Quiz: Toxicoses and 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?

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?

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?

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?

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?

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?

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?