Toxicoses Management

Question 1

What are the ABCs of emergency care?

Answer 1

• airway
  
  • check for obstruction or patency
• breathing
  
  • check for signs of ineffective breathing - apnea, stertor, stridor, hyperpnea, hypopnea, agonal breathing
• circulation
  
  • assess membrane color, CRT, HR, pulse, rhythm temperature

Question 2

What does triage entail?

Answer 2

• history and a quick evaluation of four major organ systems
  
  • cardiovascular, respiratory, CNS, renal
• determine of patient is stable or unstable

Question 3

What is the goal of decontamination?

Answer 3

• minimize exposure to potentially toxic substances
  
  • prevent or minimize absorption and enhance elimination

Question 4

Provide three contraindications for emesis.

Answer 4

• weak or severely ill patients
• ingestion of caustic substance or hydrocarbon
  
  • could aspirate into respiratory tract
• patients with altered consciousness - hyperactivity, coma
• ingestions that happened a long time ago
• unknown toxicant
• animals that cannot vomit

Question 5

Identify 3 animals that do not vomit.

Answer 5

• horse
• rabbit
• rat

Question 6

Identify emetics for cats and dogs.

Answer 6

• dogs
  
  • hydrogen peroxide (3%)
  • apomorphine
• cats
  
  • xylazine
  • dexmedetomidine
  • midazolam/hydromorphone

Question 7

Why is table salt not a recommended emetic for cats/dogs?

Answer 7

• not very effective and has substantial adverse effects
• if not vomited up can put animal at risk for potentially life threatening sodium ion toxicosis

Question 8

Why is it important to limit the amount of diluent given to a poisoned animal?

Answer 8

• diluents impair ion balance (especially Na)
• reduces risk of excessive distension of the stomach leading to vomiting and aspiration

Question 9

For what type of toxicants are repeated doses of activated charcoal recommended?

Answer 9

• for those that undergo enterohepatic circulation

Question 10

Explain how bulk, saline and osmotic cathartics work.

Answer 10

• enhance elimination of toxicants by moving them through the GIT quicker
• bulk
  
  • high in fiber - retains water in lower GIT and produces bulkier stools
  • psyllium (metamucil), canned pumpkin, whole grain breads
• osmotic
  
  • pulls free water into GIT, decreases total GI transit time
  • often combined with activated charcoal
  • 70% sorbitol
• saline
  
  • stimulates motility
  • sodium sulfate (Glauber’s salts), magnesium sulfate (Epsom salts)

Question 11

Identify contraindications for cathartics.

Answer 11

• dehydration
• electrolyte imbalances
• diarrhea

Question 12

Name two substances used as enemas.

Answer 12

• warm soapy water
• dioctyl sodium sulfosuccinate (DSS)

Question 13

Distinguish between high and low/regular enema.

Answer 13

• regular/low enema washes out fecal matter from area near rectum
• high enema cleans out most of colon

Question 14

Describe how a through-and-through lavage is done.

Answer 14

• AKA enterogastric lavage
• combine gastric lavage with high retrograde enema
• stomach tube and endotracheal tube places, enema solution given until it passes out from stomach tube

Question 15

What is PEG-ES used for?

Answer 15

• whole bowel irrigation (WBI)

Question 16

Provide one way each for dermal, inhalation and ocular decontamination.

Answer 16

• dermal
  
  • wash affected area or bathe entire animal
  • vacuuming or combing to remove powders
  • shaving, clipping
  • mineral oil, vegetable oil, peanut butter
    
    • remove glue traps, asphalt, tree sap
• inhalation
  
  • give supplemental oxygen and IV fluids
  • move patient to fresh air
• ocular
  
  • flush eyes with sterile saline or clean room temperature water

Question 17

What would you use to remove glue traps from a dog’s skin/hair?

Answer 17

• mineral oil
• vegetable oil
• peanut butter

Question 18

Identify three procedures for enhancing elimination of toxicants.

Answer 18

• gastrotomy and removal of toxicant
• urinary manipulation
  
  • forced diuresis - administer fluid overload and diuretic concurrently
    
    • toxicants with high levels of renal excretion
  • ion trapping - urine acidification
    
    • weak acids and bases excreted predominantly unchanged through the kidneys
• IV lipid emulsion (ILE)
  
  • for lipid soluble toxicants
  • fat emulsions act as sinks - toxicant unavailable for binding
• dialysis

Question 19

Provide three mechanisms of action of antidotes.

Answer 19

• limit absorption
• sequester poison
• inhibit metabolism of toxin
• promote distribution from tissues
• compete for receptor
• counteract toxic effect
• enhance detoxification
• antidotes prevent, reverse, or decrease action of poison

Question 20

What is the difference between functional and pharmacological antidotes?

Answer 20

• functional
  
  • treats symptoms caused by toxicant
• pharmacological
  
  • antagonizes or competes with toxicant at its receptor or through macromolecules
  • can bind to toxicant or target site to prevent toxicant from binding

Question 21

Provide the mechanism of action of chelators.

Answer 21

• bind toxicants to increase their water solubility and elimination
• decrease levels of free toxin in the blood, decrease tissue concentrations, increase elimination

Question 22

Name an enzyme inhibitor used for treatment of ethylene glycol toxicosis.

Answer 22

• ethanol - competitive inhibitor
• fomepizole - vet product approval withdrawn

Question 23

Name 2 hepatoprotectants and 2 GI protectants.

Answer 23

• hepatoprotectants
  
  • S-adenosyl-L-methionine (SAM)
  • N-acetylcysteine (NAC)
  • silymarin
  • vitamin E
  • vitamin C
• GI protectants
  
  • proton pump inhibitor s(PPIs)
  • histamine receptor antagonists (H2RAs)
  • sucralfate
  • misoprostol