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VLPP Newsletter Archive
Winter 2006
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Issue #18 Welcome to the Veterinary Lifeline Partner Program newsletter, brought to you by the ASPCA Animal Poison Control Center. ContentsOpportunities for Continuing Education Opportunities for Continuing EducationCE for Veterinarians The ASPCA Animal Poison Control Center is offering six hours of RACE-approved CE credits in Toxicology and Behavior via our online course to be held on Tuesday, January 23, 2007. This course is offered free to our VLPP members. The Toxicology topics (presented by APCC toxicologists) that will be covered are: Antifreeze Toxicosis, Common Household Hazards, and Hot Topics in Clinical Toxicology. The Behavior topics (presented by ASPCA certified Behaviorists) are: Anxiety in Dogs, Housesoiling in Cats, and Puppy Socialization and Restraint Training. Each topic offers one hour of approved Continuing Education; sign up for as many as you like. More information and registration information will appear on case summaries shortly and will be available in the next VLPP newsletter. And, coming soon to our website: opportunities to receive online approved CE credit. Stay tuned for details! CE Conference for Veterinary Technicians The ASPCA is pleased to announce that the 1st Annual ASPCA Continuing Education Conference for Veterinary Technicians will be held on Saturday, May 19th from 8:00 A.M. to 4:30 P.M. The conference will be held at the ASPCA’s Midwest Office in Urbana, IL. Topics will include animal behavior and veterinary toxicology. Help Us Help You!The hotline staff at the ASPCA Animal Poison Control Center wants to be able to provide you with the best information in a timely and efficient manner so that you can focus on the management of your patient. In order that we may obtain the information that we need to assist you with your case, please have the patient’s case record on hand when you call so that we may quickly gather signalment and owner information for our medical records. If the case record is not available, please have the following information available to provide to our staff: species, breed, sex, reproductive status, age, weight, patient name, owner name and any significant prior health issues. What’s New on the APCC Website?For hints on holiday poison prevention tips, point your clients to the press release on the ASPCA website. And for a fun way for children (and perhaps some adults) to learn of other household hazards, have your clients check out the interactive game featuring Cooper, the careful canine. A list of Toxicology Briefs, encompassing a wide variety of toxicants, is available in the Poison Control area of the ASPCA Professional website by clicking the link for Poison Control Resources For Vets. The newest additions to the list include:
Get a behind-the-scenes look at the APCC by checking out the May 2006 Toxicology Brief (.pdf) from Veterinary Technician written by Tamara Foss, CVT. Hot Links for the SeasonInformation for you and your technical staff about holiday hazards can be found on our website courtesy of Veterinary Technician:
Hot Links for any SeasonA handy Internet drug reference is RxList, where you can search by drug name and get information on most human medications. Winter Hazards for PetsWinter brings cooler temperatures, holidays and seasonal hazards. Listed below are a few examples of potentially hazardous items that pets might encounter during this time. Low Toxicity: (may cause gastrointestinal upset, but unlikely to cause serious problems unless very large amounts are ingested)
Moderate toxicity: (may cause significant signs beyond mild gastrointestinal upset)
High toxicity: (potential for very serious or life-threatening signs)
Practice Tips—Ethylene Glycol Testing
Holiday Reminder for Pet Owners
1. Keep all medications, OTC products, and herbal products in fully labeled containers with tightly sealed lids and store out of reach of pets. 2. Count out the number of pills in the containers and keep track of how many have been used. 3. Keep purses, toiletry bags, and pill minders safely away from pets. Do not leave medications in open suitcases in areas accessible to pets. 4. Don’t leave medication in pants pockets, coat pockets or on plates of food. 5. When taking medication, do so in a room with the door closed, away from pets to prevent ingestion of dropped medication. Medical Update—XylitolXylitol is sugar alcohol used as a sugar substitute in a variety of products, from sugar-free gums and baked goods to toothpastes. Because an increasing number of consumer products contain xylitol, clinicians should be aware that ingestion of xylitol by dogs can have serious, life-threatening effects. In humans, xylitol has little to no effect on plasma insulin or glucose levels, but in dogs, xylitol is a strong promoter of insulin release, and can cause severe hypoglycemia, with ataxia, collapse and seizures. Some dogs have presented weak, depressed, recumbent and hyperglycemic, a condition is thought to be due to a Somogyi effect; in these patients the BG drops later on in the clinical syndrome. Some dogs with severe toxicosis have developed liver failure within 72 hours of ingestion of xylitol-containing products. Some sugar-free chewing gums contain xylitol as the sole sweetener, but the majority contain other sugar alcohols. For those with xylitol as the sole sweetener, the number of grams of sugar alcohols can be read off of the nutrition label, and that value used to calculate a dose of xylitol. For gums containing more than one sugar alcohol and where xylitol is far down the list of ingredients, an estimate of xylitol content is 0.3 grams (300 mg) of xylitol per piece. Dosages of xylitol exceeding 100 mg/kg may cause hypoglycemia, and >500 mg/kg have been associated with liver damage. These dosages are based on clinical cases reported to the ASPCA Animal Poison Control Center and may not necessarily reflect the minimum toxic dose for all individuals. The relative sensitivity of cats to xylitol is not known. The most recent published article about xylitol toxicosis is: Eric K Dunayer, Sharon M Gwaltney-Brant. Acute hepatic failure and coagulopathy associated with xylitol ingestion in eight dogs, J Am Vet Med Assoc. October 2006;229(7):1113-7. Did You Know?A recent study out of the University of Tennessee, Knoxville, Dept. of SA Clinical Sciences, College of Veterinary Medicine, suggests that, contrary to popular belief, the use of acepromazine does not lower the seizure threshold in dogs. (A retrospective study on the use of acepromazine maleate in dogs with seizures, J Am Anim Hosp Assoc. 2006 JulyAug; 42(4):283-9. Karen M Tobias, Katia Marioni-Henry, Rebecca Wagner) Hotline HumorObviously somewhat embarrassed, a woman called the ASPCA Animal Poison Control Center and confessed that her cat had been trapped in a diaper pail all night. She was concerned because the deodorizer used in the diaper pail contained paradichlorobenzene and it was listed on the product label as being carcinogenic in California. She wondered if this product could be harmful to her cat and asked if the product was carcinogenic in any other states. Case Study
What is the first action that should be taken with regard to this case? a. Induce vomiting and administer Toxiban® with sorbitol b. Run an ethylene glycol test immediately after giving activated charcoal c. Bathe the dog and have the owner go back home for the container. d. Check the fur with a Wood’s lamp. If it is negative, send the dog home. Answer: The best answer is C. It is important to know what type of antifreeze to which the dog was exposed. The three most common ingredients in antifreezes are ethylene glycol, propylene glycol, and methanol, all of which differ in use, risk and approach to treatment. Generally alcohols are absorbed quickly, and decontamination may be of minimal benefit after the first 30-40 minutes. Toxiban® with sorbitol should not be given prior to drawing blood for the ethylene glycol test, as the propylene glycol in the Toxiban® can give false positive to the test. The owner returns with the bottle, and you determine what the dog had ingested was Prestone Gas Line Antifreeze containing 100% methanol. You call the ASPCA Animal Poison Control Center and consult with Dr. Hany Youssef, who is ready to give rapid and expert information. What treatments will be recommended by Dr. Youseff? a. Tell the owner that the dog is at risk for metabolic acidosis and blindness. Administer Fomepizol (4- methylpyrazole;Antizol), a specific antagonist of alcohol dehydrogenase. b. Admit dog for monitoring on fluids c. Both A and B Answer: B. Methanol’s metabolite, formaldehyde is rapidly oxidized by aldehyde dehydrogenase to formic acid (formate), which can cause metabolic acidosis if significant quantities are ingested. Treatment of methanol toxicosis with fomepizole is necessary in humans (and other primates) to prevent retinal and CNS injury, but is not indicated in non-primates, as they do not develop these lesions. Since the amount ingested is unknown, admitting the dog for monitoring and treating symptomatically would be the most appropriate management approach. What signs will you monitor for? Answer: vomiting, salivation, ataxia, inebriation, tremors, dyspnea, hypothermia, arrhythmias, coma, seizures, respiratory depression, aspiration pneumonia, hypoglycemia, and metabolic acidosis. Discussion: Methanol (also known as methyl alcohol or wood alcohol) is found most commonly in windshield washer fluid and varies in concentration from 20-100%. In general, alcohols are rapidly absorbed from the gastrointestinal tract. The minimum toxic dose in dogs is 8.0 g/kg (or 8 ml/kg). The most common exposures occur with dogs and usually involve chewing on containers or lapping up spills. Signs typically begin within 30-60 minutes of exposure and peak effect is generally within 2 hours of exposure. With small exposures in dogs and cats, only mild gastric upset is seen. Recent small ingestion, when the patient is asymptomatic, is treated with dilution (milk, water) that may help minimize gastric upset. In the case of a large ingestion, the animal should be monitored and treated for acidosis. Treatment may include IV fluids (diuresis), thermoregulation, respiratory support, correction of acidosis and hypoglycemia, and diazepam for seizures. In patients with severe CNS and respiratory depression, yohimbine or flumazenil can be tried. |
There have been questions about the usefulness of the “new” Kacey®
ethylene glycol test. There are three pads that detect blood levels at
20, 50, and 75 mg/dL. The 20 mg/dL pad may be useful in detecting
potentially toxic exposures in cats. The 50 mg/dL pad is useful in
determining whether treatment is necessary in dogs. It is also
important to realize that the Kacey test kit will test positive for
alcohols, including sugar alcohols (e.g. maltitol). So, unlike the
established PRN® ethylene glycol test, the Kacey®
test will be falsely positive if dogs or cats are exposed to windshield
washer fluid (windshield “antifreeze”) containing methanol. 
The
holidays are here, and there are many holiday dangers for pets. Tasty
chocolates, holiday feasts, visiting relatives/friends and houseguests
(who often bring along their medications) can present unanticipated
dangers for many pets.
Just
before leaving for lunch, a frantic owner arrives with his 3-year-old
dachshund mix who chewed up a partially full antifreeze container. He
thinks that the exposure was about an hour ago. There is antifreeze on
the garage floor and the dog smells like the product. The amount
ingested is unknown.
Do It Today!
