TOXICOLOGIC EMERGENCIES

Signs will vary depending on character of toxic compound Toxicity can result from exposure via many routes Ingestion Inhalation Skin contact Injection Toxicologic Emergencies

Top 10 Toxicoses (2005) – Human medication (ibuprofen, acetominophen, anti-depressants) – Insecticides—flea and tick – Rodenticides—anticoagulants – Veterinary medication – Household cleaners—bleach, detergents – Plants—sago palm, lily, azalea – Herbicides – Chocolate—highest in food category – Home improvement products—solvents, adhesives, paint, wood glue – Fertilizers Toxicologic Emergencies

HISTORY ASSESS STABILIZE – Administer oxygen – Control seizures – Correct cardiovascular abnormalities DECONTAMINATION – Emetics – Activated charcoal – Gastointestinal protectants CONTROL CLINICAL SIGNS GOOD NURSING CARE PREVENT FURTHER EXPOSURE Toxicologic Emergencies

Ocular exposure Rinse eyes with copious saline for min Chemical burns treated with lubricating ointment and suture lids closed Use corticosteroids only if corneal epithelium is intact Skin exposure Bathe with mild detergent (liquid dish soap) Bather should wear protective clothing (gloves, goggles) Toxicologic Emergencies: external exposure

Ingestion Induce vomiting—if chemical not caustic; animal conscious, not seizing Syrup of ipecac, apomorphine, Xylazine, H 2 O 2 (not reliable), salt (not recommmended) Dilute caustic substances with milk, water Gastric lavage—large bore stomach tube; light anesthesia w/ endotracheal tube Administer absorbents—activated charcoal inhibits GI absorption Give orally or via stom tube Enemas/cathartics to eliminate toxins more rapidly Toxicologic Emergencies

Toxicological Emergencies ACTIVATED CHARCOAL WITH OR WITHOUT A CATHARTIC

Methylxanthines (caffeine, theobromine, theophylline Found in: coffee, tea, chocolate, other stimulants Toxic Dose of caffeine and theobromine in dogs: mg/kg; (other sources: mg) Milk Chocolate—44-60 mg/oz Dark chocolate-150 mg/oz Baking Chocolate— mg/oz Toxicologic Emergencies

Clinical signs of methylxanthine/chocolate toxicosis (caffeine, theobromine) – Increased HR, RR – Anxiety – Vomiting/diarrhea – Seizures, coma – Cardiac arrhythmias Treatment – Induce vomiting – Activated charcoal – Control seizues – Fluid therapy Toxicologic Emergencies

Rodenticides 1. Anticoagulants (warfarin, pindone, bromadiolone, brodifacoum) Work by binding Vit K, which inhibits synthesis of factors II, VI, IX, X This effect occurs within 6-40 h in a dog; effect may last 1-4 wk Toxicologic Emergencies

Clinical signs (occur after depletion of clotting factors) – Lethargy – Vom/dia with blood; melena – Anorexia – Ataxia – Dyspnea – Epistaxis, scleral hemorrhage, pale mm Treatment – Vit K: 3-5 mg/kg PO for up to 21 d depending on anticoagulant used – Induce vomiting; activated charcoal – Whole blood transfusion if anemic Toxicological Emergencies

– Rodenticides 2.Cholecalciferol—Vit D 3 ; used in Quintox, rampage, Rat-Be-Gone -causes Ca++ reabsorption from bone, intestine, kidneys causing hypercalcemia (>11.5 mg/dl) and cardiotoxicity Clinical signs (12-36 h after ingestion) – Kidney failure » Anorexia » Vomiting » Tissue mineralization – Cardiovascular abnormalities » Muscle weakness » arrhythmias Toxicologic Emergencies

Diagnosis – Hx of exposure – Usually discovered on routine Chem panel (↑blood Ca ++ ) Treatment – Induce vom/activated charcoal if ingestion occurred with 2 h – Furosemide x 2-4 wk; increases Ca ++ excretion in urine – Prednisone x 2-4 wk; decreases Ca ++ reabsorption from bones/intesine – Calcitonin to lower blood Ca ++ concentration Toxicological Emergencies

– Rodenticides 3.Bromethalin -uncoupler of oxidative phosphorylation in CNS (stops production of ATP) -Causes cerebral edema -found in Assault, Vengence, Trounce -Toxic DoseDog: 4.7 mg/kg Cats: 1.8 mg/kg Clinical signs (>24 h after ingestion of high dose; 1-5 d--low dose) – Excitement, tremors, seizures – Depression, ataxia Rx (will take 2-3 wk to know if animal will survive) – Purge GI tract if exposure recent – Reduce cerebral edema with Mannitol and glucocorticoids – Seizure control with Diazepam and Phenobarbital Toxicologic Emergencies

Acetaminophen Common OTC drug for analgesia Toxic dose:Dog— mg/kg Cat—50-60 mg/kg (2 doses in 24 h is almost always fatal) Clinical signs (starts within 1-2 h of ingestion) – Vomiting, salivation – Facial and paw edema – Depression – Dyspnea – Pale mm – Cyanosis due to methemoglobinemia Px—poor Rx – Induce vom/activated charcoal – Antidote: N-Acetylcysteine (loading dose of mg/kg PO, IV, then at 70 mg/kg PO, IV QID x 2- 3 d Toxicologic Emergencies

Toxicological Emergencies

– Metals Lead toxicity more common in dogs than cats – Source » Lead paint (prior to 1970’s) is primary source » Batteries, linoleum, plumbing supplies, ceramic containers, lead pipes, fishing sinkers, shotgun pellets – Clinical signs (Usually involves signs of GI and nervous systems) » Anorexia » Vom/dir » Abd pain -CNS signs do not show initially » Blindness, seizures, ataxia, tremors, unusual behavior Toxicologic Emergencies

– Metals Lead toxicity – Dx » Large # nucleated RBC’s; basophilic stipling » Blood lead conc >35 μg/ml – Rx » Remove lead from GI tract (cathartic, Sx) » Chelators (to bind the Pb in blood stream and hasten its removal) -Calcium EDTA (ethylene diamine tetra acetic acid) -Penicillamine » IV fluids for dehydration and to speed removal via kidneys » Diazepam, Phenobarbital to control seizures Toxicologic Emergencies

– Metals Zinc Toxicosis – Usually from ingested pennies, galvanized metal, zinc oxide ointment Clinical signs – Vomiting – CNS depression – Lethargy Dx – Hx of exposure – Clinical signs Rx – Remove metal objects endoscopically or surgically – IV fluid therapy – Ca EDTA chelation Toxicologic Emergencies

Ethylene Glycol (antifreeze; sweet taste) Lethal dose:Cat—1.5 ml/kg Dog—6.6 ml/kg Signs (onset within 12 h of ingestion) – CNS depression, ataxia (may appear intoxicated) – Vomiting – PD/PU – Seizures, coma, death – Acute renal failure Dx – Hx, signs – Ethylene Glycol Poison Test—an 8 min test used in cats and dogs – Calcium oxalate crystals Rx – Emesis, adsorbents if ingestion within 3 h of presentation – IV fluids, NaBicarb for acidosis – Ethanol inhibits ethylene glycol metabolism Dogs (Cats): 20% ethanol—5.5 (5.0) ml/kg q6h x 5, then q8h x 4 – 4-methylpyrazole has been shown to be effective Toxicologic Emergencies

Toxicological Emergencies THE PROBLEM THE SOLUTION

Snail Bait (Metaldehyde, methiocarb ) – Metaldehyde mechanism unknown – Methiocarb is a carbamate and parasympathomimetic Signs – Hypersalivation – Incoordination – Muscle fasciculations – Hyperesthesia – Tachycardia – Seizures Rx – Emesis and absorbents – Pentobarbital, muscle relaxants to control CNS hyperactivity Toxicologic Emergencies

Garbage Toxicity – Common in dogs; not in cats – Enterotoxin-producing bacteria include Strep, Salmonella, Bacillus Signs (within min to h after ingestion) – Anorexia, lethargy – Vom/dia – Ataxia, tremors – Enterotoxic shock can cause death Rx – IV Fluid therapy – Broad-spec antibiotics – Intestinal protectants – Muscle relaxers or Valium may be needed to control tremors – Corticosteroids to counter endotoxic shock Toxicologic Emergencies

Insecticides Pyrethrins, Pyrethroids, Permethrins – Common ingredients of flea/tick sprays, dips, shampoos, etc – If used according to instructions, toxicity rarely occurs; if overused, toxicity can result Signs – Hypersalivation – Vom/dia – Tremors, hyperexcitability or lethargy – Later, dyspnea, tremors, seizures can occur Rx – Bathe animal to remove excess – Induce vomiting/charcoal/cathartics for ingestion – Diazepam may be necessary for mild tremors – Methocarbamol, a muscle relaxer, for moderate-severe tremors – Atropine for hypersalivation and bradycardia Toxicologic Emergencies

– Insecticides Organophosphates and Carbamates – Inhibit cholinesterase activity (break down of Ach is inhibited) – Highly fat-soluble; easily absorbed from skin and GI tract – Found in dips, sprays, dusts, etc for fleas and ticks, and flys Signs – Salivation – Lacrimation – Urinary incontinence – Diarrhea – Dyspnea – Emesis, gastrointestinal cramping -May progress to – Seizures, coma, resp depression, death Rx – Bathe animal – Charcoal if ingested – Atropine ( mg/kg; half IV, half IM or SQ) – Praloxime chloride (20 mg/kg BID till signs subside)—reactivates cholinesterase Toxicologic Emergencies

Plant Toxicity – Most common in confined and juvenile animals – Usually from ornamental, indoor plants – Severity varies with plants – ID scientific plant name (florist, greenhouse) Araceae family (most from this family) – Dumb cane, split-leaf philodendron – Contain calcium oxalate crystals Signs – Hypersalivation, oral mucosal edema, local pruritis -Large amount of plant may cause: – Vomiting, dysphagia, dyspnea, abd pain, vocalization, hemorrhage Rx – Rinse mouth with milk or water to remove Ca Oxalate crystals – GI decontamination (protectants) may be needed Toxicologic Emergencies

Dumb Cane (Dieffenbachia) aka Mother-in-law’s tongue Oral irritation; intense burning, excess salivation

Split Leaf Philodendron Oxalate crystals like Dieffenbachia Oral irritation; intense burning, excess salivation

Lily of the Valley Contains cardiac glycosides Cardiac arrythmias, death

Azalea (Rhododendron) Hypotension, cardiovascular collapse, death

Sago Palm ALL PARTS OF THE PLANT ARE TOXIC Coagulopathy Liver failure

Phone advice to give owners (legal issues) Protect yourself from exposure before handling animal Gloves, protective clothing Protect yourself from animal because poisoned animals may act strangely Protect animal from further exposure by removing pet from source Bring sample of vomit, feces, urine Bring container/package that toxin was in and a sample of the toxin (plant material, rat bait, etc) Toxicologic Emergencies