5 must-dos in managing poisoned pets in your veterinary practice
In her presentation “Top 5 mistakes to avoid in your poisoned patient” during the 2013 Veterinary Emergency and Critical Care Society meeting, Justine Lee, DVM, DACVECC, DABT, discussed the most common mistakes practitioners make when managing patients with a toxicosis. Here are five things you should do in these cases.
1. Get a thorough history. Be sure to find out how much and exactly what the pet ingested and ask specific questions about ingredients. For example, there is a big difference in toxicity between Claritin (loratadine) and Claritin-D (pseudoephedrine and loratadine). Also ask if the drug was a long-acting or sustained-release formulation. Dr. Lee recommends having the owners bring in packaging whenever possible (e.g. boxes, pill bottles) and being sure to ask if they have already given anything at home (i.e. milk, ipecac).
2. Triage immediately. Time is of the essence, so these are not patients that can wait in the lobby for extended periods.
3. Know when emesis is indicated. For pets that are already showing clinical signs, it is too late to induce emesis. Emesis can be induced up to four hours after ingestion, but the amount of gastric contents recovered will decrease markedly the longer you wait.
4. Use the right emetic agent. Use apomorphine or hydrogen peroxide for dogs and xylazine for cats. Dr. Lee noted that mustard powder, salt, and ipecac are no longer recommended for emesis induction because of side effects.
Contraindications to inducing emesis need to be considered as well, such as caustic or corrosive substances (e.g. undiluted drain cleaners, toilet bowl cleaners, bleach, lye). Never induce emesis if hydrocarbons and petroleum distillates (e.g. gasoline, mineral spirits, fuel, kerosene, furniture polish oils) are ingested. In certain patients (i.e. brachycephalic breeds, patients with a history of laryngeal or esophageal disease), gastric lavage will be preferable to induction of emesis. This is also true for ingestion of life-threatening drugs such as calcium channel blockers, beta blockers, or cholecalciferol.
5. Know the proper way to use activated charcoal. Charcoal only binds to nonpolar compounds, so it will not be useful for toxicants such as ethylene glycol, alcohol, xylitol, and heavy metals. Dr. Lee also recommends cautious use of activated charcoal with a cathartic such as sorbitol in patients that are dehydrated or at risk for hypernatremia since this may increase free water loss.
If you are at all uncomfortable managing a case or are unsure of treatment, Dr. Lee recommends calling an animal poison control hotline right away.