small animal exam 2

“Sola dosis facit venenum”

The dose makes the poison

Most common toxins

OTC Medications

Food

Rodenticides

Household/yard products

Plants

Illicit substances

What do we need to remember when triaging for toxins?

Our ABCDEs

Common clinical signs for toxins

Vomiting, diarrhea, ataxia/neurological signs, muscle tremors, tachy/bradycardia, hypersalivation, hyperesthesia, hepatic/renal injury

Most common medications for inducing vomiting in dogs

Apomorphine, hydrogen peroxide (PO), Ropinerole (ophthalmic)

Is hydrogen peroxide recommended to use for cats?

No

Most common meds to use for inducing vomiting for cats

Dexmedetomidine, xylazine

What are the risks of using hydrogen peroxide?

Esophageal irritation, gastric irritation, gastric ulcers, oral ulcers, aspiration

What amount do we want to use for hydrogen peroxide?

Do not exceed 4mL/lb - use only 3%

When do we not want to do a gastric lavage?

When toxin is caustic

When do we do gastric lavage?

Before body absorbs toxins. Not effective >1 hour since ingestion

Complications of gastric lavage

Aspiration, laryngospasm, hypothermia. Anesthesia is required

Purpose of enemas

Helps remove toxins from lower GI, lessens systemic effects

What can enemas help with?

Extended-release medications, raisins

Contraindications of enemas

Pets w/ diarrhea, electrolyte disturbances

What must happen for activated charcoal to work?

Must be in direct contact with toxin. The sooner the better!

IVLE

Intravenous Lipid emulsion

When do we use IVLE?

Fat loving toxins (TPN/PPN)

Patient care for toxins

Monitor clinical signs, slow movements, reduced light, reduced sound

What is xylitol and what products have it?

Sugar substitute. Peanut butter, gum, toothpaste, mouthwash, nasal sprays, lotions/creams, compounded medications

What is xylitol toxicity?

Pancreas will release insulin, severe hypoglycemia

Treatment for xylitol toxicity

Hypoglycemia: food and dextrose supplementation

Liver failure: Supportive care

Clinical signs for xylitol toxicity

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

What ingredients are dangerous in rodenticides?

Multiple active ingredients!! Anticoagulants, bromethalin, cholecaliferol

How do anticoagulants work?

Works by inhibiting Vitamin-K recycling → clotting facts are gone. Prolonged bleeding. Can occur 4-7 days after ingestion. Elevated PT

Treatment for anticoagulants

Vitamin K1, Oxygen, transfusions

How does cholicalciferol work?

Liver converts to calcifediol → Kidney converts to calcitriol → Calcifediol competes for Vitamin D receptors → Receptor activation = increase in Calcium and Phos. absorption

Clinical signs of cholicalciferol

Vomiting, diarrhea, anorexia, depression, renal failure, severe hypercalcemia, death

Treatment of cholicalciferol

Treating hypercalcemia → hydrate with 0.9% saline, furosemide (decrease sodium and calcium resorption)

Clinical signs of bromethalin

Muscle tremors, seizures, hyperexcitability, CNS depression, hyperthermia, neurological dysfunction, death

What does bromethalin do to the brain?

Increases intracellular Na+

Treatment for bromethalin

Supportive care

Mechanism of action for NSAIDS

Blocks COX-1 and COX-2 enzymes, severe stomach irritation common

Acetaminophen toxicity

Metabolized through liver, can cause liver damage/failure, limits RBCs ability to carry oxygen, changes hemoglobin to methemoglobin (cannot carry O2) Heinz body formation (anemia)

Acetaminophen clinical signs

Tachypnea, tachycardia, vomiting, drooling, anorexia, abdominal pain

Treatment for acetaminophen

Decontaminate, N-acetylcysteine, vitamin C, oxygen, IV fluids, Liver support

Permethrin toxicity

Common flea/tick prevention to dogs but TOXIC TO CATS! Acts on CNS and PNS

Treatment for permethrin toxicity

Dawn bath, benzodiazepines, methocarbamol, intralipids, IV fluids

3 types of alcohol

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

Treatment for alcohol toxicity

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

Cannabis toxicity

Tetrahydrocannabinol (THC) - Dogs have 2 receptors (CB1 and CB2)

Clinical signs for cannabis toxicity

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

Treatment for cannabis toxicity

Emesis may not be successful. Supportive care (IV fluids, intralipids, dark room w/ limited noise, time) No antidote. May recover within 24-36 hours

Chocolate toxicity

Based on type, how much they ate and weight of patient. Has theobromine and caffeine - both absorbed by GI tract. Metabolized in liver to methylxanthines.

Clinical signs for chocolate toxicity

Vomiting, diarrhea, PU/PD, tachypnea, tachycardia, VPCs, hypertension, hypokalemia

Treatment for chocolate toxicity

Decontamination if <1 hour ago, activated charcoal, symptomatic/supportive care

Mechanism for raisins/grapes/currants

Unknown, raw fruit worse than cooked, no established toxic dose, no antidote

Treatment for raisins/grapes/currants toxicity

Decontaminate, IV fluids, monitor kidney values

What are considered allium plants?

Garlic, leaks, chives, shallots, onions

What do allium plants do to dogs/cats?

Damages red blood cells. Certain breeds have increased risk (Akita, shiba inu)

Symptoms of yellow onion poisoning in dogs

Lethargy, weakness, decreased appetite, pale gums, fainting, reddish urine, rapid heartbeat

Symptoms of red onion toxicity in dogs

Vomiting, elevated heart rate, panting, smelly breath, drooling, mouth irritation, diarrhea, collapse

Treatment for allium plant toxicity

Decontaminate, activated charcoal, IV fluids

Lily toxicity in cats

LETHAL!!! Small amount is toxic. Kidney failure and death

Clinical signs of lily toxicity

Vomiting, lethargy, drooling, anorexia, seizures, coma, death

Treatment for lily toxicity

Emesis, activated charcoal, IV fluids, dialysis, cannot be delayed!!!

Treatment for macademia nut toxicity

Typically not needed. Most recover without intervention

Raw bread dough toxicity

Severe gastric distention (looks like GDV), Vascular compromise, can lead to respiratory distress

Treatment for raw bread dough toxicity

Emesis is difficult. Gastric lavage → cold water, slows fermentation. Supportive care (alcohol symptoms)

Ethylene glycol toxicity

Antifreeze toxicity. Tastes sweet. Absorbed through GI. Resembles alcohol tox. Common in cold climates (seasonal exposure) Diagnosis is difficult

what is a seizure?

sudden excessive electrical discharge in the forebrain

true or false: seizures are a disease

false - they are a clinical sign

where do seizures occur?

the forebrain

how do seizures occur?

imbalance of neurotransmitters in the brain → overstimulation

what are the stages of a seizure?

pre-ictus

ictus

post-ictal period

how long does pre-ictus last?

seconds to minutes

how long does ictus last?

~90 seconds

how long is the post-ictal period?

minutes to hours

generalized seizure

whole brain is affected

partial seizure

one area of brain affected

what are the most common types of seizures?

generalized

what are clinical signs of generalized seizures?

rhythmic, bilateral body movements (paddling, tonic/clonic), chewing, facial movements, autonomic signs

consciousness is absent/not absent during generalized seizures?

absent - they are unaware this is happening

clinical signs of a partial seizure

unilateral limb/muscle movements, facial movements, ± autonomic signs

what type of partial seizure are they present for? absent?

present for simple, absent for complex

what are some potential causes of seizures?

brain degeneration, congenital malformation, uncontrolled systemic/metabolic disease, brain tumor, nutritional deficiency, stroke, infection, head trauma

what does idiopathic mean?

we don’t know the cause

idiopathic epilepsy

most commonly diagnosed

what is the onset age of idiopathic epilepsy?

6m-6yo

how many seizures/month need to occur for idiopathic epilepsy to be considered?

at least one/month

when do seizures most commonly occur for idiopathic epileptic patients?

at night or rest

clinical signs for idiopathic epilepsy

PE normal, neurologic exam often normal (unless recent seizure)

recent seizure signs

ataxia, decreased proprioception, absent menace, absent nasal stimulus, dull/obtunded mentation

why is it important to take a history for seizures?

clients call any weird thing a seizure → we need to ask questions

what are some diagnostics we can run for seizures?

CBC/chem/urinalysis, MRI, cerebrospinal tap

what do we diagnose patient with if everything normal in diagnostics for a seizure?

idiopathic epilepsy

what is our method for management of seizures

prescribe anticonvulsant medication (may require more than one!)

what anticonvulsant is a barbiturate, metabolizes in the liver, its method of action is hyperpolarization of neuron, and has side effects of transient sedation, PU/PD and the munchies??

phenobarbital

what anticonvulsant metabolizes in the kidney, its method of action is that it selectively prevents neurotransmitter release, and has very mild side effects?

keppra (levetiracetam)

what anticonvulsant is a salt that metabolizes in the kidney, competes with chloride, and side effects include munchies, transient sedation, PU/PD?

Potassium bromide

what are some ways we can monitor for seizures?

jingle bell collars, extra padding in cages, note duration and frequency, document interventions, prevent patient from hurting themselves

what are some important long term management of seizures?

clients are crucial! log seizures, periodic bloodwork, compliance (medications are for life)

what are some things that don’t really treat seizures despite rumors?

haagen dazs vanilla ice cream, honey/sugar cubes, ice packs on head, any herbal extract or remedy, any weird diet, acupuncutre, laser therapy

cluster seizures

more than 2 in 24 hours, considered an emergency

status epilepticus

seizure lasts longer than 5 minutes, multiple seizures with no return to normal, considered an emergency (immediate treatment!)

when does permanent brain damage or death occur with status epilepticus?

within 30 minutes (hyperthermia, hypoxemia, etc)

what are some ways we stop seizures ASAP with status epilepticus?

diazepam or midazolam

what are some things that look like seizures?

vestibular dysfunction, syncope, narcolepsy, sleep movements, pain, tremors

what does the vestibular system consist of?

inner ear, vestibulocochlear nerve, brainstem, cerebellum

what does the vestibular system do?

maintains balance and body orientation