated charcoal contraindications
A
- Oral
- CNS depression
- Diminished gag reflex
- corrosive/caustic toxicant - be cautious
- predisposed to aspiration
- Oral or via stomach tube
- toxicants that don’t bind
- severe dehydration/hypovolemia
- salt tox
- hyperosmolar state
- GI obstruction/perforation/ileus
- possible endoscopy/GI sx explore
22
Q
activated charcoal
dosing
A
- 1-5 gram/kg w/ sorbitol
- 5-10 ml/lb
- repeat dosing: 1-2 grams/kg (w/o sorbitol) q4-6 hours for 24 hours
- SR/XR/LA products (NSAIDS)
- enterohepatic circ
- drugs that diffuse back into GI from systemic circulation
23
Q
Decon surgery
A
- metallic foreign body
- obstruction
24
Q
Anticoagulant rodenticides antidote
A
Vitamin K
25
Acetaminophen (tylenol) antidote
Acetylcysteine
26
Ethylene glycol (antifreeze), methanol antidotes
1. Fomepizole (antizol-vet)
2. Ethanol
\*don't use both
27
Organophosphate poisoning antidote
1. 2-PAM (Pralidoxime chloride) and atropine
28
Benzodiazepine antagonist antidote
Flumazenil
29
Opiate antagonist antidote
Naloxone
Butorphanol also a partial antagonist
30
Xylazine
amitraz (dips, preventic collar)
imidazole decongestants
antidotes
Yohimbine - alpha2 adrenergic antagonist
Atipamezole
31
Digoxin tox antidote
* Digibind, Digifab
* digoxin-specific antibody fragments
32
fluids
* IV fluids
* Excretion
* perfusion
* hydration and azotemia
* promotes renal vessel vasodilation
* diuresis for nephrotoxins
* Monitor for respiratory and cardiac stuff
* Serial exams
* USG
* PCV
33
GI protect
* GI protection and support
* antiemetic
* after emesis and before AC
* Gastric pH altering med
* Gastric ulcer med
* Pro-kinetics
* regulin
* metachlopramide
34
Neurologic support
* Seizures
* Tremors
* permethrin tox in cats
* termorgenic mycotoxins
* metaldehyde
* Anti-convulsant meds, muscle relaxants, sedatives
* Cerebral edema
* Serotonin syndrome
* SSRI antidepressants, ADD/ADHD meds
* acepromazine, chlorpromazine, cyproheptadine
35
Hepatoprotectants
* Toxins
* xylitol
* blue green algae
* NSAIDS
* Amanita mushrooms
* Acetaminophen
* Sago palm
* hepatoprotectant drugs
* S-adenosyl-methionine (SAMe)
* N-acetylcysteine
36
IV lipid Emulsion (ILE)/
IV Fat Emulsion (IFE)
* originally part of propofol vehicle
* antidote for lipophilic drug toxicosis
* extra label
* ILE lipid
* no cholesterol
* phospholipid vesicles and triacyglycerol molecules
* Soybean-oil based emulsions most frequently utilized
37
ILE
reported to treat
* Humans
* lidocaine tox
* vet
* ivermectin tox
* cholecalciferol
* beta blockers
* Ca channel blockers
38
ILE
theory of action
* Lipid sink
* sequestration
* Myocytes with energy substrates
* cardiac function
* Restores myocardial function
* inc intracellular Ca
* Inc fatty acid pool
39
ILE use
* Limit to
* life-threatening ingestions
* severely symptomatic patients
* patients that don't respond to traditional therapy
40
ILE
Adverse effects
* microbial contamination
* pyogenic/colloid reaction
* reaction to emulsion
* anaphylactoid type reaction symptoms w/in 20 min of admin
* Fat overload syndrome (FOS)
* assoc with excessive vol
* overwhelms lipid clearance mechs
* clotting
* pancreatitis
* worsening of ARDS (acute respiratory distress syndrome)
41
ILE
overdose tx
* Carnitine (levocarnitine)
* transport/clearnace of Fatty acids
* Heparin CRI
* metabolism
42
Extracorporeal therapies (ECT)
* Dialysis
* kidney and tox probs
* used for severe cases
* +/- CS
* High risk morbidity/mortality
* high prob success
43
ECT
mechanisms of solute removal
* Diffusion
* solute moves across semi-permeable membrane
* by transmembrane concentration gradient
* Convection (ultrafiltration)
* movement of water across permeable membrane
* resultant solvent drag due to pressure gradient
44
Hemodialysis
* diffusion solutes/toxins across a semipermeable membrane
* dialysate running countercurent from blood in dialyzer
* similar to body fluids without toxins
* fluid hypertonic
* to avoid absorption of water from dialysis soln
45
Types of dialysis
* Renal replacement therapy (RRT)
* intermittent hemodialysis (IHD)
* continuous renal replacement therapy (CRRT)
* Hemoperfusion (HF)
* blood passed over an absorbent substance
* charcoal hemoperfusion (CH)
* Total plasma exchange/plasmapheresis (TPE)
* plasma component of blood separated/removed/replaced
* Peritoneal dialysis (PD)
* dialysis solution into abdomen
46
To remember about ECT
* Pharmacokinetics/toxicokinetics of many toxins unknown
* limited evidence based studies
* use and justification
* human studies
* vet case studies/reports
47
Ethylene glycol (EG)
and dialysis tx
* readily dialyzed like urea
* removes EG and toxic metabolites
* oxalic acid conversion
48
NSAIDS
and dialysis tx
* Enterohepatic recirculation
* CH with HD
* Rebound/redistribution-protein binding
49
Acetaminophen
and dialysis tx
* Fast plasma peak and sig liver metabolism
* recent exposure
50
Mushrooms (Amanita phalloides)
and dialysis tx
* Enterohepatic recirculation
* High affinity to AC
* CH and HD along with TPE
51
Barbiturates (phenobarb)
and dialysis tx
* CH and HD
* rebound/redistribution
* Enterohepatic recirculation
52
Lily ingestion
and dialysis tx
* For AKI in cats not for prevention in intoxication