Renal and Hepatic

Question 1

Learning Objective - Understand why kidney and liver are major site of toxicosis in small and large animals.

Answer 1

high blood flow 25% of cardiac output, kidney has high concentration of toxin, critical for excretion of xenobiotics
PCT most common site, cytochrome P450 and beta Lyase activate toxins.

Question 2

Learning Objective - differentiate between acute and chronic kidney failure following a toxicant exposure.

Answer 2

Acute - dec. GFR, azotemia, transient damage, v/d pu/pd anuria tremors
Chronic - secondary pathological changes, edema, hypocalcemia, parathyroid activity, reduced RBCs

Question 3

Learning Objective - identify the major stages of toxicosis for ethylene glycol and how to treat

Answer 3

I. < 3 hours, drunkenness ataxia, naseau vomiting, missed by unobservant owners
II. 12-24 hr, tachypnea, tachycardia
III. 12-72 hrs, MOST PRESENT HERE, lethargy, anorexia, vomiting seizures, oral ulcers, pain, dehydration, enlarged kidneys
Treatment: 20% ethanol & Fomepizole competitive inhibitors of alcohol dehydrogenase (if EG has already been metabolized there’s no benefit)
Na Bicarb can also be used to treat the metabolic acidosis.

Question 4

Learning objective - know and diagnose other compounds that result in renal and liver damage.

Answer 4

Ethylene glycol - renal
Cholecalciferol - renal
grape/raisin - renal
acitomeniphin - hepatic

Question 5

Ethylene glycol has a very high rate of lethality due to?

Answer 5

delays in presentation

Question 6

Lethal doses of ethylene glycol?

Answer 6

cats - 1 tbsp

dogs - 7ml/kg

Question 7

ethylene glycol metabolites?

These increase unmeasured anions thus _______ the anion gap.

Answer 7

1. glycolic acid causes acidosis
2. glycooxylic acid CNS signs
3. oxalic acid causes renal damage and hypocalcemia (calcium oxalate)
   Increased anion gap

Question 8

cholecalciferol mechanism of action? presents with?

Answer 8

leads to massive amounts of calcium

pu/pd, v/d dark feces due to intestinal bleeding, hypertension bradycardia, ventricular arrthymia

Question 9

With cholecalciferol toxicity, rapid increase in plasma ______ followed by ______. Low _____ hormone. _____ urine SG with _____. Also ______ in multiple organs on histology.

Answer 9

phosphorus Calcium. low PTH
low urine SG with calciuria
mineralization.

Question 10

Treat cholecalciferol toxicity with normal saline or _____ to promote Ca excretion. ______ and ______ (very expensive) will also both lower blood calcium.

Answer 10

furosemide

prednisolone, pamidronate

Question 11

Mechanism of action is unknown for

Answer 11

grape and raisin toxicity

Question 12

grape and raisin toxicity clinical signs include vomiting followed by acute _______. Chem findings include inc. __ , ___ and ____

Answer 12

renal failure

ca, P, azotemia

Question 13

Liver is the major site of ______. intrinsic injury, often caused by reactive products of xenobiotic metabolism, leads to steatosis, necrosis, cholestasis.

Answer 13

detoxification

Question 14

one of the most serious and common causes of poisoning in humans and animals

Answer 14

acetominophen (tylenol)

Question 15

acetominophen is metabolized in the liver (glucuronidation, sulphonation, oxidation) to produce highly reactive ______.
why are cats extremely sensitive?

Answer 15

NAPQI

cats can’t do glucuronidation (so they end up with more NAPQI)

Question 16

NAPSI causes Liver necrosis and inc. MetHb when _______ is depleted.
______ injury is the predominant problem in cats

Answer 16

glutathion (antioxidant)

RBC

Question 17

Diagnosis of tylenol poisoning in dogs are associated with acute _________, nausea, vomiting, abdominal pain, shock, tachypnea, tachycardia

Answer 17

centrilobular hepatic necrosis

Question 18

treatment of tylenol toxicosis

Answer 18

replenish glutathion stores. Give glutathion precursor N-acetylcysteine (NAC)