Lecture 20: Basic Approach to Treatment of Poisoned Animals 3

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27 Terms

1
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what is activated charcoal?

organic matter → wood pulp, vegetable matter; first burned, then oxidized to increase number of pores

2
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activated charcoal pores

  • huge number of pores

  • huge surface area

  • 50 grams has surface area of 10 football fields

3
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the efficacy of activated charcoal depends on

  • time after ingestion of toxin

  • how long it stays in the GI tract

  • toxin to AC ratio

  • stomach contents

  • quality of AC product 

4
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toxin-AC can start to desorb after

30 minutes

5
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what is the optimal toxin to AC ratio?

1:10

6
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what are the lavage limits?

5-10 ml/kg

7
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prepared AC formulations

  • already in liquid solution

  • bottles or tubes

  • vet products → toxiban, liquichar

8
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prepared AC formulations can contain other ingredients like

sorbitol, kaolin, propylene, glycerol

9
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when should you give AC?

  • the sooner the better

  • best results are within 30 minutes of toxin ingestion

10
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true or false: it’s never too late to give AC as long as any toxin remains in the GI tract.

true

11
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for toxins excreted via biliary system, AC can help even if

the toxin entered the body by route other than ingestion

12
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giving AC before inducing emesis or performing lavage

  • starts binding toxin right away

  • increases contents in stomach, improves emesis

  • can’t use vomit or lavage for analysis 

  • must repeat after emesis or lavage is complete 

13
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giving AC after emesis or lavage

  • less toxin to bind up all available sites on AC

  • vomit or lavage fluid can be used for analysis

14
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hypernatremia and AC

  • can be associated with AC alone

  • no specific product association yet identified

  • thought to be more common in very small patients, mostly small dogs

15
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what are adsorbing agents other than AC?

kaolin, pectin, bentonite, bismuth, ion exchange resins, products sold as “mycotoxin binders”

16
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what is the goal of enhancing elimination?

  • to remove as rapidly as possible any toxin that has already been absorbed into the systemic circulation and tissues

  • to diminish degree and duration of toxic effects

17
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major methods of enhancing elimination

  • diuresis (urinary excretion)

  • decrease enterohepatic recycling (biliary excretion) → multiple doses of activated charcoal

18
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intravenous lipid emulsion treatment

  • use products designed for parenteral nutrition 

  • mechanism not well understood

  • examples → moxidectin, ivermectin, lipophilic drugs 

19
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what is the lipid sink theory?

lipid in blood draws lipid soluble toxin out of system and binds in blood

20
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systemic chelators

  • enhances elimination of absorbed toxin by altering diffusion gradient

  • examples → metal chelators use for various metal poisons

21
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alteration of metabolism 

  • prevention of toxic metabolite formation 

  • example → ethylene glycol

22
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what is an antidote?

an agent that reacts with the poison or its receptor or interferes with its metabolite pathway to decrease the ability of the poison to cause toxicity

23
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what overlaps with other steps like decontamination and enhancing elimination?

antidotes 

24
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universal antidote

  • NOT antidotes

  • contain a mixture of AC, kaolin, magnesium oxide, tannic acid, and other stuff

  • not superior to AC!

25
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universal animal antidote

labeled dosage on product does not provide enough AC to patient

26
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what are the antidote mechanisms?

  • block receptors used by the toxin → atropine blocks ACh receptors in organophosphate or carbamate poisoning

  • inhibit metabolism of original substance to a toxic metabolite

27
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true or false: there are a lot of antidotes that exist.

false