Management of Poisoned Animals

Question 1

What are the 6 things you should do when presented with a poisoned animal?

Answer 1

1. stabilize vital signs
2. evaluate + Hx
3. prevent continued absorption
4. antidote if possible
5. removal of absorbed toxicant
6. supportive therapy and monitor

Question 2

What are various ways to prevent continued absorption?

Answer 2

dilution, emesis, gastric and entergastric lavage, enemas, endoscopy, gatrotomy/enterotomy, cathartics, activated charcoal, IV lipid emulsion, dermal exposures

Question 3

What are ways to dilute ingested toxin? When is it used? What is controversial about it?

Answer 3

Milk or water (oral)

• delays are decreases
  used: corrosive ingestions and insoluble calcium

causes gastroenteritis

Question 4

What are indications for emetic use?

Answer 4

removes up to 75% of stomach contents
- more effective than lavage

NEED to do ASAP

• generally 2hour can varying depending on absorption rate
• important with small uncharged molecules/weak acids

Feed first so they hav e something to puke up

Question 5

What are reliable emetics in dogs?

Answer 5

apomorphone, hydrogen peroxide

Question 6

What are reliable emetics in cats? what is contraindicated?

Answer 6

dexmedetomidine, xylazine

Contraindicated: apomorphine, hydrogen peroxide

Question 7

What are some contraindications of emetics?

Answer 7

NO rabbits, rodents, or birds

not in animals that are: hypoxic, dyspneic, seizuring, very weak (young/old), comatose, lack pharyngeal reflexes (aspiration pneumonia), have already vomited, ingested corrosives, pointy objects, ingested antiemetics

Caution: brachycephalic breeds, seizure history, heart disease

Question 8

What are indications for gastric lavage?

Answer 8

species that dont vomit
unsuccessful emesis
large volume of stomach contents
symptomatic patient (cant control gag)
lethal dose (quicker than emesis)

Question 9

What are the contraindications for gastric lavage?

Answer 9

ingestion of hydrocarbons or corrosives
liquid toxicants (little benefit)
unstable patient
patient with high risk of bleeding injury
recent surgery
inappropriate time frame post ingestion

Question 10

What is the gastric lavage method?

Answer 10

sedation, intubation
lateral recumbency, head down
measure large bore stomach tube to last rib
flush 5-10ml warm water
agitate stomach
aspirate or gravity drain stomach contents
+/- activated charcoal, elevate head
keep intubation in until able to protect airway

Question 11

How/when is activate charcoal best used?

Answer 11

bets against non-polar organic compounds, but wide use
given within 2 hours with cathartic
decreased absorption by 25-30%
Dose: 1-5g/kg, diluted 1:10 in water
repeated doses 1-2kg without cathartic every 3-8 hours with toxicant subject to recirculation

Question 12

what are the contraindications of activated charcoal?

Answer 12

less benefit with ionized toxicants
cautics, hydrocarbons, metals, alcohols, xylitol
do not combine with oily cathartics
tablets less effective than slurries
messy difficult to administer
dehydration, hypernatremia (playdoh, painballs)
patient with risk of aspiration (emesis is common)
potential GI surgery)

Question 13

What are common cathartics used in small animal?

Answer 13

sodium sulfate (250mg/kg) in AC slurry - most efficient saline cathartic

magnesium sulfate (epsom salt) - 250mg/kg in slurry
- potential CNS depression

Sorbitol (1-2ml/kg of 70% solution)
- most rapid and potent

Mineral oil (not recommended)

Question 14

What are the contraindications of cathartics?

Answer 14

GI stasis, caustic ingestion, hypotention/volume depletion, preexisting diarrhea or laxative ingestion, renal insufficiency, electrolyte imbalance

Question 15

How to decontaminate dermal exposures?

Answer 15

bathing 2-3 times with dawn with copius rinsing
avoid solvents (disperse and increase exposure/alter permeability)
control/monitor seizures or tremors and hypothermia
use rubber gloves, goggles, aprons