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DWT Exam 3 > Toxicology 4: Case management & diagnostic veterinary toxicology > Flashcards

Toxicology 4: Case management & diagnostic veterinary toxicology Flashcards

1
Q

Examination

A

Preform a thorough physical exam

Conduct laboratory analyses

Case history + Exam –> establish differential diagnoses

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2
Q

Stabilize patientEstablishing patient baseline:
collect vitals

A

Preserve life of patient irrespective of cause

symptomatic/supportive treatment of animal, on presentation, regarding in majority of clinical toxicology cases
-NO need to stress about antidotes unless you KNOW a toxin is the culprit

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3
Q

Airway/Breathing (stabilize patient)

A

Tachypnea
-carbon monoxide (anoxia)
-ethyl glycol (metabolic acidosis– decreased bicarb= increased pCO2-> breath off CO2)

Some chemical and irritant toxicants can:
-cause bronchospasms
-inhibit resp. centers and paralyze resp. muscles

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4
Q

What are the ABCDs of the poisoned patient?

A

Airway/Breathing

Circulation

Disability/Deficits

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5
Q

What are the key things to check when looking into a patients circulation?

A

Mucous membrane color

Blood pressure

Body temperature

Heart rate

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6
Q

What to focus on when looking at a patients disabilities and deficits?

A

Assess gross neurological deficits

Pupillary light reflex

Mental status

Ambulation

Gastrointestinal

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7
Q

When diagnosing and conducting laboratory analyses what should we focus on?

A

Clinical chemistries, CBC

-glucose
-liverenzymes
-ceratine kinase
-prothrombin and activated partial thromboplastin times (clotting times)
-creatine and BUN
-electrolytes

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8
Q

Decontamination of patients with toxicology emergencies is done how?

A

Prevent/minimize absorption of toxicant

Enhance excretion or elimination of toxicant

Remove or dilute topical irritants

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9
Q

Method of ocular decontamination
irritant vs corrosive

A

Irritant
-caution
-owner irrigates eyes with saline, eye wash, tap water
-monitor for redness, pawing eyes, swelling, lacrimation –> see DVM

Corrosive
-“danger”
-owner irrigate eyes with saline, eye wash, tap water
-antibiotic drops or ointment
-monitor for progressive signs/damage –> fluorescein stain

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10
Q

Methods of dermal decontamination?

A
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11
Q

What species are the most sensitive to inhalation toxicity?

A

BIRDS

  • Examples:
    oTeflon fumes
    oCarbon monoxide
    oHydrogen Sulfide
    oNitrogen Dioxide

-Remove animal from source
-If minor irritant -> fresh air
-Humidified oxygen cage
-Supportive care (fluids, heat, etc.)

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12
Q

Oral exposure – how do you know when and how to decontaminate?
MOST common route of exposure

A

1) Emesis
2) Activated Charcoal
3) Gastric Lavage
4) Endoscopy/surgery
5) Lipid Emulsion Therapy

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13
Q

Ingestion of corrosive agents – what to do?

A

Dilution with milk or water

give a demulcent or other mucoprotective agent
-mylanta
-milk of magnesia
-kaopectate -> DOGS ONLY
- cats do NOT metabolize salicylates well

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14
Q

How do you induce Emesis

A

Apomorphine (apokyn)
Emetic activity = stimulating dopamine receptors
-Given parenterally (IM or IV) or topically in the conjunctival sac
- Triggers CRTZ = vomiting
- Preferred emetic drug for dogs

Clevor (Ropinirole)
Ophthalmic solution for use in dogs
Dopamine agonist
Drops depend on body weight
- 5.1 – 10 kg = 3 drops in one eye
- 20.1 – 35 kg = 4 drops in one eye

Apomorphine
Poor response in cats due to fewer dopamine receptors
side effects
-CNS and resp. depression, protracted vomiting
- sedative side effects reversed with naloxane, does NOT stop vomiting
- Treatment for vomiting
–cerenia
–reglan

Hydrogen Peroxide
DOGS

Xylazine & Dexmedetomidine
Emetic activity = stimulates a2-adrenergicreceptors and vomiting center
-CATS
side effects
CNS and resp. depression, bradycardia, hypotension
~these effects can be reversed with yohimbine

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15
Q

Drugs that DECREASE gastric emprting?

A
  • Opioids
  • Anticholinergics
  • Tricyclic antidepressants
  • Salicylates
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16
Q

Contradictions for Emesis Induction

A

Patient is symptomatic

laryngeal paralysis

megaesophagus

risk of aspiration pneumonia
-brachycephalic breeds
-ingestion of hydrocarbons
< 3 months old

Ingestion of corrosive agents

Patient is seizing

Rodents, horses, ruminants, rabbits

17
Q

Prevention of Toxicant Absorption*

A

Activated charcoal

“Activated” = petroleum or vegetable origin, not mineral/animal
Adsorbs toxin/toxicant in GI tract  fecal excretion
-Decreases systemic absorption
Implement immediately for maximal adsorption to poison
Effective for toxicants that undergo enterohepatic recirculation

ex. Toxiban (with or without cathartic 70% sorbitol)

18
Q

Why do we NOT want Sorbitol in the charcoal (all the time)?

A

Cathartics

poorly absorbable salts that osmotically draw water into the gut lumen –> stimulate movement enhancing elimination of activated charcoal

19
Q

T bind activated charcoal

A

Alcohols

Xylitol

Heavy metals

Nitrates, nitrates, chlorates

  • late-stage presentation, hypernatremia, hypovolemic shick, compormised airway, GI obstruction, Risk of aspiration pneumonia, Vomiting animal, lack of borborygmi*
20
Q

Gastric lavage prevention of toxicant absorption how?

A

May be more effective at removing gastric contents

add**

21
Q

Lipid emulsion therapy

A

Typically soybean oil

creates a lipid “sink” in the blood –> lipid binds highly lipid soluble toxicants

GivenIV as a bolus dose at 1.5 mL/kg (20% emulsion)

22
Q

Toxicology Emergencies

A

1) Calm down pet/livestock owner and prevent additional exposure to toxicant

2) Is it life-threatening requiring emergency care for the animal(s)?

3) Determine potential route of exposure
- Oral: Should owner induce emesis? At home/on the way to clinic?

4) Are any other animals or people at risk for exposure?

5)Ask owners questions that are “open” questions

The longer the animal is at home, the longer the animal is delayed emergency care
-bring animal in
-go do on-site visit

23
Q

How do you obtain a complete case history?

A

Listen to the client
avoid preconceptions

Obtain medical history

Inquire about home environment

Establish a timeline of a exposure event

24
Q

What are important things to keep in mind?

A

Keep all of your differentials open

Remain open-minded and objective
- “I think my neighbor poisoned my dog” does not mean the animal is poisoned
-Beware of “I read on the internet….”

Never tell the client “Your animal was poisoned” without conclusive evidence

Diseases progress and change in appearance with time

Most diseases encountered will have a single cause or one causative agent

Confirm active ingredient in the product for which the pet was exposed and try to get an estimate on quantity ingested
-bromethalin or brodifacoum; diphacinone or difethialone; vitamin D
-Human medications: LA, XR, ect.
-Plants

25
Q

What the TOP animal “Poisons”

A

“Dog”
“ chocolate”
-xylitol
-rodenticides
-vit/ minerals
-NSAIDs, antidepressants, acetaminophen

“Cat”
“plants”

“Large animals”
-poisonous plants
-heavy metals
-pesticides
-feed adulterants

26
Q

What should you do diagnostic toxicology when patients is Antemortem -Freeze and save?

A

Vomitus (all available)
 Urine (all available)
 Whole blood (5 mL in red top clot tube)
 Whole blood (5 mL in purple top EDTA tube)
 Serum
 Source material – water, food, suspect foodstuff, bait
 Hair or fur (if dermal exposure)

27
Q

What should you collect if the patient is no dead?

A

 Liver
 Stomach contents
 Brain (1/2)
 Kidney (1/2)
 Urine
 Eyeball or ocular fluid
 Any source material
-Water, food, suspect foodstuff, bait
 Fix representative tissues in 10% formalin
 Save samples for bacteriology and virology

28
Q

What are the top 10 things to collect for toxicology

A

Liver

Stomach contents

brain

kidney

urine

whole blood

suspect food

serum

suspect source material

fix tissues in formalin for histology

29
Q

How do qualitative test work?

A

Postive or Negative
-No concentrations given’- ethylene glycol
- cyanide
- colorimetric tests

color

30
Q

Quantitative test`

A

DWT Exam 3 (8 decks)

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