COMMON T XIN EMERGENCIES Tami Lind, BS, RVT, VTS(ECC) Dogs, cats, birds and most animals love to sink their teeth into something that is unknown to them. Unfortunately, this can lead to some major problems and land them in the emergency hospital for toxin ingestion. In 2018, the top 10 toxins that the ASPCA Animal Poison Control Center took calls on were over-the-counter medications; prescription medications; food such as xylitol, grapes, and raisins; chocolate; veterinary products; household items like paint and glue; rodenticide; insecticide; plants; and garden products. A clear patient history and owner’s trust is key to ensuring we can help their pet. If a pet comes into the hospital and a toxin is suspected, but the owners do not know what was ingested, you will have to treat based on symptoms alone. Vomiting, diarrhea, neurologic issues, distressed GI and hypersalivation are just some of the symptoms that can appear due to toxin ingestion. It is vital you ask the client about the possibility of drugs, cleaners, foods, plants and other poisons so that treatment can be as focused as possible. Decontamination is also a very important step when dealing with toxin ingestion. Decontamination is different for different toxins. Decontamination techniques can include bathing for topical toxins or the use of activated charcoal/emesis for ingested toxins. Supportive care after decontamination includes serial monitoring of vital signs and possibly diuresis, dialysis, and monitoring of kidney, liver, and electrolyte values.
Common toxins and treatments: Food:
Chocolate toxicity is most common in dogs. The clinical signs, caused by theobromide and caffeine, include vomiting and diarrhea, tachycardia, muscle tremors, seizures, coma, and death. Decontamination and the administration of activated charcoal are the first steps. Secondary steps would include IV fluid administration, if clinical signs warrant this measure. Propranolol can be prescribed to decrease heart rate, if necessary. With these calculations, you can easily figure out if the amount of chocolate ingested is toxic: • Milk Chocolate: wt (#) x 0.3 = oz needed for reaction • Dark Chocolate: wt (#) x 0.12 = oz needed for reaction • Baking Chocolate: wt (#) x 0.04 = oz needed for reaction Grapes and raisins are also a common food ingested by our canine patients. Unfortunately, the mechanism of action and toxic agent is unknown. These can cause gastrointestinal irritation as well as renal toxicity. The majority of dogs show clinical signs of vomiting 6 | FVMA ADVOCATE
Patient experiencing marijuana toxicity. Image courtesy of Tami Lind. within 24 hours of ingestion. Renal bloodwork changes occur within 24 hours of ingestion and declines around 48–72 hours. Decreased urine output and lethargy can occur after five days. When a patient first presents with grape toxicity, vomiting can be induced. Activated charcoal can be given, but there is limited evidence on if it actually is effective. IV fluids can help preserve the kidneys and keep the patient hydrated. Chemistry values should be monitored over 48 hours. If AKI persists, dialysis may be considered. Xylitol is a sugar substitute showing up in multiple products and people are using it more in baking and cooking over sugar. Xylitol can cause an insulin release in dogs leading to hypoglycemia. If patients ingest higher doses, it can lead to hepatic failure. The effect of Xylitol on cats is widely unknown. When patients come in that have ingested xylitol, vomiting may or may not be effective depending on when they ingested the toxin. Xylitol is absorbed into the body very quickly, so inducing vomiting can prove ineffective. If gum containing xylitol is ingested, inducing vomiting can be effective if the gum was ingested within a short
