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?

GARRET@VETGIRLONTHERUN.COM

JUSTINE@VETGIRLONTHERUN.COM