Differential Diagnosis of Common Acute Toxicologic Versus Nontoxicologic Illness.

This article provides a display table laying out the differential diagnosis of common acute toxicologic versus nontoxicologic illnesses in small animals. Major clinical abnormalities are listed, along with common toxicologic rule outs and nontoxicologic rule outs. Further readings are also provided.

Common Reversal Agents/Antidotes in Small Animal Poisoning.

This article provides a quick source of information for practicing veterinarians for using various antidotes in small animal poisoning cases. For easy access, this information is included in the form of a table. The first column includes common names and/or brand names of different antidotes. In the second column, names of different toxicants or indications for which these antidotes can be used are described. The third column is the comment section that briefly describes salient points or cautions for using these antidotes.

Toxicology of Frequently Encountered Nonsteroidal Anti-inflammatory Drugs in Dogs and Cats: An Update.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for their antipyretic, anti-inflammatory, and analgesic properties. Although most NSAIDs consist of a range of pharmacologically active agents with diverse chemical structures and properties, they have similar therapeutic and adverse effects associated with their use. Each year, the American Society for the Prevention of Cruelty to Animals Animal Poison Control Center (APCC) receives hundreds of cases involving acute accidental ingestion/overdose of NSAIDs in dogs and cats. This article provides an overview on the classification, uses, pharmacokinetics, mechanisms of action, and treatment of the most commonly encountered NSAIDs in dogs and cats.

Concentrated tea tree oil toxicosis in dogs and cats: 443 cases (2002-2012).

OBJECTIVE: To determine the frequency, types, and severity of clinical signs; geographic distribution; and treatment information associated with toxicosis caused by 100% tea tree oil (TTO) in dogs and cats in the United States and Canada. DESIGN: Retrospective case series. ANIMALS: 337 dogs and 106 cats with evidence of exposure to 100% TTO. PROCEDURES: 10-year incident data were retrieved from the ASPCA Animal Poison Control Center database from January 2002 to December 2012. Only evidenced or witnessed incidents assessed as toxicosis or suspected toxicosis were included. Signalment, amount of TTO used, intention of use, and outcome information were evaluated. Severity of illness and correlations with breed, sex, age, and weight were determined. RESULTS: TTO was intentionally used in 395 of 443 (89%) animals. The amount used ranged from 0.1 to 85 mL. Incidents were reported from 41 states, the District of Columbia, and 4 Canadian provinces. Exposure route was cutaneous in 221 (50%) animals, cutaneous and oral in 133 (30%), and oral in 67 (15%). Clinical signs developed within 2 to 12 hours and lasted up to 72 hours. The most common signs were increased salivation or drooling, signs of CNS depression or lethargy, paresis, ataxia, and tremors. A significant association with severity of illness was found for age and weight, with higher prevalence of major illness in younger and smaller cats. CONCLUSIONS AND CLINICAL RELEVANCE: Intentional or accidental use of 100% TTO in dogs or cats caused serious signs of CNS depression, paresis, ataxia, or tremors within hours after exposure and lasting up to 3 days. Younger cats and those with lighter body weight were at greater risk of developing major illness.

Effectiveness and adverse effects of the use of apomorphine and 3% hydrogen peroxide solution to induce emesis in dogs.

OBJECTIVE: To determine the effectiveness and adverse effects of apomorphine and 3% hydrogen peroxide solution used for emesis in dogs. DESIGN: Prospective observational study. ANIMALS: 147 dogs that received apomorphine (IV or placed in the conjunctival sac) or 3% hydrogen peroxide solution (PO) to induce emesis after exposure to toxic agents. PROCEDURES: Data regarding signalment; agent information; type, dose, route, and number of emetic administrations; whether emesis was successful; number of times emesis occurred; percentage of ingested agent recovered; and adverse effects were collected via telephone during American Society for the Prevention of Cruelty to Animals Animal Poison Control Center operations and stored in a database for analysis. Mann-Whitney and Fisher exact tests were used to evaluate emetic success rates. RESULTS: Apomorphine and 3% hydrogen peroxide solution successfully induced emesis in 59 of 63 (94%) and 76 of 84 (90%) of dogs, respectively. Mean time to onset of emesis after the first dose of emetic was 14.5 and 18.6 minutes when hydrogen peroxide (n = 37) and apomorphine (31) were used, respectively, with mean durations of 42 and 27 minutes, respectively. Mean estimates for recovery of ingested agents were 48% for hydrogen peroxide and 52% for apomorphine. Adverse effects were reported in 16 of 112 (14%) dogs for which information was available. CONCLUSIONS AND CLINICAL RELEVANCE: 3% hydrogen peroxide solution and apomorphine effectively induced emesis in dogs when used as directed. Emesis occurred within minutes after administration and helped recover substantial amounts of ingested agents. Adverse effects of both emetics were considered mild and self-limiting.

Adverse reactions from essential oil-containing natural flea products exempted from Environmental Protection Agency regulations in dogs and cats.

OBJECTIVE: To describe adverse effects in dogs and cats exposed to Environmental Protection Agency exempted plant-derived flea preventatives containing mixtures of essential oils. DESIGN: Retrospective study from 2006 to 2008. SETTING: Records of dog and cat cases were reviewed from the American Society for the Prevention of Cruelty to Animals, Animal Poison Control Center database. ANIMALS: Thirty-nine cats and 9 dogs with history of exposure to natural flea preventatives. MEASUREMENTS AND MAIN RESULTS: The following information was retrieved from each incident: number of animals, species involved, frequency, types, onset time, duration of clinical signs, exposure appropriateness, final outcome, and treatment information. Ninety-two percent of animals (n = 44) showed presence of one or more adverse effects. The frequency of adverse effects in dogs (n = 8; 89%) and cats (n = 36; 92%) was similar. Onset time of adverse effects in 39 of 44 animals occurred within 24 hours. The duration of signs in 24 animals ranged from 30 minutes to 149 hours. The products were used as per label in 77% animals (n = 37). Of 28 animals with known outcome, 50% (n = 14) recovered with bathing alone while others received intravenous fluids, muscle relaxants, and anticonvulsive medications. Death (1 cat; n = 1/28; 4%) or euthanasia (1 cat and 1 dog; n = 2/28; 7%) was reported in 3 animals. CONCLUSION: Dogs and cats can experience significant adverse effects when exposed to plant-derived flea preventatives even when used according to label directions. The number of reports of exposure in cats was higher than dogs, but the frequency of reported adverse effects was similar between the 2 species. Agitation and hypersalivation were common in cats, whereas lethargy and vomiting were common in dogs.

Toxicology of frequently encountered nonsteroidal anti-inflammatory drugs in dogs and cats.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a group of heterogeneous compounds extensively used in both human and veterinary medicine for their antipyretic, anti-inflammation, and analgesic properties. NSAIDs consist of a wide range of pharmacologically active agents with different chemical structures, with similar therapeutic and adverse effects. The ASPCA Animal Poison Control Center received 22,206 NSAID incidents in dogs and cats (3% of total cases; dogs [15,823] and cats [1244]) during 2005 to 2010. This is roughly equivalent to 4% NSAID incidents reported in humans. The most common NSAID involved was ibuprofen, followed by aspirin, naproxen, deracoxib, meloxicam, diclofenac, piroxicam, indomethacin, nabumetone, and etodolac. This article provides a brief overview of classification, mechanism of action, pharmacologic and toxicologic properties, and treatment information involving frequently encountered human and veterinary NSAIDs in dogs and cats.

Differential diagnosis of common acute toxicologic versus nontoxicologic illness.

This table outlines common toxicologic versus nontoxicologic rule outs based on clinical abnormalities seen in an acutely ill animal. The purpose is to provide an initial guideline for considering toxicologic versus nontoxicologic rule outs when a patient is presented to a practicing veterinarian. Major clinical abnormalities followed by common toxicologic rule outs and non-toxicologic rule outs have been listed so that practicing veterinarians can narrow down an etiology quickly. Based on history, physical examination findings, and blood work changes, once a reasonable etiology has been narrowed down or established, the reader is encouraged to review a more detailed discussion on management of the particular poisoning or disease listed in this or other references.

Common reversal agents/antidotes in small animal poisoning.

Different antidotes counteract the effect of a toxicant in several different ways. Antidotes can reverse, decrease, or prevent action of a toxicant. They can also help in achieving stabilization of vital signs, directly or indirectly, and promote excretion of a toxicant. However, overreliance on an antidote can be unrealistic and dangerous. While expectations of rapid recovery from antidotes are usually high, in a real life situation, there are many impediments in achieving this goal. The timing of its use, availability, cost, and sometimes adverse effects from the antidote itself can influence the results and outcome of a case. The majority of toxicants do not have a specific antidote therapy indicated and patients in these cases equally benefit from supportive care. In this chapter, commonly used antidotes and reversal agents in small animals are listed in a table form. The table lists generic name along with brand name of an antidote/reversal agent whenever available, main indications for their use, and provides comments or cautions in their use as needed. After stabilizing the patient and establishing the etiology, the clinicians must review more detailed management of that particular toxicant discussed here or in other references.

Acute renal failure in dogs after the ingestion of grapes or raisins: a retrospective evaluation of 43 dogs (1992-2002).

A review of records from the AnTox database of the American Society for the Prevention of Cruelty to Animals Animal Poison Control Center identified 43 dogs that developed increased blood urea nitrogen concentration, serum creatinine concentration, or both as well as clinical signs after ingesting grapes, raisins, or both. Clinical findings, laboratory findings, histopathological findings, treatments performed, and outcome were evaluated. All dogs vomited, and lethargy, anorexia, and diarrhea were other common clinical signs. Decreased urine output, ataxia, or weakness were associated with a negative outcome. High calcium x phosphorus product (Ca x P), hyperphosphatemia, and hypercalcemia were present in 95%, 90%, and 62% of the dogs in which these variables were evaluated. Extremely high initial total calcium concentration, peak total calcium concentration, initial Ca x P, and peak Ca x P were negative prognostic indicators. Proximal renal tubular necrosis was the most consistent finding in dogs for which histopathology was evaluated. Fifty-three percent of the 43 dogs survived, with 15 of these 23 having a complete resolution of clinical signs and azotemia. Although the mechanism of renal injury from grapes and raisins remains unclear, the findings of this study contribute to an understanding of the clinical course of acute renal failure that can occur after ingestion of grapes or raisins in dogs.

Gastric outflow obstruction after ingestion of wood glue in a dog.

A 2-year-old, male, mixed-breed dog presented with a 12-day history of vomiting, depression, and weight loss after ingestion of industrial-strength wood glue containing diphenylmethane diisocyanate as its active ingredient. A diagnosis of gastric foreign body was made from survey abdominal radiographs. A large aggregate of solidified wood glue was surgically removed, and the dog recovered uneventfully. Fourteen other cases have been reported to the Animal Poison Control Center at the American Society for the Prevention of Cruelty to Animals (ASPCA). Eight of those 14 cases required surgical intervention. All cases recovered completely.

A review of moxidectin overdose cases in equines from 1998 through 2000.

Moxidectin is a macrolide endectocide available as a 2% equine oral gel in the US. This report presents clinical signs of moxidectin toxicosis and its treatment in equines as reported to the ASPCA Animal Poison Control Center (APCC) from January 1998 to December 2000. Nine cases of moxidectin overdose in equines occurred: 5 had signs of toxicosis such as coma, dyspnea, depression, ataxia, tremors, seizures, or weakness. The approximate dose of moxidectin at which these signs were observed ranged from 1.0 to 5.1 mg/kg. The 4 equines that ingested moxidectin between 0.9 mg/kg to 1.7 mg/kg did not show signs of toxicosis. Clinical signs were seen within 6-22 h and lasted for 36-168 h. Only 1/5 clinical equines was an adult, the others were < 4 month of age. This study supports earlier report that young foals are more susceptible to moxidectin toxicosis. All 4 equines with known outcomes recovered with treatment that included decontamination, seizure control, thermoregulation, fluid therapy, and supportive care.

Clinical syndrome associated with zolpidem ingestion in dogs: 33 cases (January 1998-July 2000).

Zolpidem is a nonbenzodiazepine hypnotic of the imidazopyridine class that is used to treat insomnia in humans. Zolpidem binds selectively to the benzodiazepine omega-1 receptor and increases the frequency of chloride channel opening, which results in inhibition of neuronal excitation. A retrospective study was conducted of zolpidem ingestion in dogs that were reported to the ASPCA Animal Poison Control Center (APCC) between January 1998 and July 2000. Data analysis included amount ingested, clinical effects, and time of onset of signs. Thirty-three reports of zolpidem ingestion in dogs (ranging in age from 5 months to 16 years) were evaluated. Approximate ingested dosages ranged from 0.24 to 21 mg/kg. Clinical signs reported included ataxia (18 dogs; 54.5%), hyperactivity (10 dogs; 30.3%), vomiting (7 dogs; 21.2%), and lethargy (5 dogs; 15.2%), as well as panting, disorientation, nonspecific behavior disorder, and hypersalivation (4 dogs each sign; 12.1%). Other signs reported include tachycardia, tremors, apprehension, vocalization, hypersalivation, weakness, and hyperesthesia. In 85% percent of reports, clinical signs developed within 1 hour and usually resolved within 12 hours. Although central nervous system (CNS) depression is reported as a primary effect of zolpidem in humans and would also be expected in dogs, information obtained from this study indicates that some dogs may exhibit a paradoxical excitation reaction. This effect appears to vary among individual dogs.