Handbook of Small Animal Toxicology and Poisonings

211 Pages·1997·3.59 MB·English

by  Roger W. Gfeller DVM

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Roger W. Cfeller, DVM
Shawn P. Messonnier, DVM
A:
Airway
B:
Breathing
C: Circulation and consciousness
D: Diagnosis and decontamination
:
E Enhanced removal
I
AlRl,ltAY (p.z)
. Direct visualization Suction to clear ainvar rp" 5
. Listen Endotracheal intubation ,i, r
. Position head Tracheal intubation rp. >'
o Test gaglcough reflex (p. 4)
I
BREAIIIING (p.s)
. Blood gases, Ventilatory failure (p. 6r
pulse oximetry (p. 6) I Hypoxia (p. 12)
. Supplemental oxygen (p. 7) Bronchospasm (p. l3 r
. Ventilatory support (p. 9)
T
CARDIOI/ASCULAR AND CIRGUIAIION (P. I 4)
. Pulse rate, rhythm quality Hypotension (p. l6t
. Blood pressure Hypertension (p. 2l t
. Mucous membrane color
. Capillary refill time
.
ECG
. Urine production
I
coNsclousNEss (p.23)
r History Seizures (p.24\
. Physical findings Hyperthermia (p. 25r
r Laboratory findings Rhabdomyolysis (p.26'
Agitation, hyperactir-itr ,p- 'S
Stupor and coma (p. 29,
Hypothermia (p. 30r
7
HANDBOOK OF
Small Animal
Toxicotlogrq
Poisonings
HANDBOOK OF
Small Amimal
Toxicologk
WPoisonings
Roger W. Gfeller, DVM
Practitioner, Diplomate American College of
Veterinary Emergency and Critical Care,
Veterinary EmergencY Service,
Fresno, California
Shawn P. Messonnier' DVM
Practitioner,
Paws and Claws Veterinary HosPital,
Plano, Texas
N1| ff'Kwstuy
An I m pri nt of Elsevie r Sci e nce
St. Louis Philadelphia London Sydney
IYI vlosby
An I m pri nt of Etsevier Science
To our wives (Sandy Messonnier and Margie Gfeller) and our kids
A NOTE TO THE READER @rtca Messaonnniedr, 'H"'aoylq:Jt G!#fel:lefrr, rH#ea':thf rG'!fe:ll;eyr, ta*n d Scott Gfeller),
mtTiaTsio.hnh ecendedor ienfacnofauuorritrt rnihsecouio hnnarawg.s tn ev Tgca heornaiessndd c tviieonpsanm u npdtbc maorifnisorseatgrhing ,ieu dae.rlc o atochhrrutllaa y rvatak ecaitn -ryr*mp.ge ino aewrdiies.ter.uia ";t"eJ;*f;ivo.; ;e e;nwr.yri ;i-tt-i bh.-aJ e, tr"tnf,eoc, eimri"eewdp r r"to"f Jefrtio" - "roii a.# cirrr heilfIr-le'rtu"ly c]Hu ik.rur ir"-sd g "eo."r sdoarar u.rrdg.oorrevu.gs_gy"s_. whose tove And and resotve to
Copyright @ 1998 by Mosby, Inc. To the many patients who will be helped by caring professionals
utilizing the information contained within these pages
T. "No.part
mAstIoIe rer;idgu hi*nts, e ar elreseectri:itverivlotar.nl iscys,mteme, coorrfr ttahrainsn l;pcmuabitltlfieci;da;.t; io;in;ni la;m*n.vai yrf fnbfrier n r enprr ohd.,u oced,
,"i.'.t,1#*,r.,
without prior written permissio^n t om ifre publisher.
Ro$icPst.loe eh1psr0aemee rrrwa pimskneosiiocrnito teddpen asd cDg teoeorfnfi o v itprcsee ho ,rlpi o,pb aDtyrpoiadianrcn_orogvidvep,ei iridyrseos uecr,oc d.tl rhty o$t rhatenlha.sp_ .tr. O.ro. t!hpd"9tSeru r. ZcCtrufelro-." hr ps..h.yo girir,.eii g.rlgy. hroe .tofr nro.fCre arr$ rl. eaia.n*ral. ttoire idaodrr" n,noisp ecattesretli rb J noCuctorthie iptopa nnreepi,,rexf. esitrogfer,o 2nnrprar2dl,ul2 stuose
:lfiIlt:i.:r promotionar purposei, r5r crelting n.w coue"i.d works,
Printed in the United States of America
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Library of congress cataloging-in-publication
Data
Gfeller. Roger W.
GfHelalenrd, bSohoakw onf ps.m Ma-lle asnsimoanl ntoixeicro.l ogoyl a-nd poisonings / Roger W. /
p.
cm.
J1$3a9s UiUliographical references and index.
ISBN 0-8t5t-6454_8
l'
Dogs--Diseases--Treatment--Handbooks,
-Diseases--Treatment-_ -Handbooks, *u""ufr,'.mt.a ;n.u aills",r #etyc.' 2. cats-
Ptr.l sTgitlloe.gy- -Handbooks, manuals, .t.. i. r"r.rronnier. Shawn.
sF991.c494
IggT
6)6.O89'59__DC2t 97-42301
02t98765
Prefoce rti
Prefoce El il5ill,""o"o ffi il5il":"%d R Xl',1,.'""n'""''
Gastric IAVAGE ffi Value of gastric
*qX[, *o,
recommended I.AVAGE
recommended unknown
several years ago I (Shawn Messonnier) recognized that there was
literally no one reference for the veterinarian ireating the poisoned El tfflli:"i^' ffi tiHl"io'-*o, @ :illilSifivated
pet. when I proposed the idea for the book to orr. editor, Dr. paul
Pratt, he agreed that there was a definite void in the veterinary lit- recommended recommended unknown
erature in the area of treating small animal intoxications. with his lLlNr. ! ANTIDOTE exists #Wff i ruO known Value of ANTI-
guidance, our team was formed to address this shortcoming. Now ANTIDOTE DOTE unknown
with the completion of this text, veterinarians will have at their
disposal a handy reference to use when the need arises to treat the The text continues following a format that identifies the most
poisoned pet. we truly believe our book, Handbook of Small common sources of the poison and a brief description of its mech-
Animal Toxicology and poisonings, fills this void in our profession. anism of action. Next, the clinical signs are described in text form
- we have spent a great deal of time and energy completing this followed by a section on treatment. A list of signs is followed by a
book, doing our best to make sure it contains trr-" tut.rt and most quick guide to emergency treatment. In this area you will find
accurate information to help you in your practice. During the emergency procedures, insfiuctions for decontamination, anti-
course of this research, we discovered how little is truly known dotal and supportive care information, enhancement of elimina-
about treating poisonings in dogs and cats. Much of the literature tion procedures, and any precautions that are known'
is based on case reports and extrapolations from human literature. Section Three, Toxic Plants, provides an extensive index of
It is obvious that more research needs to be done in the field of common names of plants known to be toxic to small animals. After
veterinary toxicology. the index, each plant species is written up with a brief description
This book is organized to help the practitioner quickly get the of the known common names, the toxin or toxins produced by the
information needed to optimize probrem recognition urrd tr.ut- plant, and the part or parts of the species that are known to be
ment of the poisoned or intoxicated patient. section one, Rapid toxic. A paragraph describing clinical signs caused by the plant is
Patient Evaluation and symptomatic Treatment of the poisoned followed by known treatment recorrmendations.
Pet, is written to cover those nebulous instructions, ,,Give symp- Following Section Three are the appendices' Appendix A is a
tomatic support." using this section to identify and treat ,,p.ob- formulary of drugs often used in treating poisoned patients. We
lems" rather than a "diagnosis" will allow the practicing veteri- have taken great effort to assure that this section is accurate, but,
narian to handle most poisoned patients, even though the as with all the research we did, we found great variations in rec-
causative agent is unknown ommended dosage information. We chose the recommendations
In section Two, Toxic Drugs and chemicals, we have taken the that we could verify in referenced veterinary literature. Appendix
most commonly identified poisons and condensed the information B is the daily fluid requirements for dogs and cats. Appendix C is
that is known about each. Just underneath each agent, you will a series of "recipes" that will allow the veterinarian to accurately
find four icons. These icons are designed to provide ihe reader im- formulate and administer drugs by continuous intravenous infu-
portant information at a glance. (See page viii.) i sion. Appendix D is a flow chart that may be copied and used in
charting the course of treatment of the poisoned pet.
As with all written works, every effort has been made to pro-
vide true, factual, and accurate information. We welcome all com-
ments and advice. Although we predict that practitioners will find
this book extremely practical and useful, we know that any and
all criticism can only make the product better.
Roger W. Gfeller
Shawn P. Messonnier
rt
Acknowledgments
Contents
We first would ft"
ABAT, and his stalfgf asta yi_ra, .h ucg".e" ttthuar nks-to Brent Ekins, pharmD, ABC's of emergency care (Inside front cover)
jmccoooabonn ptadregoereras tccitoroeinp nf titinieondrn msina' awFwkarioeny sg mnt ootah ,g itsctee atp iru rifhoso j;retnh;c ieta i.ai l" rrsthyu_dc.c,cii a.-e tlusihgfsor.e rrigyrni.o" rieaoa,sr ulw .RsfTaa eryi. gs.sbsiao eissng'te.aoa.enln. mdcpe eot dihas eontoindr ASierwctaioyn 2 O . nBere,a ttRhrieanagp tidm5 poe anCttai erodnfi ottv heaesv capuloluaiars otisonyensdt ea mnp dae nstd y mcirpctuolamtoartyic I
Next, our colleagues at custer parkway Animal, plano, system 14 . Consciousness 23 . Diagnosis 3I o Decontamination 48
edreesnecrev em raetceoriganlsit.ion and our trrants tor providing additionaTle xreafs_, o Enhanced removal and elimination 58
nTMueomFrsiieb nMryao'e 'uyIrnsc, chwc' aowenm eta,m cpaukannnroidtciw accluteiaoldarnrgisl eyt v itn*thai resgtt erre rt"tidiovnit, go r* artiiyaht rrist rha atnewndxkh tsp od rm,oood nowu.i.ce.-t ipoh"n"'a" vls etpa rhfafa tord,f AS69ce ecrtt aiAomcniu ntToep Wohreogna, naTonpodhx opischp edhnrauategc esat iannn d6d o6 r cg. ahAnecoecmatorbnicaem a6a9lts e. Apcoiidsso nainndg a7l3ka .li6s5
Amitraz 77 . Amphetamines 79 . Antihistamines 82 . Antitussives
Roger W. Gfeller 84 . Arsenic 85 . Aspirin (acetylsalicylic acid, salicylate) 89 .
Shawn p. Messonnier Barbiturates 93 o Batteries 95 . Benzene 95 o Benzol 96 o Birth
control pills 96 . Bleaches 97 . Borates/Boron 99 . Botulism l0l .
Bromethalin 103 . Builders 106 . Carbon monoxide 107 .
Chocolate (theobromine) and caffeine poisoning 109 o Cocaine l13
. Coral snakes 115 o Crayons 118 . Cyanide I20 o Decongestants
I22 . DEET (N,N-diethyl-rn-toluamide) 124 e Detergents L26 .
Diatomaceous earth 131 r Dinoseb 132 . Diquat dibromide 133 .
Ethylene glycol 135 . Fertilizers 140 . Garbage and food intoxica-
tions I42 o Ginseng 145. Hashish 146. Herbicides I48. Hops 150
. Household cleaning products 152 . Hydrogen sulfide 153 .
Hymenoptera L54. Illegal drugs 157 o Insect and animal poisoning
158 o Iron I58 . Isopropanol (isopropyl alcohol) 160 . Ivermectin
(avermectins) 163 . Lead 167 . (+)-Limonene, linalool, crude citrus
oil extracts 172 . Local anesthetics 173 o Macadamia nuts 175 .
Marijuana 176 . Metaldehyde I78 . Metal poisoning 180 o
Methanol l8l . Methylene chloride l8l . Methemoglobinemia 181
. Mothballs I84 . Mushrooms 184 . Naphtha 186 . Naphthalene
(old-fashioned mothballs) 187 . Narcotics 189 r Nicotine I9l .
.
Nonsteroidal antiinflammatory drugs (NSAIDs) 193 Onion and
garlic toxicity I97 . Organic solvents and fuels 199 . Organo-
carbamate poisoning 2O2 o Organochlorines (chlorinated hydrocar-
.
bons) 202 Organophosphate-induced delayed neuropathy 205 o
Over-the-counter medications: cold and allergy remedies 206 .
Paradichlorobenzene (mothballs) 207 . Paraquat 208 o PCP 210 .
Penitrem A 2l I . Pennyroyal oil poisoning 2I3 . Persimmon toxi-
city 215 . Phencyclidine (PCP) 216 o Phenolics 218 e Pine oils 221 .
vili
tx
x
Contents
sTSPSSParotcyinirtcaor ytesvhprcp istlphoh2i oen2rr5noiri4n3sn e0s est'2 h t'ai22 vann3s4igntdo agse 'd m p2'ipay u3ionTrnm5eidos t oaD'htp ndrr hsioo rcpmoouihdosdslosoip esk rphoneo2alnt ea2itiictnen9nhih tgdyeosa il n s 2Rl2ae 5e2a2mtn0igt5oeta l5n e..s2 s T.5p2n2 o2rav43er ki7urt.sea e c.sT.mn r riesS2piic pntniyaii3 odcanr nrek<di.c er _ dtbsubourai"iutlrts,euregusisosisgaa l o2f .2r24p.a224r0rsi5g5r . 2, ,o c 2. ._33 .
rodenticides 25g 'vitamins 263 . Xylene and xyror 264 . zinc 264
Section Three, Toxic plants
269
(see pages 270 to 2g2 for at the common names to the genera.)
Appendix A" Formulary,
Appendix B, Daily fluid requiremenrs, 269
Appendix C, Recipes for dialysate and continuous t76
drug infusions,
Appendix D, Poison treatment flow chart, t78748
2
Handbook of smoll onimaltoxicology and poisonings Sedion one: Patient evaluotion and treatment of poisoning t
The initial contact with the owner of a pet that has been
cpoailsleonr emd aisy frheaqvuee natl ys ibgyn itfeicleap.hrto ninef.l rrT.h.rec ead ovince tohfefe roeudt ctoom thee.
Failure to supply the owner with appropriate information
may also affect the case and usualrn"ot'i" ffiirr. *uy FIRST AID
(Box l-l). " Attempt to identify the offending substance and route of poisoning.
The "poisoned" veterinary patient remains a significant Advise the owner as follows:
pchaatilelenntsg-ea rteo prhoeis opnraecdt,ic ainngd vneoiet rainlr aproi;is-iol;n;"e"dii- fuul...r,rtr.,r y iu Bring the package (or what is left of it) to the hospital.
pilaacifr caeotulo-c ttpxeehaildrynetu i eairolentlre.st npA maio npnuigsads ott in psei mrunosptmhb ppoleeoruedmrltsdi.a. e AtbneTserlhey edac o elwvwnveaasittiryehdusr eai,tnr hteetaehd r te ihhat eiones tmnrofrearaeyecv dree"g d ifa. o;;w; rip" irrJtiufhteer snaeat iv cair"tnitt.tgyo-. lIo.onN dGTTIunhhEcgeeSee TssseEuutmiDbboess nsttTaa isOwnn ccXaoeesInN lywiiSnn iiggft:eehssinttee ddth eww aalass snnt oo3tt 0aa tpsote r6otr0no glme uainmcuid te dosisr. tailllakateli.
examined and treated using the Allc,s. fatient is (such as kerosene, gasoline, lighter fluid).
The chart on the inside fiont cover includes a quick review o The pet is alert, conscious, and cooperative.
poaf teiemnet rgperensceyn rperdo.c ewdiurhre sth reec poomsmsiebnilditeyd offo rf i;,;";iils;;o; neodf .the Ion dSuyceru pe moefs iipse ucasicn gm:ay be administered at rlz to I teaspoon
Although written in a sequential order, several itErrir-muy u. per l0 lb PO in the dog or I teaspoon PO for an
rpeesrufosrcmitaetdio ns itmeaulmta n(feooru esxrya mapsl en, eoendee md eumvb *e.r* uesetaisbl ishoers thaen . Havyedrraoggee-sni zpeedr ocxaitd.e (3oh) may be given PO at I table-
airway while another gains IV access). . spoon per 20 lb.
Salt, mustard, and many other substances have been
--_--.f advocated but have proved ineffective and possibly even
AIRWAY dangerous.
lf the substance was a strong acid, a strong alkali, or a petroleum
ctLdhoiifermee sacpaitlrvliwycina aogtyi ro. i nninTstedh earirvsneeedcn tmptliyooa snycss aio bucblsycee lg uefidvnruee w indt hi dteohe raa tthsihreew.c aareyir twiloeanayid . itnMog a untouy l hdpyo puisopox niicns vdopaimastttemiieldlnae cttn ehdt,oa ear dcad.o vtariNsel eua( mrttmeheaeerdo no utlaw sfban eocelv irle fitotryo-r.t hdalmeod-smmceoei)nu dibnsiaytteet etrrh pemar doiolmkdw uinoncerits rset rgsaaghrtei ooa unanl vddao irfbl uaeasb chlrtee i-,tch-e
but few pet owners have one of them at hand.
GENERAL
acsooirnnowtineanenygt sooi.sfb stlohtsieus c gtorioef naat eirbswyt a cayo -fnplatrcroicbteiudc tottiovrsne g tuo.ee p foal.rt"i ea.,ns tpw idriaethtaiot hsn u fborosf emgqa uspetorniic-t IooN HMvPeAroonLvvtEeiildaD ett hi oTeanO r.ptXifaIiNctiieSanl tr etos pfrireasthio na iri f orre qanu iraereda. with adequate
Evaluate the airway by direct examination if possible. o Transport to the hospital as soon as possible.
Patients who are awake and arert are not likely to need
saiigrwnsa yo fin dteertveerinotriaotnio, nb utht atht ec avne terersinuartr yir ,te .aump miau-stto b*e" "ail"eirrt* f,o r r S. KIIfN th CeO pNaTtieAnMt IhNaAsT bIOeeNn contaminated with a dry powder,
control. Loud upper airway sounds such ai g";ghd; stertor, ' carefully brush the powder away using a firm-bristled
or stridor are indications that the patient is iridaigeiot losing (Continued)
,/
4
Hondbook of smoll onimoltoxicology and poisonings Sedion one: Patient evaluation and treotment of poisoning s
exists regarding the patient's ability to protect his or her
airway, endotracheal or tracheal intubation should be per-
formed.
SKIN CONTAMTNATTON-confd
brush. It is extremely important to protect the patient,s TREATMENT
and the caregiver's eyes, nose, and mouth to avoid inhala- Patients should be positioned in left lateral recumbency
tion or ingestion of the powder during this procedure. with the head in a slightly extended position to maximize the
o Thoroughly rinse the contaminated irea with running airway. Patients with mild risk for vomiting or aspiration
water. should be positioned with the head down so that secretions or
o Once the area has been thoroughly rinsed, wash the vomitus can drain out of the mouth by gravity flow.
area with soap and water and rinse well. If the airway is still not patent, it should be cleared using a
o continue bathing and rinsing for at least 15 minutes. suction machine (preferable), bulb syringe, or other suction
o Do not attempt to neutralize the poison. device. It is wise to have a "ready area" of the hospital where
a suction device is set up in advance to anticipate these com-
TOXIN IN THE EYE plications. Foreign bodies are removed using a Heimlich-like
o Promptly flush the eye with water or saline and maneuver, finger sweep, or forceps.
continue fo flush for at least l0 minutes. Endotracheal intubation is necessary when the patient cannot
o saline is more comfortable to the ocular tissues and can protect his or her own airway (such as coma, obtundation,
be made at home by adding 2 teaspoons of table sart to anesthesia), when there is obstruction, or when the patient
a quart of warm water. suffers ventilatory failure (see below). Endotracheal intuba-
tion provides the most reliable protection of the airway. It
Repeot the need to bring ony informotion about the poison to the prevents aspiration and obstruction by swelling of oropha-
!9tni1it (the packoge, bottle, or onythi4g else thot moy help ryngeal tissues. Endotracheal intubation also allows for
identify the octive toxic ingredient). mechanical ventilation.
Tracheal intubation (tracheostomy, tracheotomy) is neces-
sary when endotracheal intubation is not possible because of
a physical obstruction of the rostral trachea. Even though this
would be an uncofirmon finding in cases of poisoning, the
"ready area" should have a tracheotomy-tracheostomy tray to
anticipate such needs.
I
the airway. It is considerably better to secure the airway (per- BREATHING
haps) prematurely than to make the patient "prove" that the
airway is in jeopardy.
lert ryte gag/cough r_eflex by putting a tongue depressor or Once the airway is determined to be open and secure, an
other object in the pharyngear area. conscious pafrents usu- evaluation of breathing must be performed. Respiratory com-
ally have an intact gaglcough refrex and can be expected to plications fall into the categories of ventilatory failure,
protect their airway. obtunded or comatose patients may hypoxia, or bronchospasm and remain one of the major
lack this protection. These patients are in grave danger causes of patient morbidity and mortality in the poisoned or
because they may rapidry loie their airway. it urry doubt intoxicated patient.