Toxicology 4

Front 1

what are common exposure scenarios?

Back 1

animal has been exposed to a known toxicant, animal has been exposed to an unidentified toxicant, animal is showing clinical signs due to an unknown cause for which toxicants should be included in a differential diagnosis

Front 2

what do you need to figure out on an exposure?

Back 2

establish exposure dose, compre dose with specific toxicity information about a chemical

Front 3

what should you remember most in treating an exposed patient?

Back 3

treat the patient not the poison! The identity of the poison is important in managing a poisoning, estimated there are 30k species of plants where 300 are significantly injurious, 300k household products, 50k prescription drugs, 100k nonprescription drugs

Front 4

what are general principles for treatment of toxicant exposure?

Back 4

goals for the management of acutely poisoned animals include: stabilization of vital signs, ongoing clinical evaluation, prevention of continued exposure to the toxicant, administration of an appropriate antidote, facilitation of the removal of the absorbed toxicant, supportive therapy

Front 5

what should be done in the first few minutes?

Back 5

life support (patent airway, adequate ventilation, prevent vomitus aspiration, seizure control, fluid/acid base status, control body temperature, manage CNS depression), dilution, ocular irrigation

Front 6

how do we do dilution?

Back 6

rapid dilution: water or milk, management of corrosive ingestions (GI protectorants and demulcents), neutralization of the corrosive with vinegar, sodium bicarbonate, etc in contraindicated

Front 7

how do we treat acid corrosives?

Back 7

acids: ingestion (oral and esophageal irritation, pain on swallowing, mucous membrane burns, epiglottal edema-dyspnea, esophageal necrosis and stricture), Tx: emetics No, dilution yes (but must be rapid), steroids-controversial, bougienage-esophageal strictures, neutralization with acid or base-No)

Front 8

how do we treat alkaline corrosives?

Back 8

alkalies: sodium hypochlorite, socium hydroxide, button batteries, ingestions (more severe vs acids, mucous membrane burns, esophageal necrosis/stricture-can occur w/out any evidence of injury in the oral cavity)

Front 9

what are symptoms of dermal exposure to acids or alkalies?

Back 9

pain, edema, wash with water, more penetrating injury with bases (saponifiction of skin fat occurs)

Front 10

describe ocular irrigation?

Back 10

irrigation of chemically injured eyes with water or physiological saline solutions should never be delayed, a minimum of 2-30 minutes of water irrigation is recommended, the use of neutralizing agents (eg boric acid) is not recommended

Front 11

what should be done in the first few hours?

Back 11

decrease absorption (bathe animal, emetics, activated charcoal-cathartics), increase excretion (diuresis, ion trapping), antidotal therapies, life support

Front 12

what measures may be taken to reduce absorption?

Back 12

absorption occurs along a concentration gradient-treatments that reduce this gratient will result in reduced absorption: emetics/lavage, absorbents, dilution, cathartics

Front 13

what measures may be takent to reduce dermal exposure?

Back 13

mild hand washing detergent shampoo, mixed dermal and oral exposure

Front 14

how are emetics used for exposures?

Back 14

emetics are most effective when administered as quickly as possible after toxicant ingestion and when food is present in the stomach, can remove 30-60% of the chyme from the stomach when vomiting successfully occurs

Front 15

what emetics should be used?

Back 15

salt (sodium chloride) is never indicated as an emetic (unreliable, salt toxicosis), syrup of ipecac (avoid using the fluid extract of ipecac-cardiotoxic, 1-2ml/kg for dog, 3.3 ml/kg for cat), apomorphine (as effective as syrup of ipecac, can induce CNS toxicity, 0.03 IV or 0.04mg/kg IM for dogs, give as eyedrop as well, xylazine (as effective as syrup of ipecac: 1.1 mg/kg, IM/SQ for cats), hydrogen peroxide (high volumes, use turkey baster at home)

Front 16

what are contraindications of emetics?

Back 16

dyspnea, hypoxia, seizures, coma, or abnormal pharyngeal reflexes, corrosive agents, volatile hydrocarbons (emesis is rarely recommended with ingestion of low viscosity hydrocarbons-gasoline, xylene, toluene, lighter fluid, and mineral seal oil), species that can not vomit (horses, rodents, rabbits)

Front 17

how do we treat toothpaste ingestion?

Back 17

calcium in milk decreased fluoride ingestion