ECC recognition and treatment of intoxications

Question 1

What do we use to induce emesis in dogs vs cats

Answer 1

Dogs use apomorphine
Cats can go for xylazine
–> can reverse after with atipam

+ oral options: hydrogen peroxide, washing soda, salt, ipecac syrup

Question 2

When is induction of emesis contraindicated

Answer 2

After ingestion of corrosive/caustic agents or petroleum
If >4 hrs post ingestion not beneficial
With CNS depression/seizures due to aspiration risk

Question 3

What must we ensure before doing a gastric lavage

Answer 3

Have well cuffed ET tube in place

Do not do if corrosive/causatic or petroleum ingested

Question 4

When is activated charcoal beneficial

Answer 4

Best within 2 hrs but can be useful up to 24hrs after ingestion

Question 5

When might we give repeated administration of activated charcoal

Answer 5

For toxins that undergo enterohepatic recirculation

Question 6

When are cathartics contraindicated

Answer 6

Dehydration
Diarrhoea
ILeus
GI obstructions

Question 7

What can be used as a cathartic to induce diarrhoea

Answer 7

Lubricants e.g mineral oil
Osmotic agents e.g sorbitol
Bulking agents e.g metamucil, pumpkin

Question 8

What toxins are intralipid infusions particularly good for

Answer 8

Lipophilic ones
- This includes neurotoxins and cardiotoxins e.g ivermectin, permethrin, ibuprofen etc

Question 9

What are some potential adverse effects of intralipid infusion

Answer 9

Hyperlipidaemia
Pancreatitis

Question 10

What are the toxins within chocolate and how do they work

Answer 10

Methyxanthines (includes theobromine and caffeine); these inhibit PDE causing an increase in cAMP and catecholamine release

Question 11

signs of chocolate intoxication and treatment

Answer 11

Signs of catecholamine release:
- Vomiting, diarrhoea, excess urination, arrhthmias, seizures, hyperthermia etc

Treat via standard things; emesis/lavage if recent, activated charcoal, supportive care, may need diazepam to control seizures or antiarrhthymic therapy

Question 12

When do we see a prolongation of PT/APTT after rodenticide intoxication

Answer 12

Not until 36-48hrs after because of long half life of factor VII

Question 13

How do anticoagulant rodenticides cause toxicity

Answer 13

Via inhibition of vitamin K epoxide reductase
So don’t get recyc,ing of vit K so no activation of factors II, VII, IX and X

Question 14

Signs of rodenticide toxicits and traetment

Answer 14

Signs = lethargy, haemopytsis, intracavity bleeding, exercise intolerance

(NB: petechiation/mucosal bleeding less common than with issues of primary haemostasis)

INduce emesis, give vitK1 immediately if symptomatic or if prolonged PT/APTT seen

Question 15

Signs with NSAID toxicity

Answer 15

Within 12 hrs see GI signs; vomiting, haematemesis (due to ulcerations), melaena

Within 1-2 days see evidence of AKI

Question 16

CAn we prevent AKI from NSAID toxicity via fluids

Answer 16

No but should do anyway to maintain perfusion

Question 17

What toxin undergoes enteropheptic recirculation

Answer 17

NSAIDs, paracetamol - do repeated activated charcoal

Question 18

What issues does paracetamol cause

Answer 18

Its metabolite NAPQI causes oxidative damage to RBCs and heinz body anaemia

+ causes oxidation of ferrous iron to ferric iron Fe3+ which gives methaemoglobinaemia

Question 19

Signs with paracetamol toxicity

Answer 19

Methaemaglobinaemia, tachycardia, lethargy
Then Heinz body anaemia; pallor, tachycardia etc

Question 20

Treatment of paracetmaol toxicity

Answer 20

Emesis
N-acetylcysteine
Charcoal repeatedly
SAM-e if hepatic necrosis

Question 21

Signs with xylitol toxicity

Answer 21

Dogs more sensitive
- Hypoglycaemia within 30 mins - tremor, seizure, recumbency etc

MAY SEE Hepatic necrsis up to 3 days later; icterus,, high ALT, lethargy, coagulopathy

Question 22

How to treat hepatic necrosis due to toxicity

Answer 22

SAM-e

Question 23

Ethylene glycol toxicity how does it work

Answer 23

Metabolised to toxic metabolites (glycolic acid, oxalic acid etc)
These cause calcium oxalate crystalluria and renal rubular obstruction

VOmiting et at first; then look fine for a day; then severe AKI signs

Ethylene glycol test only works for <24hrs post-ingestion

Question 24

Treatment of ethylene glycol

Answer 24

If within 3 hrs in cats, 12 in dogs
- Ethanol IV
- Fomepizole to slow metabolism

Question 25

How does propylene glycol cause toxicity

Answer 25

metabolised to lactic acid and causes metabolic acidosis

Heinz body anaemia

Lower doses cause issues in cats

Tends to be related to chornic exposure over weeks/months

Question 26

What toxicity do lillies cause

Answer 26

AKI

+ 1/3 develop ataxia, depression, seizure etc

Just affects cats