Toxicology

Question 1

paracetamol

Answer 1

v.dangerous to cats - lackmetaboliccapacitytodetoxify paracetamol
Toxicityoccursviasaturationofmetabolic pathways
Toxicmetaboliteconjugatedby glutathione
Glutathionepromptlydepleted

Question 2

paracetamol toxicity - clinical signs - early <4h

Answer 2

Progressivecyanosis
Brown/Bluemucousmembranes
Weakness&lethargy

Question 3

paracetamol toxicity - clinical signs - 4-24h

Answer 3

Facial&PawOedema
Vomiting
Depression
Darkbrownblood‐ Methaemoglobinemia

Question 4

paracetamol toxicity - clinical signs - the days after

Answer 4

SevereMethaemoglobinemia

Hepaticnecrosis

Question 5

paracetamol‐ Methaemoglobinaemia

Answer 5

blue or brown mucousmembranes
arterial blood is chocolatebrown in colour and remains
dark on aeration
Cyanosis fails to respond to oxygen therapy

Question 6

paracetamol‐ treatment

Answer 6

Emesis(vomiting)
Dogs:Apomorphine
Cats:Xylazine
ActivatedCharcoal
Antidote:Acetylcysteine (Parvolex ®)
Precursorofglutathione

Question 7

paracetamol - monitoring

Answer 7

1 week
liver function
blood clotting
renal function 
total blood count

Question 8

NSAIDs - clincal signs - early

Answer 8

Gastrointestinalerosion,ulcerationandpossibly
perforation.
Vomitinganddiarrhoea(bothmaybebloody).
RarelyCNSsymptoms(ataxia,lethargy,drowsiness)

Question 9

NSAIDs - clincal signs - late

Answer 9

Renalfailure

Hepaticimpairment

Question 10

NSAIDs - treatment

Answer 10

emesis 
activated charcoal
gastric ulcer prevention - H2receptorantagonists, Protonpumpinhibitors, Ulcerhealing/coatingagent
Prostaglandinsupplementation 
Maintenanceofrenalfunction

Question 11

theobromine (chocolate) - clinical signs

Answer 11

Vomiting,diarrhoea,polydipsia,salivation‐ dehydration
CNS/Myocardialstimulation- tremor, convulsions, tachycardia, hypertension‐ arrhythmia
Renalfailure
Fatalcases– severeconvulsions/circulatoryfailure

Question 12

theobromine (chocolate) - treatment

Answer 12

Emesis‐ Apomorphine
Repeatdoseactivatedcharcoal
Adequaterehydration
Surgeryobservation
monitor vital signs

Question 13

Tremorgenic Mycotoxins

Answer 13

Mycotoxins arefungalmetabolitesproducedbymould typefungus
found in mould food products/rubbish

Question 14

Tremorgenic Mycotoxins - clinical signs

Answer 14

Vomiting,ataxia,whole‐bodymuscletremors,rigiditywith hyperextensionofextremities,hyperactivity,hyperaesthesia,tachycardia,panting,tachypnoea,nystagmus andblepharospasm.

Question 15

Tremorgenic Mycotoxins - severe cases

Answer 15

severetremorsandopisthotonus,convulsionsandcomawith
paddling.Rarelyaspiration
Incrmuscularactivity‐ hyperpyrexia,exhaustion,rhabdomyolysis,
dehydrationandhypoglycaemia.
raisedLDH,CKandliverenzymes.

Question 16

Tremorgenic Mycotoxins - treatment

Answer 16

decontamination - emesis + gastric lavage
anticonvulsants
Supportivecare– rehydration, coolingmeasures, ventilation, antiemetics

Question 17

allium spp.

Answer 17

leeks,onions,shallots,springonions,garlic&chive

forms heinz bodies in RBC - these are removed from circulation - anaemia

Question 18

allium spp. - clinical effects

Answer 18

GIT - vomiting,inappetance
Heinzbodyanaemia - lethargy,paleMM,tachycardia&tachypnoea
Haematuriaandhaemoglobinurea
Methaemoglobinaemia
severecases,icterusduetohaemosiderin(highironstores)intheliver

Question 19

allium spp. - treatment

Answer 19

Emesis
AC
Monitorhaematologicalparameters
IVfluids
Anti‐emeticsifneeded

Question 20

Anticoagulant Rodenticides - clinical effects

Answer 20

clinical signs rare
Maineffectishaemorrhage
Maypresentwithsignsofdyspnoea,lethargy,weakness/anorexia
Bruising,bleedingfromgums,nose,GItractandwounds

Question 21

Molluscicides – Metaldehyde ‐ ClinicalEffects

Answer 21

Hypersalivation,vomiting,diarrhoea,ataxia,panting,tremors,
convulsions,hyperthermia
Tachypnoea,dyspnoea,hyperventilationandrespiratory
depression
Tachycardiaorbradycardia
fatalities due to resp failure

Question 22

European adder - clinical effects

Answer 22

Hypovolaemia andlocaloedema
Localhaemorrhage (rare)
Cardiaceffects
Renalimpairment

Question 23

European adder - systemic effects

Answer 23

Shock,collapseandhypotensioncanoccurrapidly.
Pain,panting,hypersalivation,mentalstatuschanges,hyperthermia,bruising,palemucousmembranes,tachypnoea andlameness
Coagulopathy – Anaemia,thrombocytopenia,leucocytosis,disseminatedintravascularcoagulation(DIC)andhaematuria.
Renaleffects
Hepaticeffects– mild/moderate
Cardiaceffects‐ duetomyocardialdamageoccurwithorwithoutECGabnormalities

Question 24

European adder - treatment

Answer 24

antivenom
BP,Pulse,respiration,temperature
ECG(arrival,12hrs&24hrs)
BT‐ Checkforcoagulopathy
Renal&hepaticparameters
can also give - analgesia, antibiotics, antihistamines

Question 25

Cycads spp

Answer 25

small ferns looking plants | 1-2 seeds can cause toxicity/death in dogs

Question 26

cycads spp - clinical effects

Answer 26

Vomiting, haematemesis, diarrhoea, dehydration, abdominal discomfort Hepatocellular necrosis with raised liver enzymes, hypoproteinaemia, jaundice and secondary cholestasis. In severe cases coagulopathy, thrombocytopenia and ascites.

Question 27

cycads spp - treatment

Answer 27

``` Emesis + RDAC Rehydration + Anti-emetics if required Gastroprotectants monitor haematology Vitamin K1 - hyprothrombinaemia. ```

Question 28

xylitol

Answer 28

natural sugar causes potent insulin release in dogs liver damage

Question 29

xylitol - treatment

Answer 29

gastric decontamination monitor bloog glucosse levels - often become hypoglycaemic dextrose for sugar levels + hepatotoxicity