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Veterinary Toxicology > Management of Toxicoses > Flashcards

Management of Toxicoses Flashcards

1
Q

What are the 3 typical scenarios in suspected toxicoses?

A
  1. animal has been exposed to a known toxicant
  2. animal has been exposed to an unknown substance that may be a toxicant
  3. animal displays signs of disease of an undetermined cause for which toxicosis must be considered as part of the differential diagnosis
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2
Q

What are the 5 steps to diagnosing toxicosis?

A
  1. obtain a complete history (onset, indoor/outdoor, information on toxic agent, home environment)
  2. perform a complete physical examination
  3. perform an exposure assessment to calculate dose-resonse and exposure assessment
  4. consider clinical signs and clinical pathologic findings
  5. sample collection and toxicology testing

(+/- postmortem examination/sampling and bioassay)

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3
Q

How should toxicologic samples be held and used?

A

hold until the results of other tests (clinical pathology, histopathology, bacteriology) are available to allow for focused toxicologic testing

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4
Q

What are the 5 most diagnostically useful samples for toxicological assessment? How should they be stored/shipped?

A
  1. gastric contents (vomitus, lavage) - frozen
  2. fecal material - frozen
  3. urine - frozen
  4. serum - separated from clot promptly and frozen
  5. blood - refrigerated
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5
Q

How should liver, kidney, brain, lung, food source/material, and water be stored and shipped for toxicological testing?

A

LIVER = frozen
KIDNEY = frozen
BRAIN = frozen
LUNG = frozen
FOOD = dry material should be kept dry at room temperature; moist material should be frozen
WATER = refrigerated

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6
Q

What are the AMCs of emergency care?

A

A = AIRWAY = check for airway patency/obstruction

B = BREATHING = check for signs of ineffective breathing, like apnea, stertor, stridor, hyperpnea, hypopnea, and agonal breathing (gasping)

C = CIRCULATION = assess mucous membrane color, CRT, heart rate, pulse quality and rhythm, and peripheral temperature for blood supply

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7
Q

What is triage? What 4 organ systems are included?

A

quick evaluation of 4 organ systems to determine whether the patient can be categorized as stable or unstable (less than 5 mins)

  1. CARDIOVASCULAR - heart rate, mucouse membrane color, CRT, pulse quality and rhythm
  2. RESPIRATORY - airway patency, respiration rate
  3. CNS - gait, level of consciousness, pupil size and position
  4. RENAL - abdominal palpation for obstruction
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8
Q

What are the 5 levels of conciousness?

A
  1. alert = normal
  2. depressed = quiet, but responds to stimuli
  3. obtunded = minimally responds to stimuli
  4. stuporous = only responds to pain
  5. comatose = no response to any stimuli
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9
Q

What 3 drugs are commonly given to control seizures and muscle tremors commonly caused by toxicosis? What other situations must be controlled?

A

Diazepam, Pentobarbital, Methocarbamol

  • control exsanguinating hemorrhage
  • assess metabolic derangements (acidosis, alkalosis)
  • perform decontamination
  • provide supportive and symptomatic care
  • antidote therapy
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10
Q

When is decontamination needed for toxicosis? What is the goal?

A

oral, inhalation, dermal, and ocular exposures

minimize exposure to potentially toxic substances by preventing/minimalizing absorption and enhancing elimination

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11
Q

How should personnel properly protect themselves during decontamination?

A

wear PPE - gloves, aprons, or other water-resistant clothing and eye protection

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12
Q

How does oral decontaminationg done? When is it most useful?

A

induce vomiting (emesis) to remove potentially harmful substances from the stomach

within 30-90 mins of ingestion

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13
Q

In what 6 situations is it contraindicated to induce emesis?

A
  1. weakened or severely ill patients
  2. ingestion of caustic substances or hydrocarbons that could aspirate into lungs
  3. patients with altered levels of consciousness
  4. ingestion that took place a long time ago
  5. unknown toxicant
  6. animals that don’t vomit (rodents, horses, rabbits)
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14
Q

What emetics are used in dogs and cats? What 4 things are not recommended?

A

DOGS - hydrogen peroxide, Apomorphine

CATS - Xylazine, Dexmedetomidine, Midazolam/Hydromorphone

  1. liquid dishwashing detergent - intestinal damage
  2. powdered mustard - intestinal damage
  3. syrup of ipecac
  4. salt - sodium toxicosis
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15
Q

What is the most common dilutent used during toxicosis? How does it work?

A

water

diltes and makes ingested compounds less irritating

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16
Q

How can milk and liquid antacids be used as dilutents?

A

soothes and coats damaged mucous membrane surfaces while diluting the compound

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17
Q

Why should the amount of dilutent given to patients be limited?

A

reduces the risk of excessive distention of the stomach that can lead to unwanted vomiting and aspiration

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18
Q

How can activated charcoal be used to treat toxicosis? When are repeated doses necessary?

A

acts as an adsorbent that binds most organic compounts, reducing their absorption and facilitating their elimination in feces

toxicants that undergo enterohepatic recirculation

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19
Q

How do cathartics work? What are the 3 types?

A

enhance elimination of toxicants by moving them through the GI tract more quickly

  1. bulk cathartics
  2. osmotic cathartics
  3. saline cathartics
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20
Q

How do bulk cathartics work? What are 3 examples?

A

have high fiber content to retain water in the lower GI and produce bulkier stools

  1. psyllium (Metamucil)
  2. canned pumpkine
  3. whole grain bread
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21
Q

How do osmotic cathartics work? What is an example?

A

pull free body wayer into the GI tract to decrease totaly GI transit time of the toxicant

sorbitol

22
Q

What cathartic is most commonly combined with activated charcoal?

A

osmotic cathartics
(sorbitol)

23
Q

How do saline cathartics work? What are 2 examples?

A

stimulated GI motility

  1. sodum sulfate (Glauber’s salts)
  2. magnesium sulfate (Epsom salts)
24
Q

In what 3 situations should cathartics not be administered?

A
  1. pre-existing dehydration
  2. electrolyte imbalances
  3. diarrhea
25
Q

What are enemas used for? What 2 substances are most commonly used as enemas?

A

eliminate toxicants from the lower GI tract

  1. warm soapy water
  2. dioctyl sodium sulfosuccinate (DSS)
26
Q

What is required to perform gastric lavage? When is it most commonly performed?

A

general anesthesia and a cuffed endotracheal tube

potentially life-threatening oral exposures, followed by the instillment of activated charcoal

27
Q

What is an enterogastric lavage?

A

(through-and-through)

gastric lavage combined with retrograde high enema by placing a stomach tube and an endotracheal tube, then an enema solution is instilled until it passes out from the stomach tube

28
Q

What is whole-bowel irrigation (WBI)?

A

GI tract is cleaned by enteral adminiastration of large volumes of osmotically balanced polyethylene glycol electrolyte solution (PEG-ES) until a clear liquid stool is achieved

29
Q

How do regular (low) enemas and high enemas compare?

A

REGULAR (low) = washes out fecal matter from the area near the rectum

HIGH = cleans out most of the colon

30
Q

How is dermal decontamination done? What is safe to use?

A

wash the affected area or bathe the entire animal
- vacuum/comb to remove powders and dry compounds
- shave
- clip

liquid hand dishwashing detergent (repeated baths may be necessary for heavily contaminated animals

31
Q

What can be used to remove glue traps, asphalt, and tree sap from animals for dermal decontamination?

A
  • mineral oil
  • vegetable oil
  • peanut butter
32
Q

How does decontamination for inhalation exposure done?

A
  • move patient to fresh air
  • administer supplemental oxygen and IV fluid
33
Q

How is ocular decontamination done?

A

flush eyes with sterile saline solution or clean room temperature water

  • sterile eye wash solution
  • bagged or bottled IV solutions
34
Q

What 4 procedures are used to enhance elimination of toxicants?

A
  1. gastrotomy and removal of toxicant
  2. urinary manipulation
  3. IV lipid emulsion
  4. dialysis
35
Q

What toxicant requires a gastrotomy for removal?

A

iron bezoars

36
Q

What are the 2 types or urinary manipulation? What are each good for removing?

A
  1. FORCED DIURESIS - administer a fluid overload and a diuretic concurrently (mannitol, furosemide); toxicants with high levels of renal excretion
  2. ION TRAPPING - urine acidification (ammonium chloride/DL-methionine) or alkalization (potassium citrate); weak acids and bases excreted predominantly unchanged through the kidneys
37
Q

What is IV lipid emulsion best to eliminate? How does it work?

A

lipid-soluble toxicants —> makes them unavailable for binding to target sites

38
Q

What are the 4 types of dialysis used for enhanced elimination?

A
  1. hemodialysis
  2. peritoneal dialysis
  3. pleural dialysis
  4. hemoperfusion
39
Q

What are antidotes? In what 7 ways do they do this?

A

substances that counteract poisons by preventing, reversing, or decreasing the action of a poison

  1. limit absorption
  2. sequester toxicant
  3. inhibit metabolism to a toxic metabolite
  4. promote distribution from tissues
  5. compete with poison for a receptor
  6. counteract toxic effect
  7. enhance detoxification
40
Q

What are 3 major cautions about antidotes?

A
  1. there are no specific antidotes for the vast majority of toxicoses
  2. antidotes are often expensive and unavailable due to limited demand (not enough profit for manufacturers)
  3. antidotes can cause poisoning or adverse reactions
41
Q

Treatment for most toxicoses is symptomatic and supportive: “Treat the ______ not the _______.” What dose this mean?

A

patient, poison

patient stabilization if priority - follow the ABCs

42
Q

What are the 3 types of antidotes? How do they work?

A
  1. CHEMICAL - act directly on a toxicant to decrease toxicity or increase excretion
  2. PHARMACOLOGICAL - antagonize or compete with a toxicant at its receptor, binding to it, or through other macromolecules
  3. FUNCTIONAL - treat the symptoms caused by the toxicant (symptomatic)
43
Q

What are 3 types of chemical antidotes?

A
  1. chelators
  2. antibodies
  3. enzyme inhibitors
44
Q

How do chelators work as antidotes? What are they mostly used for? What are 5 examples?

A

binds toxicants to increase their water solubility and elimination, decrease levels of free toxicant in the blood, and decrease tissue concentrationc

treatment of metal toxicosis

  1. calcium disodium EDTA
  2. deferoxamine
  3. dimercaprol (BAL)
  4. D-penicillamine
  5. succimer (DMSA)
45
Q

How do antibodies work as antidotes? What are 3 examples?

A

comprise antitoxin-specific serum and monoclonal antibodies to decrease the free from and tissue concentration of the toxin and increase its elimination

  1. antivenin for snakes and black widows
  2. digoxin specific antibody fragments (DigiFab)
  3. botulinum and tetanus antitoxins
46
Q

How do enzyme inhibitors work as antidotes? What 2 are used to treat ethylene glycol (antifreeze) toxicosis? How do they work?

A

inhibit the formation of toxic metabolites by either competitive of irreversible inhibition

  1. ETHANOL - competitive inhibitor of alcochol dehydrogenase
  2. FOMEPIZOLE - competitive inhibitor of alcohol dehydrogenase (expensive, approval of veterinary drug withdrawn)
47
Q

What respiratory, cardiovascular, neurologic, GI, renal, temperature, hepatic, hematologic, and nutritional supportive care can be given to patients undergoing toxicosis?

A
  • RESP = artificial respiration, oxygen therapy
  • CARDIO = antiarrhythmics, cardiovascular drugs, IV fluids
  • NEURO = support respiration and circulation, sedatives, tranquilizers
  • GI = antiemetics, GI protectants
  • RENAL = maintain blood flow and urine output, manipulate uring pH to hasent excretion
  • TEMP = rewarm or cool patient
  • HEPATIC = hepatoprotectants
  • HEMAT = correct electrolyte imbalances, acid-base balance, blood volume (IV fluids, transfusions), coagulation defects, and oncotic pressure
  • NUTRITION = enteral and/or parenteral nutrition
48
Q

What 2 antiemetics can be used for supportive care? 2 GI protectants?

A

ANTIEMETICS = proton pump inhibitors, H2 receptor antagonists

GI PROTECTANTS = sucralfate, misoprostol

49
Q

What 4 hepatoprotectants can be used for supportive care?

A
  1. S-adenosyl-L-methionine (SAMe)
  2. N-acetyl cycteine (NAC)
  3. silymarin
  4. vitamin C/E
50
Q

What is PEG-ES used for?

A

whole-bowel irrigation (WBI)

Veterinary Toxicology (29 decks)

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