SA Nursing 2- Toxins

What does "sola dosis facit venenum"

the dose makes the poison (just adding this bc i feel she would put this in the exam lol)

What are the most common types of toxins?

OTC meds, food, rodenticides, yard products, plants, illicit substances

What 4 things do you do for toxin triage?

-ABCDEs

-temperature

-IV access

-decontamination

what to ask in your patient history?

What? When? How much? Did you see it happen? did you try to induce vomiting at home? clinical signs? also ask for packaging

What are some common clinical signs of toxin ingestion?

V/D, ataxia/neurological signs, muscle tremors, tachy/bradycardia, hypersalivation, hyperesthesia, hepatic/renal injury

what is hyperesthesia?

extremely sensitive to touch

what medications can you give to induce vomiting in dogs?

apomorphine, hydrogen peroxide, ropinerole

what ways can you give apomorphine?

IV (preferred), in conjunctival sac (0.02 mg/kg, 0.25 mg)

what ways can you give hydrogen peroxide?

PO

is hydrogen peroxide recommended?

no

what species is ropinerole for?

ONLY dogs

what route do you give ropinerole?

ophthalmic

what medications can you give cats to induce vomiting?

dexmedetomidine, xylazine

what routes can you give dexmedetomidine and xylazine for cats?

IV or IM

dex-6-18 mcg/kg

xylazine- 0.4-0.5 mg/kg

what are the risks of using hydrogen peroxide?

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

and you have to think about how effective it is

if you use hydrogen peroxide what percentage should you use?

3% ONLY

what is the dose you should use for hydrogen peroxide?

1 tsp/10 lbs (do NOT exceed 4 mL/lb)

When should you use gastric lavage?

before body absorbs toxin

when to not use gastric lavage?

if toxin is caustic

gastric lavage can reduce severity by up to _____% in ____ minutes

50%, 5 minutes

when is gastric lavage not effective?

>1 hour since ingestion

complications of gastric lavage?

aspiration, laryngospasm, hypothermia

**anesthesia is required

What do enemas help with?

-remove toxins from lower GI, lessens systemic effects, can help with extended-release meds and raisins

what are some contraindications of enemas?

-pets with diarrhea, electrolyte disturbance, not always helpful

how does activated charcoal work?

it is porous (absorbs chemicals), must be in direct contact with toxin, uses ionic hydrogen bonds, interrupts enterohepatic circulation

when should you give activated charcoal?

sooner the better, repeat every 6-8 hours

what is the dose for activated charcoal?

1-3 grams/kg

what is IVLE?

intravenous lipid emulsion

where is IVLE used?

TPN/PPN (total parental nutrition, peripheral parental nutrition)

when to use IVLE?

for local anesthetics, pyrethrins, ivermectin, THC, metaldehyde

Patient care for animals with toxin ingestion?

-monitor clinical signs

-slow movements

-reduce lights

-reduce sounds

what is xylitol?

sugar substitute

where is xylitol found?

peanut butter, gum, toothpaste, mouthwash, nasal sprays, lotions and creams, compounded meds

what happens in dogs when they ingest xylitol

pancreas releases insulin, severe hypoglycemia

is xylitol dose dependent?

yes

>0.1 g/kg = hypoglycemia

>0.5g/kg = hepatotoxic

clinical signs of xylitol?

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

what anticoagulants are in rodenticides?

warfarin, brodifacoum, difethialone, brimadilone

what are the active ingredients in rodenticides?

anticoagulants, bromethalin, cholecalciferol (vitamin B3)

what happens when anticoagulants are ingested?

clotting factors inhibited, prolonged bleeding (mouth, nose, lungs), onset is 3-5 days after ingestion, elevated PT

treatment for anticoagulants?

vitamin K, oxygen, transfusions

clinical signs of cholicalciferol?

V/D, anorexia, depression, +/- PU/PD, renal failure, severe hypercalcemia, death

at what dose do you see clinical signs of cholicalciferol?

0.5mg/kg

treatment of hypercalcemia for cholicalciferol?

hydrate with 0.9% saline, furosemide

(watch potassium)

clinical signs of bromethalin?

-Muscle tremors

-Seizures -Hyperexcitability

-CNS depression

-Hyperthermia

-Hind limb paralysis

-Neurological dysfunction

-Death

what species is more sensitive to bromethalin?

cats

what are the toxic doses of bromethalin in dogs and cats?

cats: 0.4-0.71 mg/kg

dogs: 2.38-5.6 mg/kg

treatment for bromethalin ingestion?

supportive care

clinical signs of NSAID toxicity?

-diarrhea +/- melena

-vomiting

-lethargy

-anorexia

-weakness

-dehydration

-abdominal pain

-pale gums

-seizure, coma, death

what is the mechanism of action for NSAIDs?

-blocks COX-2 enzymes (inflammatory mediators)

-blocks COX-1 enzymes (gastric mucosal barrier, renal blood flow, platelet action)

what are other concerns to remember about NSAIDs?

high bioavailability, severe stomach irritation common

where is acetaminophen metabolized?

liver- so it can cause liver damage or failure

What does acetominophen do to the blood?

limits RBCs ability to carry oxygen (oxidative stress), changes hemoglobin into methemoglobin (which can't carry O2), heinz body formation --> rbc destruction --> anemia

Toxic doses of acetaminophen

cats: >50 mg/kg

dogs: > 10 mg/kg

clinical signs of acetominophen toxicity?

-Tachypnea

-Tachycardia

-Vomiting

-Drooling

-Anorexia

-Abdominal pain

-Cyanotic mucous membranes

-Swelling of face, paws, forelimbs

-Icterus

-Polyuria/polydipsia

-Death

treatment for acetominophen toxicity?

-Decontaminate

-N-acetylcysteine (5%)

-Vitamin C• Oxygen

-IV fluids

-Liver support

what is pyrethrin?

Common drug in topical flea/tick prevention for dogs

what species is it toxic to?

cats

what does pyrethrin act on?

CNS and PNS- alters function of NA+ channels, prolongs nerve impulse

clinical signs of pyrethrin ingestion?

ataxia, tachypnea, mydraisis, hyperexcitation, seizures, muscle tremors

treatment for pyrethrin?

dawn bath, benzos, methocarbamol, intralipids, IV fluids

what are the 3 different types of alcohol?

ethanol (alcoholic beverages), isopropanol (rubbing alcohol), methanol (wood alcohol)

signs of alcohol toxicity can occur depending on?

stomach contents, empty stomach: 15-30 mins, full stomach: 1-2 hours

clinical signs of alcohol toxicity?

ataxia, polyuria, nausea/vomiting, lethargy, hypothermia/tension, blindness, tremors, tetraplegia, seizures, resp. depression, coma, death

treatment for alcohol toxicity?

IV fluids, cardiovascular support, electrolyte correction, ventilator in severe cases, confinement

what does THC stand for?

tetrahydrocannabinol

True or False: THC content is rarely accurate on commercial packages

true

clinical signs in dogs for cannabis?

lethargy, urinary incontinence, hyperesthesia, diarrhea, ataxia, bradycardia, hypothermia, hypotension, tremors, mydriasis

clinical signs in cats for cannabis?

ataxia, lethargy, vomiting

treatment for cannabis?

emesis- may not be successful,

supportive care- iv fluids, intralipids

chocolate toxicity varies based on what?

type of chocolate, how much they ate, weight of patient

theobromine and caffeine are both absorbed by what?

GI tract, and metabolized in liver

clinical signs for chocolate toxicity?

V/D, PU/PD, tachypnea, tachycardia, VPCs, hypertension, hypokalemia, ataxia, seizures, coma, resp. failure

treatment for chocolate toxicity?

decontamination if <1 hour ago, activated charcoal

raisins, grapes and currants

mechanism unknown, cooked version isn't as bad (but still don't), no toxic dose, no antidote

clinical signs for raisins, grapes and currants ingestion?

V/D, lethargy, anorexia, PD, dehydration, abdominal pain, weakness, tremors, hematochezia

treatment for raisins, grapes and currants ingestion?

decontaminate, iv fluids, monitor kidney values

what allium plant is worse?

garlic

what are other allium plants?

leeks and chives, shallots, other onions (all forms- dried, powdered, liquid, cooked, raw)

what do allium plants do?

damage RBCs (hemolysis), heinz body formation, oxidative stress

what breeds have increased risk from allium plants?

akita, shiba inu

symptoms of onion poisoning in dogs?

lethargy, weakness, pale gums, fainting, tachycardia, panting, vomiting, diarrhea

treatment for allium plants?

decontaminate, activated charcoal, iv fluids, +/- O2 supplementation, +/- blood transfusions

are lilies toxic to cats?

YES, lethal

what organ do lillies damage?

kidneys

clinical signs of lily ingestion?

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

treatment for lily ingestion?

emesis, activated charcoal, iv fluids, dialysis

clinical signs of macadamia nut ingestion?

weakness, depression, vomiting, tremors, hyperthermia

is treatment needed for macadamia nut ingestion?

no, most recover without intervention

what can raw bread dough do to patients?

severe gastric distention, vascular compromise, fermentation = alcohol, respiratory distress

treatment for raw bread dough?

emesis -difficult

gastric lavage, support care (treat like you would for alcohol)

what is ethylene glycol?

antifreeze- tastes sweet

where is ethylene glycol absorbed?

GI, resembles alcohol tox