This self-quiz reviews common small animal toxin exposures and associated treatments.
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This self-quiz reviews common small animal toxin exposures and associated treatments.
Molson, a 2-year old neutered Labrador retriever, presents approximately 30 minutes after ingesting 28 pieces of sugar-free gum containing xylitol. You calculate the toxic dose at 0.17 g/kg, and worry about the risk of hypoglycemia. Molson is quiet, alert, and hydrated. No significant abnormalities are found on physical examination.
Based on the toxic dose ingested, what are your next steps?
Induce emesis STAT
Check a stat blood glucose (BG); if normal, induce emesis with apomorphine.
Check a stat blood glucose (BG); if normal, induce emesis with apomorphine.
Induce emesis and give a dose of activated charcoal
Induce emesis and give a dose of activated charcoal
Gastric lavage with the patient under anesthesia
Gastric lavage with the patient under anesthesia
Administer 50% dextrose SC
Administer 50% dextrose SC
Incorrect—do not induce emesis in a potentially hypoglycemic patient.
The correct answer is B.
Correct!
Incorrect—xylitol does not reliably bind to activated charcoal.
The correct answer is B.
Incorrect—lavage is too invasive.
The correct answer is B.
Incorrect—dextrose should never be administered SC.
The correct answer is B.
This video demonstrates the use of IV lipid emulsion (ILE) to treat ingestion of baclofen, a centrally acting muscle relaxant. A 4-month old, mixed-breed puppy presented sedate, ataxic, and with a decreased gag reflex 8 hours after ingesting 1.3 mg/kg of baclofen. The patient was already showing severe clinical signs; therefore, it was too late for decontamination.
Clinical signs consistent with baclofen toxicosis include sedation, ataxia, bradycardia, respiratory depression, seizures, and coma. Treatment is typically aimed at decontamination (if appropriate), fluid therapy, anticonvulsants, anxiolytics, and symptomatic supportive care. Because baclofen is fat-soluble, ILE was considered.
Which of the following is true about ILE in the poisoned patient?
It can be used for fat-soluble toxicants such as baclofen, lidocaine, and ivermectin
It can be used for fat-soluble toxicants such as baclofen, lidocaine, and ivermectin
It can be administered through a sterile, peripheral IV catheter
It can be administered through a sterile, peripheral IV catheter
It can be used in patients with clinical signs of intoxication
It can be used in patients with clinical signs of intoxication
It is readily available and inexpensive
It is readily available and inexpensive
All of the above
All of the above
Incorrect. The correct answer is E.
Additional resource: VetGirl
Incorrect. The correct answer is E.
Additional resource: VetGirl
Incorrect. The correct answer is E.
Additional resource: VetGirl
Incorrect. The correct answer is E.
Additional resource: VetGirl
Correct!
Additional resource: VetGirl
Buddy, a 1-year-old castrated yellow Labrador retriever, presents for possible exposure to a corrosive housecleaner. The client had sprayed an entire bottle of corrosive detergent cleaner into the oven and had left the oven door open. He returned 10 minutes later and found Buddy licking food remnants from the oven door.
On presentation, Buddy is bright, alert, and hydrated. Oral ulcerations are not present, but you note a chemical smell on Buddy’s breath.
What is the most appropriate treatment for Buddy?
Induce emesis immediately
Induce emesis immediately
Offer some water or milk to flush the corrosive agent out of the mouth, followed by actively flushing the mouth for 10 minutes to dilute the corrosive agent in the oral cavity, stomach, and esophagus
Offer some water or milk to flush the corrosive agent out of the mouth, followed by actively flushing the mouth for 10 minutes to dilute the corrosive agent in the oral cavity, stomach, and esophagus
Perform gastric lavage with the patient under anesthesia
Perform gastric lavage with the patient under anesthesia
Since there are no oral ulcers, it is unlikely that exposure occurred
Since there are no oral ulcers, it is unlikely that exposure occurred
Skip emesis induction and immediately administer activated charcoal
Skip emesis induction and immediately administer activated charcoal
Incorrect—emesis should not be induced with corrosive agents.
The correct answer is B.
Correct!
Incorrect—gastric lavage is contraindicated with corrosive agents.
The correct answer is B.
Incorrect—oral ulcers may take hours to develop, and the absence of ulcers does not rule out corrosive agent exposure.
The correct answer is B.
Incorrect—charcoal is contraindicated with corrosive agents because it does not reliably bind.
The correct answer is B.
Tuffy, a 6 month-old spayed, mixed-breed dog, was discovered drinking gasoline from a waste container, presumably dumped from a lawn mower. The client calls you, and you advise him to immediately bring Tuffy to the practice.
Tuffy presents 30 minutes postexposure, and is bright, alert, and hydrated. You worry about hydrocarbon ingestion.
What is the most appropriate treatment for Tuffy?
Induce emesis immediately
Induce emesis immediately
Because of the delayed presentation, skip emesis induction and administer one dose of activated charcoal
Because of the delayed presentation, skip emesis induction and administer one dose of activated charcoal
Administer a potent anti-emetic (eg, maropitant, dolasestron) and discuss the potential risks for gastrointestinal distress or aspiration pneumonia associated with hydrocarbon ingestion
Administer a potent anti-emetic (eg, maropitant, dolasestron) and discuss the potential risks for gastrointestinal distress or aspiration pneumonia associated with hydrocarbon ingestion
Perform gastric lavage with the patient under sedation to remove the motor oil
Perform gastric lavage with the patient under sedation to remove the motor oil
Administer milk, and send the patient home with antacids
Administer milk, and send the patient home with antacids
Incorrect—emesis should never be performed with hydrocarbons because of the risk for aspiration pneumonia.
The correct answer is C.
Incorrect—charcoal does not bind to hydrocarbons and should not be administered.
The correct answer is C.
Correct!
Incorrect—gastric lavage is likely too invasive, and there is a risk for hydrocarbon aspiration upon extubation.
The correct answer is C.
Incorrect—milk is not a true antidote and typically should not be recommended for a poisoned patient. Because motor oil is not a corrosive or gastrointestinal irritant, antacids are not indicated.
The correct answer is C.
Although it is not commonly performed for gastric decontamination, gastric lavage can be life saving for a poisoned veterinary patient. Emesis induction is easier to perform, but gastric lavage is indicated in certain poisoning situations. This video demonstrates gastric lavage on a poisoned patient.
Based on the video, which of the following is an indication for gastric lavage?
Ingestion of a toxicant with a narrow safety margin (eg, calcium channel blocker, metaldehyde, ivermectin/moxidectin, organophosphate/carbamate, baclofen, cholecalciferol product)
Ingestion of a toxicant with a narrow safety margin (eg, calcium channel blocker, metaldehyde, ivermectin/moxidectin, organophosphate/carbamate, baclofen, cholecalciferol product)
Ingestion of a toxic dose approaching the LD50
Ingestion of a toxic dose approaching the LD50
Ingestion of large amounts of a product that may form a bezoar or concretion (eg, iron tablets, large wads of aspirin, bone meal), which can cause foreign body obstruction
Ingestion of large amounts of a product that may form a bezoar or concretion (eg, iron tablets, large wads of aspirin, bone meal), which can cause foreign body obstruction
A patient with clinical signs for which emesis induction that requires controlled decontamination is contraindicated because of excessive sedation, lack of consciousness, tremors, or seizures
A patient with clinical signs for which emesis induction that requires controlled decontamination is contraindicated because of excessive sedation, lack of consciousness, tremors, or seizures
All of the above
All of the above
Incorrect. The correct answer is E.
Additional resource: VetGirl
Incorrect. The correct answer is E.
Additional resource: VetGirl
Incorrect. The correct answer is E.
Additional resource: VetGirl
Incorrect. The correct answer is E.
Additional resource: VetGirl
Correct!
Additional resource: VetGirl
Tigger, a 5-year-old neutered Domestic Short Hair, ingested 2 leaves of an Asiatic lily. The client calls your practice approximately 45 minutes after the ingestion, and confirms that the toxic plant is a true lily (ie, Lilium spp) from a recently purchased florist bouquet. You worry about nephrotoxicity.
What are your next steps?
Instruct the client to orally administer 10 mL of hydrogen peroxide
Instruct the client to orally administer 10 mL of hydrogen peroxide
Instruct the client to orally administer one teaspoon of syrup of ipecac
Instruct the client to orally administer one teaspoon of syrup of ipecac
Instruct the client to monitor for clinical signs of polyuria, polydipsia, vomiting, or anorexia, and to seek medical attention if these signs are observed
Instruct the client to monitor for clinical signs of polyuria, polydipsia, vomiting, or anorexia, and to seek medical attention if these signs are observed
Recommend immediate veterinary attention for emesis induction with IM xylazine, followed by appropriate fluid diuresis for 48 hours while monitoring renal function at appropriate time intervals
Recommend immediate veterinary attention for emesis induction with IM xylazine, followed by appropriate fluid diuresis for 48 hours while monitoring renal function at appropriate time intervals
Recommend immediate veterinary attention to sedate the cat for gastric lavage
Recommend immediate veterinary attention to sedate the cat for gastric lavage
Incorrect—hydrogen peroxide can cause hemorrhagic gastritis in cats, and generally is not recommended for poisoned feline patients.
The correct answer is D.
Incorrect—syrup of ipecac is not recommended as an emetic agent because it can cause profound clinical signs such as profuse hemorrhagic vomiting and diarrhea.
The correct answer is D.
Incorrect—this will cause the window for decontamination to be missed.
The correct answer is D.
Correct!
Incorrect—gastric lavage is labor-intensive and rarely performed successfully in cats.
The correct answer is D.
Maggie, a 3-year-old spayed, mixed-breed dog, presents 20 minutes after chewing on a block of bromethalin. The client noted that only one block (1 ounce) was missing. No previous exposure to bromethalin has occurred.
On presentation, Maggie is bright, alert, and hydrated, and has green-colored bait remnants stuck in her teeth.
Based on this exposure, what is your plan?
Induce emesis with apomorphine to aid decontamination, followed by a dose of activated charcoal with sorbitol cathartic
Induce emesis with apomorphine to aid decontamination, followed by a dose of activated charcoal with sorbitol cathartic
Administer a SC dose of Vitamin K1, and check a prothrombin in 48 hours
Administer a SC dose of Vitamin K1, and check a prothrombin in 48 hours
Send Maggie home on an anti-inflammatory dose of prednisone
Send Maggie home on an anti-inflammatory dose of prednisone
Send Maggie home on oral Vitamin K1 q12h for 30 days
Send Maggie home on oral Vitamin K1 q12h for 30 days
Give a dose of mannitol IV to treat cerebral edema
Give a dose of mannitol IV to treat cerebral edema
Correct!
Incorrect—bromethalin results in cerebral edema and is not an anticoagulant.
The correct answer is A.
Incorrect—because of the recent ingestion, Maggie should be decontaminated. Also, steroids are no longer the standard treatment for cerebral edema.
The correct answer is A.
Incorrect—bromethalin results in cerebral edema and is not an anticoagulant.
The correct answer is A.
Incorrect—the patient does not exhibit clinical signs, and because ingestion was recent, decontamination should be initiated first.
The correct answer is A.
Quiz: Toxicoses and Treatments
Final scoreAuthor Information
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