Toxicities in Small Animals Flashcards
Top 10 pet toxins?
- Over-the-counter meications
- Human food
- Human prescriptrion
- Chocolate
- Plants
- Household toxicant
- vet products
- Rodenticides
- Insecticides
- Garden proucts
What details on tox emergency call ?
- Advise to bring to clinic
- Ctainers/inserts/vomitus/plant
- Careful advice
- Petroleum, acids, alkalis
- Warn owner to avoid contact with vomitus/ source of toxin
What History considerations?
Be careful – owners think sick dogs have been poisoned
* Ask detailed questions*
* Did owner witness exposure?
* Other evidence of exposure?
* How much was the pet exposed to?
* Are signs getting worse or better?
* Ask about illicit substances – owners may not volunteer this information
When to suspect poisoning ?
- Reent use of pesticides/ chmicals in / around house
- Possible access to human/veterinary meds
- Exposure to garbage
- Malicious exposure
- Sudden illness without infectious cause
- New environment/ new human activity
- New plants/ flower bouquets
- New food – or very old food
- Animal had access to areas not
commonly allowed – garage, shed
What should u not forget while doing PE?
GLOVES!
If toxin is known what additional exams?
- Choline-esterase in organophosphate cases
- Ethylene glycol in serum
In suspected cases / additional monitoring?
- CBC? Serum chemistry, urinalysis
Toxo analyses ?
- Gastric content
- Vomitus
- Faeces
- Urine
- Food/water / suspected
Treatment goals for toxins?
- Prevent furhter exposure - coat decontamination
- Dec absorption - GI decontamniation
- Improve elimination
- Supportive care and antidotes
What useful mes might we give?
- Emetics – apomorphine
- Activated charcoal
- Vitamin K1
- Fresh frozen plasma
- Intralipid (for lipophilic drug poisoning)
- Acetylcysteine (acetominophen tox)
- Methocarbamol (tetanus associated spasms)
- Snake antivenom
How do we prevent exposure/ Decontaminate coat ?
- Both human & animal
- Remove poison and bait containing poison
- Wash or brush coat
- Remove vomitus containing poison
- Mild detergent
How do we decrease GI absorption?
- Emetics – apomorphine
- Activated charcoal
- Vitamin K1
- Fresh frozen plasma
- Intralipid
- Acetylcysteine
- Methocarbamol
- Snake antivenom
How long after toxin ingestion is too long to induce emesis?
over 60 mins
When is it not safe to decontaminate patient ?
Seiures/ unconscious - NO EMESIS
When is it safe for type of poison to decontaminate?
- Caustic substances - petroleum
- Activated charcoal dangerous in hypernatraemia
Describe the seps of Gastric Lavage
- Light anaesthesia
- Tracheal intubation- CUFF
- Large bore stomach tube
- 10ml/kg warm water
- Gently massage/palpate stomach
- Drain by gravity (see photo)
- Repeat if needed – mostly clear fluid drained
- BEWARE: if already passed into intestines or if particles too big for tube
What do we use to improve elimination/ avoid reabsorption?
- Ativated charcoal
- Laxative - lactulose, Sorbitol
- Fluid diuresis in renally excreted toxins
Sorbitol – latest paper shows
charcoal with or without sorbitol is equally effective – BUT
make sure patient passes faeces
What are ILE?
Intravenous Lipid emulsions -> act as a trap for lipophilic toxins
- dec free substance in circulation
What substances are lipophilic?
Organophosphates, carbamates, permethrin, macrolytic lactones -
ivermectin, marijuana, lidocaine, NSAIDs, bromethalin, amphetamine,
amlodipine, phenobarbital
What supportive care for toxicosis?
- Oxygen
- Fluid and electrolytes
- Seizure control/ sedation
- Anti-emetics and gastric protectants
- Tube feeding
- Mechanical ventilation
- Maintain euglycaemia
- Haematology and coagulation
- Nursing care
What specific antidotes do we have ?
- Antivenom for snakes and spiders
- Atropine for cholinesterase inhibitors
- Bisphosphonates for VitD3/cholecalciferol
- Chelating agents for heavy metals
- Fomepizole/ ethanol for ethylene glycol
- Naloxone for opioids
- Vit K1 for anticoagulant rodenticides
- Acetylcysteine for paracetamol toxicity
often none available
What is a common toxicosis of cats
(they can’t metabolize it)
Acetaminophen (paracetamol)
What signs will we see with Paracetamol tox in cats?
- Haemolytic anaemia
- Heinz bodies
- Methaemoglobinaemia
- Brown blood & mucus membranes
- Facial oedema
- Acute hepatic failure
What does Acetaminophen poisoning look like in Dogs?
- Hepatic failure more common and BIG OVERDOSE
- Anorexia, vomiting, abdominal pain, respiratory distress,
icterus.
- Anorexia, vomiting, abdominal pain, respiratory distress,
- Rarely erythrocyte damage alone.
What Tx for Acetaminophen tox?
- Gi decontamination
- N-acetylcysteine binds metabolites
What supportive care for Paracetamol tox?
- Fluid therapy
- Blood transfusion
- Liver support like SAMe
- Gastric protectanrs
Prognosis for acetaminophen tox?
- Prognosis guarded to poor
- Better when cats presented wihtin 11’ hours and ogs within 72 hrs
Mycotoxins are found in ….
Mouldy foods or compost
What symptoms of mycotoxin poisoning?
vomiting, ataxia, muscle tremors, tachycardia, tachypnoea,
nystagmus, mydriasis
What tx for mycotoxin toxicity?
Gi decontmaination, activated charcoal, IV fluids, diaepam for tremors
And aflat
What is mycotoxin tox called? what does it primarily cause?
Aflatoxicosis -> liver failure
What does Onion/Garlic cause ?
Erythrocyte damage to Heinz bodies
(within 24 hrs top days)
What symptoms of Garlic/ onion tox?
V+ Abd pain, Heinz body anaemia
Tx for onion/garlic tox?
Decontaminate GIT, activated charchoal, monitor RBC parameters
Describe Lead tox
- Not only old paint! ingested
- GIT and CNS signs
Symptoms of LEad tox?
anorexia, vomiting, diarrhoea, salivating, aneamia, PUPD,
blindness, nystagmus.
Tx for Lead Tox?
GIT decontamination, laxative, Chelation if severe – Ca-
EDTA.
What causes Organophosphate and Carbamate poisoning?
Many pesticides
What does Organophosphate cause?
OP and carbamate bind to (acetylcholine esterase)AChE – continued
nerve stimulation
What different types of OP and carbamate tox can we get?
- Muscarinic (Salivation, Vomiting, Diarrhoea, Lacrimation, Dyspnoea, Bradycardia,
Miosis) - Nicotinic (muscle trmors and weakness)
- CNS (depression seizure)
How can we get Pyrethroid poisoning?
Owners use dog products on cats - rapidly absorbed in GIt -> central and peripheral NS effects (Interfetres with sodium channels
hypersalivation, midl tremors, vomiting diarrhoea
Describe tox with Metaldehyde (slug killer)
- Rapid onset
- Msucle spasms, hyperaesthesai, hyperthermia
- Resp distress, cyanosis
Should u induce emesis with OPS/ carbamates/ Pyrethroids/ Metaldehyde
NO!
Tx for OPS/ CARBAMATES/ PYRETHROIDS/ METALDEHYDE
decontamination, activated charcoal, atropine for severe salivation or bradycardia, diazepam for seizures, methocarbamol as muscle relaxant for tremors (can give rectally), ILE (lipids), supportive
care
Describe rodenticide poisoning
- Signs in 3-5 days
- Different active ingredients differ in severity of dx and duration of Vit K rq - findout WHICH ONE
What symptoms of rodenticide poisoning?
Lethargy, weakness, body cavity haemorrhage with respiratory distress, skin hemorrhages, haematomas, joint swelling/lameness, pale mm’s, overt bleeding, hypovolaemic shock, sudden death
How does Anticoagulant rodenticide poiosning work?
- Inhibit enzyme Vitamin K1 reductase
- Vitamin K 1 NB in activation Vitamin K1 dependent clotting
factors (II,VII,X) - When circulating factors are consumed – bleed
- PT, PTT, PIVKAs and D-dimers increase
Tx for anticoagulant poisoning?
- Recent exposure (3h) – GI decontamination; measure PT and PTT at 24 and
72 hours - Symptomatic patients – blood and plasma transfusions, chest drain (not
always indicated!), fluids, O2, feed, vitamin K1(expensive – 2-4 weeks) - Vit K1 iv followed by oral
with fatty meal - Repeat PT and PTT
- 48 hours after last dose
What is Alphacholoralose? What signs?
Rodenticide that affects CNS =>
* Mixed CNS signs: excitation, depression, tremors, hyperesthesia, seizures
* Other: Hypothermia (more common in cats), salivation, miosis, ataxia, and coma (more common in dogs)
Describe Ethylene glycol poisoning?
radiator antifreeze -> sweet taste
- 5ml to kill a cat, 20 ml to kill a dog
(toxic metabolite glycoaldehyde)
Describe stage 1 (0mins-12h) of ethylene glycol tox?
- Cns signs due to metabolites (rowsy, stumbling, stupor, vomiting, drunken state, may go unnoticed)
Describe stage 2 (12-24h) of ethylene glycol toxicity?
Metabolic acidosis (tachycardia, tachypnoea)
Stage 3 (24-72h) of ethylene glycol tox?
Acute renal failure due to calcium oxalate that precipitates in microvasculature and renal tubules
What Tx for ethylene glycol tox?
- Recent exposure
- Gastric decontamination
- Renal failure – prognosis POOR
- Fluids
- Electrolytes
- Mannitol
- Furosemide
- Dopamine
- Dialysis
- Antidotes: fomepizole, ethanol
Describe signs and cause of grape/raisin toxicity?
- MEchanism unknown, dried fruit worse
- Signs: V+ D+ anorexia, ataxia, weakness, **acute renal failure **
What Tx and Pg for raisin/grape tox?
Tx: Decontaminate GIt, charcoal, fluids for ARF
Pg good if no ARF
Lilies ingested can cause….
Renal tubular necrosis
Also V+ PUPD, anorexia, pancreatitis, renal failure
Tx and Pg for Lilly tox?
Tx = decontaminate skin and GIT, activated
charcoal, IV fluids.
* Monitor kidneys.
* Prognosis good if no ARF.
Describe Blue green algae toxicity
- Bacteria in water source – cyanobacteria.
- Fresh/salt water – more in summer.
- Affects GIT, liver, CNS within minutes to days.
Signs, tx and pg for algae ?
- Vomiting (blood), salivating, diarrhoea, twitching, seizures, respiratory
distress, collapse, sudden death. - Treatment: decontaminate skin and GIT, charcoal, fluids,
anticonvulsants. - Monitor liver, kidneys and electrolytes.
Describe Chocolate Toxicity
- Dark chocolate worse
- theobromine is the toxic substance
- Pg usually good
Signs and Tx of Chocolate tox?
- Signs: vomiting, abdominal pain, PU/PD, ataxia, tachycardia
(bradycardia), hypertension, irritability/excitability. - Treatment: decontaminate, activated charcoal, fluids, sedation, beta
blockers.
Descrribe Xylitol poisoning
- Insulin release with severe hypoglycaemia, liver damage, seizures.
- In gum, sweeteners, sweets, baked goods, toothpaste, peanut butter.
- Within 30-60 min.
Signs and Tx of Xylitol Poisoning?
- Lethargy, ataxia, tremors, seizures, vomiting, coma.
- Treatment: Decontaminate GIT (NO EMESIS), dextrose.supplementation, fluids, anti-emetics, GI and liver protectants.
What to do for Battery ingestion?
Many will pass no problem -> leaking batteries problem
DON’T INDUCE EMESIS
When to remove batteries via surgery/ endoS
- Leaks/ damage sene on radiograph
- Too large to pass
- Not moving or 24 hrs
Marijuana overdose?
- Ataxia, CNS dullness, tremors.
- Vomiting, bradycardia, mydriasis, hypothermia, urinary incontinence.
- Treatment: decontamination, anticonvulsants if needed, ILE, supportive
care.
