Poisons Flashcards
When should we suspect intoxication?
Usually acute onset
Signs referable to affected organ system(s)
Often accidental/inadvertent
Usually oral ingestion
How do we phone triage suspected poisoning cases?
What, when and dose? (need up-to-date bodyweight)
If asymptomatic/unknown or low-risk product - call VPIS
Symptomatic / known ingestion of high-risk product - immediate veterinary attention
What instructions should we give the owner during phone triage?
Bring product label/photo/sample if label not available
Approximate time and quantity
If dermal contamination, try to prevent self-grooming - use buster collar if available
Ensure other pets/children do not have access
Do not follow online remedies
How can we prepare for arrival of an intoxication patient?
If dose/toxin/bodyweight known, consult VPIS/other sources
Prepare for triage and initial management
Inform vet if not already aware, hospital sheet/recording chart, IV catheter/fluids, oxygen supply
Diagnostic samples - blood tubes/needle/syringe (if suspected anti-coagulant ingestion, use peripheral vein)
Decontaminants/emetics etc.
What history can we collect on arrival of the intoxicated patient?
Patient signalment
Pre-existing medical history - signs, medications
Onset and progression of current signs
Specific information regarding possible toxin
Signed consent form
What are the 5 stages of a primary survey?
Respiratory system Cardiovascular system Neurological system Urogenital system Other
How can we diagnose an intoxication?
History of possible exposure
Clinical suspicion - acute onset signs, especially GI/renal/neuromuscular
‘Toxin panel’ analysis possible - rarely used except for legal reasons (suspected malicious poisoning)
What are the general principles of managing intoxication?
Remove/eliminate toxin
Reduce ongoing absorption
Dilution of toxin
When is admin of oral products/induction of emesis contraindicated?
Where there is risk of aspiration (i.e. obtundation, seizures, pre-existing laryngeal compromise, respiratory distress)
In what ways can we remove/eliminate the toxin?
Induce emesis
Gastric lavage
Cutaneous decontamination
Haemodialysis
Describe induction of emesis.
Emesis empties ~40-60% of gastric contents (may enhance effectiveness by feeding small meal immediately prior)
Indicated within 2-3hrs of oral ingestion of non-corrosive intoxicant
Possibly effective >3hrs post-ingestion with substances likely to coalesce in stomach, e.g. chocolate
What are the three main reasons induction of emesis may be contraindicated?
If intoxicant is corrosive/irritant
Pre-existing aspiration risk
Specifically contraindicated if petroleum distillate is ingested (aspiration risk)
What are the available emetic agents?
Dogs - Apomorphine SC
Cats - Xylazine IM (effective in <50% cats, use reversal agent afterwards) / other alpha-2 agonists if xylazine not available
When would we consider gastric lavage?
Known significant intoxication within last hour or so
AND induction of emesis unsuccessful or contraindicated
AND benefits considered to outweigh risks
Unlikely to be of benefit if emesis has already occurred
What are the potential complications with gastric lavage?
Anaesthesia-related
Aspiration
Gastro-oesophageal trauma/perforation
How can we perform cutaneous decontamination?
Wear appropriate PPE
Clip affected regions in long-haired patients
Warm water
Mild shampoo/detergent (e.g. baby shampoo) or degreasing agents if especially greasy
Care to avoid ocular contamination and patient self-grooming post-bath
Do not attempt to neutralise acids/alkalis with the opposite
Do not use solvents/alcohol - likely to spread toxin
Describe haemodialysis.
Extracorporeal therapy - renal replacement (for nephrotoxins) / toxin removal
Rarely used, limited access in UK
In what two ways can we reduce ongoing absorption?
Enteric adsorbents (activated charcoal) Intralipid IV
