Toxicities Flashcards
What should be on your checklist?
Who is at risk?
Clinical symptoms?
Time frame
To vomit or not to vomit
Treatment available
Expected volume
What household plants can cause GI signs?
Azaleas, Rhododendron
Bulb- tulips, Iris , daffodils
Ivy, mistletoe
What household plants can cause Glossitis stomatitis?
Philodendron
What houseplant can cause cardiac problems? And what arrhythmia can we see?
Oleandor, foxglove
Atrial arrhythmia
What household plants can cause renal failure in cats?
Easter Lillie’s/ most Christmas related plants
What allium species are toxic?
Onion, garlic, shallots, chives and a variety of flower species
What is the toxic component of these allium species?
Propyl disulfide
What can propyl disulfide produce?
Produces oxygen free radicals which will damage erythrocytes
What is the timing between consumption and clinical signs?
7-10 days
What are the clinical signs?
Inappetence
Ataxia
Lethargy
Vomiting
Icteric MM
What may lab test reveal?
Heinz bodies
Howell jolly bodies
Regenerative anemia
Hemoglobinuria
Elevations in lactate and bilirubin levels
What is the treatment?
Supportive care
Blood products if anemia is severe
What is the toxic principle with marijuana?
THC
ingestion or inhalation
Highly lipophilic
What are the clinical signs?
Generally within 1 hour
Dribbling urine, staring off into space
Slow to respond
Mydriasis, drooling, bradycardia
What is the treatment?
Fluids, supportive care
Not making them vomit unless it’s within chocolate
What is the prognosis?
Generally, very good
What can dogs get when ingesting Acetaminophen?
Hepatic necrosis
What can cats develop is investing acetaminophen?
Methemoglobinemia
What is the toxic dose for dogs and cats?
Dogs: 150mg/kg
Cats: 50mg/kg
What are some clinical signs seen in dogs who have ingested acetaminophen?
Progressive depression
Vomiting
Abdominal pain
Dark urine and serum
This can cause death in ____ to _____ days?
2 to 5 days
What do cats lack to metabolize acetaminophen?
Glucuronyl
T or F: They produce a toxic metabolite which causes oxidative damage to RBC and live cells
True
What are clinical signs with cats and Tylenol?
Anorexia, salivation, vomit within 1-2 hours
Depression, weakness
Brown and cyanotic MM
Dyspnea
Hemoglobinuria
Dark chocolate coloured blood and urine
Edema of face and paws
Death can occur in _____ to _____ hours
18 to 36 hours
What is the treatment?
Decontamination with emesis
Activated charcoal, N- Acetylcysteine to inactivate toxic metabolites and ascorbic acid for the methemoglobinemia
NSAIDS toxicosis
Are NSAIDS reversible?
Yes, they are reversible competitive inhibitors of the enzyme cyclooxygenase
What does reduced gastric prostaglandin result in?
Gastrointestinal toxicity
What does reduced renal PG result in?
Renal toxicity
What are the clinical symptoms of NSAID toxicosis?
Gastric ulceration
Renal necrosis
Decrease renal blood flow will lack what?
Lack perfusion + oxidative damage to the tissue
What can we see on blood results?
Elevated BUN and creatinine
elevated WBC
Anuria
What common medications can we see with NSAIDS toxicity?
Ibuprofen,indomethacin,aspirin,naproxen,acetaminophen,ketoprofen,carprofen
T or F: Cats are more sensitive than dogs?
True
What are the treatments for NSAID toxicity?
Supportive care ( iv fluids)
sucralfate
Omeprazole,famotidine
Misoprostol
Pain management - tramadol, other opioids
What will sulcralfate cover?
Covers gastric ulceration with a protective coating
What is Misoprostol?
Is a PG analogue which may prevent GI irritation and ulceration
What does Anticoagulant rodenticide toxicosis inhibit?
Inhibit the enzyme responsible for recycling of vitamin K which reduces production of Vit K- depending coagulation factors in II,VII,IX,X
T or F: Vitamin K is antagonist
True
Rat bait
First generation coumarins of what?
Warfarin and coumarin
Dicoumarol or dicoumarol synthesis are ________?
Active substances
What is the toxic dose for rat bait?
Dogs: 5-50mg/kg once or 1-5mg/kg/day for 5-15 days
Half life 14 hours
Tx: 7-14 days
Cats: 5-30mg/kg once or 1mg/kg/day for 5 days
Half life of 6 days
Tx: 4 weeks
Anticoagulant rodenticide
Second generation coumarin of what?
Brodifacoum and bromadiolone
What is the toxic dose for dogs?
Brodifacoum 0.25-3.5mg/kg
Bromadiolone 11-15mg/kg
What is the toxic dose for cats?
Both drugs 25mg/kg
What is the half life of inandones?
Half life 4-5 days
What are the clinical signs?
Acute death due to hemorrhage into the pleural cavity, lung parenchyma and mediastinal space
What is the treatment?
Vitamin K
May need to give plasma
What is ethylene glycol?
A sweet tasting liquid found in antifreeze, hydraulic fluid, transmission fluids, polishes, paints and plastic
What is the toxic dose? Where is it rapidly absorbed?
4.4ml/kg
Rapidly absorbed in the GI tract
What are the symptoms for ethylene glycol?
CNS depression
Vomiting, ataxia, lethargy, PU/PD and tachycardia
When can symptoms typically appear after ingestion? What can occur occur rapidly?
12-24 hours after ingestion
Death
What will you look for in lab work?
Hypocalcemia, metabolic acidosis and calcium oxalate mono hydrate crystals in the urine
What is the treatment goal?
Goal is to reduce absorption and block metabolism
What is not helpful to give?
Emesis and activated charcoal
What can you administer within 4 hours of ingestion?
Administer acetylcysteine
T or F: fluid diuresis is essential, and promotes Urinary excretion and maintain and maintains renal perfusion?
True
T or F: ethanol is not an antidote?
False, it is an antidote
What foods are toxic to pets?
Grapes
Raisins
Currents
What are the symptoms for foods toxicities?
Vomiting
Diarrhea
Anorexia
Lethargy
Polydipsia
Renal failure
What is the treatment?
Decontamination with emesis, activated charcoal and supportive care
Chocolate and methylxanthine toxicosis
Where is Methylxanthines found in
Caffeinated sodas
Stimulants
Coffee
Tea
Açai berries
Chocolate
What is the active ingredient in chocolate?
Theobromine
What are the clinical signs for chocolate toxicities?
Vomiting/ diarrhea
Hyperactive
Restless
Diuresis
Ataxia
Muscle tremors
Tachycardia/ arrhythmia
Hyperthermia
Seizure
Coma
Death
What is the treatment?
There is no specific treatment
Supportive care: diazepam for seizures, fluids, anti-arrhythmia
Emesis within first 2 hours
How long can symptoms consist can consuming theobromine?
72 hours
What is Xylitol?
A sweetening agent
Causes little insulin release to be released
In dogs, it causes an insulin release how many times stronger than glucose?
6x stronger
Is it rapidly absorbed? When will clinical symptoms appear after ingestion?
Yes
30-60 minutes
What do clinical signs include?
Vomiting
Lethargy
Ataxia
Seizures
Severe ______ can also present idiosyncratic hyperglycemia can also present?
Hypoglycemia
What can occur after 12-24 hours after ingestion?
Liver failure
What is the treatment for xylitol?
Emesis in only acute ingestion cases
Activated charcoal
How come activated charcoal is not very effective?
Due to rapid absorption of xylitol in the gut
T or F: liver production and antioxidants may be of use, including acetylcysteine and S-adenosylmethionine
True
Mold
What is produced by fungal metabolism?
Tremorgenic mycotoxins
Often found in _________?
Composted remains
Is it rapidly absorbed? Where does it get excreted? What are they prone to?
Yes
Excreted in bile
Prone to enterohepatic recirculation
________ so it easily crosses the blood brain Barrier.
Lipophilic
What are the clinical signs?
Vomiting
Hyperactivity
Panting
Muscle tremors
Rigidity
When can we see clinical signs occurring?
As early as 30 minutes post ingestion up to 2-3 hours
What do later symptoms include?
Seizures
Recumbency
Paddling nystagmus
What can increased muscle activity cause?
Hyperthermia, metabolic changes and rhabdomolysis
What is the treatment when an animal ingests mold?
Goal: stabilize vital signs
Control tremors, seizures and hyperthermia
If the patient is stable what can you give them to decontaminate?
Emesis and administer activated charcoal
Muscle relaxants may be required ( methcarbamol)
What is the prognosis?
Good if decontamination is early
Poor if clinical signs established already
Pesticides/ anti parasitic compounds
Permethrin are derived form?
Chrysanthemum flower
Available as dust, spray gels and shampoo
T or F: pyrethoids are synthetic analogs of permethrins and more toxic?
True
T or F: Cats are more sensitive and can become symptomatic after exposed to treated dog?
True
Pathophysiology of permethrin
How do these components work?
Work by binding to the membrane lipid phase of nerve cells, slowing the opening and closing of neural Na+ channels
T or F: less than 1% of Na+ must be affected to produce clinical signs
True
What are the clinical signs?
Paresethsia
Hyperesthesia
Ear twitching
Gail flicking
Twitching on the skin
What can progression lead to?
Tremors and seizures and onset can be within minutes
What is the treatment?
Decontamination is critical in the early phase of exposure
Bath in dishwasher detergent, if neurologic
What should you not do?
Induce emesis or five charcoal
______ critical, _______ help control tremors?
Thermal regulation, muscle relaxant
Why is IV fluids treatment needed?
To prevent myoglobinuric- induced renal failure and helps with hyperthermia
T or F: IV lipid therapy may be beneficial?
True
Organophosphate and metaldehyde
Where are Organophosphates found in?
Tick collars
Dips
Sprays
What do they inhibit?
Cholinesterase activity, interfering with autonomic nervous system function
What do clinical signs include?
Excessive salivation
Vomiting
Diarrhea
Muscle twitching/ fasiculation
Seizures
Coma
Death
What does the treatment include?
Removing collar, washing with a mild soap detergent and activated charcoal
Metaldehyde and methiocarb are _____ and _____ bait killers
Snail and slug
What do severe neurologic signs include?
Hypersalivation
In coordination
Hyperesthesia
Tachycardia
Seizures
T or F: hyperthermia and severe acidosis are also common
True
What do the vomit contents smell like?
Formaldehyde
What is the treatment?
Supportive care
Decontamination and activated charcoal if neurologic signed aren’t too severe
Ivermectin toxicity
It is available ____ _____ _____ and owners often mistakenly ___________ their animals
Over the counter
Overdose
In vertebrates at high doses, it will overwhelm what? And enter what?
The BBB drug transport and enter the CNS
What does it act as?
GABA agonist causing hyper-polarizing cell membrane and preventing neuronal depolarization
What do clinical symptoms include?
Ataxia
Agitation
Mydriasis
Blindness
Seizures
Death
T or F: young animals have an underdeveloped BBB and are more at risk
True
What is the treatment?
Supportive care and decontamination critical
What does ivermectin undergo as?
Enterohepatic recirculation
Multiple doses is charcoal are necessary
What can be used to control seizures?
Phenobarbital
Propofol
Etomidate
T or F: IV lipid therapy may be helpful as ivermectin is lipid soluble?
True
