SA toxicology

Question 1

what needs to be stabilised in suspected toxin ingestion cases?

Answer 1

respiratory
CV
CNS
thermoregulation
electrolyte/acid-base derangement

Question 2

if there has been topical exposure of a sticky toxic substance, what should be done?

Answer 2

clip animal or wash with vegetable oil

Question 3

how should the eye be irrigated in cases of topical exposure to toxins?

Answer 3

saline/tepid water for 20 minutes

treat ulceration

Question 4

what is the aim of treating ingested toxins?

Answer 4

decrease absorbed dose - prevent absorption, bind toxin, increase elimination

Question 5

what can be used to induce vomiting in dogs?

Answer 5

apomorphine

Question 6

what can be used to induce vomiting in cats?

Answer 6

xylazine or dexmedetomidine

Question 7

what can be done prior to inducing vomiting to aid emesis?

Answer 7

feed small amount of food/water

Question 8

what are the contraindications for inducing emesis?

Answer 8

already vomiting
absent gag reflex
sedated/unconscious
seizing
corrosive substance ingested

Question 9

how fast after ingestion should emesis be induced?

Answer 9

3 hours (6 for aspirin and 12 for chocolate)

Question 10

what must be placed prior to gastric lavage?

Answer 10

cuffed ET tube

Question 11

what can be used at the end of gastric lavage?

Answer 11

activated charcoal (leave for 10 minutes)

Question 12

can charcoal be given if emesis has been induced?

Answer 12

yes - wait 30 minutes so charcoal isn’t vomited

Question 13

other than emesis, what can be used to enhance the clearance of toxins?

Answer 13

cathartics
enema
diuresis

Question 14

what do cathartics do?

Answer 14

reduce the time a toxin is exposed to the GI tract

Question 15

what toxicities can IV lipid emulsion be used for?

Answer 15

local anaesthetics
calcium channel blockers
macrocyclic lactones
pyrethrin

Question 16

what are antidotes?

Answer 16

any compound which counteracts the effect of a toxicant

Question 17

what analgesics should be avoided in toxicity cases?

Answer 17

NSAIDs (GI problems)

Question 18

what analgesics should be used in toxicity cases?

Answer 18

opioids (pethidine)

Question 19

what can be used to treat seizures?

Answer 19

diazepam
phenobarbital
propofol

Question 20

what species are lilies toxic to?

Answer 20

cats

Question 21

what is the first sign of lily toxicity in cats?

Answer 21

gastritis - vomiting

Question 22

what is the major consequence of lily toxicity?

Answer 22

acute kidney injury (neurological, salivation…)

Question 23

how is lily toxicity treated?

Answer 23

induce emesis
activated charcoal
fluid therapy

Question 24

how do pyrethrins affect mammals?

Answer 24

CNS affected by prolonging sodium conductance (increase nerve firing)

Question 25

what are the clinical signs of pyrethrin toxicity?

Answer 25

salivation tremor, ataxia, depression hyper/hypothermia

Question 26

what can be used to treat pyrethrin toxicity?

Answer 26

bathing emesis activated charcoal diazepam

Question 27

what does paracetamol toxicity cause?

Answer 27

oxidative injury to RBCs | hepatotoxic (hepatic failure)

Question 28

what are the clinical signs of paracetamol toxicity?

Answer 28

``` vomiting abdominal pain tachycardia pallor cyanosis chocolate colour MM ```

Question 29

how can paracetamol toxicity be treated?

Answer 29

``` emesis (within 2 hours of ingestion) activated charcoal cathartics ascorbic acid N-acetylcysteine ```

Question 30

where is ethylene glycol metabolised?

Answer 30

liver by alcohol dehydrogenase

Question 31

what is ethylene glycol metabolised to?

Answer 31

``` glycolic acid (metabolic acidosis0 oxalic acid (renal epithelial damage) ```

Question 32

what are the three clinical phases of ethylene glycol toxicity?

Answer 32

GI irritation CNS toxicity nephrotoxicity

Question 33

what are the clinical signs of the first phase of ethylene glycol toxicity?

Answer 33

``` ataxia tachycardia PUPD vomiting (2-12 hours post ingestion) ```

Question 34

what are the clinical signs of phase 2 of ethylene glycol due to?

Answer 34

metabolic acidosis

Question 35

what are the clinical signs of the second phase of ethylene glycol toxicity?

Answer 35

anorexia, vomiting depression, hypothermia (8-24 hours post ingestion)

Question 36

what are the clinical signs of phase 3 of ethylene glycol due to?

Answer 36

oliguric renal failure

Question 37

what are the clinical signs of the third phase of ethylene glycol toxicity?

Answer 37

``` large/painful kidneys oral ulceration vomiting seizures (1-3 days post ingestion) ```

Question 38

what crystals can be found in the urine of animals with ethylene glycol toxicity?

Answer 38

calcium oxalate monohydrate crystals

Question 39

how is ethylene glycol toxicity treated?

Answer 39

``` (poor prognosis past phase 1) supportive care (IV fluid) antidote ```

Question 40

what are the antidotes available for ethylene glycol toxicity?

Answer 40

ethanol (CNS/respiratory depression) | fomepizole (best)

Question 41

how do ethanol and fomepizole work as an antidote to ethylene glycol toxicity?

Answer 41

inhibits alcohol dehydrogenase

Question 42

how do anticoagulant rodenticides work?

Answer 42

vitamin K antagonists

Question 43

what effect does rodenticides antagonising vitamin K have?

Answer 43

prevents certain clotting factors being activated (coagulopathy)

Question 44

how is anticoagulant rodenticide toxicity treated?

Answer 44

vitamin K supplementation (absorbed better with fatty foods) | supportive (for blood loss)

Question 45

what effects does cholecalciferol rodenticides have?

Answer 45

increase calcium absorption (from intestines, osteoclastic from bone, reabsorption in renal tubules)

Question 46

what are the clinical signs of cholecalciferol toxicity related to?

Answer 46

hypercalcaemia

Question 47

how is cholecalciferol toxicity treated?

Answer 47

``` emetic, activated charcoal treat hypercalcaemia (calcitonin, saline diuresis) ```

Question 48

what is ingested to cause metaldehyde toxicity?

Answer 48

slug/snail pellets

Question 49

what type of toxicity does metaldehyde cause?

Answer 49

neurotoxicity (then hepatotoxicity if they survive)

Question 50

what are the clinical signs of metaldehyde toxicity?

Answer 50

anxiety, restlessness, salivation, tremors, ataxia, seizure, coma

Question 51

how is metaldehyde treated?

Answer 51

emesis, gastric levage liquid parafin fluid therapy diazepam (seizures)

Question 52

how do NSAIDs cause toxicity?

Answer 52

inhibit prostaglandin synthesis

Question 53

what can be done to treat NSAID toxicity?

Answer 53

emesis, gastric lavage cathartics repeated doses of charcoal

Question 54

why are repeated doses of activated charcoal needed for NSAID toxicity?

Answer 54

NSAIDs undergo enterohepatic recirculation

Question 55

what are methylxanthines found in?

Answer 55

chocolate, tea, coffee (caffeine and theobromine)

Question 56

what are the clinical signs of methylxanthine toxicity?

Answer 56

ventricular arrhythmias tremor/seizure GI upset

Question 57

how is methylxanthine toxicity treated?

Answer 57

emesis and activated charcoal | keep bladder small (absorbed across the wall)

Question 58

what is the toxic effect of grapes/raisins in dogs?

Answer 58

acute kidney injury (proximal tubular necrosis)

Question 59

what are the clinical signs or marijuana toxicity?

Answer 59

hypothermia depression, disorientation compulsive eating (munchies)

Question 60

how is marijuana toxicity treated?

Answer 60

supportive therapy | repeat charcoal administration

Question 61

what does xylitol cause?

Answer 61

hypoglycaemia (massive insulin release)

Question 62

how can xylitol toxicity treated?

Answer 62

emesis N-acetylcysteine supportive therapy (glucose)

Question 63

what causes toxicity to onions/leeks?

Answer 63

disulphide and thiosulfate

Question 64

what does onion/leek toxicity cause?

Answer 64

Heinz bodies and haemolysis