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47 Cards in this Set
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- Back
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General Tx Strategies:
GI protectant drugs |
H2 Blockers (famotidine, cimetidine...)
PPIs (omeprazole) PG analogs (mesoprostol) Sucralfate (coating) |
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General Tx Strategies:
Antiemetic drugs |
5HT3 (Serotonin) Antagonists (Ondansetron)
DA Antagonists (Metaclopramide) NK1 Antagonists (Cerenia) Phenothiazines (chlorpromazine) |
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General Tx Strategies:
Antiepileptic drugs |
Benzodiazepines (valium)
Barbiturates (thio, phenobarb) Anesthetics (propofol CRI) |
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General Tx Strategies:
Muscle Relaxant drugs |
Methocarbamol
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Organs most commonly affected by household hazards? (4)
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1. GI
2. CNS 3. Renal 4. Neuromuscular |
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What are your dangerous household Acids?
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Cleaning Agents
Anti-Rust Pool Sanitizers Car Batteries |
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What do the acids do?
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Local Coagulative Necrosis with Immediate, Severe Pain
Signs depend on location exposed (oral, dermal, inhaled, ocular) |
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How do you treat acids?
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Dilute (water or milk)
do NOT Neutralize! (exothermic rxn) **strictures are possible - giving potentially LONG-term sequela, so check back in. |
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What are your dangerous household Alkali agents?
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NaOH, KOH, NH4OH, KMnO4
(Drain openers, Dishwashing Detergent, Batteries, Toilet Bowl Cleaners, Pool, Radiator agents) |
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What do the alkali agents do?
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Rapid tissue Liquefactive Necrosis. Little pain initially, develops over 2-12 hours
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How do you treat alkali exposure?
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Dilute
do NOT Neutralize! (exothermic rxn) **strictures are possible - giving potentially LONG-term sequela, so check back in. |
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Kitchen Hazards:
Chocolate / Cocoa What is the toxin? |
Methylxanthines (Theobromine and Caffeine mostly -- also Theophylline)
Darker the Chocolate, the more Methylxanthines. |
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Kitchen Hazards:
Chocolate / Cocoa How does it impact animal? |
Upper
Inhibit Ca sequestration Antagonizes Adenosine-R's (vasoconstrxn, tachycardia) PDE inhibitor --> inc. cAMP |
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Kitchen Hazards:
Chocolate / Cocoa When will you see clinical signs? |
Usually within 1 minute for most methylxanthines - but Chocolate is absorbed slower (up to 10hrs)
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Kitchen Hazards:
Chocolate / Cocoa What are the clinical signs? |
Hyper-everythign (alert, stimuli)
Vomiting / Diarrhea PU/PD Muscle Twitching, Seizures Hypokalemia Tachycardia, Arrhythmia Hypertension Hyperthermia Coma |
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Kitchen Hazards:
Chocolate / Cocoa How do you Tx? |
Decontamination (AC x)
Supportive Care (Tachy/PVCs - B-Blockers, Lidocaine) *Catheterize as methylxanthines can be reabsorbed from bladder |
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Kitchen Hazards:
Grapes/Raisins |
Renal Failure in Dogs and Cats
(unknown pathogenesis) Tx: Emesis, AC, Diuresis Monitor Renal for 3 days Guarded Prognosis with ARF |
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Kitchen Hazards:
Xylitol (sugar substitute - Trident, sugar-free puddings, toothpastes) |
Strong Insulin Stimulator in Dogs -- Hypoglycemia in 5mins-18hrs
OR Hepatic Necrosis w/in 8-12hrs 1-2 sticks of trident can be toxic to a 10kg dog Tx: Emesis, Supportive Care AC not effective |
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Kitchen Hazards:
Moldy Food |
Tremorgenic Mycotoxins (Penetrim A, Roquefortine C) from Penicillium
Tx: Asymptom - Emesis, AC Symptoms - Supportive Care (Antiepileptic, M. relaxant) (signs may persist up to a week) |
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Bedroom/LivingRoom Hazards
Mothballs |
Napthalene
Heinz bodies, Hemolysis, metHg-emia --> emesis, icterus, collapse Paradichlorbenzene Liver and CNS --> GI upset, ptyalism, ataxia, tremors, seizures Tx: Supportive Care |
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Bedroom/LivingRoom Hazards:
Coins/Pennies |
1983-Present = 99% Zinc
Stomach Acids leach Zn -> Zn absorbed -> IV Hemolysis (Hg-emia/uria, icterus) Tx: Emesis, Go in and Get 'em, Chelation, Supportive Care |
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Bedroom/LivingRoom Hazards:
Lead Where do you find it, and what does it do? |
Old paints/toys/fishing-tackle/golf-balls/plumbing material
Pb decreases RBC stability --> Regen Anemia, Basophil stippling, nRBCs, hemolysis |
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Bedroom/LivingRoom Hazards:
Lead Clinical signs? |
3-15 days post ingestion
GI and CNS signs Vomiting, Anorexia, Vocalization, ~paresis, ~megaesophagus |
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Bedroom/LivingRoom Hazards:
Lead Dx? Tx? |
Dx - Blood-Pb levels...or X-ray
Tx - Decon/Cathartic, Remove sources of Pb, Chelation, supportive care |
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What's Chelation Therapy?
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Succimer (dimethylmercaptosuccinic acid)
Oral Tx that chelates Pb (NOT Zn) and excretes it in the Urine. Ca-EDTA - SubQ, okay for Pb or Zn |
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Sources of Ethylene Glycol?
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Antifreeze:
Automobiles, Toilets, Industrial Solvents, Rust Removers, Color Film Processing Fluids, Heat Exchangers ...Taste Sweet |
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Margin of Safety for Ethylene Glycol:
Dog? Cat? Human? |
Dog -- 2-6 mL/kg
Cat -- 2-4 mL/kg Human -- 1.5 mL/kg |
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Okay, so... what exactly IS ethylene glycol?
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An alcohol
causes inebriation and mild gastritis (worry if owner says "my dog is acting drunk") |
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So then why is this alcohol a problem?
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Absorbed FAST and Alcohol Dehydrogenase converts it into GLYCOALDEHYDE (CNS dysfnxn)
Then metabolized to GLYCOLIC ACID (metabolic acidosis) and then to GLYOXYLIC ACID and finally Hippuric, OXALIC (with Ca --> ARF), and Formic Acids. |
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Review - General fx of:
A. Ethylene Glycol B. Glycoaldehyde C. Glycolic Acid D. Oxalate + Ca |
A. Happy Drunk
B. Ugly Drunk (alters glucose, serotonin, cell respiration) C. Metabolic Acidosis D. Ca-Oxalate Crystals --> ARF (and hypocalcemia) |
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3 Phases of Ethylene Glycol Tox:
Phase 1 |
usually 1-4hrs (up to 12)
nausea, vomit, CNS depression, ataxia, tachycardia, PU/PD, dehydrated Good Drunk turning to Bad Drunk |
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3 Phases of Ethylene Glycol Tox:
Phase 2 |
4-24hrs after ingestion
Metabolic Acidosis increased RR, cardiac conduction disturbance, coma, convulsion, death |
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3 Phases of Ethylene Glycol Tox:
Phase 3 |
24-72 hrs later
Oliguric Renal Failure, Anorexia, Vomiting --- typically past the point of no return at this point. |
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Clin Path for catching Ethylene Glycol early?
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Increased Anion Gap
(AG = Na - (Cl+HCO3) (unmeasured anions - Lactate, GLYCOLIC ACID, GLYOXYLIC ACID) - increases up to 50 (normal ~20) |
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When can you catch these Anion Gap increases?
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Increased by 3hrs
Peaks at 6hrs Remains elevated 48hrs |
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How do you calculate Osmolality?
How do you measure osmolality? |
Na*2 + BUN/2.8 + Glucose/18
Measure via Freezing Point Depression of Serum |
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Osmolar Gap
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Measured Osmol - Calc Osmol
Normal is < 10mOsm / kg |
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Osmolar Gap in animals that consumed Ethylene Glycol?
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150 to 450
(ie - there are extra uncharged particles in the plasma --- Glycolic Acid, Glyoxylic Acid) Osmolar Gap x 5 = ~[serum EG] |
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Urine signs indicative of Ethylene Glycol?
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Monohydrate Ca-Oxalate Crystals
(dihydrate too, but dihydrate may be normal) |
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Difference bw monohydrate and dihydrate crystas?
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Monohydrate - Indicative of EG - looks like Picket Fence piece
Dihydrate - loos like envelope |
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Blood Tests to detect EG Metabolites...
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either have a lot of False Positives or are not sensitive enough
...don't trust them. Gold Standard - send to Tox Lab to analyze, but usually no time for that. |
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Treatment for EG animals?
General |
Emesis no good (absorbs immediately) (and they usually vomited on their own)
Support for convulsion/seizing/arrhythmia/Acid-Base/Urine Flow/Serum-Ca/*DIALYSIS* |
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Treatment for EG animals?
Specific Drugs |
Ethanol - competitive substrate for Alcohol DeHydrogenase
Fomepizole (4-MP) - ADH inhibitor |
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Ethanol Administration
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within 8hrs
20% soln or 7% soln, (100proof = 50%) 24-72hrs worth of infusions Keep up with their outs - keep them alive. Vodka diluted in filtered IV line is okay. |
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Fomepizole
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works great for dogs w/fewer side fx
Not approved for cats (unless really high doses within 3hrs of ingestion) |
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Overall -- what do you do when a EG toxic animal enters your ER?
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Get a vein!
Collect for CBC/Chem/Blood-Gas/EG-analysis/Osmol PCV, TS, Dipstick, BG, Ca UA Place Urinary Cath - Match Fluids in and Out Administer 4-MP or Ethanol Dialysis Monitor |
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Prognosis for Ethylene Glycol?
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Good if caught early
...poor, very poor, if not |
