Diagnosis and Treatment of Toxicity Flashcards Preview

Toxicology > Diagnosis and Treatment of Toxicity > Flashcards

Flashcards in Diagnosis and Treatment of Toxicity Deck (40):
1

5 things to look for and treat immediately

  1. heart rate
  2. respiratory rate
  3. temperature
  4. seizure and brain function
  5. hemorrhage

2

respiratory maintenance

  • unconscious, paralyzed, and severe respiratory distress patients are candidates for intubation
  • ventilation may be needed if there is:
    • hypoventilation and hypercapnia
    • metabolic acidosis
    • hypoxia (treat with 40% oxygen)

3

control CNS activity

  • control hyperactivity 
    • diazepam, phenobarb, methocarbamol
  • control depression 
    • analeptics, doxapram

4

control CV function

  • tachycardia and arrythmias
    • correct acid/base, electrolyte or fluid disorders
    • lidocaine, propanolol
  • hypertension
    • nitroprusside, hydralazine
  • fluid therapy-balanced electrolyte solution for shock and dehydration, monitor urine output, inotropic drugs like dobutamine

5

stabilize the patient

  • priority in animals presenting with severe clinical signs (hyper/hypothermia)
  • obtain venous access and draw for lab profile and potential diagnosis testing (3 cc EDTA, 2 serum)
  • once stable, perform a more comprehensive physical exam

6

obtain a complete history

  • one of the most important and most overlooked parts of diagnosing toxicity
  • once stable, question owner fully in attempt to narrow down possible causes

7

4 major themes to question owner about

  1. health status overall
  2. clinical signs currently
  3. environment at home
  4. diet

8

questions to ask about current clinical history?

  • how long was problem present?
  • when was animal observed sick?
  • if animal was found dead-when were they last seen healthy?
  • size of herd?

9

systems to cover for clinical signs

CNS, GI, renal, hepatic, cardiac, hematopoietic

10

what to learn about the environment?

type of environment where the animal lives

indoor only? fenced yard? roaming?

11

what to ask about diet?

what are they eating?

method of feeding?

presence of moldy or spoiled food?

water source?

water supply changes

12

general supportive care includes:

  • ensuring adequate urine output
  • monitor respiratory, cardiac and neurological status
  • manage clinical signs as they develop
  • manage secondary hepatic or renal injury
  • administer GI protectants/anti-emetic

13

what is involved in symptomatic care?

  • maintain body temperature
    • hypothermia: balnkets, circulating warm water pads-avoid heat lamps!
  • alleviate pain
  • prevent irritation of skin and membranes with demulcents, milk, sucralfate

14

when to decontaminate?

only after animal has been fully stabilized

15

what are the 2 most common types of decontamination?

emesis and activated charcoal

cathartics also used

16

emesis for decontamination

  • potential in clincally normal animals with suspected oral exposure
  • should be induced within 60 minutes of known toxic ingestion
  • intubate, wash stomach 3 times with warm water until fluid is clear
  • possibly save vomitus for possible analysis

17

when do you induce emesis?

  • toxic dose of substance ingested
  • no vomiting has yet occurred
  • activated charcoal is not an option

18

activated charcoal

  • prevents toxic absorption
  • animal may eat, can be mixed with baby food
  • earlier given = more effective
  • give repeated doses ever 4-6 hours
  • can give alone or after emesis
  • caution: aspiration potential

19

activated charcoal contraindications

corrosive agents

non-polar material

20

4 reasons to give activated charcoal

  1. substance is known/thought to be absorbed by it (excluded acids, alkalis, alcohols/glycols, metals, oils, petroleum distillates, detergents)
  2. ingestion was very recent/undergoes eneterohepatic circulation/is sustained release
  3. can tolerate it
  4. no immediate need to administer oral meds (reasonable to wait at least 2 hours between charcoal admin and oral med)

21

cathartics

  • decrease GI transit time, increase movement of toxins, or charcoal-toxin complex, and decrease possible absorption of the toxin
  • use as adjunct to activated charcoal therapy to reduce transit time
  • ex: mineral oil, saline cathar

22

how to prevent absorption for corrosives, strong acids and bases:

  • use dilution instead of emesis
  • can dilute with milk, water, or eggs
  • (caution: using milk or water may enhance absorption)

23

 dermal exposures:

may bathe in liquid dish soap, rinse well

24

lipid infusion

  • relatively new treatment
  • off label use of IV lipids
  • case reports/case series demonstrates its efficacy and safety
  • promising adjunct to conventional treatments

25

primary use and limitations for activated charcoal

  • use: absorbent material with large surface area, bind most drugs
  • limit: some toxins not absorbed

26

primary use and limitations for apomorphine

  • use: emetic agent for dogs, pigs
  • limit: may cause prolonged vomiting

27

primary use and limitations for xylazine

  • use: emetic agent for cats
  • limit: may cause hypotension and bradycardia

28

primary use and limitations for gastric lavage

  • use: sustained release products, massive overdoses
  • limit: invasive! risk of perforation or rupture

29

primary use and limitation for salt water, H2O2

  • use: for at home emesis induction
  • limit: might delay treatment for vet

30

primary use and limitation for surgical removal

  • use: lead, pennies, etc
  • limit: invasive!

31

primary use and limitation for whole-bowel irrigation

  • use: removal of sustained-release pharmaceuticals, for toxins not absorbed by activated charcoal
  • limit: primarily for small animals, may cause prolonged diarrhea, safer than gavage

32

analytic testing

  • no one test that will "screen" for all known toxicants
  • multiple test for specific agents can become costly
  • must narrow down general type of agent involved
  • test: blood, serum, urine, liver, vomitus, kidney, brain, fat

33

common toxins associated with an increased anion gap

ethylene glycol, ethanol, iron, methanol, salicylates, strychnine

34

normal anion gap

10-12 mEq/L

35

clinically significant anion gap

> 30 mEq/L suggests metabolic acidosis

36

common toxins associated with CNS depression

  • ivermectin
  • cholinesterase in inhibitors
  • organophosphate insecticides
  • carbamate insecticides
  • blue-green algae
  • slaframine
  • lead
  • locoweed
  • ethylene glycol

37

common toxins associated with seizures

  • bromethalin
  • chocolate
  • lead
  • organophosphate insecticides
  • pyrethrins/pyrethroids
  • strychnine
  • water deprevation/sodium ion toxicosis
  • water hemlock

38

4 parts to accurately diagnose any toxicity

  1. history (health, current clinical hx, environment, diet)
  2. clinical signs
  3. pathology/necropsy
  4. chemical analysis

39

how to prevent further exposure?

  • change pasture, feed, water, etc
  • remove baits, old pesticides, etc
  • bathe or flush for cutaneous or ocular exposure
  • EDUCATE

40

summary of how to manage a poisoned patient

  1. assess ABC's
  2. control seizures, cardiac
  3. metabolic derangements
  4. history
  5. GI decontamination
  6. supportive and symptomatic care