Toxins in the Garage

Question 1

What toxin is found in most commercial antifreezes?

Answer 1

Ethylene glycol

Question 2

How does ethylene glycol taste?

Answer 2

Sweet

Question 3

What is the pathophysiology of ethylene glycol toxicity?

Answer 3

Metabolized to oxalic acid and glycolic acid

Question 4

What metabolizes ethylene glycol?

Answer 4

Alcohol dehydrogenase

Question 5

What will you see on a urinalysis of ethylene glycol tox as early as 6h post ingestion?

Answer 5

Ca oxalate crystalluria

Question 6

What is stage 1 of ethylene glycol toxicity and how long does it last?

Answer 6

Neurological phase, 30min-12h

Question 7

What are clinical signs of the neuro phase of ethylene glycol toxicity?

Answer 7

Ataxia, knuckling, “drunken behavior”, anorexia and vomiting

Question 8

What is stage 2 of ethylene glycol toxicity and how long does it last?

Answer 8

Cardiovascular phase, 12h-24h

Question 9

Which phase of ethylene glycol toxicity often goes unnoticed?

Answer 9

Cardiovascular phase

Question 10

What are clinical signs of the cardiovascular phase of ethylene glycol toxicity?

Answer 10

Tachycardia and tachypnea

Question 11

What type of renal failure is assoc. w/ethylene glycol tox?

Answer 11

Oliguric

Question 12

What blood gas abnormalities are assoc. w/ethylene glycol tox?

Answer 12

High anion gap, metabolic acidosis, high osmolar gap

Question 13

When must treatment be given in order to combat ethylene glycol toxicity?

Answer 13

Before toxic metabolites are generated

Question 14

What is the most effective medical treatment for ethylene glycol tox and how soon after ingestion but it be given?

Answer 14

Fomepizole (4-MP), w/in 8h of ingestion

Question 15

What is the MoA of 4-methylprazole?

Answer 15

Competitive inhibition of alcohol dehydrogenase

Question 16

If you choose to treat ethylene glycol toxicity with 20% ethanol, why is close monitoring required?

Answer 16

Can cause worsening of acidosis and diuresis and resp/CNS depression

Question 17

What are symptomatic treatments for ethylene glycol tox?

Answer 17

GI protectants, IVFT, diuretics

Question 18

What is the prognosis for ethylene glycol toxicity?

Answer 18

Good if tx w/in 4-8h; guarded if azotemia present; grave if oliguria/anuria present

Question 19

What do household cleaners contain that can cause caustic or corrosive lesions?

Answer 19

Acids and alkalis

Question 20

What should you absolutely NOT do if an animal has ingested a household cleaner?

Answer 20

DO NOT INDUCE VOMITING

Question 21

Why do you not want to induce vomiting in a patient that has ingested an acid/alkali?

Answer 21

Further damage esophagus

Question 22

How soon after ingestion of a non-dilute acid do burns appear and where will you see them?

Answer 22

Immediately; mouth, esophagus, stomach

Question 23

How soon after ingestion of a non-dilute alkali do burns appear?

Answer 23

8-12h later

Question 24

How do you treat an acid/alkali toxicity?

Answer 24

Dilute milk/water, GI protectant

Question 25

Why is activated charcoal not an appropriate treatment for acid/alkali toxicity?

Answer 25

Does not bind acids or alkalis

Question 26

What varnishing products are very irritating and painful when contacting skin and foot pads?

Answer 26

Paint thinners and turpentine

Question 27

How do you treat a paint thinner ingestion?

Answer 27

Milk or water

Question 28

Why do you not want to induce vomiting in a patient that has swallowed paint thinner?

Answer 28

Risk of aspiration pneumonia

Question 29

What is the neurotoxicant produced by Aspergillus?

Answer 29

Penitrem A

Question 30

Where might an animal ingest penitrem A?

Answer 30

Moldy food

Question 31

What is the MoA of penitrem A?

Answer 31

Raises resting membrane potential = facilitates depolarization

Question 32

What are clinical signs of moldy garbage intoxication?

Answer 32

Fine motor tremors, restlessness, hypersalivation

Question 33

How severe can moldy garbage intoxication signs become?

Answer 33

Tonic spasms, hyperthermia, seizures

Question 34

How do you treat moldy garbage intoxication?

Answer 34

Emesis, activated charcoal, supportive care

Question 35

What supportive care helps with muscle tremors assoc. w/moldy garbage intoxication?

Answer 35

Methocarbamol (Robaxin)

Question 36

How can you symptomatically treat seizures assoc. w/moldy garbage intoxication?

Answer 36

Diazepam, phenobarbital

Question 37

What GI protectants can you use for treatment of moldy garbage intoxication?

Answer 37

H2 blockers, sucralfate

Question 38

Which species has trouble with 4-MP treatment for ethylene glycol and why?

Answer 38

Cats need a much higher dose than dogs