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ACVECC boards: Journals and equations > Toxin/envenomation articles > Flashcards

Toxin/envenomation articles Flashcards

1
Q

Use of charcoal hemoperfusion and hemodialysis in the treatment of methotrexate toxicosis in a dog

Mariana Pardo, et al jvecc 2018

A

Methotrexate (MTX) antifolate chemotherapeutic and immunosuppressive drug – counteract + compete w/ folic acid in neoplastic cells
Adverse effect: myelosupression, GI epithelial necrosis, hepatocellular tox and nephrotoxicity

Sequential use of HP (protein bound) and HD to enhance toxin removal

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2
Q

Severe lactic acidosis and hypoglycemia due to acute metformin intoxication in a dog

Yu Ueda et al jvecc 2018

A

Metformin = antidiabetic agent, reduce hepatic glucose production by inhibiting key enzymes in GNG pathway and by mitochondrial depletion of energy needed for GNG

Tx: IV fluids and dextrose

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3
Q

Treatment of carprofen overdose (72mg/kg) with therapeutic plasma exchange in a dog

Astrid B. Kjaergaard et al jvecc 2018

A

Carprofen- 99% plasma protein bound, small Vd (0.18 L/kg), t/12 8-118h, liver metabolism + fecally excreted w/ 34% enterohepatic recirculation

Able to reduce 51% plasma carprofen conc over 180 min

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4
Q

Retrospective evaluation of feline rodenticide exposure and gastrointestinal decontamination: 146 cases (2000–2010)

Karie L. Walton et al jvecc 2018

A

Prevalence is low (0.39%)

More likely to be young, indoor, intact, and in fall

Anticoagulant > cholecalciferol > bromethalin

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5
Q

Anticoagulant rodenticide toxicosis causing tracheal collapse in 4 small breed dogs

Thomer jvecc 2018

A

Hemorrhage into the tracheal membrane
Tx: FFP, Vit K1, support care

CXR: diffuse tracheal narrowing (extra- and intrathoracic), incr mediastinal ST opacity w/o tracheal narrowing, generalized patchy interstitial/alveolar pulmonary infiltrates, pleural effusion

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6
Q

Acute liver failure in two dogs following ingestion of cheese tree (Glochidion ferdinandi) roots.

Christine Griebsch, et al jvecc 2019

A

Recovered x2

High ALT, bili, prolonged coags.

Tx: IVF, hepatoprotectants, vit K1, ABX, lactulose, antacids, anti-emetic, multiple FFP

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7
Q

Acute barium poisoning in a dog after ingestion of handheld fireworks (party sparklers).

stanley jvecc 2019

A

Toxic signs: flaccid paralysis, acidemia, and severe hypokalemia

Barium ions interfere outwards K+ efflux
3 stages: GI signs -> progressive LMN neuropathy, muscle paralysis, loss of deep pain –> generalized muscle paralysis incl. resp paralysis

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8
Q

Antivenin-associated serum sickness in a dog.

Benjamin M Lee, et al jvecc 2019

A

Recurrent delayed hypersensitivity reaction (serum sickness) for 2 weeks following administration of a novel plasma ACP product in a dog.

Entire IgG complexes
The Fc portion shown to be the most immunogenic

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9
Q

Use of gas chromatography-mass spectrometry for definitive diagnosis of synthetic cannabinoid toxicity in a dog.

Efrat Kelmer, et al jvecc 2019

A

Gas chromatography-mass spectrometry analysis of the plant material and a plasma sample

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10
Q

Acute chlorfenapyr toxicity in 3 dogs from a single household.

Rachel B Davy, et al jvecc 2019

A

Pesticide: uncoupler of OxPhos in mitochondrial –> cell death d/t lack of ATP

Cx acute onset progressive panting, ataxia, restlessness, tachycardia, hypthermic
-2/3 had rapid death within 60-90 mins

Tx: IVF, intubation, gastric lavage then activated charcoal, ILE, active cooling

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11
Q

Effect of single dose administration activated charcoal containing sorbitol on serum sodium concentration and hydration status in dogs.

Mix jvecc 2019

A

2g/kg incr serum Na, K, Cl, lactate and osmolality, HCT, and decr weight

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12
Q

Retrospective evaluation of Micrurus fulvius (Eastern coral snake) envenomation and the use of mechanical ventilation in dogs and a cat (2011-2016): 8 cases.

Samantha Campos, et al jvecc 2019

A

7/8 had antivenoml
On vent d/t to progressive hypoventilation (VC, SIMV + PS)
Mean duration 58h with LOH 8d
Vent associated complications occurred in all
7/8 survived to discharge

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13
Q

A prospective multicenter observational study of Viperidae polyvalent immune F(ab’)2 antivenom administration for the treatment of viper envenomation in dogs

Michele Vanni jvecc 2020

A

Equine derived polyvalent viperid antivenom (EPVA) = has active F(ab’)2 of equine Ig molecules

Viperidae (Adders): proteases, metalloproteinases, amino acid esterases, phospholipase-A2, phospholipase-B, kininogenases, prothrombin-activating factors, hyaluronidases, and neurotoxins —>AKI, coagulopathy, hemolysis

Most dogs had improved snakebite severity scores after EPVA admin (improved and no progression after 4h)

Acute rx 15%

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14
Q

Survival of a dog with accidental colchicine overdose

Ingrid Henrietta Goodman jvecc 2020

A

Colchicine = alkaloid derivative
MoA: bind intracellular tubulin to stop polymerization into microtubules –> inhibit mitosis and inflammatory signalling pathway, block neut chemotaxis and adhesion

direct cardiac toxic
neutropenia
CNS signs –> edema

Tx: AC, ILE (log p >1), supportive care

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15
Q

Retrospective evaluation of the clinical course and outcome following grape or raisin ingestion in dogs (2005–2014): 139 cases

Colin F. Reich DVM, DACVECC et al jvecc 2020

A

Prevalence of AKI 6.7% - not sig. different b/w early and late presentation

88% were GI decontaminated and sig. more in early group

2/139 had RRT, 1/139 died

V+ = most common signs

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16
Q

Retrospective evaluation of the use of hemodialysis in dogs with suspected metaldehyde poisoning (2012–2017): 11 cases

Teichmann-Knorrn , jvecc 2020

A

All dogs presented with seizures, tachycardia, and mydriasis

Dialysis decreased requirement of Ax AND shorter LOH. No AED needed. No aspiration pneumonia.

Metaldehyde = snail/slug bait –> gait changes, hyperesthesia, hyperthermia, and panting, and progress to severe muscle tremors, convulsions, seizures, respiratory failure

17
Q

Retrospective evaluation of the induction of emesis with apomorphine as treatment for gastric foreign bodies in dogs (2010-2014): 61 cases

Zersen JVECC 2020

A

Emesis successful in 97% of dogs
-most received 0.03 mg/kg

78% produced FB

18
Q

Treatment of phenobarbital intoxication using hemodialysis in two dogs

Jessica Kielb Basile jvecc 2020

A

Ingested toxic doses of pheno –> comatosed –> 3h IHD –> complete resolution of Cx and normal mentation by the end of therapy

No side effects

19
Q

Efficacy of a single session in-series hemoperfusion and hemodialysis in the management of carprofen overdose in two dogs

Fick jvecc 2020

A

In-series HP/HD: blood is first filtered with HP and then processed through an HD filter before returning to the patient

HP molecular absorption - removes any drug/toxin that has affinity to charcoal independent of MW and PPB until filter is saturated

Hemodialysis = no use
Hemoperfusion = short-lived effect, if using >1h need to replace filter hourly
20
Q

Systemic lime sulfur toxicosis secondary to dermal exposure in two cats

Nix jevv 2020

A

Lime sulfur = calcium polysulfide
-polysulfide penetrates fungus mycelia + affect mitochondrial resp complex

30% solution instead of 3% solution –> chemical burns, hypotension, bradycardia, hypothermia, hyperCa, hyperPhos, azotemia

IVF, benadryl, dexamethasone (Calciuresis), gastroprotectant, cerenia, phosphate binder (AlOH)
Chemical burns tx w/ unasyn + SSD + bup = recovered

21
Q

Efficacy of specific antivenom and fresh frozen plasma in reversing Daboia palaestinae venom-induced hemostatic derangement

Nivy jvecc 2020

A

Dp-venom caused hypercoagulable and hyperfibrinolytic changes – negated by antivenom but not FPP

22
Q

Gastrointestinal obstruction secondary to activated charcoal granule impaction in a dog

Farrell jvecc 2020

A

GRANULES

Charcoal granule causing SI obstruction

23
Q

Oxidative red blood cell damage associated with propofol and intravenous lipid emulsion therapy in a dog treated for 5-fluorouracil toxicosis

romans jvecc 2020

A

Prop + ILE caused oxidant-induced anemia –> HB anemia + spherocytes

Hz body anemia:

  1. RBC GSH inhibition, incr oxidative damage susceptibility?
  2. High ratio of n-6 to n-3 PUFA to alter RBC membrane, incr osmotic fragility

ROS/oxidant damage RBC via:

  1. Oxidation of hemoglobin and formation of clumps of denatured hemoglobin over the inner RBC membrane (Heinz bodies)
  2. Eccentrocyte formation
  3. Formation of metHb
24
Q

Retrospective evaluation of acute kidney injury in dogs with pit viper envenomation (2008–2017): 56 cases

Martinez jvecc 2020

A

Dogs w/ AKI received higher dose of antivenom, had more severe shock (higher SI, tachycardic, hypotensive), and more likely to receive pRBC transfusion

Receipt of blood transfusion and # of antivenom vials received were associated w/ development of AKI

Development of AKI negatively affected outcome – 31% survived to discharge vs 98% non-AKI survived to discharge

Pit viper AKI: pre-renal AKI and primary renal (rhabdomyolysis + hemolysis –> myoglobinuria + hemoglobinuria)

25
Q

Thromboelastographic evaluation of 2 dogs with boomslang (Dispholidus typus) envenomation

kopke jvecc 2020

A

Hypocoagulable state preadministration of monovalent antivenom, followed by return to a normocoagulable state immediately postadministration, along with resolution of clinical bleeding

26
Q

Successful management of minoxidil toxicosis in a dog

Tyler J. M. Jordan, javma 2018

A

Minoxidil is an ATP-sensitive potassium channel opener with potent vasodilatory effects
- Direct arterial smooth muscle vasodilation

Cx: exaggerated carotid pulsation, tachycardia, and hypotension

Tx: IVF, alpha1-agonists (dopamine or phenylephrine), beta-blocker (esmolol= b1 selective) PRN to decr HR, intralipids

27
Q

Myocardial hypertrophy associated with long-term phenylpropanolamine use in a dog

Kayla R. Hanson DVM; Wendy A. Ware DVM
javma 2018

A

PPA can cause systemic hypertension which can cause ventricular hypertrophy

Reversible

28
Q

Efficacy of intravenous administration of apomorphine for removal of gastric foreign material in dogs: 495 cases (2010–2015)

Kevin S. Kirchofer JAVMA 2019

A

Overall success rate: 75%

Dose: 0.03 mg/kg +/- 0.01

More likely in younger dogs or those who ingested fabric, leather, or bathroom waste

Become less likely if duration b/w Fb ingestion + emesis increased and for dogs that received opioids, sedative, or anti-emetic

SE: ataxia, tachycardia, nausea

29
Q

Duloxetine ingestion in 364 dogs

Natalie K. James, javma 2019

A

Duloxetine = serotonin and norepi reuptake inhibitor, limited effect on dopamine reuptake inhibition
-highly PPB, liver metabolized, excreted in urine

Cx: lethargy, mydriasis, V+, trembling – more likely in >20 mg/kg

30
Q

Clinical, clinicopathologic, and hepatic histopathologic features associated with probable ketoconazole-induced liver injury in dogs: 15 cases (2015–2018)

Luis P. Macho JAVMA 2020

A

Ketoconazole to tx Malassezia infection, avg 7.8 mg/kg/day PO

All had ELE and occ. hyperBil

Histopath: Variable lobular injury, mixed inflammation, aggregates of ceroid-lipofuscin-engorged macrophages

31
Q

Companion animal exposures to potentially poisonous substances reported to a national poison control center in the United States in 2005 through 2014

Alexandra L. Swirski, javma 2020

A

Dogs: human meds, food, pesticides
Cats: human meds, plants, vet medicine
-human meds: CNS disorder, analgesics, CVS drugs

Chocolate and Lilium plants = most common in dogs and cats

5-FU (62.5%) and bifenthrin (66.7%) highest mortality rate in dogs and cats respectively

32
Q

Use of therapeutic plasma exchange to treat nonsteroidal anti-inflammatory drug overdose in dogs.

Melisa G Rosenthal and Mary A Labato. jvim 2019

A

TPE is an effective tx for NSAID OD (ibuprofen, naproxen, deracoxib)

Complications were common (54.5%) associated w/ TPE– bleeding, clotting, hypotension

Large initial dose of NSAID associated w/ higher max serum Cr and a larger change in sCr during

27% developed AKI.

Lower PCV had lower LOH

33
Q

Ambulatory electrocardiography and serum cardiac troponin I measurement in 21 dogs envenomated by the European adder (Vipera berus)

Hannah J. Harjen jvim 2020

A

100% survival
57% had ventricular arrhythmias

Dogs w/ arrhythmia had increased cTnI at >1 time point (myocardial cell injury)

34
Q

Toxicosis with grapes or raisins causing acute kidney injury and neurological signs in dogs

Ariane Schweighauser jvim 2020

A

marked forebrain, cerebellar, or vestibular signs

53% survival

Unrelated to AKI

ACVECC boards: Journals and equations (15 decks)

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