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Emergency and critical care > Toxicities > Flashcards

Toxicities Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What should be on your checklist?

A

Who is at risk?
Clinical symptoms?
Time frame
To vomit or not to vomit
Treatment available
Expected volume

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2
Q

What household plants can cause GI signs?

A

Azaleas, Rhododendron
Bulb- tulips, Iris , daffodils
Ivy, mistletoe

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3
Q

What household plants can cause Glossitis stomatitis?

A

Philodendron

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4
Q

What houseplant can cause cardiac problems? And what arrhythmia can we see?

A

Oleandor, foxglove
Atrial arrhythmia

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5
Q

What household plants can cause renal failure in cats?

A

Easter Lillie’s/ most Christmas related plants

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6
Q

What allium species are toxic?

A

Onion, garlic, shallots, chives and a variety of flower species

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7
Q

What is the toxic component of these allium species?

A

Propyl disulfide

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8
Q

What can propyl disulfide produce?

A

Produces oxygen free radicals which will damage erythrocytes

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9
Q

What is the timing between consumption and clinical signs?

A

7-10 days

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10
Q

What are the clinical signs?

A

Inappetence
Ataxia
Lethargy
Vomiting
Icteric MM

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11
Q

What may lab test reveal?

A

Heinz bodies
Howell jolly bodies
Regenerative anemia
Hemoglobinuria
Elevations in lactate and bilirubin levels

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12
Q

What is the treatment?

A

Supportive care
Blood products if anemia is severe

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13
Q

What is the toxic principle with marijuana?

A

THC
ingestion or inhalation
Highly lipophilic

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14
Q

What are the clinical signs?

A

Generally within 1 hour
Dribbling urine, staring off into space
Slow to respond
Mydriasis, drooling, bradycardia

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15
Q

What is the treatment?

A

Fluids, supportive care
Not making them vomit unless it’s within chocolate

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16
Q

What is the prognosis?

A

Generally, very good

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17
Q

What can dogs get when ingesting Acetaminophen?

A

Hepatic necrosis

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18
Q

What can cats develop is investing acetaminophen?

A

Methemoglobinemia

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19
Q

What is the toxic dose for dogs and cats?

A

Dogs: 150mg/kg
Cats: 50mg/kg

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20
Q

What are some clinical signs seen in dogs who have ingested acetaminophen?

A

Progressive depression
Vomiting
Abdominal pain
Dark urine and serum

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21
Q

This can cause death in ____ to _____ days?

A

2 to 5 days

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22
Q

What do cats lack to metabolize acetaminophen?

A

Glucuronyl

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23
Q

T or F: They produce a toxic metabolite which causes oxidative damage to RBC and live cells

A

True

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24
Q

What are clinical signs with cats and Tylenol?

A

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

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25
Q

Death can occur in _____ to _____ hours

A

18 to 36 hours

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26
Q

What is the treatment?

A

Decontamination with emesis
Activated charcoal, N- Acetylcysteine to inactivate toxic metabolites and ascorbic acid for the methemoglobinemia

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27
Q

NSAIDS toxicosis
Are NSAIDS reversible?

A

Yes, they are reversible competitive inhibitors of the enzyme cyclooxygenase

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28
Q

What does reduced gastric prostaglandin result in?

A

Gastrointestinal toxicity

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29
Q

What does reduced renal PG result in?

A

Renal toxicity

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30
Q

What are the clinical symptoms of NSAID toxicosis?

A

Gastric ulceration
Renal necrosis

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31
Q

Decrease renal blood flow will lack what?

A

Lack perfusion + oxidative damage to the tissue

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32
Q

What can we see on blood results?

A

Elevated BUN and creatinine
elevated WBC
Anuria

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33
Q

What common medications can we see with NSAIDS toxicity?

A

Ibuprofen,indomethacin,aspirin,naproxen,acetaminophen,ketoprofen,carprofen

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34
Q

T or F: Cats are more sensitive than dogs?

A

True

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35
Q

What are the treatments for NSAID toxicity?

A

Supportive care ( iv fluids)
sucralfate
Omeprazole,famotidine
Misoprostol
Pain management - tramadol, other opioids

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36
Q

What will sulcralfate cover?

A

Covers gastric ulceration with a protective coating

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37
Q

What is Misoprostol?

A

Is a PG analogue which may prevent GI irritation and ulceration

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38
Q

What does Anticoagulant rodenticide toxicosis inhibit?

A

Inhibit the enzyme responsible for recycling of vitamin K which reduces production of Vit K- depending coagulation factors in II,VII,IX,X

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39
Q

T or F: Vitamin K is antagonist

A

True

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40
Q

Rat bait
First generation coumarins of what?

A

Warfarin and coumarin

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41
Q

Dicoumarol or dicoumarol synthesis are ________?

A

Active substances

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42
Q

What is the toxic dose for rat bait?

A

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

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43
Q

Anticoagulant rodenticide
Second generation coumarin of what?

A

Brodifacoum and bromadiolone

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44
Q

What is the toxic dose for dogs?

A

Brodifacoum 0.25-3.5mg/kg
Bromadiolone 11-15mg/kg

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45
Q

What is the toxic dose for cats?

A

Both drugs 25mg/kg

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46
Q

What is the half life of inandones?

A

Half life 4-5 days

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47
Q

What are the clinical signs?

A

Acute death due to hemorrhage into the pleural cavity, lung parenchyma and mediastinal space

48
Q

What is the treatment?

A

Vitamin K
May need to give plasma

49
Q

What is ethylene glycol?

A

A sweet tasting liquid found in antifreeze, hydraulic fluid, transmission fluids, polishes, paints and plastic

50
Q

What is the toxic dose? Where is it rapidly absorbed?

A

4.4ml/kg
Rapidly absorbed in the GI tract

51
Q

What are the symptoms for ethylene glycol?

A

CNS depression
Vomiting, ataxia, lethargy, PU/PD and tachycardia

52
Q

When can symptoms typically appear after ingestion? What can occur occur rapidly?

A

12-24 hours after ingestion
Death

53
Q

What will you look for in lab work?

A

Hypocalcemia, metabolic acidosis and calcium oxalate mono hydrate crystals in the urine

54
Q

What is the treatment goal?

A

Goal is to reduce absorption and block metabolism

55
Q

What is not helpful to give?

A

Emesis and activated charcoal

56
Q

What can you administer within 4 hours of ingestion?

A

Administer acetylcysteine

57
Q

T or F: fluid diuresis is essential, and promotes Urinary excretion and maintain and maintains renal perfusion?

A

True

58
Q

T or F: ethanol is not an antidote?

A

False, it is an antidote

59
Q

What foods are toxic to pets?

A

Grapes
Raisins
Currents

60
Q

What are the symptoms for foods toxicities?

A

Vomiting
Diarrhea
Anorexia
Lethargy
Polydipsia
Renal failure

61
Q

What is the treatment?

A

Decontamination with emesis, activated charcoal and supportive care

62
Q

Chocolate and methylxanthine toxicosis
Where is Methylxanthines found in

A

Caffeinated sodas
Stimulants
Coffee
Tea
Açai berries
Chocolate

63
Q

What is the active ingredient in chocolate?

A

Theobromine

64
Q

What are the clinical signs for chocolate toxicities?

A

Vomiting/ diarrhea
Hyperactive
Restless
Diuresis
Ataxia
Muscle tremors
Tachycardia/ arrhythmia
Hyperthermia
Seizure
Coma
Death

65
Q

What is the treatment?

A

There is no specific treatment
Supportive care: diazepam for seizures, fluids, anti-arrhythmia

Emesis within first 2 hours

66
Q

How long can symptoms consist can consuming theobromine?

A

72 hours

67
Q

What is Xylitol?

A

A sweetening agent
Causes little insulin release to be released

68
Q

In dogs, it causes an insulin release how many times stronger than glucose?

A

6x stronger

69
Q

Is it rapidly absorbed? When will clinical symptoms appear after ingestion?

A

Yes
30-60 minutes

70
Q

What do clinical signs include?

A

Vomiting
Lethargy
Ataxia
Seizures

71
Q

Severe ______ can also present idiosyncratic hyperglycemia can also present?

A

Hypoglycemia

72
Q

What can occur after 12-24 hours after ingestion?

A

Liver failure

73
Q

What is the treatment for xylitol?

A

Emesis in only acute ingestion cases
Activated charcoal

74
Q

How come activated charcoal is not very effective?

A

Due to rapid absorption of xylitol in the gut

75
Q

T or F: liver production and antioxidants may be of use, including acetylcysteine and S-adenosylmethionine

A

True

76
Q

Mold
What is produced by fungal metabolism?

A

Tremorgenic mycotoxins

77
Q

Often found in _________?

A

Composted remains

78
Q

Is it rapidly absorbed? Where does it get excreted? What are they prone to?

A

Yes
Excreted in bile
Prone to enterohepatic recirculation

79
Q

________ so it easily crosses the blood brain Barrier.

A

Lipophilic

80
Q

What are the clinical signs?

A

Vomiting
Hyperactivity
Panting
Muscle tremors
Rigidity

81
Q

When can we see clinical signs occurring?

A

As early as 30 minutes post ingestion up to 2-3 hours

82
Q

What do later symptoms include?

A

Seizures
Recumbency
Paddling nystagmus

83
Q

What can increased muscle activity cause?

A

Hyperthermia, metabolic changes and rhabdomolysis

84
Q

What is the treatment when an animal ingests mold?

A

Goal: stabilize vital signs
Control tremors, seizures and hyperthermia

85
Q

If the patient is stable what can you give them to decontaminate?

A

Emesis and administer activated charcoal
Muscle relaxants may be required ( methcarbamol)

86
Q

What is the prognosis?

A

Good if decontamination is early
Poor if clinical signs established already

87
Q

Pesticides/ anti parasitic compounds
Permethrin are derived form?

A

Chrysanthemum flower
Available as dust, spray gels and shampoo

88
Q

T or F: pyrethoids are synthetic analogs of permethrins and more toxic?

A

True

89
Q

T or F: Cats are more sensitive and can become symptomatic after exposed to treated dog?

A

True

90
Q

Pathophysiology of permethrin
How do these components work?

A

Work by binding to the membrane lipid phase of nerve cells, slowing the opening and closing of neural Na+ channels

91
Q

T or F: less than 1% of Na+ must be affected to produce clinical signs

A

True

92
Q

What are the clinical signs?

A

Paresethsia
Hyperesthesia
Ear twitching
Gail flicking
Twitching on the skin

93
Q

What can progression lead to?

A

Tremors and seizures and onset can be within minutes

94
Q

What is the treatment?

A

Decontamination is critical in the early phase of exposure
Bath in dishwasher detergent, if neurologic

95
Q

What should you not do?

A

Induce emesis or five charcoal

96
Q

______ critical, _______ help control tremors?

A

Thermal regulation, muscle relaxant

97
Q

Why is IV fluids treatment needed?

A

To prevent myoglobinuric- induced renal failure and helps with hyperthermia

98
Q

T or F: IV lipid therapy may be beneficial?

A

True

99
Q

Organophosphate and metaldehyde
Where are Organophosphates found in?

A

Tick collars
Dips
Sprays

100
Q

What do they inhibit?

A

Cholinesterase activity, interfering with autonomic nervous system function

101
Q

What do clinical signs include?

A

Excessive salivation
Vomiting
Diarrhea
Muscle twitching/ fasiculation
Seizures
Coma
Death

102
Q

What does the treatment include?

A

Removing collar, washing with a mild soap detergent and activated charcoal

103
Q

Metaldehyde and methiocarb are _____ and _____ bait killers

A

Snail and slug

104
Q

What do severe neurologic signs include?

A

Hypersalivation
In coordination
Hyperesthesia
Tachycardia
Seizures

105
Q

T or F: hyperthermia and severe acidosis are also common

A

True

106
Q

What do the vomit contents smell like?

A

Formaldehyde

107
Q

What is the treatment?

A

Supportive care
Decontamination and activated charcoal if neurologic signed aren’t too severe

108
Q

Ivermectin toxicity
It is available ____ _____ _____ and owners often mistakenly ___________ their animals

A

Over the counter
Overdose

109
Q

In vertebrates at high doses, it will overwhelm what? And enter what?

A

The BBB drug transport and enter the CNS

110
Q

What does it act as?

A

GABA agonist causing hyper-polarizing cell membrane and preventing neuronal depolarization

111
Q

What do clinical symptoms include?

A

Ataxia
Agitation
Mydriasis
Blindness
Seizures
Death

112
Q

T or F: young animals have an underdeveloped BBB and are more at risk

A

True

113
Q

What is the treatment?

A

Supportive care and decontamination critical

114
Q

What does ivermectin undergo as?

A

Enterohepatic recirculation
Multiple doses is charcoal are necessary

115
Q

What can be used to control seizures?

A

Phenobarbital
Propofol
Etomidate

116
Q

T or F: IV lipid therapy may be helpful as ivermectin is lipid soluble?

A

True

Emergency and critical care (3 decks)

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