Small Animal Toxins

Small animal Sem 1 (Exam 2)

Most Common Small Animal Toxins

OTC Medications, Food, Rodenticides, Household/Yard Products, Plants, Illicit substances

Toxin Triage

-ABCDEs -Body Temp -IV Access

-DECONTAMINATION!

-Patient History: (what kind of questions)

What, When, How much, Induce vom at home, Clin Signs, request packaging

Common Clinical Signs?

V/D, Ataxia/neurological signs, muscle tremors, tach/bradycardia, Hypersalivation, Hyperesthesia, Hepatic/Renal Injury

-Apomorphine (IV, Conjuctival sac)

-Hydrogen Peroxide (PO) - no cats

Ropinerole (ophthalmic) - dogs only

vomiting induction Canine

-alpha 2s

• Xylazine

• Dexmedetomidine

Vomit induction Feline

-esophageal irritation

-gastric irritation

-gastric ulcers

-oral ulcers

-aspiration

-efficacy

Hydrogen Peroxide risks

• 3% ONLY

• 1tsp/10lbs

• DO NOT exceed 4mL/lb

If using Hydrogen Peroxide

-DO NOT DO if toxin caustic

• why/why not?

-used before body absorbs toxin

-can reduce severity by up to 50% in 5vminutes

-Not effective > 1 hour since ingestion

-anesthesia required

Gastric Lavage?

-Aspiration

-Laryngospasm

-Hypothermia

Complications of gastric lavage

-Help remove toxins from lower GI

-Lessens systemic effects

Enemas

-extended-release medications

-raisins

Enemas can help with

-Pets with diarrhea

-Electrolyte disturbances

Contraindications of Enemas

-Porous- absorbs chemical

-must be in direct contact with the toxin

-uses ionic hydrogen bonds

-interrupts enterohepatic circulation

*Sooner the better*

1-3 g/kg

-repeat every 6-8 hours

Activated Charcoal

-used in TPN/PPN

-no definitive use in toxicoses

-inexpensive

-adjunct therapy

Intravenous Lipid Emulsion

-prevents the compound reaching the site of actin

-local anesthetics

-pyrethrins

-ivermectin

-THC

-Metaldehyde

IVLE Lipophilic toxicosis

-monitor clinical signs

-slow movement

-reduced light

• cover eyes

• Doggles

-reduced sound

• gauze pack ears

• shut cage doors quietly

• keep voices down

  • avoid interacting with patient if possible

Patient Care

-Sugar substitute

-It’s everywhere!

• Peanut butter

• gum

• toothpaste

• mouthwash

• nasal sprays

• lotion and creams

• compounded medications

Xylitol Toxicity

-pancreas releases insulin

SEVERE hypoglycemia

Dose Dependent:

• >0.1 g/kg = hypoglycemia

• .>0.5 g/kg = hepatotoxic

Xylitol is absorbed rapidly in dogs

Hypoglycemia:

-food and dextrose supplementation

Liver Failure:

-supportive care

Xylitol toxicity treatment

• vomiting

• ataxia

• collapse

• liver failure

• bleeding issues

• seizures

• coma

• death

Xylitol toxicity clinical signs

-multiple active ingredients

-anticoagulants

-Bromethalin

-Cholecalciferol ( Vitamin D3)

Rodenticides Toxicity

• Warfarin

• Brodifacoum

• Difethialone

• Bromadiolone

The anticoagulants in Rodenticides

Works by inhibiting Vitamin-K recycling

-clotting factors gone

-Prolonged bleedsing

-ONSET: 4-7 DAYS after ingestion

-Elevated PT

Anticoagulant toxicity

• Vitamin K 1

• Oxygen

• Transfusions

Anticoagulant toxicity treatment

-Mouth

-Nose

-Lungs

Anticoagulants Prolonged bleeding

Cholecalciferol → Liver converts to calcifediol→ Kidney converts to calcitriol → Calcifediol competes for Vitamin D receptors → Receptor activation = increases Calcium/Phosphorus absorption

Cholicalciferol chart

-seen at 0.1 mg/kg dose

-Vomiting

-Diarrhea

-Anorexia

-Depression

+ / - PU/PD

-Renal failure

-SEVERE hypercalciemia

-Death

-Prevents Calcium ++ uptake in Loop of Henle

Cholicalciferol Clinical Signs

Treatment of Hypercalcemia:

-hydrate with 0.9 %

• Na uses the same pumps as Ca

• Faster excretion

-Furosemide (decreased Na Ca resorption)

-Watch potassium!

Cholicalciferol treatments

-muscle tremors

-seizures

-Hyperexcitability

-CNS depression

-Hyperthermia

-Hind limb Paralysis

-Neurologic dysfunction

-Death

Bromethalin clinical signs

-cerebral edema

-spinal cord edema

-nerve demyelination

Bromethalin Neurologic dysfunction

-supportive care

Bromethalin Treatment

-Casts more sensitive than dogs

Increases intracellular Na+ in the brain in the brain = BAD

-Cats:

• clinical signs appear: 0.05 mg/kg

• Toxic dose: 0.4-0.7 mg/kg

-Dogs:

• Clinical signs appear: 0.5 mg/kg

• Lethal dose: 0.95 mg/kg in dogs < 6months, 2.38 mg/kg for adults

Bromethalin Neurotoxic per species

-diarrhea + /- melena

-vomiting

Lethargy

-ANorexia

-Weakness

Dehydration

-Abdominal pain

-Pain gums

-Seizure

-Coma

-death

NSAIDs Clinical Signs

-Narrow safety margin

• 5 mg/kg/day

-high bioavailability

-severe stomach irritation common

NSAIDs

Blocks COX -1 enzymes:

-gastric mucosal barrier

-renal blood flow

-platelet action

Blocks COX -2:

-inflammatory mediators

NSAIDs mechanism of action

• vomiting

• Diarrhea

• nausea

• abdominal pain

• anorexia

Ibuprofen dose 25-125mg/kg signs in dogs

• all of the above

• hematemesis

• melena

• PU/PD

• oliguria

• uremia

• acute renal failure

Ibuprofen dose >175mg/kg signs in dogs

• all of the above plus..

• seizures

• ataxia

• coma

• shock

Ibuprofen dose >400 mg/kg signs in dogs

• death

Ibuprofen dose >600 mg/kg signs in dogs

-metabolized though liver

-can cause liver damage/failure

Limits RBC’s ability to carry oxygen

• oxidative stress

-changes hemoglobin to methemoglobin

• methemoglobin CANNOT carry O2

Acetaminophen toxicity

Oxidative damage to heme

-Ferrous Iron

• binds to oxygen and releases to tissue (normal)

-Ferric Iron:

• Binds to oxygen, does not release (acetaminophen)

RBCs:

-Heinz body formation → RBC destruction → anemia

Acetaminophen Blood Changes

Dogs:

• >10 mg/kg

Cats:

• >50 mg/kg

Acetaminophen toxic doses

• tachypnea

• tachycardia

• Vomiting

• Drooling

• Anorexia

• Abdominal pain

• Cyanotic mucous membrane

• Swelling of face, paws, forelimbs

• Icterus

• PU/PD

• Death

Acetaminophen Clinical Signs

• Decontaminate

• N-acetylcysteine (5%)

• Vitamin C

• Oxygen

• IV fluids

• Liver Support

Acetaminophen Treatment

-common drug in topical flea/tick prevention for dogs

-TXIC to CATS!

-Acts on CNS and PNS

• Alters function of Na channels

• Prolongs nerve impulse

Permethrin

• Ataxia

• Tachypnea

• Mydriasis

• Hyperexcitation

• Seizures

• Muscle tremors

Permethrin Clinical Signs

• Dawn bath

• Benzodiazepines

• Methocarbamol

• Intralipids

• IV fluids

Permethrin treatment

• Ethanol (alcoholic beverage)

• Isopropanol (rubbing alcohol)

• Methanol (wood alcohol)

Three types of Alcohol

-strengths may very, but clinical signs

-signs occur depending on stomcah contents

• Empty; 15-30 mins

• Full: 1-2 hours

-CNS depressants

Alcohol

• ataxia

• PU

• Nausea/Vom.

• Lethargy

• Hypothermia/tension

• Blindness

• tremors

• Tetreaplegia

• Seizures

• Respiratory depression

• Coma

• Death (uncommon but possible)

Alcohol Clinical Signs

• IV fluids

• Cardiovascular support

• Electrolyte correction

• Ventilator in severe cases

• Confinement

Alcohol Treatment

-Increases legalization= more ingestions

• not just the flowering plant

Tetrahydrocannabinol (THC)

-Dogs have 2 receptors

• CB 1 - Psychoactive - # higher than other species

• CB 2 - inflammation and pain

-Edibles: other toxins (chocolate, xylitol, raisins)

-Toxic dosing not established

Cannabis

Range from mild to severe 30 mins → 72 hours

• Lethargy

• Urinary incontinence

• Hyperesthesia

• Diarrhea

• Ataxia

• Bradycardia

• Hypotension/thermia

• Tremors

• Mydriasis

Cannabis Clinical Signs Dogs

Range from mild to severe 30 mins → 72 hours

• Ataxia

• Lethargy

• Vomiting

Cannabis Clinical Signs Cats

-emesis may not work

-supportive care

• IV fluids

• Intralipids

• Dark room with limited noise

• No stairs or jumping

• Time

-Not antidote

Most recover within 24-36 hours

OTC do NOT work

Prognosis good with appropriate care

Cannabis - treatment

-toxicity varies based on:

• type of chocolate

  • some owrse than others

• How much they ate

• Weight of patient

Theobromine and Caffeine

• both absorbed by GI tract

• Metabolized in liver to methylxanthines

Chocolate

• V/D

• PU/PD

• Tachypnea/cardia

• VPCs

• Hypertension

• Hypokalemia

• Ataxia

• Seizures

• Coma

• Respiratory failure

Chocolate Clinical Signs (within 6-12 hours)

-decontamination if < 1hour

-Activated charcoal (1-4 g/kg)

-Symptomatic/Supportive care

Chocolate treatment

• ECG

• Methocarbamol

• Benzodiazepines

• IV fluids

• Sedatives

Chocolate supportive care

-mechanism unknown

• Tartaric acid or Mycotoxin

-Raw fruit worse than cooked

-No established toxic dose

-No antidote

Raisins/grapes/currants

• V/D

• Lethargy/Anorexia

• PD

• Dehydrations

• Abdominal pain

• Weakness

• Tremors

• Hematochezia

Raisins/grapes/currants clinical signs

-Decontaminate

-IV fluids

-Monitor Kidney Values

• Kidney failure possible

Raisins/grapes/currants -Treatments

-Garlic is the WORST

-Leeks and Chives

-Shallots and other onions

-All forms toxic

• Dried, powdered, liquid, cooked, raw

-Cats Too!

Allium Plants

-Akita

-Shiba Inu

Allium Plants breeds with increased risk

Damages RBC’s

-Hemolysis

• Cats: 5 g/kg

• Dogs: 15-30 g/kg

-Heinz body formation

-Oxidative Stress

Allium Plants - RBCs

-V/D

-Tachycardia/pnea

-Smelly breath

-Drooling A LOT

-Mouth irritation

-Collapse

Allium Plants (Onion) Clinical Signs

-Lethargy

-Weakness

-Decreased appetite

-Pale gums

-Fainting

-Reddish urine

-Tachycardia

Allium Plants (Garlic) Clinical Signs

-Decontaminate

-Activated Charcoal

-IV fluids

+/ - oxygen supplementation

+ / - blood transfusion

Allium Plants - Treatment

-LETHAL to CATS

• Dogs get minor GI upset

-Small amount is toxic

• any part of the plant

• Water from the pot

-Kidney failure and death

• 36-72 hours after ingestion

Lilies

• Vomiting

• Drooling

• Lethargy

• Anorexia

• Anuria

• Seizures

• Coma

• Death

Lilies Clinical Signs

• emesis

• activated charcoal

• IV fluids

• Dialysis

• Cannot be delayed!

  • >18 hours w/o = irreversible kidney failure

Lilies Treatment

-mechanism unknown

-Clinical signs at 2.4 g/kg

-one study 20 g/kg

• dogs normal after 48 hours

-NONFATAL

Macadamia Nuts

• Typically, not needed

• most recover w/o intervention

• Severe ingestion;

  • Emesis

  • Activated charcoal

  • Antiemetics

  • IV fluids

  • Analgesics

  • Antipyretics

Macadamia Nuts - Treatment

• Weakness

• Depression

• Vomiting

• Tremors

• Hyperthermia

Macadamia Nuts - Clinical Signs

Yest=BAD!

-Severe gastric distention

• looks like GDV

-Vascular compromise

-fermentation = alcohol

• Identical clinical signs

-Can lead to respiratory distress

Raw bread dough

-emesis - difficult

• dough is gelatinous

-Gastric lavage

• cold water

• slows fermentation

-Supportive care

• See alcohol slide

Raw Bread Dough - treatment

• antifreeze

• Tastes sweet

• Absorbed thorugh GI

• Rese,bles alacohol tox

• Common in cold climates

  • seasonal

• lethal dose

  • Dog: 3-4 tsp

  • Cats: 1-2 tsp

Ethylene Glycol

-Diagnosis difficult

Tx:

• EVERCLEAR!

Ethylene Glycol - treatment