Principles Of Treatment Of Toxicosis Flashcards
True or False. An acutely poisoned animal must be considered as an emergency.
True
Explain the telephone instructions to the owner of the acutely poisoned animal.
- keep in quiet safe place to avoid further stress
- if topical exposure, skin and eyes of animal should be cleaned with copious amounts of shampoo and water (owner wear protective clothing)
- inducing emesis when combining is indicated using syrup of IPECAC (1/2-2 teaspoonfuls in small animals) or HYDROGEN PEROXIDE 3% (1-2ml/kg PO) in conscious animals
- admin of milk or egg white or activated charcoal tabs in some cases (if animal is not depressed or in seizures)
- bring to the vet asap
- bring any suspected specimens
What are the 4 treatment principles of toxicosis?
- Symptomatic (supportive tx) – the ABCs- airway, breathing and CV support
- Removal of the Poison
- Specific (antidotal) treatment
- Observation of the acutely poisoned animal
Give some examples of symptomatic supportive tx for respiration
Tracheostomy under local anesthesia
Cuff endotracheal tube in unconscious animals
Ventilators or manual compression of bad
Bronchodilators
Respiratory analeptics
What is an example of a bronchodilator?
Aminophylline
What is an example of an respiratory analeptics?
Doxapram IV (not always effective)
If the patient is hypovolemic (CV problems) how can we get adequate circulatory volume back?
Blood transfusion, plasma or fluid therapy depending on the level of the hypovolemia
What are two ways we can increase cardiac activity?
Cardiac massage (closed or open chest)
Cardiac stimulants -10% calcium gluconate IV, glucagon IV, digoxin IV
Hypotension - fluid therapy, sympathomimetics
If the patient is suffering from an acid base imbalance, how do you treat each case?
Acidosis- sodium bicarb IV every 15 mins; 1/66 molar sodium lactate of lactated Ringer’s soln
Alkalosis- (Normal saline IV followed by ammonium chloride only)
How do you treat pain in a patient?
Opioids
Explain how to treat changes in body temp.
Hypothermia (blankets or warm water pads)
Hyperthermia (ice bags, cold water, baths, cold water enema, or cold periotoneal dialysis)
Explain how to treat CNS problems.
CNS depression- artificial respiration
CNS stimulation- anticonvulsants
What are the 4 ways to remove the poison?
Removal of the suspected source of poisoning
Removal of the poison from the site of absorption
Decreasing the rate of absorption
Enhancing elimination of the poison
Explain how to remove poison via the suspected source of poisoning.
- figure out if farm or companion animal (indoor/outdoor)
- cut the link between animal and source of poisoning
- many different sources
What are the 6 ways to remove the poison from the site of absorption?
Emetics Gastric lovage Enterogastric lavage Rumenotomy Purgatives (cathartics) Skin
When are emetics used?
Used in vomiting animals such as dogs and cats within 1-2 hours
What are the contraindications of emetics?
Unconsciousness Corrosives Petroleum products Dehydration Animals showing convulsions
What is the emetic of choice in dogs? And dosages?
What are antidotes?
Apomorphine
- can be given IV 0.04mg/kg; IM or SC 0.08mg/kg; or instilled into conjunctival sac
- toxicity causes respiratory depression and severe vomiting
- antidote is Naloxone IV, or levallorphan IV
- NOT USED IN CATS
What is the emetic of choice for cats? Dosages
Xylazine
- IV 0.5 mg/kg, or IM 1mg/kg is effective in cats
- has CNS depression for several hours
What are other examples of emetics that could be used?
Syrup of ipecac undiluted (6.6 ml/kg) PO effective in 15 mins
Fresh ground mustard
Saturated soln of NaCl
Hydrogen Peroxide 3%
Explain how and when to use gastric lavage.
Use in unconscious or anesthetized patients
Stomach tube, funnel, and endotracheal tube
Tap water is the lavage fluid
Perform several washings (10-15)
Amount of fluid is 5-10ml/kg
Activated charcoal is commonly added to tap water
Explain how to do an enterogastic lavage.
Performed by using a combo of stomach tube and an enema
After light anesthesia and stomach lavage, high enema is used with warm water until a clear fluid comes from the oral side of the stomach tube
When can you use a rumenotomy to remove poison?
When the condition of the animal allows surgery
What types of purgatives can be used?
Saline; such as sodium sulfate or magnesium sulfate (1g/kg, 40%)
Mineral oil is used, in case of lipid soluble toxicants, followed by saline purgative
What should you do if the skin is exposed to toxins?
Rinsed immediately with plenty of soap and water
What are 4 ways to decrease the the rate of absorption?
Precipitation
Adsorption
Ion trapping
Precipitation
What is precipitation?
Decreasing the rate of absorption by chemicals that bind the toxicant
What are three precipitates and the common toxin they bind?
Sulfate- lead
Calcium- oxalate
Tannic acid- alkaloids
What is adsorption?
Physical binding of the toxicant
What is the adsorbent of choice?
Activated charcoal
What are some important facts about charcoal?
Considered universal antidote (not ammonia or cyanide)
Charcoal with a small particle size is most effective
Plant charcoal more effective than animal charcoal
Charcoal is not very effective for ethanol, methanol, heavy metal salts, fluoride, iodides, nitrate and nitrite, sodium chloride, bleach and fertilizer
Larger molecules may compete with smaller molecules on adsorption sites
Charcoal is most effective when given as soon as toxicant ingestion is suspected
Can be used as multiple doses in toxicants that undergo enterohepatic circulation
Ipecac decreases effectiveness of activated charcoal
True or False. Ion trapping is very effective in decreasing absorption
False.
What are 4 ways to enhance elimination?
Fluid therapy and diuretics
Urine pH modifiers
Peritoneal dialysis
Hemodialysis
What does fluid therapy generally enhance?
Renal excretion
-make sure to monitor renal fx and hydration of the animal (urinary output)
What two drugs are most commonly used as diuretics in the treatment of poisoning?
Mannitol
Furosemide
What two urinary acidifiers enhance renal excretion of weak basic drugs (alkaloids or amphetamines)?
Ammonium chloride
Methionine
What urinary alkalinizer enhances renal excretion of weak acidic drugs (NSAIDs or phenobarb)?
Sodium bicarb
When do you use periotoneal dialysis?
When the animal is suffering from oliguria or anuria
What do you use for treatment of toxicoses associated with lipophilic agents?
Intravenous lipid emulsion (ILE) as an antidote (also called IFE- intravenous fat emulsions)
When do you use specific antidotal treatment (ILE)?
Used in toxicoses with high morbidity when conventional treatments fail (ventilator)
Response depends on the degree of lipid solubility of the toxicant
What is a common ILE?
Soybean-oil-based emulsions
What is the mechanism of action of an ILE?
Unknown, but thought to relate to improved cardiac performance, sequestration of the toxic compound into a lipid compartment with the blood stream
What are the adverse effects ILEs?
Many are uncommon but may be caused by contamination of the lipid due to direct acute adverse pyrogens conditions rxn (colloid rxn), or acute anaphylactic reaction or delayed allergic reactions due to overdose (fat overload syndrome, FOS)
