54. The basic principles of detoxification of small animals & ABC therapy

What are the primary principles of intoxication treatment?

Control of life-threatening conditions (ABC therapy) and removal of the poison

What are the stages of treatment of intoxications?

1. Assess and stabilise

2. History

3. Physical examination

4. Decontaminate/detoxify

5. Specific antidote

6. Supportive and symptomatic care

What are the ABCDs of initial assessment and stabilisation?

Airway, Breathing, Circulation, Drugs/Disability

What are the steps involved in Airway management?

Ensuring free airways, oxygen supplementation, and intubation or tracheostomy if necessary

What are the steps involved in Breathing management?

1. Manual ventilation if the animal is not breathing adequately

2. CPR if no breathing, but clear airway

3. Thoracocentesis if no/dull lung sounds

What are the steps involved in Circulation management?

Monitoring heart rate, rhythm, and pulse. Administering cardioactive drugs (adrenaline, atropine) and IV fluids

What are examples of Drugs given during ABCD assessment?

1. Diazepam (seizures)

2. Adrenaline (bronchodilator, elevates BP)

3. Atropine (for bradycardia)

4. Dopamine/doxapram (stimulates respiration)

What other vital parameter should be assessed?

Body temperature (hypothermia/hyperthermia)

What information should be gathered in the history of a suspected intoxication case?

Type of toxin, amount ingested, route of exposure, clinical signs (which and for how long), prior health status, and concurrent medications

What should be performed after history taking?

A thorough physical examination, including collecting blood and urine for analysis

How is decontamination performed for topical/contact toxic agents?

Washing with lots of clean water and mild soap

How is decontamination performed for ingested toxic agents?

1. Physical removal of gastric content (up to 2 hours post-ingestion)

2. Reduce absorption

3. Enhanced excretion

How is physical removal of gastric content carried out?

1. Emetic

2. Gastric lavage

What emetic can be used in dogs?

1. Apomorphine. Animals must be conscious and have an intact gag reflex. Not recommended for cats

2. Ropinirole (Clevor, eyedrops)

What emetic can be used in cats?

Xylazine

When is gastric lavage indicated?

When emesis is contraindicated or under general anaesthesia

How is gastric lavage performed?

Anaesthesia, intubation, placement of a gastric tube, and lavage with warm saline water containing activated charcoal (10-15 washes)

How can absorption of ingested toxins be reduced?

1. By increasing the speed of passage through the GIT and decreasing absorption (sorbitol + charcoal, paraffin oil)

2. Using adsorbents (activated charcoal, repeatedly dosed to limit enterohepatic recycling)

How can excretion be enhanced and the renal system and liver supported?

Aggressive fluid therapy and diuretics (mannitol, furosemide). Careful monitoring of fluids and electrolytes is essential

What is used if a specific antidote exists?

It is administered. General detoxicants include glucose, calcium gluconate, and sodium thiosulphate

What are the specific antidotes for ethylene glycol or methanol intoxication?

Fomepizole or ethanol

What constitutes supportive and symptomatic care in intoxication cases?

1. Maintenance of hydration, electrolytes, normothermia

2. Control cardiovascular & acid/base abnormalities

3. Symptomatic treatment of neurological & gastrointestinal signs

4. Promote normal urinary function.

What is prioritised in emergency and critical care?

Treating the most life-threatening problems first (ABC therapy). This may include trauma, shock, poisons, severe burns, seizures, excessive bleeding, prolapsed organs, etc.

What are the steps in Airway management in emergency situations?

Clearing the airways and intubating to deliver oxygen if the animal is unconscious and not breathing. Tracheostomy may be necessary in some cases

What are the steps in Breathing management in emergency situations?

1. It is important to carefully observe the breathing pattern & listen to the animal’s chest.

2. If the animal is not breathing & the airway is clear CPR should be performed.

3. Dull/absent lung auscultation? Fluid /air in pleural space! Thoracocentesis!!

What are the steps in Circulation management in emergency situations?

1. Careful observation of heart rate, mucous membrane colour, capillary refill time, and pulse intensity.

2. White gums may indicate blood loss or shock.

3. CPR chest compressions if no heartbeat is detected.

4. Shock is characterised by rapid heart rate, pale mucous membranes, low blood pressure, and weak pulses.

5. Treatment aims to deliver blood to tissues with oxygen and nutrients.

   1. Oxygen can be delivered by mask, bag, nasal, or tracheal tube.

   2. Bleeding must be controlled, and IV fluids/blood transfusions administered

Why are fluids given to correct blood pressure?

To maintain perfusion to vital organs so they don’t start shutting down

How long are fluids maintained for?

Until physiological status is reached

What do you do if you don’t know the antidote to a toxin?

1. General symptomatic treatment

2. Phone state toxicology department for advice