Evacuation via Emesis

Amanda A. Cavanagh, DVM, DACVECC, Colorado State University

Emergency Medicine & Critical Care

|October 2020

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In the literature

Zersen KM, Peterson N, Bergman PJ. Retrospective evaluation of the induction of emesis with apomorphine as treatment for gastric foreign bodies in dogs (2010-2014): 61 cases. J Vet Emerg Crit Care (San Antonio). 2020;30(2):209-212.

FROM THE PAGE …

Pharmacologic induction of emesis is a commonly employed technique used to achieve gastric decontamination following acute toxin ingestion. This retrospective study showed that induction of emesis can also be used to evacuate gastric foreign bodies shortly after a witnessed ingestion. Successful emesis can prevent the need for costly invasive interventions such as endoscopic removal or laparotomy to prevent pyloric or small intestinal mechanical obstruction.

Apomorphine is a centrally acting emetic that elicits vomiting by activating dopamine receptors in the chemoreceptor trigger zone.¹In this study, 97% of dogs vomited following IV apomorphine administration and 78% successfully evacuated a foreign object via emesis. No dogs experienced immediate complications related to vomiting (eg, object becoming lodged in the esophagus or oropharynx, aspiration of the object, aspiration pneumonia, esophagitis resulting in stricture formation).

Apomorphine does not induce emesis in cats and may cause CNS excitation.² α₂-adrenergic agonists (eg, dexmedetomidine, xylazine) can be used to induce emesis in cats.³ Clinicians should discourage the use of hydrogen peroxide to induce emesis in cats, as it is ineffective in cats and can lead to esophageal, gastric, and/or jejunal lesions in dogs.^3,4

… TO YOUR PATIENTS

Key pearls to put into practice:

In dogs and cats presented for recent foreign body ingestion, pharmacologic induction of emesis should be considered.

Apomorphine (0.02-0.04 mg/kg IV) in dogs and dexmedetomidine (7-10 μg/kg IM or 3.5 μg/kg IV) in cats are the preferred pharmacologic methods.^3,5

Contraindications to inducing emesis include increased aspiration risks (eg, diminished mentation, megaesophagus, brachycephalic anatomy, laryngeal paralysis), composition of the foreign object (eg, large, sharp, caustic), and the presence of small intestinal foreign objects. Objects in the small intestine are not amenable to removal via emesis; abdominal radiography should be considered in such cases to determine the location of ingested objects.

References

Plumb DC. Apomorphine. Plumb’s Veterinary Drugs website. https://www.plumbsveterinarydrugs.com/#!/monograph/9113HOC31W. Updated April 2020. Accessed June 16, 2020.
Willey JL, Julius TM, Claypool SPA, Clare MC. Evaluation and comparison of xylazine hydrochloride and dexmedetomidine hydrochloride for the induction of emesis in cats: 47 cases (2007-2013). J Am Vet Med Assoc. 2016;248(8):923-928.
Thawley VJ, Drobatz KJ. Assessment of dexmedetomidine and other agents for emesis induction in cats: 43 cases (2009–2014). J Am Vet Med Assoc. 2015;247(12):1415-1418.
Niedzwecki AH, Book BP, Lewis KM, Estep JS, Hagan J. Effects of oral 3% hydrogen peroxide used as an emetic on the gastroduodenal mucosa of healthy dogs. J Vet Emerg Crit Care (San Antonio). 2017;27(2):178-184.
Plumb DC. Dexmedetomidine hydrochloride. Plumb’s Veterinary Drugs website. https://www.plumbsveterinarydrugs.com/#!/monograph/2ZRdK5kAcz. Updated March 2020. Accessed June 16, 2020.

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