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Small Animal Final Year > Supporting the Poison Case > Flashcards

Supporting the Poison Case Flashcards

1
Q

What are the general principles when it comes to toxin case?

A
  • Is there a known toxin?
  • How long since exposure?
  • What was the route of exposure?
  • The initial phone call is an opportunity to give advice and receive information
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2
Q

How can we minimise exposure to inhaled toxins?

A

Remove from the environment

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3
Q

How can we minimise exposure to dermal contamination?

A
  • wear gloves!
  • brush off any powder
  • clip the hair
  • wash with tepid water & mild detergent (eg w/up liquid)
    • 15-20 minutes?
    • multiple wash/rinse cycles
  • avoid any solvents/neutralising agents (eg white spirit, turpentine)
  • think about avoiding hypothermia
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4
Q

How can we minimise ongoing exposure to ocular exposure? What about immediately or in the practice?

A
  • corneal ulceration/injury
  • Immediate
    • flush with saline or water for 10-15 mins
  • At the practice
    • continue flushing under sedation if necessary
    • fluorescein stain to examine carefully for ulceration
      • repeat to monitor?
    • lubrication, topical antibiotics, analgesia
    • buster collar
    • consider referral if alkali injury
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5
Q

How can we minimise ongoing exposure to oral toxins?

A
  • Gastric decontamination
    • emesis
    • gastric lavage
    • administer adsorbents
  • Seek advice if the toxin is known
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6
Q

Can we use diluents? If so what?

A

Milk (~2-6 mls/kg?)

Liquid antacids

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7
Q

What do liquid antacids do and why do we offer small amounts?

A
  • Soothe and coat damaged mucous membranes
  • Offer small amounts only
  • avoids over distension of stomach
  • less likely to vomit
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8
Q

What is diuresis useful for and what can we use?

A
  • renal excreted toxins
  • iv fluids +/- mannitol
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9
Q

How commonly are cathartics and laxatives used? What can we use? (3)

A

RARE

  • sorbitol 70% solution 1-3 ml/kg
  • lactulose 0.5-1ml/kg
  • magnesium sulphate
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10
Q

If we promote elimination what do we need to take care with?

A

Hydration status

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11
Q

What do we do to treat the consequences of ingesting toxins?

Note:

  • Fluids
  • Hepatoprotectans
  • Haemhorrhage
  • Respiratory depression
  • Seizures
  • Hyperaesthesia
  • Tachycardia
  • Bradycardia
  • Hypothermia
  • Hyperthemia
  • Nutrition
A

Fluid therapy

  • manage hypoperfusion
  • diuresis to enhance elimination of renal excreted toxins
  • maintain renal perfusion to protect against nephrotoxins
  • “dilution” of toxins that might otherwise be toxic to renal tubules

Hepatoprotectants/antioxidants

  • s-adenosylmethionine
  • sylibin (milk thistle)

Haemorrhage?

  • apply pressure at site of haemorrhage
  • are there indications for transfusion
  • IV fluids

Respiratory depression?

  • oxygen
  • intubate and ventilate

Seizures?

  • anti-epileptic medication e.g. diazepam, barbiturates

Hyperaesthesia?

  • sedatives eg ACP, diazepam

Tachycardia?

  • beta-blockers, antidysrhythmics

Bradycardia?

  • atropine

Hypothermia?

  • external warming
  • warm saline enemas/bladder lavage

Hyperthermia?

  • ice packs
  • muscle relaxants
  • NSAIDs (if no concerns about renal and GI perfusion)

Nutrition?

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12
Q

What are the indications to induce emesis? (3)

A
  • Appropriate time window
    • ideally <1-2 hours
      • can vomiting be induced at home (washing soda crystals)?
    • delayed up to 4-6 hours OK in some situations
      • slow gastric emptying
      • chocolate
      • grapes
  • Can consider in asymptomatic patients if potential toxicity worrying
    • “better safe than sorry?”
  • Be aware that evidence for beneficial effects of inducing emesis is lacking
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13
Q

What are the contraindications to induce vomiting? (9)

A
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14
Q

Even though it might be contraindicated.. Why might it be worth making an animal vomit who ha already vomited? What else could we do?

A

Vomiting might only empty the stomach by 40-60%. It might still be appropriate to induce further emesis. A lateral radiograph of the abdomen might give an idea of residual gastric volume.

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15
Q

Apomorphine can be given to induce emeis, how can we administer and what are the side effects?

A

Administration

  • 0.02-0.04 mg/kg iv, im or sc
  • higher or repeated doses may be required.
  • can be given by subconjunctival administration

Side effects include

  • sedation
  • may become a contraindication to repeat dosing
  • bradycardia
  • protracted vomiting
  • consider fluid therapy
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16
Q

What else used to be given to induce emesis? Causes severe haemhorrhage

A

Hydrogen Peroxide

17
Q

What can we use to induce emesis in cats? What is ineffective

A

α 2 agonists:

  • medetomidine 0.01 mg/kg im or sc
  • medetomidine 0.01mg/kg and morphine 0.2mg/kg s/c
  • xylazine 0.44mg/kg im
  • hydroxymorphone 0.05 mg/kg + midazolam 0.2mg/kg sc
  • consider side effects such as
    • bradycardia
    • sedation

Apomorphine is ineffective in cats

18
Q

What are the indications for a gastric lavage? (4)

A
  • Failure to induce vomiting
  • Radiographic or ultrasonographic evidence of residual gastric contents
  • Respiratory or CNS depression meaning emesis is contraindicated but recent toxin ingestion
    • loss of gag reflex/laryngeal paralysis
    • reduced mentation
  • Where major concerns that
    • dose is close to LD50
    • severe clinical signs could occur
19
Q

What are the contraindication of a gastric lavage? (3)

A
  • Risk of gastric perforation
  • Corrosive or caustic substance
  • High anaesthetic risk
    • cardiovascular collapse?
20
Q

What is the technique for a gastric lavage?

A
  • Stabilise patient–>GA & cuffed ET tube
  • Sternal recumbency
  • Orogastric tube:
    • large bore
    • premeasure from canine tooth to last rib
    • mark the site
    • lubricate the tube well
    • gently pass from oropharynx in to stomach
    • ensure appropriate placement
  • Lavage with 5-10mls/kg tepid water
  • Gently palpate the stomach to avoid overfilling but encourage mixing
  • Lower end of orogastric tube in to a bucket at floor level
  • Drain by gravity +/- suction
  • Repeat the lavage multiple (15-20) times until fluid appears clear
  • Administer activated charcoal at this stage if appropriate
  • Kink off the tube and withdraw
  • Recover in sternal recumbency
  • Remove ET tube only when a strong gag reflex is present
    • careful observation is essential
21
Q

What are the functions of absorbents? (3)

A
  • Bind toxin to prevent further absorption from GI tract
  • May be more effective than emetic agents used alone
  • Must be given swiftly to be helpful
22
Q

How does activated charcoal work? How do you dose? What are the negatives?

A
  • Provides a large surface area to adhere organic toxins
    • eg grape/raisin toxicity and many others
  • Dosing:
    • mix with water to make a slurry (1g/5mls)
    • 0.5-4g/kg orally
    • syringe/stomach tube
  • Doesn’t adsorb all toxins
    • seek advice regarding the specific toxin
    • not helpful for ethylene glycol toxicity
    • “if in doubt give it”
23
Q

When is Multiple dose activated charcoal (MDAC) indicated?

How do you dose?

A
  • Indicated when there is
    • enterohepatic circulation
    • eg theobromine toxicity, cholecalciferol
    • ingestion of an extended release drug
    • potential for “GI dialysis”
    • absorbed toxins are drawn out of systemic circulation along a concentration gradient back in to the GI tract
  • Loading dose 1-5g/kg as before
  • Repeat dose every 4-6 hours for 24-72 hrs
24
Q

What are the problems with activated charcoal? (5)

A
  • Not always easy to give
    • risk of aspiration pneumonia
  • Very messy
  • Administration in food
    • increases palatability and ease of dosing
    • ??reduced efficacy??
  • Risk of aggravating fluid and electrolyte imbalance?
  • Avoid if endoscopy is imminent….
25
Q

Discuss the use of an antidote…

A
  • Aim is to prevent, reverse or reduce effect of a toxin
  • May not be available
  • May be cost prohibitive
  • Consider if an antidote might cause adverse effects
26
Q

What is the anti-dote or:

A) Snake bite?

B) Paracetamol?

C) NSAIDs?

D) Cholecalciferol/vitD analogues

A

A) Anti venom

B) N-acetyl cysteine

C) H2 antagonists

D) Pamidronate/calcitonin

27
Q

What is the anti-dote for:

A) Opioid?

B) Ethylene glycol?

C) Anticoagulant rodenticide?

D) Permethrin?

A

A) Naloxone

B) Ethanol

C) Vitamin K1

D) Methocarbamol

28
Q

How common is IV lipid emulsion used in animals?

A

Increasing awareness of this as a simple, easy and relatively cheap treatment

•shortens duration and severity of clinical signs

29
Q

What is the mechanism of action of IV lipid emulsion?

A
  • Mechanism of action unclear
  • lipid sink mechanism
  • eg makes toxin unavailable to act on target receptors
  • metabolic effect
  • eg reduced cardiotoxic effects by providing an energy source
30
Q

What are IV lipid emulsion suitable for?

A

Lipophilic compounds with short to moderate t1/2

  • permethrin
  • macrocyclic lactones (ivermectin, moxidectin)
  • baclofen
31
Q

What are the adverse effects of IV lipid emulsions? (4)

A
  • pancreatitis
  • pain at site of extravasation
  • potential to trap useful drugs eg anticonvulsants?
  • hypersensitivity reactions?
32
Q

Where can you go for info about toxins and treatments.. (2)

A

VPIS

iCatCare information

33
Q

On the inital phone call.. what ifo do we need to get?

A
  • How will the owners feel?
    • ask for a contact number
  • Information about the pet
    • species
    • breed
    • age
    • sex
    • weight
    • medical history
    • any current medication
  • Details of the poison
    • full name (from the packaging)
    • concentration of active ingredient
    • manufacturer’s name
    • other composition (eg solvents)
    • presentation and packaging
      • tablets/capsules
      • bottles or boxes
    • if suspected toxin is a plant…
      • seeds?
      • berries?
      • leaves?
    • how much of the toxin is left
  • Details of the incident
    • what happened?
    • route of exposure
    • time since exposure
    • duration of exposure
    • how many animals might be involved?
  • Are there any clinical signs?
34
Q

What advice do we give on the inital phonecall with regard to the toxin ingestion?

A
  • remove pet from source of poison and isolate
  • prevent access to any vomit which might contain poison
  • take care and avoid contamination of owners
  • bring sample of poison and packaging to the practice along with the pet if any concerns
    • “better safe than sorry”

Small Animal Final Year (317 decks)

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