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VLPP Newsletter Archive
VLPP Newsletter, Winter 2007
Issue #22Welcome to the Veterinary Lifeline Partner Program newsletter, brought to you by the ASPCA Animal Poison Control Center. ContentsJob Opportunities at ASPCA-APCC Looking for a Change of Pace?Considering an alternative to private practice? Interested in specializing and obtaining specialty board certification? Enjoy working in a fast-paced, challenging environment where you learn something new every day? Enjoy having the support of board certified specialists? The ASPCA Animal Poison Control Center continues to grow, and we are currently searching for veterinarians to join our team of experts, which includes 13 board certified toxicologists. Of our 28 veterinarians, 13 are board certified in general (ABT) and/or veterinary (ABVT) toxicology, and most received their training by working at the APCC. Our veterinarians are assisted by an excellent support staff that includes 9 certified veterinary technicians and 5 full-time veterinary assistants. 2008 Fee IncreaseBeginning January 1, 2008, the ASPCA Animal Poison Control Center will be increasing the fee for consultations by $5 per case. Individual credit cards will be charged $60, while VLPP clinics with credit cards on file will be charged $55, reflecting the $5 discount that VLPP clinics receive. Billing (individual and VLPP) will likewise increase by $5. What’s New on the APCC Website?Steer your clients to the ASPCA Animal Poison Control Center website, where they can view a video of our Senior Vice President, Dr. Steve Hansen, explaining the hazards of items that tend to be around the house during the holiday season. Useful Websites for the SeasonInformation for you and your technical staff can be found on our website courtesy of Veterinary Technician:
Did You Know?A recent survey of over 68,000 non-mixed breed dogs exposed to potentially toxic agents showed that Labrador retrievers were the number one breed when it comes to getting into potentially toxic agents (ASPCA Animal Poison Control Center AnTox database). No surprise here, right? But you might be surprised to know that when compared to the breed’s relative popularity (also #1), Labradors are NOT more likely to be involved in accidental poisonings when compared to other breeds. Labradors make up approximately 15% of all breeds registered with the American Kennel Club (AKC), and they account for 17% of all canine exposures to potentially toxic agent—the 2% difference is not statistically significant. So it would seem that we don’t see more poisonings in Labradors due to their propensity to get into things, but rather that there are more Labradors around! And Did You Know?So, what breeds appear more likely to get into things when compared to their overall popularity? Based on calls to the APCC, Chihuahuas rank 6th in number of calls on poisonings, but rank 11th in AKC registration. Likewise, Bichons frises rank 26th in registration yet 15th in poisoning calls; Australian cattle dogs are 35th in poisoning calls but 70th in registration; Dalmatians are 36th in poisoning calls and 77th in registration, and Portuguese water dogs are 37th in poisoning calls and 71st in registration. Which breeds appear less inclined to get into potentially toxic situations? Yorkshire terriers ranked 3rd in registration but 8th in poisoning calls; Great Danes are 38th in poisoning calls, yet 24th in registration; Bullmastiffs are 72nd in poisoning calls, yet 42nd in registration, and St. Bernards are 76th in poisoning calls, yet 37th in registrations. Winter Hazards
Moderate toxicity: (may cause significant signs beyond mild gastrointestinal upset)
High toxicity: (potential for very serious or life-threatening signs)
Now that the colder months are upon us, snow and ice are sure to follow. Soon folks will use a variety of ice melt products to keep their sidewalks and driveways safe. House pets can accidentally be exposed to these types of products and experience potentially serious problems because of that exposure. There are several common ingredients in most commercially available ice melt products, including sodium chloride, potassium chloride, magnesium chloride, calcium salts and urea. Sodium Chloride: Sodium toxicosis is possible after large ingestions of ice melts, salt, or rock salt. A dose of 4 g/kg of sodium chloride can be lethal in dogs. Ingestion can cause gastrointestinal signs, PU/PD, hypernatremia leading to tremors, seizures, tachycardia and metabolic acidosis. Treatment of acute (< 24 hours duration) sodium chloride toxicosis involves administration of parenteral fluids, water enemas, and managing clinical signs (e.g. diazepam for seizures). The intravenous fluid of choice is either half strength saline + 2.5% dextrose, or 5% dextrose in water. Furosemide may help prevent pulmonary edema during fluid therapy. Warm water enemas (5 ml/lb) may also be used to drop the sodium level. For hypernatremia of greater than 24 hours duration, it is important to correct sodium slowly over a period of 48 to 72 hours in order to avoid cerebral edema. The sodium should not be lowered at a rate of more than 0.7 mEq/L/hr. Sodium bicarbonate should be used cautiously when treating acidosis so as not to exacerbate hypernatremia. Potassium Chloride: Ingestion of this ingredient can cause severe irritation to the GI tract, including hemorrhage. Hyperkalemia can also occur, primarily in patients with renal insufficiency. Signs associated with hyperkalemia are vomiting/diarrhea, weakness, hypotension, and abnormal cardiac conduction.Treatment usually begins with dilution, as induction of emesis is controversial. Fluids (LRS or saline) and furosemide or hydrochlorothiazide are used to treat the hyperkalemia. Other recommended treatments include monitoring of electrolyte, glucose and renal function. Magnesium Chloride: Hypermagnesemia can occur after ice-melt ingestion. Hypermagnesemia can cause hypotension, hypophosphatemia, cardiac abnormalities (atrioventricular block, prolonged QT intervals, and bradycardia), weakness, and impaired neuromuscular transmission. Patients with renal insufficiency are more susceptible to developing hypermagnesemia. The LD 50 of magnesium chloride in rats is about 4,000 mg/kg. Dust from products containing magnesium may be irritating and can cause upset stomach. Treatment of magnesium salt ingestion is symptomatic and supportive. Emesis may reduce the amount absorbed if induced within two hours of ingestion. Calcium Carbonate and Calcium Magnesium Acetate: Acute ingestion of calcium salts is unlikely to increase serum calcium concentrations, because of the requirement of an acidic pH, parathyroid hormone, and vitamin D for absorption.The calcium carbonate and calcium magnesium acetate forms are irritants, and can cause gastritis, while the calcium chloride form is capable of causing severe irritation, including hemorrhage. Treatment is symptomatic and supportive, including treatment for severe mucosal irritation (e.g. sucralfate slurries) with exposure to the calcium chloride form. Urea: Monogastric animals are not susceptible to urea poisoning but may exhibit increased blood ammonia concentrations. Ruminants and large-bowel fermenters are susceptible because their intestinal microflora provides an ideal environment for the hydrolysis of urea, releasing carbon dioxide and ammonia. Ingestion of urea by dogs usually results in local irritation, and signs of hypersalivation, gastroenteritis and abdominal pain. Less frequent signs include methemoglobinemia, weakness and tremors. Managing urea ingestion in monogastric animals includes inducing emesis and monitoring electrolyte values. Practice TipsThere continue to be questions about the usefulness of the newer 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 a problem in cats. The 50 mg/dl pad is useful in determining whether treatment is necessary in dogs. It is also important to know that the KACEY test kit will test positive with the presence of any alcohol, including sugar alcohols such as xylitol, so the risk of false positives is higher than with the older PRN test. And remember, propylene glycol (found in some injection solutions) and activated charcoal may give you a false positive with either EG test, so always get your blood sample prior to giving these agents. When in doubt, a blood sample should be submitted to a human hospital for quantitative evaluation—the tests run there are highly sensitive and specific. Case Study
Question 1: What treatments will you recommended at this time? a. Bathe with liquid dishwashing detergent b. Dilute with milk or tuna juice c. Induce vomiting with hydrogen peroxide and call back d. a and c e. a and b Answer: e Question 2: The owner tells you that she is leaving in a few hours to go on a trip. A pet sitter will check on the cat once a day starting tomorrow. You call the APCC and talk with Dr. Donna Mensching, who gives you fast and accurate information about liquid potpourri. Her recommendations regarding this case will likely include which of the following? a. It should be fine to leave the cat alone until the pet sitter comes tomorrow. b. We are likely seeing the maximum effects by this point in time (a few hours post exposure). c. Signs should be limited to mild dermal and GI irritation. d. Toby should be hospitalized, as liquid potpourri products have caused serious illness in cats. e. a, b and c Answer: d. Liquid potpourri products may contain essential oils and cationic detergents. Of the 352 cases the APCC has helped manage since 2001, most of these cases have involved cats, likely because cats have greater access to the simmer pots, which are usually kept on countertops or other high-level surfaces. The majority of significant exposures to liquid potpourri in cats occur when the product is spilled, and cats get the product on their coats and groom it off. Essential oils in liquid potpourris can cause mucous membrane and gastrointestinal irritation or ulceration, central nervous system depression, and dermal hypersensitivity and irritation. Aspiration pneumonia is also possible. Severe clinical signs can be seen with potpourri products that contain cationic detergents. Dermal exposure to cationic detergents can result in erythema, edema, intense pain and ulceration. Clinical signs from ingestion of cationic detergents may not develop immediately, and it may require up to 12 hours for the full extent of tissue damage to become apparent. Signs resulting from ingestion of cationic detergents may include depression, hypersalivation, anorexia, oral inflammation or ulceration, dysphagia, vomiting (± blood), abdominal pain and melena. Significant hyperthermia (>104 F) may accompany oral inflammation. Esophageal and/or pharyngeal ulceration may occur. Systemic effects such as hypotension, weakness, fasciculation, seizures, coma and metabolic acidosis are also possible from cationic detergents. Sequelae can include esophageal perforations or strictures, and pleuritis or peritonitis from leakage of ingesta through perforated mucosa. Question 3: What treatment recommendations will be made by Dr. Mensching in this case? Answer: As with ingestion of any potentially corrosive agent, emesis should NOT be induced, nor should activated charcoal be given. Complete evaluation of the oral cavity and pharynx for ulceration or irritation should be performed upon presentation of the cat to the veterinarian, although with very recent exposures the oral cavity may appear normal. Evidence of oral discomfort and inflammation generally develops within 2 to 4 hours, although the full extent of injury may not be evident until 12 hours post exposure. Should mucosal burns develop, treatment should include antibiotics, pain medication as needed, gastrointestinal protectants (e.g. sucralfate slurries or suspensions) and general supportive care. In cases with severe oral burns or esophageal burns, placement of a gastrotomy tube will facilitate nutritional support while allowing for mucosal healing. Symptomatic care for systemic effects (e.g. fluids for hypotension, diazepam for seizures) should be provided as needed. Not a VLPP Member?If you are not a member of the Veterinary Lifeline Partner Program and would like to join, please click here or call (888) 332-3651 to be prepared for any poison emergency. Authors: Editor: |
The owner of Toby, a healthy, seven-year-old neutered male DMH cat,
calls your busy practice. She found an overturned pot of liquid
potpourri and a spot of vomit on the carpeting. She said that Toby
seems fine, but his fur smells like potpourri, and she is concerned.
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