According to the ASPCA Animal Poison Control Center (APCC), its agents made more than 232,000 calls in 2019 about animals exposed to potentially harmful toxins. This corresponds to an increase of almost 10% compared to the previous year.
Confident that you know common household items that can be toxic to pets? Do you know when inducing vomiting can be dangerous?
Fortunately, Liz Hughston, MEd., RVT, CVT, LVT, VTS (SAIM) (ECC) is very familiar with identifying and managing cases of veterinary toxicity and has recently shared her knowledge with those attending the Get the dvm360® virtual conference.
“Toxicities are one of my favorite emergencies,” said Hughston, founder of VetTechXpert, at the start of the presentation. “I find it very fulfilling because you are often immediately satisfied with your work. You will know that you really helped the patient because you can see the results pretty quickly. “
Chocolate remains the most commonly reported toxin ingested by dogs Pet Poison Helplinefollowed by rodenticides, anti-inflammatory drugs, xylitol, and grapes / raisins.
It’s always an emergency when a dog eats raisins or grapes because of the unpredictable reaction, Hughston said. “We don’t know the toxic principle behind it. Some dogs can eat a lot of grapes and have no problem, but another dog may only eat 1 grape or raisin and get into kidney failure immediately. “
In cats, the Pet Poison Helpline identified lilies as the most commonly reported toxin, followed by insecticides (mostly dog flea medicines), household cleaners, antidepressants, essential oils and anti-inflammatory drugs.
Though not listed by the Pet Poison Helpline, Hughston noted that the toxicity of tetrahydrocannabinol (THC, the main psychoactive ingredient in marijuana) is becoming increasingly common and requires immediate attention. “THC toxicity – from marijuana as opposed to hemp,” she clarified, “is usually a very dramatic toxicity. People will want their pets treated because it looks very scary, although it isn’t necessarily dangerous in and of itself. “
Basics of toxicity treatment
As with any emergency, it is important to ensure that the patient remains stable. “We always want to make sure we are careful about our airways, breathing and circulation,” said Hughston. “This part is really important because whether or not you have a toxicity that you want to treat, if your patient is not alive, your treatment will not be successful.” Treat what kills first.
While the patient is stabilizing, the support staff should receive as much information as possible from the customer. “This is a really valuable role for veterinary technicians,” she said. “You need to know exactly what the patient came up with, when they were exposed, how much they were exposed and how they got in.”
Ideally, customers should be asked to bring any packaging or bottles that the pet has come into contact with. This provides important information about active and inactive ingredients and the concentration of the product. “This is especially important when it comes to things like iron, fertilizer, or slug bait as the concentrations vary,” said Hughston. “We have to look at what concentration we are dealing with so we can calculate the amount of toxic intake or use.”
In the absence of packaging, online searches can help identify active ingredients and contents if the pet owner knows the brand name.
In addition to exposure information, staff should record current medications and any significant persistent health conditions such as asthma or heart disease. Hughston suggested that Toxin exposure triage form Provided by the ASPCA APCC as a guide to ensure that all relevant information is collected.
The solution to pollution is dilution
Once the patient is stable, the poison has been identified, and the details of exposure are known, steps should be taken to prevent further absorption. “The more toxins we can remove or prevent, the better,” she said.
In most cases of toxicity, dilution is the most effective means.
For patients with topical exposure, bathe the patient in lukewarm water to remove as much contamination as possible from their skin or fur. Flush the affected area for at least 10 minutes and longer if the signs persist.
To avoid aspiration, be extra careful when bathing patients who are lying down or who have decreased responsiveness or reflexes, she advised. Also, dry the patient thoroughly and check the body temperature regularly to avoid hypothermia.
When a patient has ingested a toxin, inducing vomiting is generally the first step in decontaminating the gastrointestinal tract (GI). In dogs, Hughston prefers the use of a compound injectable apomorphine that will induce vomiting within 2 to 3 minutes of administration.
In June of this year the The FDA approved the use of ropinirole eye solution (Clevor, Orion Corp) for the induction of vomiting in dogs. In a field efficacy clinical study in which Clevor 100 customer-owned dogs were given to induce vomiting of their last meal (no toxins or noxious objects were given to the dogs). 95% vomited within 30 minutes. Vomiting occurred in 86% of the dogs after the first dose. “This is a good option if you have a canine patient who is constantly busy with things. It can be useful for the customer to have these drops at home, ”said Hughston.
While apomorphine is very useful in dogs, it’s not an effective emetic in cats because cats don’t have as many dopamine receptors, she said. Veterinarians often spin cat patients to make them dizzy and cause them to vomit. “But there are more effective options,” said Hughston. Alpha-2 agonists, including xylazine or dexmedetomidine, are better choices.
Hughston also highlighted a 2019 study published in the Journal of Veterinary Emergency and Critical Care that examined the effectiveness of hydromorphone in inducing vomiting in cats. The researchers found that vomiting was successful in 75% of the cats treated with hydromorphone (0.1 mg / kg subcutaneously), resulting in less sedation and a smaller decrease in heart rate.
Emesis isn’t always the answer
There are certain instances when vomiting could prove dangerous, warned Hughston. This is especially true if a patient is vomiting, has difficulty breathing, or has ingested caustic or caustic agents that can damage the GI tract.
If vomiting is not encouraged, Hughston offered several alternatives to remove or dilute the toxicity:
- Adsorption: Activated charcoal can be administered in many cases of toxicity to prevent absorption from the GI tract. The charcoal adsorbs certain toxic substances and facilitates elimination.
- Kathartika: Sorbitol, lactulose, magnesium salts, or fiber can be used to speed up the transport of a toxin through the GI tract. The increased speed reduces the chances of absorption in both the large and small intestines.
- Dilution: Induction of vomiting is contraindicated when caustic or caustic agents are ingested. Instead, it needs to be diluted with milk or GI coatings (e.g. magnesia milk). “Don’t forget the value of IV fluids as both a toxin thinner and a supportive measure in patient care,” she added.
- Gastric lavage: Ingesting hydrocarbons, corrosives, or very deadly toxins may require gastric lavage, Hughston said. Gastric lavage requires general anesthesia and must always be performed with a tied endotracheal tube to protect the airways from both the irrigation fluid and gastric contents.
- Operative removal: If the poison is solid (e.g., intact batteries, pennies), endoscopic or surgical removal is the most effective way to prevent absorption.
Regardless of the toxin, supportive treatment is essential for positive patient outcomes. “Veterinarians who are familiar with toxicology concepts and treatments are critical to ensuring that patients recover with minimal long-term effects,” Hughston reminded participants.
Amanda Carrozza is a freelance writer and editor based in New Jersey.