Toxicology Flashcards
What is the MOA of acetaminophen toxicity?
- Reactive oxygen metabolites → oxidative damage to hemoglobin → causes Fe3+ methemoglobinemia and Heinz bodies → hemolysis
- Hepatotoxicity
What diagnostic results would be supportive of acetaminophen toxicity?
- Heinz body anemia
2. Elevated liver enzymes
How is acetaminophen toxicity treated?
- N-acetylcystein
- Cimetidine
- Ascorbic Acid
- SAMe
What are clinical signs associated with acetaminophen toxicity?
- Muddy mucous membranes
2. Anemia
What is the MOA of anticoagulant rodenticide (warfarin, brodifacoum, bromadiolone, etc)?
- Inhibit recycling of Vit K by inhibiting vitamin K epoxide reductase
- Will cause a reduction in factors II, VII, IX, and X
What clinical signs are associated with anticoagulant rodenticide toxicity?
- Prolonged bleeding
- Hemorrhage into body cavities
- Hematomas
- Anemia
What diagnostic findings would be supportive of anticoagulant rodenticide toxicity?
- Prolonged PT then ACT/PTT
How is anticoagulant rodenticide toxicity treated?
- Vitamin K supplementation
- Bioavailability is best by mouth!
What is the MOA of ethylene glycol toxicity?
FIRST PHASE: Causes neuro signs/depression within one hour
- Ethylene glycol → alcohol dehydrogenase (rate limiting step) → Glycoaldehyde
SECOND PHASE: Causes acidosis/cardiopulmonary signs (within 8-24 hours)
- Glycoaldehyde → aldehyde dehydrogenase → glycolic acid
THIRD PHASE: Stone formation (calcium oxalate monohydrate) in 3hrs (cat) and 5hrs (dog); also renal failure (1-3 days)
- Glycolic acid → lactic dehydrogenase/glycolic acid oxidase → glycoxylic acid → glycine, oxalic acid, CO2
What are the main causes of acidoses in ethylene glycol toxicity? What is the most important final metabolite of ethylene glycol?
- Glycolic acid and lactic acid
2. Oxalic acid → cytotoxic to renal tubule and causes Ca precipitation
What are the diagnostic findings associated with ethylene glycol toxicity?
- “Halo” effect on AUS → decreased echogenicity of corticomedullary junction
- Isosthenuria
- AG acidosis
- Hypocalcemia
- Hyperosmolarity
- Crystalluria
What are the clinical signs associated with ethylene glycol toxicity?
- Gastric irritant
2. CNS depression
When should the ethylene glycol test be performed?
- Within 1-12 hours of exposure
- Will not work after 24-48 hours-
- Wont detect <50 mg/dl so it wont work well in cats
What are causes of false positives on the ethylene glycol test?
- Glycerol
- Metaldehyde
- Propylene glycol
How is ethylene glycol treated?
- Ethanol → competitive inhibitor of alcohol dehydrogenase
- 4-MP → competitive inhibitor of alcohol dehydrogenase but doesn’t cause CNS signs like ethanol
- Treatment for acute renal failure
What is the MOA of bromethalin rodenticide?
- Uncouples oxidative phosphorylation → leads to hyper excitability acutely, and then depression chronically
What is the MOA of strychnine?
- Inhibits glycine on motor neurons and interneurons → it inhibits the buffering effect of glycine on post-synaptic motor/interneurons
What clinical signs are seen with strychnine toxicity?
- Extensor rigidity (esp after stimuli) → spastic paralysis also noted
- Respiratory muscle paralysis