HOW COMMITTED ARE YOU? - PowerPoint Presentation

HOW COMMITTED ARE YOU? “ commitment is doing what you said you were going to do, long after the mood you said it in has left you.”

TOXICOLOGIC EMERGENCIES CTVT pg. 898

Toxicologic Emergencies Top 10 Toxicoses Human medication (ibuprofen, acetominophen , anti-depressants) Insecticides—flea and tick Rodenticides—anticoagulants Veterinary medication Household cleaners—bleach, detergents Plants—sago palm, lily, azalea Herbicides Chocolate—highest in food category Home improvement products—solvents, adhesives, paint, wood glue Fertilizers

Toxicologic Emergencies Signs will vary depending on character of toxic compound Toxicity can result from exposure via many routes Ingestion Inhalation Skin contact Injection

Ocular exposure Rinse eyes with copious saline for 20-30 min Chemical burns treated with lubricating ointment and suture lids closed Use corticosteroids only if corneal epithelium is intact Skin exposure Bathe with mild detergent (liquid dish soap) Bather should wear protective clothing (gloves, goggles) Toxicologic Emergencies: external exposure

Toxicologic Emergencies Ingestion Induce vomiting—if chemical not caustic; animal is conscious, not seizing Syrup of ipecac, apomorphine , Xylazine , H2 O 2 (not reliable), salt (not recommmended ) Dilute caustic substances with milk, water Gastric lavage—large bore stomach tube; light anesthesia Administer absorbents—activated charcoal inhibits GI absorption Give orally or via stomach tube Enemas/cathartics to eliminate toxins more rapidly

TO VOMIT OR NOT TO VOMIT? VOMIT Acetone Alcohol Amphetamines, opiates, cocaine, heroin Arsenic Snail or rat bait Marijuana, tobacco, cigarettes/cigars Pesticides and insecticied i.e. malathion, dichlorvos , diazononHouse plants and sago plantsPine oilChocolateXylitol containing food items DO NOT VOMIT Petroleum distillates Sharp objects Bread dough Commercial or industrial cleaners Alkali/ caustic cleaners Bleach Burnt lime Volatile substances i.e. gasoline or paint thinner Unknown chemicals Fertilizers Lye Gorilla glue Strychnine

Toxicological Emergencies ACTIVATED CHARCOAL WITH OR WITHOUT A CATHARTIC

Toxicologic Emergencies Methylxanthines (caffeine, theobromine, theophylline) Found in: coffee, tea, chocolate, other stimulants LD 50 for caffeine is 140 mg/kg Milk chocolate – 60-66 mg/ oz Dark chocolate -150 mg/ oz Baking Chocolate - 390-450 mg/ oz

Toxicologic Emergencies Clinical signs of methylxanthine /chocolate toxicosis (caffeine, theobromine) Increased HR, RR Anxiety Vomiting/diarrhea Seizures, coma (greater than 60mg/kg) Cardiac arrhythmias (50mg/kg) Treatment Induce vomiting Activated charcoalControl seizuresFluid therapy

Toxicologic Emergencies Rodenticides Anticoagulants (warfarin, pindone , bromadiolone , brodifacoum ) Work by inhibiting Vit K, which inhibits synthesis of factors II, VI, IX, X This effect occurs within 6-40 hrs in a dog; effect may last 1-4 wks

Toxicological Emergencies Clinical signs (occur after depletion of clotting factors) Lethargy Vomiting/diarrhea with blood; melena Anorexia Ataxia Dyspnea Epistaxis, scleral hemorrhage, pale mm Treatment Vit K: 3-5 mg/kg PO for up to 21 days depending on anticoagulant used Induce vomiting; activated charcoal Whole blood transfusion if anemic

Toxicologic Emergencies Rodenticides Cholecalciferol - Vit D 3 ; causes Ca++ reabsorption from bone, intestine, kidneys causing hypercalcemia (>11.5 mg/dl) and cardiotoxicity Clinical signs (12-36 hrs after ingestion) Kidney failure AnorexiaVomitingTissue mineralizationCardiovascular abnormalitiesMuscle weaknessarrhythmias

Toxicological Emergencies Diagnosis Hx of exposure Usually discovered on routine Chem panel (↑blood Ca ++ )Treatment Induce vom /activated charcoal if ingestion occurred with 2 hrs Calcitonin to lower blood Ca++ concentration

Toxicologic Emergencies Rodenticides Bromethalin stops production of ATP in CNS Causes cerebral edema (swelling in the brain caused due to excessive fluid) Toxic Dose Dog: 4.7 mg/kg Cats: 1.8 mg/kg Clinical signs (>24 h after ingestion of high dose; 1-5 d--low dose) Excitement, tremors, seizures Depression, ataxiaRx (will take 2-3 wks to know if animal will survive)Purge GI tract if exposure recent Reduce cerebral edema with Mannitol and glucocorticoids Seizure control with Diazepam and Phenobarbital

STAY FOCUSED “I ALREADY KNOW WHAT GIVING UP FEELS LIKE. I WANT TO SEE WHAT HAPPENS IF I DON’T.”

Toxicologic Emergencies Acetaminophen Common OTC drug for analgesia Toxic dose Dog—160-600 mg/kg Cat—50-60 mg/kg (2 doses in 24 hr is almost always fatal)

Toxicologic Emergencies Clinical signs (starts within 1-2 hrs of ingestion) Vomiting, salivation Facial and paw edema Depression Dyspnea Pale mm Cyanosis due to methemoglobinemia Treatment Induce vom/activated charcoalAntidote: N-Acetylcysteine

Toxicological Emergencies causing the blood to be dark brown in color

Toxicologic Emergencies Metals Lead toxicity more common in dogs than cats Source Lead paint (prior to 1970’s) is primary source Batteries, linoleum, plumbing supplies, ceramic containers, lead pipes, fishing sinkers, shotgun pellets Clinical signs (Usually involves signs of GI and nervous systems) Anorexia Vom / dia Abd painCNS signs do not show initiallyBlindness, seizures, ataxia, tremors, unusual behavior

Toxicologic Emergencies Metals Lead toxicity Dx Large # nucleated RBC’s; basophilic stippling Blood lead conc >35 μ g/ml Rx Remove lead from GI tract (cathartic, Sx )Chelators (These agents bind to lead and promote its excretion)Calcium EDTA (ethylene diamine tetra acetic acid)PenicillamineIV fluids for dehydration and to speed removal via kidneysDiazepam, Phenobarbital to control seizures

Toxicologic Emergencies Metals Zinc Toxicosis Usually from ingested pennies, galvanized metal, zinc oxide ointment Clinical signs Vomiting CNS depression Lethargy Anemia Weakness Renal failure

Toxicologic Emergencies Dx Hx of exposure Clinical signs, radiographs Rx Remove metal objects endoscopically or surgically IV fluid therapy Ca EDTA chelation

Toxicologic Emergencies Ethylene Glycol (antifreeze; sweet taste ) Lethal dose: Cat - 1.5 ml/kg Dog - 6.6 ml/kg Signs (acute inset) CNS depression, ataxia (may appear intoxicated) Vomiting PD/PU Seizures, coma, death Acute renal failure

Toxicologic Emergencies Dx Hx , signs Ethylene Glycol Poison Test—an 8 min test used in cats and dogs Calcium oxalate crystals in urine Rx Emesis, adsorbents if ingestion within 3 h of presentation IV fluids, NaBicarb for acidosis Ethanol inhibits ethylene glycol metabolism FOMEPIZOLE : 4-methylpyrazole, “antizole”, has been shown to be effective

Toxicologic Emergencies Insecticides Pyrethrins, Pyrethroids, Permethrins Common ingredients of flea/tick sprays, dips, shampoos, etc If used according to instructions, toxicity rarely occurs; if overused, toxicity can result Signs Hypersalivation Vom ./diarrhea Tremors, hyperexcitability or lethargy Later, dyspnea, tremors, seizures can occurhttps://www.youtube.com/watch?v=I5YJm7IvPNMhttps://www.youtube.com/watch?v=7MNizOBPDjo

Toxicologic Emergencies Rx Bathe animal to remove excess Induce vomiting/charcoal/cathartics for ingestion Diazepam may be necessary for mild tremors Methocarbamol, a muscle relaxer, for moderate-severe tremors Atropine for hypersalivation and bradycardia

Toxicologic Emergencies Insecticides Organophosphates and Carbamates Inhibit cholinesterase activity (break down of Ach is inhibited) Highly fat-soluble; easily absorbed from skin and GI tract Found in dips, sprays, dusts, etc for fleas and ticks, and flys https://www.youtube.com/watch?v=OrmJF0E5D_s

Toxicologic Emergencies Signs S alivation L acrimation U rinary incontinence Diarrhea D yspnea E mesis, gastrointestinal crampingSeizures, coma, resp. depression, deathRxBathe animalCharcoal if ingestedAtropine (0.2-0.4 mg/kg; half IV, half IM or SQ)Pralidoxime chloride(20 mg/kg BID till signs subside)—reactivates cholinesterase