third year small animal nursing exam 2

whats the most common toxins?

OTC meds, food, rodenticides, household yeard products, plants, illicit substances

what are common clinical signs associated with toxicity?

vomiting, diarrhea, ataxia/neuro, tremors, tachy/bradycardia, hypersalivation, hyperesthesia, hepatic/renal injury

medications to induce canine vomiting

hydrogen peroxide, apomorphine (IV or eye), ropinerole

medications to induce feline vomiting

dexmedetomidine, xylazine

hydrogen peroxide risks

esophageal irritation, gastric irritation, gastric ulcers, oral ulcers, aspiration

important when using hydrogen peroxide

3% only, 1tsp/10lbs, dont exceed 4ml/lb

when do you not use gastric lavage?

if toxin is caustic, greater than 1 hour since ingested

how much does gastric lavage reduce severity?

50% in 5 mins

gastric lavage complications

aspiration, laryngospasm, hypothermia, AX required

enemas

help remove toxins from lower GI, lessen systemic effects

what can toxins can enemas help with?

raisins, extended release medications

contraindications of enemas

pets with diarrhea, electrolyte disturbances

activated charcoal

porous absorbs chemicals, must be in contact with toxin, uses ionic hydrogen bonds, every 6-8 hours

what does activated charcoal interrupt?

enterohepatic circulation

intravenous lipid emulsion (IVLE)

used in parenteral nutrition for lipophilic toxicosis to prevent the compound reaching site of action

indications for intravenous lipid emulsion

toxicity from local anesthetics, pyrethrins, ivermectin, THC, metaldehyde

patient care for toxicity

reduce light, monitor clinical signs, reduce sound

xylitol toxicity

sugar substitute, peanut butter, gum, toothpaste, nasal sprays, lotion and creams, compounded medications

xylitol absorbtion in dogs

rapid, pancreas releases insulin, severe hypoglycemia

xylitol dose

>0.1g/kg =hypoglycemia

>0.5g/kg= hepatoxic

xylitol toxicity treatment

hypoglycemia: food and dextrose supplementation

liver failure: supportive care

xylitol toxicity clinical signs

vomiting, ataxia, collapse, liver failure, bleeding, seizures, coma, death

rodenticides active ingredients

anticoagulants: warfarin, brodifacoum, difethialone, brimadilone

other: bromethalin, cholecalciferol (vit B3)

how to anticoagulants work?

inhibit vitamin K recycling which inhibits clotting factors causing prolonged bleeding from mouth, nose, lungs

treatment for rodenticides with anticoagulants

vitamin K, oxygen, transfusion

rodenticides with cholicalciferol clincial signs

vomiting, diarrhea, anorexia, depression, PU/PD, renal failure, severe hypercalcemia, death

rodenticides with cholicalciferol treatment

treat hypercalcemia by hydrating with saline, furosemide, watch potassium

rodenticides with bromethalin toxicity clinical signs

muscle tremors, seizures, hyperexcitabilty, CNS depression, hyperthermia, hind limb paralysis, death

rodenticides with bromethalin

neurotoxin, cats more senstive, increases intracellular Na in brain

rodenticides with bromethalin treatment

supportive care

NSAID toxicity clinical signs

diarrhea with melena, vomiting, lethargy, anorexia, weakness, dehydration, abdominal pain, pale gums, seizure, coma, death

acetaminophen metabolization

metabolized through liver causing liver damage or failure

acetaminophen impact on RBCs

limits ability to carry oxygen, changes hemoglobin to methemoglobin which cant carry oxygen, heinz body anemia

ferrous iron

bind to oxygen and releases to tissue (normal)

ferric iron

binds to oxygen does not release (acetaminophen toxicity)

acetaminophen toxicity clincal signs

tachypnea, tachycardia, vomiting, rolling, anorexia, abdominal pain, cyanotic MM, swelling of face paws forelimbs, icterus, PU/PD, death

acetaminophen toxicity treatment

decontaminate, N-acetylcysteine, vit C, oxygen, IV fluids, liver support

pyrethrin toxicity

common in dog flea/tick, toxic to cats, acts on PNS and CNS, altering Na channels prolonging nerve impulse

pyrethrin toxicity clinical signs

ataxia, tachypnea, mydriasis, hyperexcitation, seizures, muscle tremors

pyrethrin toxicity treaments

dawn bath, benzos, methocarbamol, intralipids, IV fluids

three types of alcohol

ethanol (drinks), isopropanol (rubbing alcohol), methanol (wood alcohol)

alcohol tocixity clinical signs

CNS depressents, ataxia, PU, nausea/vomiting, lethargy, hypothermia, blindness, tremors, tetraplegia, seizures, respiratory depression, coma, death

alcohol toxicity treatment

IV fluids, cardio support, electrolyte correction, ventilator, confinement

cannabis toxicity in dog clinical signs

lethargy, incontinance, diarrhea, ataxia, bradycardia, hypothermia, hypotension, tremors

cannabis toxicity in cat clinical signs

ataxia, lethargy, vomiting

what are the two receptors dogs have for cannabis

CB1- psychoactive CB2- inflammtion and pain

what percent of cannabis packages are accurately labeled?

17%

what percent of cannabis packages are under labeled?

23%

what percent of cannabis packages are over labeled?

60%

cannabis toxicity treatment

emesis, supportive care

chocolate toxicity

methylxantines (theobromine and caffeine)

chocolate toxicity clinical signs

vomiting, diarrhea, PU/PD, tachypnea, tachycardia, VPCs, hypertension, hypokalemia, ataxia, seizures, coma, resp failure

chocolate toxicity treatment

decontamination if <1 hour, activated charcoal, supportive care

raisins grapes and currants toxicity clinical signs

vomiting/diarrhea, lethargy, PD, dehydration, abdominal pain, weakness, tremors

raisins grapes and currants toxicity treatment

decontaminate, IV fluids, monitor kidney values

allium plants

garlic (worst), leeks, chives, shallots, other onions all forms are toxic

allium plants toxicity damge to RBCs

hemolysis, heinz body formation, oxidative stress

what breeds have an increased risk for allium plant toxicity?

akita, shibas

allium plant toxicity clinical signs

lethargy, weakness, panting, drooling, mouth irritation, diarrhea, collapse

allium plant toxicity treatment

decontaminate, activated charcoal, IV fluids

lilies toxicity

lethal to cats, and dogs minor GI upset, a small amount is toxic, any part of the plant including water from the pot causes kidney failure and death

lily toxicity clinical signs

vomiting, lethargy, drooling, anorexia, seizures, coma, death

lily toxicity treatment

emesis, activated charcoal, IV fluids, dialysis

macadamia nut toxicity clinical signs

weakness, depression, vomiting, tremors, hyperthermia

macadamia nut toxicity treatment

typically not needed, severe ingestion: emesis, fluids, activated charcoal, analgesics

raw bread dough toxicity

yeast is bad causing severe gastric distention, and respiratory depression

raw bread dough toxicity treament

emesis, gastric lavage, supportive care

ethylene glycol toxicity

antifreeze, tatses sweet, absorbed through GI, small lethal dose

seizures

sudden excessive electrical discharge in the forebrain

where do all siezures occur?

the forebrain

are seizures a clinical sign or disease?

clinical sign of forebrain dysfunction

inhibitory neurotransmitters

prevent neuron from firing

excitatory neurotransmitters

help neurons fire

an imbalance of what can cause a seizure

neurotransmitters causing neurons to be overstimulated

three stages of seizures

pre-ictus, ictus, post-ictal

pre-ictus

initial manifestation of seizure lasts seconds to minutes

ictus

actual seizure event lasts seconds to minutes avg is 90 sec

post-ictal

period of confusion, drowsiness, disorientation foloowing seizure lasts minutes to hours

2 locations of seizures

generalized (whole brain) , partialor focal (part)

generalized seizures

most common, rhythmic bilateral body movement, chewing facial movements, autonomic signs, consciousness is absent

partial seizures

brain is affected focally, unilateral limb or muscle movements, facial movements, aware for simple and absent for complex

idiopathic epilepsy

most common, onset 6 m- 6 yrs, recurring seizures at least one per month, typically generalized

idiopathic epilepsy clinical signs

physical exam is normal, neuro exam normal, seizure activity

diagnostics for seizures

CBC/chem/UA, MRI, CSF tap

goal of managing seizures

reduce frequency and duration

phenobarbital

barbiturate, hepatic metabolism, hyperpolariazation of neuron making it harder to fire, side effects: transient sedation ataxia, PU/PD PP

keppra (levetiracetam)

anticonvulsant, renal metabolism, selectively prevents neurotransmitter release, side effects: mild sedation, overall safe

potassium bromide

salt, renal metabolism, hyperpolarization of neuron, side effects: sedation, ataxia, PU/PD/PP, GI upset

when siezures are an emergency

cluster siezures, status epilepticus

cluster siezures

more than 2 in 24 hours

status epilepticus

>5 minutes, multiple seizures with no return to normal between, requires immediate treatment

vestibular system contains

inner ear, vestibulocohlear nerve, brainstem, and cerebellum

what does the vestibular system maintain

balance and body orientation

vestibular signs

ataxia, head tilt, leaning/falling, nystagmus, anorexia, nausea

causes for vestibular disease

otitis media/interna, idiopathic, hypothyroidism, metronidazole toxicity, neoplasia, stroke

vestibular diagnostics

otic exam, CBC/chem.UA/T4, MRI, CSF tap

vestibular treatment

time and supportive care

traumtic brain injury primary vs. secondary

primary: direct tissue trauma to brain

secondary: cellular metabolism effects, ischemia, edam, hypo/hypertension

clinical signs of head trauma

wounds, innappropriate mentation, abnormal cranial nerve, seizures

head trauma diagnostics

CBC/Chem/UA radiographs, CT, MRI