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ECC > Intoxications (Corrie) > Flashcards

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
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2
Q

Poison control centers

A
  • case number!
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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
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4
Q

Testing

A
  • Min database
    • CBC
    • Chem
    • U/A: SG and sediment
  • Coagulation testing
  • Imaging
  • Specific drug testing
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5
Q

Decontamination

A
  • Prevent further absorption
  • Speed up removal
    • excretion
    • elimination
  • Tme limits
  • Extended decontamination
    • long acting and sustained release
    • enterohepatic circulation
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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
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7
Q

Topical decon

A
  • No time limit
  • Bath
    • repeatedly
    • mild dishwashing detergent
  • be conscientious about lowering body temp
    • young/old
    • debilitated
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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
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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
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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
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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
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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
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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
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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
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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
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16
Q

Decon

activated charcoal

about

A
  • Binds instead of absorbs
  • Negative charge
  • Large surface area
  • indigestible
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17
Q

charcoal reliabel for

A

reliable

  • organic compounds
  • pesticides
  • mercury
  • fertilizer
  • many pharm drugs
  • NSAIDS
  • illegal drugs
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18
Q

Charcoal unreliable for

A
  • Unreliable
    • strong acid and bases
    • heavy metals
    • xylitol
    • alcohols
    • sodium
    • arsenic
    • iodine
    • boric acid
    • hydrocarbons
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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
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20
Q

sorbitol contraindicated

A
  • dehyrdation
  • diabetes mellitus
  • diabetes insipidus
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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

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

ECC (18 decks)

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