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CVNT 2 > Poisons > Flashcards

Poisons Flashcards

1
Q

when to suspect intoxication

A
  • usually acute onset
  • often accidental (human meds, overdose, exposure to toxins at home)
  • usually oral ingestion, can be topical
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2
Q

phone assessment questions

A
  • what, when, dose
  • up-to-date body weight
  • call VPIS if needed
  • avoid house calls
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3
Q

owner instructions for emergency admit

A
  • bring product label, photo
  • sample of product
  • try to prevent self grooming if dermal toxin
  • do not follow internet remedies
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4
Q

before owner arrival

A
  • consult VPIS/others for up-to-date management advice
  • prep for triage (catheter, oxygen, decontaminants, emetics)
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5
Q

primary survey

A
  • respiratory
  • cardiovascular
  • neurological
  • renal/urogenital
  • pain
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6
Q

diagnosing intoxication

A
  • history, clinical suspicion
  • toxin panel (blood, gastric contents)
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7
Q

managing intoxication general principles

A
  1. remove/eliminate toxin
  2. reduce ongoing absorption
  3. dilution of toxin
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8
Q

options for removing/eliminating toxin

A
  1. induce emesis
  2. gastric lavage (reserved for patients where emesis doesn’t work)
  3. cutaneous decontamination
  4. haemodialysis
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9
Q

induction of emesis

A
  • empties 40-60% gastric contents
  • indicated within 2-3hrs oral ingestion
  • possibly effective >3hrs post-ingestion with substances that coalesce
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10
Q

contraindications of inducing emesis

A
  • if patient is seizing, unconscious
  • if intoxicant is corrosive, irritant
  • if petroleum distillate is ingested
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11
Q

emetic agent for dogs

A
  • apomorphine (subcut)
    • long lasting (anti-emetic after)
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12
Q

emetic agent for cats

A
  • xylazine (IM) effective in <50%
    • use reversal agent after
    • used as sedative
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13
Q

gastric lavage considerations

A
  • uncommon
  • known significant intoxication within the last 1hr
  • and induction of emesis unsuccessful or contraindicated
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14
Q

potential complications of gastric lavage

A
  • induce anaesthesia (risks)
  • aspiration pneumonia
  • gastro-oesophageal trauma
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15
Q

gastric lavage steps

A
  • anaesthetised patient in left lateral recumbency
  • measure nares to last rib, lube tube tip
  • lavage with 10-30ml/kg warmed saline
  • kink tube prior to removal to prevent spilling of contents
  • suction oropharynx prior to recovery
  • ensure swallow reflex returned prior to extubation
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16
Q

cutaneous decontamination

A
  • clip affected regions in long-haired patients
  • warm water, mild shampoo
  • degreasing agents if necessary
  • avoid ocular contamination
  • prevent patient grooming
  • do not neutralise acids/alkali
  • do not use alchol/solvents
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17
Q

haemodialysis

A
  • extracorporeal therapy
  • renal replacement
  • very unavailable
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18
Q

reducing ongoing absorption methods

A
  • enteric adsorbents (activated charcoal)
  • intralipid (IV)
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19
Q

enteric adsorbents

A
  • reduces ongoing absorption and facilitates faecal excretion of toxin
  • liquid/powder
  • not effective for all toxins
  • repeated admin for enterohepatic recirculation cases
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20
Q

complications for enteric adsorbents

A
  • not effective for all toxins
  • can cause black faeces, constipation
  • may cause GIT irritation
21
Q

intralipid IV

A
  • creates lipid sink, holding lipids in intravascular space preventing its effect on the brain
  • not effective for all toxins
22
Q

complications of intralipid (IV)

A
  • toxin must be lipophilic
  • can cause fat embolization, pancreatitis
23
Q

supportive care for poison patients

A
  • specific antidote
  • maintain hydration and nutrition
  • manage nausea, pain
  • turn recumbent patients regularly
  • lubricate eyes for patients with reduced blink
24
Q

special considerations for neurotoxins

A
  • manage seizures
  • check no metabolic cause
  • monitor gag reflex
25
Q

which ingestants not to worry about

A
  • contraceptive pill (GI upset)
  • silica gel
  • catnip exposure
  • novelty luminous items (hypersalivation)
26
Q

clinical signs of nephrotoxin ingestion

A
  • sudden onset
  • signs of AKI
  • inappetence
  • lethargy
  • vom, diarrhoea
27
Q

diagnosis of nephrotoxin ingestion

A
  • azotemia
  • calcium oxalate monohydrate crystals in ethylene glycol toxicity
28
Q

common nephrotoxins

A
  • NSAIDs
  • lilies (cats)
  • grapes, raisins (dogs)
  • ethylene glycol (antifreeze)
  • vitamin d analogues (renal calcification)
29
Q

nephrotoxin management

A
  • decontamination (induce emesis, activated charcoal, wash)
  • specific antidotes for some toxins
30
Q

nephrotoxin nursing considerations

A
  • maintain euhydration and euvolaemia
  • monitor fluid ins/outs
  • often nauseous- antiemetics
  • analgesia
  • hypertension common
31
Q

clinical signs of neurotoxins

A
  • hyper-excitability, agitation
  • tachycardia, arrhythmias
  • muscle tremors (risk of hyperthermia_
  • seizures
  • obtundation
32
Q

common neurotoxins

A
  • theobromine (chocolate)
  • permethrin (spot-on) on cats
  • metaldehyde (slug pellets)
  • tremorogenic mycotoxins (mould)
  • canabis
33
Q

management of neurotoxins

A
  • decontaminate (emesis, activated charcoal, wash)
  • muscle relaxants (diazepam)
  • anti-epileptics
  • ensure no hypoglycaemia, calcaemia
  • intra-lipid treatment
34
Q

neurotoxin nursing considerations

A
  • regular turning for obtunded patients
  • toileting considerations
  • monitor for seizures, tremors
  • monitor gag reflex
35
Q

common hepatotoxins

A
  • xylitol (artificial sweetner)
  • mushrooms
  • blue green algae
  • alfatoxins (found in mould)
  • drugs
36
Q

considerations for hepatotoxins

A
  • monitor for hypoglycaemia, coagulopathy
  • may develop hepatic encephalopathy
37
Q

how do anticoagulant rodenticides cause coagulopathies?

A
  • impacting vitamin K dependant clotting factors (II, VII, IX, X)
    • produced in the body in inactive form
    • become active through carboxylation (Vit K)
    • Vit K becomes inactive (oxidised)
    • can be reduced through Vit K-epoxide reductase
  • anticoagulant rodenticides block Vit K-epoxide reductase
  • inactive clotting factors can no longer be activated
38
Q

presentation of anticoagulant rodenticide

A
  • pre-symptomatic- witnessed ingestion
    • takes 2-5 days to develop symptoms) - symptomatic- severe coagulopathy
  • haemoabdomen/haemothorax
  • collapse, hypovolaemic, anaemic
  • indirect toxicity due to ingestion of dead rats is unlikely
39
Q

witnessed ingestion of rat bait- treatment

A
  • GI decontamination (emesis, activated charcoal)
  • measure clotting times (PT, aPTT) immediately and 48hrs after
  • Vit K1 therapy
  • repeat PT, aPTT post-treatment
40
Q

treatment of symptomatic anticoagulant rodenticide

A
  • care when taking bloods
  • too late for decontamination
  • Vit K1 therapy
  • plasma, RBC, replacement of clotting factors
41
Q

methaemoglobinaemia

A
  • caused by paracetamol toxicity in cats
  • oxidative damage to RBC
  • iron should be Fe2+ state to bind to O2, oxidative damage causes Fe3+ (methaemoglobin)
42
Q

clinical signs of methaemoglobinaemia

A
  • chocolate coloured mucous membranes
  • brown blood
43
Q

clinical signs of paracetamol toxicity in cats

A
  • methaemoglobinaemia- reduced O2 delivery, signs of shock
  • cardiorespiratory distress
  • neurological signs
  • facial and limb oedema
44
Q

treatment of paracetamol toxicity

A
  • induce emesis if ingested <1hr, no contraindications
  • activated charcoal
  • anti-oxidants (N-acetylcysteine)
45
Q

clinical signs of adder bite

A
  • usually within 2hrs
  • puncture wounds
  • swelling, bruising local to bite
  • altered mentation- depressed)
  • panting, pyrexia
  • +/- cardiac arrhythmias
46
Q

treatment of adder bite

A
  • keep patient quiet and calm
  • leave bite well alone
  • antivenom
  • analgesia
  • fluid therapy?
47
Q

common irritant/caustic substances

A
  • batteries
  • benzalkonium chloride (disinfection)
  • petrolleum distillate
  • washing tablets
48
Q

clinical signs of caustic substances

A
  • oral ulceration- pain, hypersalivation, anorexia
  • oesophageal ulceration- regurgitation
  • gastric ulceration- vomiting
  • dermal alopecia, burns, ulceration
49
Q

treatment of caustic substances

A
  • gut decontamination contraindicated
  • dermal decontamination (warm water rinse)
  • analgesia (opioids)
  • maintain hydration
  • tube feeding (bypass ulcerated areas)
  • radiograph to locate battery

CVNT 2 (33 decks)

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