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Toxicology 5172 (Fall 2014) > L2: Diagnosis and Treatment of Toxicity (Martyniuk) > Flashcards

L2: Diagnosis and Treatment of Toxicity (Martyniuk) Flashcards

1
Q

In a patient with intoxication, what should you do first?

A

assess patient, evaluating for immediate life-threatening problems. Assess:
-Cardiac (brady/tachycardia)
-Respiratory (apnea, shallow breathing)
-Seizures
-Hemorrhage
-Temperature (hypothermia)
Then obtain brief history including duration of signs, initial signs, age, prior health status, environment, diet

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2
Q

3 most lethal compounds for small animal

A

rodenticide
ethylene glycol
organophosphates (pesticides)

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3
Q

Respiratory maintenance

A
  • unconscious, paralyzed, paretic, or severe resp. distress patients are candidates for intubation
  • intubation required if no voluntary breathing effort or if you plan to do gastric lavage
  • prevent aspiration of vomitus by placing head lower than body
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4
Q

Control of breathing

A
  • if animal hypoventilating (hypercapnic PCO2 >45mmHg, acidotic pH 7.35), ventilation with room air may be required
  • if hypoxemia present (PO2 < 65mmHg), treat with 40% oxygen. May need assisted ventilation
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5
Q

Control of CNS activity

A

Hyperactivity (seizures):

  • Diazepam (tx of choice if etiology unknown)
  • Phenobarbital (or pentobarbital)
  • Methocarbamol (causes skeletal m. relaxation and may be useful in controlling seizures)
  • most are GABA agonists (GABA is inhibitory for seizures)

Depression:
-Analeptics such as Doxapram (can make stabilization difficult)

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6
Q

Things to do while stabilizing the patient

A
  • obtain venous access and draw for laboratory profile and potential diagnostic testing (ideally pre-medicating)
  • once stable, perform thorough PE
  • fluid therapy (balance electrolyte solution for shock/dehydration)
  • monitor urine output
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7
Q

less than what percent of poisonings are intentional?

A

1%

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8
Q

health history should include:

A
  • illness in past few months
  • recent animal exposure
  • vax current
  • medications, sprays, dips, antihelmintics, etc. in past few months
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9
Q

current clinical history should include:

A
  • how long problem present
  • when observed sick
  • when animal last seen healthy (if dead)
  • size of herd
  • morbidity/mortality numbers
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10
Q

CNS CS ex.

A

head-pressing, circling, ataxia, seizures, depression,etc.

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11
Q

GI CS ex.

A

vomiting, diarrhea, painful abdomen, painful constipation, etc.

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12
Q

Renal CS ex.

A

PU, proteinuria, anuria, kidney enzyme abnormalities, etc.

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13
Q

Hepatic CS ex.

A

jaundice, elevated liver enzymes

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14
Q

Cardiac CS ex.

A

arrythmias, brady/tachycardia, BP changes

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15
Q

Hematopoietic CS ex.

A

anemia, hemoglobinemia, MetHb, petechia, etc.

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16
Q

Diet History

A
  • what diet
  • changes in diet
  • method of feeding
  • presence of moldy/spoiled food
  • drinking water osurce
  • water supply changes
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17
Q

1 priority pollutant for human consumption concerns

A

arsenic

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18
Q

blood gas can rule out:

A

hypoxia

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19
Q

ancillary support

A
  • maintain hydration
  • monitor urine output
  • monitor resp, cardiac, neuro status
  • manage CS as they develop
  • manage 2ary hepatic or renal injury
  • admin. GI protectants/anti-emetic
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20
Q

symptomatic care

A

maintain body temp
alleviate pain
prevent irritation of skin and membranes (ie. demulcents, sucralfate, kaolin-pectin)

21
Q

when to induce emesis

A
  • only after animal fully stabilized
  • within 60 minutes of known toxic ingestion (can be effective 3-4 hours later depending on toxin)
  • save vomitus!
22
Q

contraindications to inducing emesis

A
  • corrosives, volatile hydrocarbons, petroleum distillates
  • seizures/convulsions
  • horses, ruminants, rodents, rabbits
  • unconscious, no gag reflex, coma
23
Q

activated charcoal

A
  • administer early to prevent toxicant absorption
  • works well for pesticides, pharmaceuticals
  • repeated doses q4-6hours
  • contra: corrosive agents, ethylene glycol, Fe
24
Q

vomiting removes what percent of stomach contents?

A

40-50%

25
Q

cathartics

A
  • factors that help move things through GIT and decrease possible adsorption of the toxin
  • adjunct to activated charcoal therapy
  • Ex: mineral oil (DON’T use with act. charc.), Saline cathartic such as MgSO4 or Na2SO4
26
Q

apomorphine

A

emetic for dogs, pigs

-may cause prolonged vomiting

27
Q

xylazine

A

emetic for cats

-my cause hypotension and bradycardia

28
Q

gastric lavage

A
  • removal of concretions (bezoars), sustained-release products, or w/ massive overdoses
  • INVASIVE; risk of perf/rupture: don’t use with toxicants that weaken gastric wall
29
Q

salt water, hydrogen peroxide

A

commonly used at-home emesis inducers

-may delay vet. tx

30
Q

sx removal

A

FB

-invasive

31
Q

whole-bowel irrigation

A

removal of sustained-release pharmaceuticals

  • for toxins not adsorbed by act. charc.
  • mainly for SA
  • causes d
  • safer than lavage
32
Q

if toxic agent has been identified, what antidote should be used?

A

specific antagonist (after p stable). Otherwise, tx is supportive and symptomatic

33
Q

rodenticide antidote

A

vitamin K

34
Q

pro/cons of analytic testing

A

pro: human hospitals can test for human meds
cons: no one test will screen for all toxicants. Multiple tests become costly.

35
Q

blood sample tests for:

A 
heavy metal
anticoags
antifreeze
cholinesterase
cyanide
chlorinated pesticides
36
Q

serum sample tests for:

A

Cu,Zn
nitrate/nitrite
ammonia

37
Q

liver sample tests for:

A

metals
aflatoxin
alkaloids

38
Q

vomitus sample tests for:

A 
heavy metals
anticoags
antifreeze
pesticides
various poisons
39
Q

kidney sample tests for

A

As, Pb
phenolic compounds
oxalates

40
Q

brain sample tests for

A

chlorinated pesticides
pyrethrins
cholinesterase
metals

41
Q

fat sample tests fo

A

chlorinated pesticides

dioxins

42
Q

% =

A

parts per hundred

1% = 100 ppt = 10,000 ppm

43
Q

0.25% gossypol is what ppm?

A

2500 ppm

44
Q

Q: before beginning tx, dog starts seizing. How change tx plan?

A

tx with diazepam, phenobarbital (receptor-acting compounds). Don’t use charcoal or induce vomiting

45
Q

4 parts to accurately diagnosing any toxicity:

A

1) History (health, current clinical, env., diet)
2) Clinical signs
3) Pathology/necropsy
4) Chemical analysis

46
Q

Main things to remember when managing a poisoned patient

A 
ABCs (airway, breathing, circulation)
Control seizures
metabolic derangements
GI decon
Supportive care
47
Q

Future Prevention methods

A
  • change pasture, feed, water, etc.
  • remove baits, old pesticides
  • bathe/flush for cutaneous or ocular exp.
  • educate clients!
48
Q

common toxins assoc. with increased anion gap

A 
ethylene glycol
ethanol
iron
methanol
salicylates (aspirin)
strychnine
49
Q

anion gap

A

ratio b/w cations (Ca,K) and anions (bicarb, Cl)
(high anion gap = acidosis (>30mEq/L))
Normal = 10-12

Toxicology 5172 (Fall 2014) (8 decks)

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