toxins SA

Potential clinical signs

·    GI: V+/D+

o  Don’t give anti-emetic straight away (might be helpful), IVFT if dehydrated

·    CRS: tachy/bradycardia, tachy/bradypnoea, arrythmias, anaemia, hypovolaemic shock

o  IVFT for shock, ECG to monitor rhythm, blood transfusion/plasma, oxygen therapy

·    Hepatic: jaundice, azotaemia, uraemic crisis

o  Give fluids and anti-oxidants (silybin, vit E)

·    Renal: AKI, proteinuria, haematuria

o  Give fluids

·    Neurological: seizures, ataxia, collapse

o  Phenobarbital/midazolam/diazepam for seizures

Basic principles

·    Decontamination

o  If absorbed across MMs – too late

o  If absorbed across intestinal mucosa – induce emesis (amorphine in dogs, medetomidine in cats)

§ Reduce intestinal absorption – charcoal

o  If absorbed across the skin – gentle washing with fairy liquid

o  If in blood stream – IVFT to dilute

·    Assessment of effects

·    Treatment of symptoms

Common known toxins

·    Paracetamol – brown MMs, neck oedema, respiratory distress, abdominal pain

o  Treatment: anti-oxidants (silybin), IVFT, N-acetyl cysteine

·    NSAIDs – haemorrhagic V+/D+, AKI (but GI signs more common)

o  Treatment: stop NSAIDs, omeprazole/cimetidine (decrease gastric acid production), misoprostal (increase mucosal blood flow ® healing)

·    Chocolate – hyperactivity, V+/D+, tachyarrhythmias, collapse, seizure, death

o  Treatment: induce emesis if only ingestion, if toxicity (see CS) – repeated doses of activated charcoal every 4-6h

·    Xylitol – prolonged hypoglycaemia, jaundice, weakness, collapse, seizure, minty smell

o  Treatment: anti-oxidants (silybin), glucose supplementation (CRI to prevent insulin spikes)

·    Anti-freeze – ataxia, V+, lethargy, tachyarrhythmias, hypoCa, AKI

o  Diagnosis: blood gas (normochloraemic acidosis), urinalysis (azotaemia, hyperK), hypoCa

o  Treatment: slow production of toxic metabolites by giving something to compete with enzymes – vodka diluted with saline, repeated boluses for 3d (cant assess if worked until 12h, if not – PTS, not ethically great)

·    Rat poison – coagulopathies (increased PT, big bleeds) – don’t see CS until 1-3d post-ingestion

o  Treatment: injectable vit K supplementation, then oral supplement for 8w (expensive), if severe then FFP transfusion (provides extra clotting factors)