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Toxicology > Lecture 4 > Flashcards

Lecture 4 Flashcards

1
Q

What are two hepatic toxins

A

Acetaminophen

Xylitol

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2
Q

What are renal toxins

A

Ethylene glycol
Cholcalciferol/vit D3
Grape/raisin

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3
Q

Who is most sensitive to acetaminophen

A

Cats

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4
Q

What does oxidation of acetaminophen give

A

NAPQI- highly reactive

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5
Q

Acetaminophen MOA

A

Formation of NAPQI causes liver tissue necrosis and increased methemoglobin

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6
Q

What is the main problem with acetaminphen in cats

A

Erythrocyte injury- methemoglobin and heinz body production

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7
Q

Clinical signs of acetominaphen

A 
Methemoglobinemia
Hepatotoxicity (dogs get centrilobular hepatic necrosis)
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8
Q

Treatment of acetominaphen

A

N-acetyl cysteine is gold standard

Abscorbic acid can reduce methemoglobin
Cimetidine can be given to cats but less effective
Antioxidants
Supportive care

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9
Q

Xylitol MOA

A

Dose dependent release of insulin causing acute liver failure from depleted cellular ATP levels

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10
Q

Clinical signs of xylitol

A

Vomiting, lethargy, ataxia, collapse, seizures

May see elevated liver enzymes and coagulopathies

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11
Q

What should you differentiate xylitol from

A

Hypoglycemia, acetaminophen, aflatoxins

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12
Q

Treatment of xylitol

A

Activated charcoal NOT recommended because it doesn’t bind xylitol well
Monitor blood glucose and liver function- can give dextrose

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13
Q

Why is the kidney a common site of toxicity

A

High blood flow
High concentraion of toxins
Critical for excretion of foreign substances

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14
Q

Where in the kidney is the most common site of toxin induced injury

A

Proximal convoluted tubule

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15
Q

Describe acute renal failure

A

Decreased GFR and azotemia
Caused by transient damage to tubule, glomerulus, or vasculature
Signs are vomiting, GI bleed, PU/PD, anuria, diarrhea, tremors

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16
Q

Describe chronic renal failure

A

Will see edema, hypocalcemia, parathyroid activity, anemia

17
Q

Ethylene glycol MOA

A

Metabolizes to
Glycolic acid which causes acidosis
Glyoxylic acid which causes CNS signs
Oxalate/oxalic acid which causes renal damage and hypocalcemia

18
Q

Stage 1 clinical signs of ethylene glycol

A

30 min to 3 hours
Drunkeness, ataxia, CNS depression
Nausea vomiting
PU/PD

19
Q

Stage 2 clinical signs of ethylene glycol

A

12 to 24 hours
Tachypnea, tachycardia or bradycardia
Cats usually just remain depressed

20
Q

Stage 3 clinical signs of ethylene glycol

A 
12-72 hours
Most animals present in this stage
Polyuria progressing to anuria
Lethargy, anorexia, seizures
Oral ulcers, abdominal pain, dehydration, enlarged kidneys
21
Q

Diagnosing EG toxicity

A 
Measure EG in blood
Azotemia
Low urine SG
Calcium oxalate crystals in urine and kidneys
Hyperglycemia
Hypocalcemia
High anion gap and high osmolal gap
22
Q

Treatment of EG

A

Prevent formation of metabolites with ethanol and sodium bicarb
Fomepizole

*contraindicated in animals with renal failure and pointless in animals if it has already metabolized

23
Q

What should you treat cats with EG to survive? What about dogs?

A

Cats- 3 to 4 hours

Dogs- 6 to 8 hours

24
Q

Cholecalciferol MOA

A 
Causes increased Ca by
Increasing GI absorption
Decreasing renal excretion
Increasing synthesis of Ca binding proteins
Mobilizing bone calcium
25
Q

Clinical signs of cholecalciferol

A

Anorexia, weakness, depression,
Thirst, polyuria
Diarrhea, dark feces from intestinal bleeding, vomiting
Hypertension, bradycardia, ventricular arrhythmia
Mineralization of tissues

26
Q

Diagnoses of cholecalciferol

A

Increased P, Ca, BUN, creatinine,
Low PTH, urine SG with calciuria
High hydroxycholecalciferol levels in bile and kidney

27
Q

What should you differentiate cholecalciferol from

A

Paraneoplastic syndrome, juvenile hypercalcemia, hyperparathyroidism

28
Q

Treatment of cholecalciferol

A

GI decontamination
Fluids and furosemide
Prednisone to reduce renal calcium resorbtion and GI absorption
Pamidronate as calcitonin

29
Q

MOA of grapes and raisins

A

Unknown

30
Q

Clinical signs of diagnosis of grapes and raisins

A

Vomiting followed by renal failure

Increased Ca, P, and azotemia

31
Q

Treatment of grapes and raisins

A

Emesis, lavage, activated charcoal
Fluids
Other supportive care

Toxicology (8 decks)

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