Tina Wismer ASPCA VG NO PICS (1) - VETgirl · ASPCA Animal Poison Control Center Introduction...
Transcript of Tina Wismer ASPCA VG NO PICS (1) - VETgirl · ASPCA Animal Poison Control Center Introduction...
12/14/2013
1
Top 20 poisons affecting small animal patients
Tina Wismer, DVM, DABVT, DABTASPCA Animal Poison Control Center
Justine A. Lee, DVM, DACVECC, DABT
CEO, VetGirl
@VetGirlOnTheRun
VetGirl…on the RUN!
♦ The tech-saavy way to get CE credit!
♦ A subscription based-podcast service offering RACE-approved CE
Subscription plans
♦ VetGirl Standard: 50-60 podcasts/year
� $99/year
� 4 hours of RACE-CE
♦ VetGirl ELITE: 50-60 podcasts/year plus 12 hours of webinars!
� $199/year
� 16+ hours of RACE-CE
Blogs and Social Media
facebook.com/VetGirlOnTheRun
@vetgirlontherun
http://www.pinterest.com/vetgirlontherun/
Introduction
Tina Wismer, DVM,
DABVT, DABT
ASPCA Animal Poison Control Center
Introduction
Justine A. Lee, DVM,
DACVECC, DABT
CEO, VetGirl
12/14/2013
2
ASPCA Top 20 poisons♦ Human prescription
medications
� Cardiac medications
� Antidepressants
� ADHD meds
� Sleep aids
♦ Insecticides
� Pyrethrins
� Ant/Roach baits
♦ OTC medications
� Acetaminophen
� NSAIDs
♦ Plants
� Lilies
♦ Household products
� Firestarter logs
� Household cleaners
� Batteries
� Silica Gel
♦ People food
� Xylitol
� Grapes
� Chocolate
♦ Rodenticides
� Anticoagulants
� Bromethalin
♦ Lawn and garden products
� Fertilizer
� Blood meal
Ant and Roach Baits
♦ Active ingredients: sulfluramid, fipronil, propoxur, boric acid, and hydramethylnon
♦ Avermectin, chlorpyrifos, and arsenic
♦ Inert ingredients: peanut butter, sugar, breadcrumbs, vegetable or animal fats
♦ Plastic/metal may pose FB hazard
Rodenticides
♦ Commonly encountered
♦ Accurate identification required
� Each class unique
♦ Color and formulation not unique
� Baits come in blocks, pellets and granules
� Blue, green, red or tan
Anticoagulants: Mechanism of Action
♦ Still most common type
♦ Stops production of clotting factors� Inhibit vitamin K 1,2,3-epoxide reductase
� Prevents vitamin K recycling
♦ Affected factors � II, VII, IX, and X
� extrinsic, intrinsic and common coagulation pathways
Anticoagulant Rodenticides
♦ Short-acting (rarely found)
� Warfarin, Pindone
♦ Long-acting (second generation)
� Brodifacoum, Bromadiolone, Diphacinone, Difethialone, Chlorophacinone
♦ Duration of clinical signs:
� Warfarin - 14 days
� Bromadiolone - 21 days
� Brodifacoum - 30 days (stored in the liver)
Clinical Signs
♦ Generally 3-7 days before clinical signs are seen
� Coagulopathies develop as vitamin K dependent clotting factors are depleted
� Factor VII has shortest half-life (6.2 hours)
♦ Initially, signs are vague:
� Lethargy, exercise intolerance
� +/- anorexia
12/14/2013
3
Clinical Signs
♦ As signs progress:
� weakness
� frank hemorrhage
� dyspnea
� bruising
� lameness
� seizures
� death
Decontaminate
♦ Warfarin� Decontaminate at 0.5 mg/kg
♦ Second generation� Decontaminate at 0.02 mg/kg
♦ Emesis � if less than 4 hours following ingestion
♦ Activated charcoal?♦ PT testing
� 48 – 72 h
Treatment
♦ Vitamin K1
� 2.5-5 mg/kg/day divided BID-TID PO, IM, SQ
� 6-12 hours for new clotting factors to be synthesized
� give with fatty meal to increase absorption
� injectable product may be given orally
Treatment
♦ Emergency needs for clotting factors (whole blood transfusion, fresh plasma, fresh frozen plasma)
♦ Oxygen
♦ Restrict exercise/cage rest
♦ Recheck PT 48 hours after last dose of vitamin K1
Primary and Secondary Toxicity
♦ Primary toxicity to all mammals is high
♦ Poisoned rodents have killed avian and mammalian secondary consumers
Bromethalin
♦ Neurotoxin - NOT an anticoagulant!
� Concentration is 0.01%
♦ Increasing in popularity and usage
♦ Converted to desmethylbromethalin
� Several times more toxic than bromethalin
♦ Half life (dog) = 5.6 days
Acute oral LD50 mg/kg
Norway Rat
2
Mouse
5
Dog
4.7
Cat
1.8
Monkey
5
Rabbit
13
Guinea Pig >1000
12/14/2013
4
Mechanism of Action
Oxidativephosphorylationuncoupled
ATP production
Loss of Fluid PumpsEdema of Myelin Sheaths
Clinical Signs
♦ Acute syndrome (doses at or above LD50)� Mortality rate ~100%
� Agitation, depression, hind limb paresis, tremors, seizures, death
• Signs appear about 10 hours post ingestion
♦ Chronic syndrome � Signs may last up to 12 days
• may fully recover or may have permanent impairment
� Tremors, depression, ataxia, rear limb paresis, vomiting, recumbency
• Signs may occur 24-86 hours post exposure
Treatment
♦ DECONTAMINATION
♦ DECONTAMINATION
♦ DECONTAMINATION� Emesis, activated charcoal (repeated)
♦ If clinical, can try to decrease cerebral edema� dexamethasone, mannitol, furosemide
Prognosis
♦ Prognosis varies with severity of presenting signs
� Asymptomatic or mild depression, ataxia = good prognosis, recovery in 1-2 weeks
� Severe neurologic signs (coma, paralysis) = poor prognosis
Lilies (Lilium and Hemerocallisspp.)
♦ All parts of plant toxic
� Pollen
♦ Only cats
♦ Acute renal failure
� Necrosis of proximal renal tubular epithelial cells
� Unknown water soluble toxin
True Lilies
� Easter lily (Lilium longiflorum)
� Tiger lily (Lilium tigrinum)
� Rubrum lily (Lilium speciosum)
� Japanese show lily (Lilium lancifolium)
� Day lily (Hemerocallis spp.)
12/14/2013
5
Lilies
♦ By 2-6 hours: vomiting
♦ By 24-72 hours: ARF
♦ Delaying treatment results in death
♦ Activated charcoal
♦ IV fluids
Pyrethrins
♦ Concentration is the biggest factor in toxicity
♦ Low toxicity
� Shampoos, foggers, sprays
♦ Higher toxicity
� Dips (undiluted), spot-ons
Concentrated Pyrethrins and Dogs
♦ Skin hypersensitivity disorders� Pruritus
� Erythema
� Alopecia
� Behavior changes• Hyperactivity, hyperesthesia
♦ Cause?
� Allergic reaction to carriers
� Tingling sensation documented in people
Treatment of skin hypersensitivity reactions
♦ Bathe with liquid dish washing detergent
� Signs usually resolve within a couple of hours after bathing
♦ Topical vitamin E oil
♦ If not, consider:
� +/- antihistamines
� +/- steroids
Concentrated Pyrethrins and Cats
♦ Most commonly seen with mis-application of dog only labeled product
� Cats that groom or engage in close physical contact with recently treated dogs
Concentrated Pyrethrins and Cats
♦ Clinical signs � Muscle tremors
� Seizures
� Hypersalivation
� Depression
� Vomiting
� Anorexia
� Death
12/14/2013
6
Feline Pyrethrin Toxicosis
♦ Signs usually within 2 - 4 h, can be delayed up to 24 h
♦ Treatment:
� Methocarbamol for tremors
� Bathe entire cat with liquid dish washing detergent
♦ Fluids
♦ Prognosis: Usually good
♦ Treatment duration:
� Normally 24 hours, some cases need 48-72 hours to resolve
Acetaminophen
♦ Forms:� Tablets: 80-650 mg
� Liquid: 32-100 mg/ml
♦ Rapidly absorbed from the GI tract
♦ Peak plasma levels � 10-60 m for regular products
� 60-120 m for extended release
APAPGlucuronideConjugate(non-toxic)
SulfationConjugate(non-toxic)
CytochromeP450
NAPQI Methemo-globinemia
Hepato-
toxicosis
Nephrotoxicosis
PAP
Acetaminophen
♦ Dogs
� Therapeutic dose = 10 mg/kg q 12 h
� Hepatotoxicity = 100 mg/kg
� Methemoglobinemia = 200 mg/kg
� KCS = any dose (48-72 hr post ingestion)
♦ Cats
� 10 mg/kg has produced signs of toxicity
♦ Ferrets are as sensitive as cats
Acetaminophen Clinical Signs
♦ Methemoglobinemia
� Tachycardia, tachypnea
♦ Depression
♦ Hypothermia
♦ Vomiting
♦ Death
♦ Facial or paw edema
� More common in cats
Decontamination
♦ Emesis � Early
♦ Activated charcoal and cathartic � Enterohepatic recirculation
♦ Monitor for methemoglobinemia � Values rise in 2-4 hours, followed by Heinz body
formation
♦ Monitor liver values � If values are normal at 48 h, no
problems expected
12/14/2013
7
Acetaminophen: Treatment
♦ N-acetylcysteine (Mucomyst®)
� precursor in the synthesis of glutathione
� can be oxidized to organic sulfate needed for the sulfation pathway
� provides an alternate substrate for conjugation to reduce the extent of liver injury or methemoglobinemia
Treatment
♦ NAC available in 10% and 20% solutions
� dilute to 5% concentration in 5% Dextrose or sterile water
� Oral or IV
♦ Loading dose: 140 mg/kg
♦ 70 mg/kg QID for 7 treatments
� 12 to 17 doses
� 280 mg/kg loading dose
Treatment
♦ IV fluids
♦ Oxygen/whole blood
♦ Ascorbic acid? • helps with reduction of methemoglobin back to
hemoglobin
♦ Cimetidine? • inhibits cytochrome p-450 oxidation system
• Not in cats
NSAIDs
♦ Popular in vet and human medicine
♦ Inhibit prostaglandin synthesis
� Good vs bad
• decreases pain and inflammation
• Decreases protective mucous layer in the stomach and small intestine
• causes vasoconstriction in gastric mucosa
• inhibits renal blood flow
Ibuprofen
♦ Dogs
� Vomiting = any dose
� GI ulcers ~75 mg/kg
� Renal failure ~ 125 mg/kg
� CNS ~ 400 mg/kg
♦ Cats
� Approximately twice as sensitive as the dog
♦ Ferrets
� High risk for CNS depression and coma
Ibuprofen: Chronology
♦ Onset of GI symptoms:
� GI upset: 2-6 hours
� GI hemorrhage/ulceration: 12 hours to 4 days
♦ Onset of Renal failure:
� Usually within 12 hours but may be delayed until 3-5 days post-exposure
12/14/2013
8
Ibuprofen: Decontamination
♦ Emesis if < 15 minutes
� up to 2 hours if large number of pills (bezoar)
♦ Activated charcoal with cathartic
� repeat dose in 8 hours if large ingestion
♦ GI protectants for 5-7 days
� synthetic prostaglandin, H2 blocker, proton pump inhibitor, gastromucosal protectant
• Combination?
Ibuprofen: Treatment
♦ IV fluids
� 2x maintenance for 48 hours (at least)
♦ Monitor BUN, creatinine
� baseline
� repeat in 24, 48, 72 hours
♦ Monitor electrolytes and for acidosis (rare)
Naproxen
♦ Naprosyn®, Aleve®, Anaprox®
♦ Extensive enterohepatic recirculation
� prolonged half life (e.g. naproxen 74 hrs in dogs)
♦ Very high ulcerogenic potential in dogs
� 5 mg/kg naproxen
♦ Renal effects ~ 10 mg/kg
Veterinary NSAIDs
♦ Carprofen (Rimadyl®)
♦ Dog
� GI ulcers 20 mg/kg
� ARF 40 mg/kg
♦ Cat
� GI ulcers 4 mg/kg
� ARF 8 mg/kg
♦ Deracoxib(Deramaxx®)
♦ Selective Cox-2
♦ Dog
� GI ulcers 15 mg/kg
� ARF 30 mg/kg
Chocolate
♦ Methylxanthines: theobromine, caffeine � CV and CNS stimulation
� LD50 ~100-300 mg/kg
• 20 mg/kg--mild signs possible
• 40-50 mg/kg—cardiotoxic effects possible
• 60 mg/kg—seizures possible
• Death due to cardiac arrhythmias or respiratory failure
� Signs may be delayed up to 12 hours
Compound Theobromine
(mg/oz)
Caffeine (mg/oz)
White Chocolate 0.25 0.85
Milk Chocolate 58 6
Semi-sweet
Chocolate Chips
138 22
Sweetened Cocoa
Mix
138 22
Unsweetened
Chocolate
393 47
Unsweetened
cocoa powder
737 70
Cocoa Bean
Mulch
255 NA
12/14/2013
9
Chocolate
♦ 20 lb dog
♦ How much to cause seizures?
� Milk chocolate = 9 oz
� Dark chocolate = 4 oz
� Bakers chocolate = 1.5 oz
Chocolate
♦ Emesis
� often successful several hours after ingestion
♦ Activated charcoal?
♦ IV fluid diuresis
� Urinary catheter
♦ Phenothiazines for agitation
♦ Manage arrhythmias prn (propranolol)
Chocolate
♦ Tremor control: Methocarbamol
♦ Seizure control
� Diazepam, barbiturate or general anesthetic
♦ Thermoregulation
♦ Signs may last up to 72 hours
♦ Pancreatitis possible
Grapes and Raisins
♦ Renal failure associated with ingestion
♦ Dogs� Cats, ferrets?
♦ Grapes from variable sources
� Private vines
� Organic
� Commercial
Grapes and Raisins
♦ MOA and toxic principle unknown
� Histopath: damage to the proximal tubules
� Toxin is water soluble, in fleshy part
♦ How much is too much?
� Individual sensitivity?
Grapes and Raisins
♦ Clinical Signs� Vomiting and/or diarrhea (within 6 hours)
� Depression, dehydration, anorexia, abdominal pain
♦ Clinical Pathology� Elevated creatinine (w/in 12 hours)
� Elevated BUN in most dogs
� ↑ Ca, ↑P, elevated liver enzymes, elevated lipase/amylase, hyperglycemia
12/14/2013
10
Grapes and Raisins -Decontamination
♦ Decontaminate recent ingestions
� induce emesis up to 6 hours post exposure
♦ Activated charcoal
� within the first 12-24 hours
♦ Fluid diuresis for 48 hours
♦ Monitor renal values
� if normal after 48 hrs discontinue fluids
Grapes and Raisins - Treatment
♦ Symptomatic and supportive care
� GI protectants
� antiemetics
� phosphate binders
♦ Oliguric/anuric renal failure developed within 72 hours of ingestion
� poorly responsive to treatment
� dialyzed dogs had mixed results
Xylitol
♦ 5-carbon sugar alcohol
� other sugar alcohols include sorbitol, maltitoland mannitol
♦ Used in sugar-free chewing gums and candies and for baking
� anti-cavity, reduces severity of ear infections, low carb diets, diabetics
Xylitol
♦ Humans
� Doesn’t significantly raise blood glucose or significantly stimulate insulin release
� Good alternative to glucose for diabetics
♦ Dogs
� Stimulates insulin release for several hours
� Peak insulin level is dose related
� Changes can be seen at as low as 0.1 g/kg
Xylitol - Clinical Signs
♦ Rapid onset -- signs can be seen within 15-30 minutes or delayed up to 8 h (gum)� vomiting, depression, weakness, ataxia,
seizures, coma
� hypoglycemia, hypokalemia
♦ Liver failure � MOA (decreased ATP production???)
Xylitol - Treatment
♦ Emesis -- only if asymptomatic
♦ No activated charcoal
♦ Symptomatic dogs
� Dextrose -- bolus and CRI
� Small frequent meals
� Can see prolonged hypoglycemia
� Monitor liver enzymes
12/14/2013
11
Antidepressants
♦ Most common type: SSRIs
♦ Selective serotonin re-uptake inhibitors (SSRIs)
♦ Tricyclic antidepressants
♦ Other drugs affecting norepinephrine or serotonin
SSRIs: How do they work?
♦ Inhibit the reuptake of serotonin at the presynaptic membrane
♦ More serotonin � more serotonin syndrome!
Permission granted Dr. Joe Stirt from http://www.bookofjoe.com/2005/03/07/
Clinical signs from SSRIs
♦ CARDIAC: hypertension, tachycardia
♦ CNS: sedation or agitation, mydriasis, vocalization, tremors, seizures
♦ GI: drooling, vomiting, diarrhea
♦ RESP: panting (to blow off heat)
♦ MISC: Hyperthermia secondary to tremors
♦ How do we treat? Same as amphetamines!
Amphetamines
♦Recognize!♦Ritalin or Concerta (methylphenidate)♦Vyvanse (lisdexamfetamine)♦Adderall (dextroamphetamine /amphetamine)♦D-amphetamine (Dexedrine)
♦ Similar to crystal meth!
What are amphetamines used for?
♦#1 ADD/ADHD
�College kids
♦ Illegal purposes (street drug)
♦Narcolepsy
♦Obesity (weight loss)
Amphetamines: How do these drugs work?
♦ Sympathomimetics!
♦ Similar to norepinephrine � stimulate alpha and beta-adrenergic receptors
♦CS: Overstimulation!
12/14/2013
12
Clinical signs from amphetamines
♦ CARDIAC: hypertension, tachycardia
♦ CNS: sedation or agitation, mydriasis, ear flicking, vocalization, tremors, head bobbing, seizures
♦ GI: drooling, vomiting, diarrhea
♦ RESP: panting (to blow off heat)
♦ MISC: Hyperthermia secondary to tremors
♦ How do we treat it? Same as SSRIs!
Do we decontaminate?
♦ Is it asymptomatic?
♦ Rapid onset of clinical signs
♦ Should you have the pet owner do it? (NO)
� Best done in clinic once TPR is assessed
� If asymptomatic
� If recent ingestion (< 1 hour)
Should we give charcoal?
♦ If ASX � one dose of activated charcoal + cathartic (ACC)
♦ If extra letters behind brand name (e.g., XR, ER, SR, etc.), give multiple doses of AC
� No sorbitol with additional doses
69
Treatment
♦ IV fluids:� Aids in enhanced urinary elimination
• Amphetamines only
� Keeps them cool if hyperthermic
� Minimizes risk of myoglobinuria damage
♦ Hyperthermia: � Stop the tremoring� sedatives/methobarbamol
� Provide cooling measures if > 105ºF/40.5ºC
� Stop cooling measures if 103.5ºF/39.7ºC
TreatmentMonitoring:
� Check TPR � monitor blood pressure and ECG
� When do we care? > 180 bpm /180 mmHg
Anxiolytics:� If anxious, tachycardiac, hypertensive �
� Acepromazine
• 0.05-0.1 mg/kg IV, IM, or SQ, titrated to effect
• Plumbs: Do not “exceed 3 mg total”
Treatment♦ Tachycardia (HR > 170-180 bpm):
� Check stat BP
• Typically hypertensive with SSRI/ADD medications �
♦ Anxiolytics (more acepromazine)
♦ Anxiolytics (more ace + butorphanol?)
• Still tachycardiac?
♦ Beta-blocker (propranolol 0.02-0.06 mg/kg IV)
♦ Tremors:
� Methocarbamol 44-220 mg/kg IV or PO q. 6-8
� Ideally IV
� “Do not exceed 330 mg/kg/day” ☺
� Rectal absorption?
12/14/2013
13
Treatment:♦Serotonin syndrome:
� Serotonin antagonist � cyproheptadine
� Consider PO or rectal administration
� Dogs: 1.1 mg/kg q. 6-8-12 hours
� Cats: 2-4 mg total q. 6-8-12 hours
� Seizures: � Stop the seizure!
• Phenobarbital 4-16 mg/kg IV or PO PRN, titrated to effect
• Diazepam 0.25-0.5 mg/kg IV PRN, titrated to effect
Sleep Aids
♦ AI: non-benzodiazepine hypnotics
♦ Brands to know!
� Zolpidem (Ambien)
� Eszopiclone (Lunesta)
♦ How do they work?
� The non-benzos are similar to benzos
� Potentiate GABA transmission
� Inhibition of neuronal excitation
Sleep Aids
♦ Rapid onset of clinical signs: 1-2 hrs
♦ How long do they last? 11- 12 hrs
♦ Most common clinical signs:
� CNS: Sedation, ataxia, weakness
� GI: drooling, vomiting, diarrhea
Clinical signs
♦ 50% � paradoxical CNS stimulation!
� Hyperactivity
� Aggression
� Agitation
� Hyperventilation
� Rarely: tremors
♦ Rare to see severe respiratory and cardiac depression
Treatment:
♦ Is the patient clinical?
♦ Decontamination – if appropriate!� Induce emesis? Only if asymptomatic
� Activated charcoal + cathartic X 1
Treatment
♦ Baseline blood work if suspect renal/hepatic disease
♦ Let them sleep it off!
♦ If paradoxical stimulation � acepromazine
� NO BZO
• When to reach for the reversal agent:
– Flumazenil – only if severe
12/14/2013
14
Silica gel packs vs. food oxidizer packs
♦ Low risk of toxicosis
♦ Food oxidizer packs�contain iron � risk of iron toxicosis
� Sources
• Rawhide bags
• Beef jerky bags
• Hand warmer packs
♦ Does it:
� Stick to a magnet?
� Is it black or brown powder?
♦ Treatment
� Decontamination?
� NO charcoal
� Milk of magnesia X3-5 days
� Measuring iron levels?
Cardiac medications
♦ Everyone’s on it!
♦ Cardiac medications
� ACE-inhibitors
� Statins
� Diuretics
� Calcium channel blockers (CCB)
� Beta-blockers (BB)
Cardiac meds♦ Safer:
� Angiotensin-converting enzyme (ACE) inhibitors• > 10-20X therapeutic dose generally safe?
• Signalment?
� Statins• GI signs
• No big deal!
� Diuretics• PU/PD
• GI signs
• Renal disease?
Cardiac meds♦ Deadly:
� Calcium channel blockers (e.g., diltiazem)
� Beta-blockers (e.g., atenolol)
♦ Deadly because it causes life-threatening bradycardiaand hypotension � decreased cardiac output � AKI!
Calcium channel blockers
♦ Common active ingredients:
� Diltiazem
� Verapamil
� Amlodipine
� Nifedipine
Calcium channel blockers (CCB): How do they work?
♦ Inhibits influx of extracellular Ca++ in the vascular smooth muscle and myocardial cells � hypotension
♦ Goals: used for hypertension (to ↓ blood pressure)
♦ Results in: ↓ total peripheral resistance and cardiac
afterload� relaxation of the heart!
12/14/2013
15
Beta blockers: Ends with an “-ol”
♦ Atenolol
♦ Carvediolol
♦ Esmolol
♦ Metoprolol
♦ Propranolol
♦ Sotalol
♦ Timolol
♦ Exception: isoproterenol (makes HR faster)
Beta blockers: How do they work? ♦ Beta BLOCK (Beta-antagonist)
� Cardiac: B1
� Lungs: B2
♦ Opposite of asthma inhalers (Beta-agonists)
♦ Used clinically for:
� Hypertension � causes hypotension
� Tachycardiac � causes bradycardia
• Arrhythmias
� Angina
� Myocardial infarction
� Stage fright
Cardiac medications
♦ Deadly because it causes life-threatening bradycardia and hypotension � decreased cardiac output � ARF!
Treatment♦ Identify if toxic
♦ Decontamination
♦ Aggressive IV fluids
♦ Blood pressure/ECG monitoring
♦ Blood work monitoring
♦ Consider referral
♦ “Antidotes”� Intravenous lipid
emulsion
Household cleaners♦ Most household bleach is not corrosive—GI irritants
♦ Ultra bleaches may be corrosive!
� No emesis induction!
� Sodium hypochlorite 6-7%; sodium hydroxide also
♦ Treatment
� Solution to pollution = dilution
� Anti-emetics
� Anti-ulcer
� Analgesics
Batteries
♦ Alkaline or acidic material inside
♦ Most common type:
� Dry cell battery
♦ Acid dry cell � coagulation necrosis � limited tissue injury
� Ammonium chloride or manganese dioxide
♦ Alkaline dry cell � liquefaction necrosis � deeply penetrating ulcers
� Potassium hydroxide or sodium hydroxide
12/14/2013
16
Batteries
♦Disc-shaped batteries � electric current �current induced necrosis � tissue injury (perforation)
♦Lithium button type � most dangerous �severe necrosis
Batteries
♦Danger: Corrosive to GIT, heavy metal toxicity
♦Radiopaque! � get FB out
Fertilizers/Soil amendments♦ Primarily made of elements (e.g., 40:10:10)
� Nitrogen� Phosphate� Potash
♦ Commonly implicated, rarely toxic
♦ Wide margin of safety� Directly ingested from bag?
♦ Washes off with rain� Kitty litter remnants� Corn cob industry
Organic fertilizers♦ “Organic” but still dangerous!
♦ Palatable!
♦ Crushed up dead things
♦ Mixed in with ??? � Organophosphate granules?
� Spring bulbs?
Bone meal/blood meal:
♦ Clinical signs:
� Hypersalivation
� Bloat
� Vomiting
� Pancreatitis
� Foreign body obstruction (FBO)
♦ Treatment:
� Palpate abdomen
� Radiographs to r/o bezoarbone
� Emesis induction �gastric lavage to break up
� Anti-emetics
� Fluid therapy
• IV fluids
• SQ fluids
� Supportive care
Fire starter logs:
♦AI: wax, compressed sawdust
♦Non-toxic!
♦Foreign bowel obstruction (FBO)
♦Rare: heavy metal (colored flames!)
12/14/2013
17
Conclusion
♦ Be aware of human medications: 50% of calls
♦ Common toxicants to be aware of!
� Human medications
� Food toxins
� Household goods
♦ Call for help, especially with ones you’re not familiar with!
Huge thank you for our sponsor!
Want more? Check out these VetGirl toxicology podcasts!
♦ Toxicology mistakes to avoid in your poisoned patients!
♦ Sleep aid poisoning in dogs and cats
♦ Intravenous lipid emulsion (ILE) with ivermectin toxicity in dogs : Getting the skinny on using fat!
♦ Inducing vomiting in dogs and cats: Picking the right emetic agent
♦ Activated Charcoal: To Give or Not To Give…
♦ Which emetic should you pick in dogs: Hydrogen peroxide or apomorphine?
♦ Fluorouracil (5-FU) poisoning in dogs: A deadly topical toxin
Want more? Check out these VetGirl toxicology podcasts!
♦ Fertilizer poisoning: Commonly implicated, rarely toxic
♦ Your patient ate what? Intravenous Lipid Emulsion with Lidocaine Toxicity in Cats
♦ Baclofen Toxicity – Why NOT to relax with this muscle relaxant!
♦ Cathartics: What you need to know about accelerating defecation!
♦ How to induce vomiting in veterinary medicine
♦ Xylitol poisoning in dogs
♦ Veterinary NSAIDS: Friend vs. foe?
Exhibiting debut!♦ January 2014:
� NAVC, Orlando, FL
� Stop by and get a free VetGirlsticker and water bottle!
� Free running t-shirt when you sign up at NAVC!
@VetGirlOnTheRun
VetGirlOnTheRun
Questions?