Toxin/envenomation articles Flashcards
Use of charcoal hemoperfusion and hemodialysis in the treatment of methotrexate toxicosis in a dog
Mariana Pardo, et al jvecc 2018
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
Severe lactic acidosis and hypoglycemia due to acute metformin intoxication in a dog
Yu Ueda et al jvecc 2018
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
Treatment of carprofen overdose (72mg/kg) with therapeutic plasma exchange in a dog
Astrid B. Kjaergaard et al jvecc 2018
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
Retrospective evaluation of feline rodenticide exposure and gastrointestinal decontamination: 146 cases (2000–2010)
Karie L. Walton et al jvecc 2018
Prevalence is low (0.39%)
More likely to be young, indoor, intact, and in fall
Anticoagulant > cholecalciferol > bromethalin
Anticoagulant rodenticide toxicosis causing tracheal collapse in 4 small breed dogs
Thomer jvecc 2018
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
Acute liver failure in two dogs following ingestion of cheese tree (Glochidion ferdinandi) roots.
Christine Griebsch, et al jvecc 2019
Recovered x2
High ALT, bili, prolonged coags.
Tx: IVF, hepatoprotectants, vit K1, ABX, lactulose, antacids, anti-emetic, multiple FFP
Acute barium poisoning in a dog after ingestion of handheld fireworks (party sparklers).
stanley jvecc 2019
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
Antivenin-associated serum sickness in a dog.
Benjamin M Lee, et al jvecc 2019
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
Use of gas chromatography-mass spectrometry for definitive diagnosis of synthetic cannabinoid toxicity in a dog.
Efrat Kelmer, et al jvecc 2019
Gas chromatography-mass spectrometry analysis of the plant material and a plasma sample
Acute chlorfenapyr toxicity in 3 dogs from a single household.
Rachel B Davy, et al jvecc 2019
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
Effect of single dose administration activated charcoal containing sorbitol on serum sodium concentration and hydration status in dogs.
Mix jvecc 2019
2g/kg incr serum Na, K, Cl, lactate and osmolality, HCT, and decr weight
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
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
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
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%
Survival of a dog with accidental colchicine overdose
Ingrid Henrietta Goodman jvecc 2020
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
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
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
Retrospective evaluation of the use of hemodialysis in dogs with suspected metaldehyde poisoning (2012–2017): 11 cases
Teichmann-Knorrn , jvecc 2020
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
Retrospective evaluation of the induction of emesis with apomorphine as treatment for gastric foreign bodies in dogs (2010-2014): 61 cases
Zersen JVECC 2020
Emesis successful in 97% of dogs
-most received 0.03 mg/kg
78% produced FB
Treatment of phenobarbital intoxication using hemodialysis in two dogs
Jessica Kielb Basile jvecc 2020
Ingested toxic doses of pheno –> comatosed –> 3h IHD –> complete resolution of Cx and normal mentation by the end of therapy
No side effects
Efficacy of a single session in-series hemoperfusion and hemodialysis in the management of carprofen overdose in two dogs
Fick jvecc 2020
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
Systemic lime sulfur toxicosis secondary to dermal exposure in two cats
Nix jevv 2020
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
Efficacy of specific antivenom and fresh frozen plasma in reversing Daboia palaestinae venom-induced hemostatic derangement
Nivy jvecc 2020
Dp-venom caused hypercoagulable and hyperfibrinolytic changes – negated by antivenom but not FPP
Gastrointestinal obstruction secondary to activated charcoal granule impaction in a dog
Farrell jvecc 2020
GRANULES
Charcoal granule causing SI obstruction
Oxidative red blood cell damage associated with propofol and intravenous lipid emulsion therapy in a dog treated for 5-fluorouracil toxicosis
romans jvecc 2020
Prop + ILE caused oxidant-induced anemia –> HB anemia + spherocytes
Hz body anemia:
- RBC GSH inhibition, incr oxidative damage susceptibility?
- High ratio of n-6 to n-3 PUFA to alter RBC membrane, incr osmotic fragility
ROS/oxidant damage RBC via:
- Oxidation of hemoglobin and formation of clumps of denatured hemoglobin over the inner RBC membrane (Heinz bodies)
- Eccentrocyte formation
- Formation of metHb
Retrospective evaluation of acute kidney injury in dogs with pit viper envenomation (2008–2017): 56 cases
Martinez jvecc 2020
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)
Thromboelastographic evaluation of 2 dogs with boomslang (Dispholidus typus) envenomation
kopke jvecc 2020
Hypocoagulable state preadministration of monovalent antivenom, followed by return to a normocoagulable state immediately postadministration, along with resolution of clinical bleeding
Successful management of minoxidil toxicosis in a dog
Tyler J. M. Jordan, javma 2018
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
Myocardial hypertrophy associated with long-term phenylpropanolamine use in a dog
Kayla R. Hanson DVM; Wendy A. Ware DVM
javma 2018
PPA can cause systemic hypertension which can cause ventricular hypertrophy
Reversible
Efficacy of intravenous administration of apomorphine for removal of gastric foreign material in dogs: 495 cases (2010–2015)
Kevin S. Kirchofer JAVMA 2019
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
Duloxetine ingestion in 364 dogs
Natalie K. James, javma 2019
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
Clinical, clinicopathologic, and hepatic histopathologic features associated with probable ketoconazole-induced liver injury in dogs: 15 cases (2015–2018)
Luis P. Macho JAVMA 2020
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
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
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
Use of therapeutic plasma exchange to treat nonsteroidal anti-inflammatory drug overdose in dogs.
Melisa G Rosenthal and Mary A Labato. jvim 2019
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
Ambulatory electrocardiography and serum cardiac troponin I measurement in 21 dogs envenomated by the European adder (Vipera berus)
Hannah J. Harjen jvim 2020
100% survival
57% had ventricular arrhythmias
Dogs w/ arrhythmia had increased cTnI at >1 time point (myocardial cell injury)
Toxicosis with grapes or raisins causing acute kidney injury and neurological signs in dogs
Ariane Schweighauser jvim 2020
marked forebrain, cerebellar, or vestibular signs
53% survival
Unrelated to AKI
