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  • 12/14/2013

    1

    Top 20 poisons affecting small animal patients

    Tina Wismer, DVM, DABVT, DABT ASPCA Animal Poison Control Center

    Justine A. Lee, DVM, DACVECC, DABT

    CEO, VetGirl

    @VetGirlOnTheRun

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    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

    Oxidative phosphorylation uncoupled

    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 Hemerocallis spp.)

    ♦ 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

    APAPGlucuronide Conjugate (non-toxic)

    Sulfation Conjugate (non-toxic)

    Cytochrome P450

    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