General Principles of Management of Toxicoses Flashcards
What are some typical scenarios in which an animal is suspected for toxicosis?
i. The animal has been exposed to a known
toxicant
ii. The animal has been exposed to an unknown
substance that may be a toxicant
iii. The animal displays signs of disease of an
undetermined cause for which toxicosis must be
considered as part of the differential diagnosis
How do you approach making a diagnosis when you suspect toxicosis?
- Obtain a complete history
- time of onset of clinical signs and linking to particular toxicant
- treat life-threteaning problems
- description of home environment
- information about toxic agent
- was animal indoors, outdoors? when toxicosis occured. MUST remove from environment to prevent re-exposure/exposure to others.
- Trade name of product/medication, active and inactive ingredients, ingredient concentrations, contact information from packaging if available. - Perform a complete physical examination
- Perform an exposure assessment: dose-response assessment and exposure assessment calculations
- Consider clinical signs and clinical pathologic findings
- Sample collection and toxicology testing
– Hold toxicologic samples until the results of other tests (e.g., clinical pathology, histopathology, and bacteriology) are
available to allow for focused toxicologic testing - If needed, Postmortem examination and sampling
- Occasionally a bioassay may be done
What condition should gastric contents and fecal material be stored in? This sample is considered?
frozen
Diagnostically useful
What condition should urine be stored in? This sample is considered?
frozen
Diagnostically useful
What condition should serum be stored in? This sample is considered?
separated from clot promptly and frozen
Diagnostically useful
What condition should blood be stored in?
Refrigerated
What condition should liver be stored in?
frozen
What condition should kidney be stored in?
frozen
What condition should brain be stored in?
Frozen
What condition should lung be stored in?
frozen
What condition should food and source material be stored in?
Dry material should be kept dry at room temp. moist material should be frozen
What condition should water be stored in?
refrigerated
_______ and ______ samples may also be useful for diagnostic purposes.
CSF, tissue
What are ABC’s of emergency care?
- A = Airway: Check for airway patency/obstruction. Most common factors contributing ot death from poisoning is loss of airway protective reflexes with subsequent airway obstruction caused by flaccid tongue, permanent aspiration of gratric contents, or respiratory arrest.
- B = Breathing: Check for signs of ineffective
breathing, e.g., apnea, stertor = high pased breathing sound caused by disrupted airflow due to obstruction in pharynx or trachea, stridor = noise from vibration of pharyngeal tissues due to significant UR obstruction and subsequent turbulent airflow downstream in upper airway, hyperpnea (deep breathing), hypopnea (shallow breathing), agonal breathing (gasping) - C = Circulation: Assess mucous membrane color, capillary refill time, heart rate, pulse quality & rhythm, and peripheral temperature
How do you triage a patient when you suspect them for toxicoses?
- Triage: involves a quick evaluation of four major
organ systems to determine whether the patient
can be categorized as stable or unstable = experiencing life threatening signs and requires quick judgement and timely action. Should take less than 5 minutes.
– Cardiovascular: heart rate, mucous membrane color, capillary refill time, pulse quality & rhythm
– Respiratory: airway patency, respiration rate
– Central nervous system: gait, level of consciousness, pupil size, and position - Levels of consciousness are: alert = normal, depressed = quiet, unwilling to perform normal function but responds to env stimuli, obtunded = minimally responsive to auditory or tactile stimuli, stuporous = unresponsive to environmental stimuli but responds to painful stimuli or comatose = not responding to environmental or painful stimuli
– Renal: assessed by abdominal palpation for renal obstruction, other emergencies of renal are identified while assessing cardiovascular status
– Obtain an abbreviated history
How do you medically manage a patient suffering from toxicsosis?
- Control seizures, muscle tremors
– Diazepam, pentobarbital, methocarbamol - Control exsanguinating hemorrhage
- Assess metabolic derangements
– Correcting Acid-base and electrolyte imbalances → which can cause acidosis or alkalosis - Perform decontamination
- Provide supportive and symptomatic care
- Antidote therapy if antidote is available
- What is decontamination?
- When is decontamination required?
- What is the goal of decontamination?
- What are you, the clinician, supposed to wear when performing decontamination?
- Important step in treating toxicosis
- Decontamination may be required for oral, inhalation, dermal, and ocular exposures
- The goal of decontamination is to minimize exposure to potentially toxic substances
– Prevents or minimizes absorption
– Enhances elimination - While performing decontamination, Wear personal protective equipment (PPE)
– Gloves, apron or other water-resistant clothing, and eye protection
- What is oral decontamination?
- What is its function?
- This is most useful within what amt of time post-ingestion?
- What are the contraindications?
- Induction of Vomiting (Emesis)
- Removes potentially harmful substances from the stomach
- Most useful within 30-90 min of the ingestion
- Emesis contraindications:
– Weakened or severely ill patients
– Ingestions of caustic substances (acidic or alkaline substances capable of damaging living tissue) or hydrocarbons b/c following ingestion of these could aspirate into resp. tract if vomiting occurs.
– Patients with altered level of consciousness (hyperactivity or depression/coma)
– Ingestions that took place a long time ago
– Unknown toxicant
– Animals that do not vomit (e.g. horse)
What are emetics used in dogs?
– Hydrogen peroxide (3%)
– Apomorphine
What are emetics used in cats?
– Xylazine
– Dexmedetomidine
– Midazolam/hydromorphone
What is not recommended to use as an emetic? Explain why for each.
Not recommended: liquid dishwashing detergent,
powdered mustard = GI irritation, syrup of ipecac, salt = animal at risk for sodium ion toxicosis
Detergents and mustard are not particularly effective in companion animals and can cause
significant gastrointestinal irritation.
Syrup of ipecac does not consistently induce vomiting in animals and has been associated with
adverse cardiovascular effects in humans; there is also a significant delay of up to 40 minutes for
emesis to occur.
Salt is another substance that also often fails to induce emesis after oral administration and if
not vomited up can put the animal at risk for potentially life-threatening sodium ion toxicosis.
How does water act as a diluent?
Water: works by diluting and making ingested
compounds less irritating
How does milk and liquid antacids act as diluents?
Milk and liquid antacids: sooth and coat damaged
mucous membrane surfaces
Why do you have to limit the amount of diluent given to a patient?
Reduces the risk of excessive distention of the
stomach leading to vomiting and aspiration
What are chelators?
