Chapter 26: Toxicology in Medicine

Define alkalis

Produce(s) an initially nonpainful, deep, and penetrating wound

Define anionic detergent

Found in shampoos

Define toxin

A poisonous substance

Define cationic detergents

Found in fabric softeners

Define decontamination

Neutralization of injurious agents

Define acids

Produce(s) an initially painful wound

Define toxicosis

Any disease of toxic origin

What type of toxin is St. John's wort?

Dermal

What type of toxin is tobacco?

Reproduction

What type of toxin is yew?

Cardiogenic

What type of toxin is lantana?

Hepatotoxic

What type of toxin are raisins?

Nephrotoxic

What type of toxin is marijuana?

Neurotoxic

What type of toxin is cocklebur?

Hepatotoxic

What type of toxin is avocado?

Cardiogenic

What type of toxin are white and yellow sweet clover?

Fungal

What type of toxin is Bermuda grass?

Neurotoxic

What type of toxin is cotton?

Cardiogenic

What type of toxin is milkweed?

Cardiogenic and Neurotoxic

What type of toxin is buckwheat?

Dermal

What type of toxin is shamrock?

Nephrotoxic

What type of toxin is agave?

Hepatotoxic

What type of toxin is fescue?

Reproduction

What type of toxin is rhubarb?

Nephrotoxic

What type of toxin is common juniper?

Reproduction

What type of toxin is Queen Anne's Lace?

Dermal

What type of toxin are amanita mushrooms?

Hepatotoxic

Why is dilution with milk or water used for orally ingested toxins?

To dilute contents of a corrosive or irritant ingestion

What is the dose for dilution with milk or water for orally ingested toxins?

1-3mL/lb

When is dilution with milk or water contraindicated?

Exotic animals use juicy fruits or vegetables in place of milk

Why is emesis with hydrogen peroxide used for orally ingested toxins?

To remove contents from a toxin ingestion

What is the dose for emesis with hydrogen peroxide for orally ingested toxins?

1 tsp (5mL)/5 lb, not to exceed a total dose of 3 tbsp (45mL)

When is emesis with hydrogen peroxide contraindicated?

In rodents, rabbits, birds, horses; animals, with a history of cardiovascular abnormalities, poorly controlled, epilepsy, recent abdominal surgery, those that are severely depressed, severely dehydrated, in a coma, hyperactive, or have already vomited; for corrosive agents and hydrocarbon ingestion.

Why is activated charcoal used for orally ingested toxins?

To absorb (bind) ingested toxins, preventing absorption into the bloodstream

What is the dose for activated charcoal for orally ingested toxins?

1-3g/kg

When is activated charcoal contraindicated?

In an animal that ingested caustic materials. Ethanol, methanol, fertilizer, fluoride, petroleum distillates, heavy metals, iodides, nitrates, nitrates, sodium chloride, and chlorate are not effectively absorbed.

Why are enemas used for orally ingested toxins?

To eliminate toxicants from the lower GI tract

When are enemas contraindicated?

Premixed human solutions are contraindicated in small animals. Enemas are not performed in birds.

Why is gastric lavage used for orally ingested toxins?

Gently pump out stomach contents

What is the dose for gastric lavage for orally ingested toxins?

Repeated until the fluid removed is clear; no more than 10 mL/kg in rabbits

When is gastric lavage contraindicated?

In cases of caustic or petroleum distillate. Performed under general anesthesia with a cuffed endotracheal tube.

Why is enterogastric lavage used for orally ingested toxins?

Lethal oral exposure

What is the dose for enterogastric lavage for orally ingested toxins?

Continued until the fluid removed is clear

Toxicity is dependent upon the ___ and ___ dose, as well as the ___ and ___ of the animal

Substance, exposure, breed, age, size

The general rule of toxicology is to ____________________________.

Treat the patient, not the poison

___________________________ is the preferred emetic agent for dogs.

Apomorphine hydrochloride

Sedation that can result from the use of apomorphine hydrochloride can be reversed with ____________________________.

Naloxone

___________________________ or ____________________________ should never be used as an emetic.

Salt, saltwater

__________________________ % solution of hydrogen peroxide has been shown to be an effective emetic for dogs, ferrets, and ____________________________.

3, pigs

As a general rule, the ____________________________ and more ____________________________ the choco-late, the more toxic it likely is.

Darker, bitter

Members of the Allium family that can be harmful to all animals include onions, ____________________________, ____________________________, ____________________________, and ____________________________.

Garlic, leeks, shallots, chives

___________________________ is recommended in patients with hemoglobinuria.

Fluid diuretics

Grapes and raisins have shown to cause ____________________________ in some dogs when eaten.

Kidney failure

__________________________ is the only toxin that will cause intermittent seizures.

Lead

__________________________ and ____________________________ are effective chelating agents that can be administered in the case of lead poisoning.

Succinct, calcium ethylenediaminetetraacetic acid

Signs of nicotine poisoning usually occur ____________________________ minutes of ingestion.

15-45

___________________________ is commonly found in snail or slug bait and is highly toxic.

Metaldehyde

Anticoagulant rodenticides act by competitive inhibition of vitamin ____________________________.

K

___________________________ ____________________________ is the most dangerous type of antifreeze.

Ethylene glycol

__________________________ are more sensitive to acetaminophen than dogs.

Cats

Initial signs of marijuana toxicity in dogs include ___ and ___ that can progress into ___.

Nervousness, disorientation, depression

An ataxic animal dribbling urine is considered to be intoxicated by ____________________________ until proven otherwise.

Marijuana

Ingestion of members of the Rhododendron family can lead to ____________________________.

Cardiovascular dysfunction

T/F: The best way to prevent serious problems from toxicosis is to have emetics and activated charcoal on hand.

False: The best way to prevent serious problems resulting from toxicosis is poison prevention. Exercising caution with harmful substances by "pet proofing" the home environment is the only safe choic

T/F: Taking a good history will be critical for preparation for the toxicologic emergency.

True

T/F: The general rule of toxicology is to "treat the patient, not the poison."

True

T/F: Decontamination is performed to prevent other animals from similar ingestion.

False: Decontamination is performed to prevent absorption of toxicants.

T/F: With any ocular exposure, the eyes should be flushed repeatedly with tepid water or saline solution for a min-imum of 20 to 30 minutes.

True

T/F: To remove sticky substances from birds, work a small amount of vegetable oil, mineral oil, mayonnaise, or peanut butter through the rest of the substance until it breaks down into "gummy balls."

False: To remove sticky substances from mammals, NOT BIRDS, work a small amount of vegetable oil,

mineral oil, mayonnaise or peanut butter through the rest of the substance until it breaks down into

"gummy balls". For birds, follow the same instructions, but do not use mineral oil as it is very difficult

to remove from feathers.

T/F: Hypothermia is not a concern when treating a patient for toxicosis.

False: Hypothermia can cause further complications when treating a patient for toxicosis.

T/F: Emesis is contraindicated in rodents, rabbits, birds, horses, and ruminants.

True

T/F: Emesis is more likely to be productive if the animal is fed a large, moist meal before inducing vomiting.

False: Emesis is more likely to be productive if the animal is fed a small, moist meal before inducing

vomiting.

T/F: Food-grade hydrogen peroxide is an acceptable grade for animal use.

False: Do not use food grade hydrogen peroxide as it is about 100 times more concentrated and can

cause severe gastrointestinal hemorrhage.

T/F: Salt water should be administered within 10 minutes of arrival to the clinic when ingestion of a caustic agent is suspected.

False: Salt or salt water should never be used as an emetic.

T/F: Chocolate contains theobromine and caffeine, which are both classified as methylxanthines.

True

T/F: If ingested by dogs, macadamia nuts may cause weakness, depression, vomiting, ataxia, tremors, and hyperthermia.

True

T/F: Grapes and raisins, when eaten, cause cardiovascular episodes in cats.

False: Grapes and raisins have been shown to cause kidney failure in some dogs when eaten.

T/F: Alkali burns are initially nonpainful.

True

T/F: Acid and alkali burns are treated the same.

True

T/F: Bathing and dilution are the cornerstones in treating contact with bleach.

True

T/F: The treatment for zinc ingestion is dilution.

False: It is imperative to remove the source of zinc from the GI tract via endoscopy or surgery. Chelators

can be used once the object/s have been removed.

T/F: Lead must be in an acidic environment to be absorbed into the bloodstream.

True

T/F: Toxicity risks for the ingestion of dangerous plants are similar for all plant types.

False: Toxicity risk varies greatly depending on the species of the plant and type of animal involved.

T/F: One of the most potent plant toxins is contained in the castor bean, for which there is no anecdote.

True

T/F: Delaying treatment for the ingestion of an Easter lily in a cat beyond 18 hours frequently results in death.

True

T/F: Outdoor plants contain calcium oxalate crystals; common houseplants do not.

False: Common houseplants contain calcium oxalate crystals.

T/F: Cats are extremely sensitive to concentrated permethrin.

True

T/F: The first step in treating symptomatic cats exposed to permethrin compounds is emesis.

False: The first step for treating symptomatic cats exposed to permethrin compounds involves controlling

muscle tremors with methocarbamol.

T/F: Cats are very sensitive to bromethalin; dogs are more resistant.

True

T/F: Vitamin B12 increases the absorption of calcium, stimulates bone resorption, and enhances kidney reabsorption of calcium.

False: Vitamin D3, cholecalciferol, increases the absorption of calcium, stimulates bone resorption, and

enhances kidney reabsorption of calcium.

T/F: The smell of rotten fish in the air could signal a phosphine gas, dangerous to both humans and animals.

True

T/F: Large ingestions of methanol require monitoring for acidosis.

True

T/F: The ingestion of ethylene glycol can cause acute renal failure.

True

Why do apples and cherries cause problems in grazing animals?

Seeds, bark, and leaves contain cyanide.

Why do dallis, perennial ryegrass, Bermuda, and phalaris grasses cause grass staggers and tremors?

Because of a fungal infection of the plant.

Why is aspiration a concern with the ingestion of ethanol?

Aspiration is a concern as ethanol affects the

closing of the epiglottis during vomiting.

Why should emesis only be induced within 15 minutes of ingesting cocaine?

Due to

the quick onset, emesis should only be induced within 15 minutes of ingestion because the patient

can rapidly deteriorate. An alternative is gastric lavage under anesthesia, followed by administration

of activated charcoal.

Why should aspirin be used with caution in cats?

Because of their inability to rapidly metabolize and excrete salicylates, cats must be monitored very

closely when treated with aspirin.

Why does 10mg/kg of acetaminophen produce signs of toxicity in cats?

Cats are more sensitive to

acetaminophen as they are deficient in the enzyme glucuronides that detoxifies acetaminophen.

The test kit for EG poisoning must be used very carefully with consultation to the package insert and directions.

Why?

The blood sample should be obtained before giving any treatment, as both activated

charcoal and some injectable medications can cause a false-positive result.