Fall 2010 Newsletter #33. Contents. Featured Staff of the Toxicology Team. Featured Staff of the Toxicology Team. Hints for the APCC Hotline

Transcription

1 Fall 2010 Newsletter #33 Contents Featured Staff of the Toxicology Team Hints for the APCC Hotline Did You Know? And Did You Know? Fall Hazards for Pets Useful Websites Toxicant Update Case Study Featured Staff of the Toxicology Team Ashley Armsbury CVT Before coming to work at the Poison Control Center, I was living in a south suburb outside of Chicago called Tinley Park, Illinois. I lived there with my parents for the last 23 years, and just recently moved to Bloomington, Illinois, where I live with my boyfriend, Mike, and my 10 year old beagle mix, Milkshake. I graduated from the Vet Tech Institute back in 2008, and have worked at multiple private and corporate owned veterinary practices over the last few years. Brandy Sloan CVT My name is Brandy Sloan and I m originally from a small town in northern IL called Mt. Morris. I grew up there with my Mom, Dad, and 3 little brothers, Josh, Jonah and Ben. I graduated from Oregon High School in 2005 and went to Kishwaukee Community College until January I transferred to Parkland College and moved down to Champaign in January I recently graduated from the Vet Tech Program at Parkland in May and have recently passed my boards. I live in Champaign with my 2 yr old cat Dotty, whom I bottle raised, and my 16 month old daughter, Adison Lyn.

2 Hints for the APCC Hotline Now that we are about 2 years into our new phone system, there are a few reminders that may help you navigate our system better. We have made numerous upgrades and improvements to the system which should help us better serve your clinic. If all of your clinic phone numbers (main line and back lines) are in our system, then the majority of the time you will be routed directly to a veterinarian. Because we have designed this as a means for your veterinary staff to directly reach our veterinarians, please be sure to have your clients contact us from their own phone line whenever possible. Otherwise your wait time may be lengthened if all our DVM s are speaking with owners who are calling from clinic phone lines. We have put together a Triage Sheet to use when calling us. This can be helpful to you in collecting the information we need to assist you expeditiously with a poisoning case. Copies may be printed and kept next to the phone. G:\Word\Triage Sheet for Toxin Exposure Call to APCC.doc Did you know? Every year around Halloween, the APCC receives many calls about exposures to Glow Jewelry. Glow jewelry contains dibutyl phthalate and when ingested causes hypersalivation, head shaking, vomiting, retching, face rubbing, hiding, licking and lip smacking, and hyperactivity or lethargy. Can you guess what animal is most frequently is exposed to glow jewelry? It is the cat! And Did You Know? Theophrastus Philippus Aureolus Bombastus von Hohenheim was born on Nov 11, He gave himself the title of Paracelsus, meaning greater than Celsus (yes, THAT Celsus). He studied medicine at the University of Basel. Paracelsus pioneered using chemicals to treat disease. He created laudanum, an opiod tincture. He is especially famous for treating syphilis with mercury. This lead to Paracelsus famous quote: "What is not a poison? All things are poison and nothing is without poison. It is the dose that makes the poison." This all leads to Paracelsus being named the father of Toxicology. He died Sept 24, unless you believe the Internet, in which case he is still living and fabulously wealthy, having learned the elusive alchemy secret of turning things into gold.

3 Fall Hazards for Pets Low toxicity (may cause gastrointestinal upset, but unlikely to cause serious problems unless very large amounts are ingested) Glow jewelry, glow sticks (can cause intense taste reaction) School glues, epoxy glue Pencil Magic markers Charcoal briquettes Mosquito Dunks containing Bacillus thuringenesis Moderate toxicity (may cause significant signs beyond mild gastrointestinal upset): Expandable wood glues (e.g. Elmer s ProBond, Gorilla Glue even small amounts can form large gastric foreign bodies requiring surgical removal) Liquid potpourri Batteries Charcoal lighter fluid DEET High toxicity (potential for very serious or life-threatening signs): Antifreeze/coolants Chocolate Rodenticides Human medications (cold and flu medications, decongestants) Alcoholic beverages Homemade play-dough (high sodium content) Useful Websites

4 Toxicant Update Amphetamines Amphetamines are used to treat attention deficit disorder, Parkinson s, narcolepsy, behavior disorders and for appetite depression. They have also been used recreationally. Amphetamines include dexedrine, dextroamphetamine, methamphetamine, Crystal Meth, Exstasy, and Crank. They are stimulatory to the central nervous and cardiovascular systems and can be taken orally, inhaled or injected IV. These chemicals are rapidly absorbed orally from the gastrointestinal tract (usually 30 minutes to 2 hrs) and stimulatory signs include: restlessness, hyperactivity, ataxia, tremors, apprehension, disorientation, seizures, pacing, panting, mydriasis, hyperthermia, anorexia, tachycardia, and hypertension. Signs can last anywhere from 24 hours up to 72 hours. Treatment generally includes some form of decontamination (emesis for asymptomatic patients within an appropriate time frame and health history and/or activated charcoal administration), cardiovascular monitoring, fluids, thermoregulation, monitoring for CNS signs and treating them symptomatically. Typical options are acepromazine, chlorpromazine, cyproheptadine, or barbituates. Valium is to be used only with caution as sometimes this medication can make CNS stimulation worse. Tachycardia is usually treated with propranolol though esmolol can be used for patients that are tachycardic and hypertensive. The biggest risk to these patients is for seizures and for cardiac failure, but if signs can be adequately controlled, then usually prognosis is good. Case Study Chocolate season is coming! One of your best clients comes to your clinic very distraught. Her favorite Labradoodle, Sir Eats a Lot ( Sir ), got into a Christmas present that evidently contained chocolate because Sir is still licking some off his paws. Because Sir ingested most of the packaging, one of the few things you read on the remaining packaging is 70% Cacao. Question: What should you tell the owner? A. Sir is a big dog so this will not be a problem B. This chocolate is stronger than regular dark chocolate and could be a problem, we need to get more information C. You aren t sure, you want to call Animal Poison Control Center D. You need to make Sir vomit and then he will be fine Answer: B or C. The percentage cocoa (or Cacao) refers to the amount of chocolate liquor in the chocolate. Chocolate liquor is produced by grinding the cocoa bean center in to a smooth liquid state and then cooling it and molding it into blocks known as unsweetened baking chocolate. The methylxanthine (caffeine and theobromine) content of unsweetened baking chocolate is 400 mg/oz. Therefore to know how concentrated the chocolate Sir ingested you need to multiple 70% by 400 mg/oz that s 280mg/oz. This is nearly double the concentration of regular dark chocolate!

5 So you talk to the owner and find out that Sir ingested 1 lb of this chocolate 5 hours ago. Since Sir is 40 lbs you determine his methylxanthine dose is 246 mg/kg. To your amazement, his only abnormality on exam is he appears a little nauseated. Question: Should you induce vomiting? Yes or No Answer - Yes. Not only does chocolate tend to form a ball in the stomach and take longer to get absorbed, theobromine is slowly absorbed in dogs (peak plasma is 10 hours in the dog versus 3 hours in humans), so since Sir does not appear stimulated or tachycardic, it may be beneficial to induce emesis. So you go ahead and induce emesis but only get back at best 50% of the chocolate. After consulting with Dr. Tina Wismer, a toxicologist at Animal Poison Control Center, you explain to the owner that Sir is still at risk for chocolate toxicity and needs to stay in the hospital to be monitored, get IV fluids, and repeated doses of activated charcoal. The owner, who is very attached to Sir, asks why he needs to stay when her friends dogs have eaten chocolate and have not had any problems. Question: What do you tell the owner? A. That it depends on the type of chocolate, the size of the dog, and the amount of chocolate the dog got into whether or not it s going to be a problem. B. Sir s methylxanthine dose is still a potentially lethal dose C. Theobromine is removed much more slowly in dogs than in people and thus can build up to toxic amounts more quickly. D. All of the above Answer D. Not only is the peak plasma of theobromine much longer in dogs than people, the half life is longer as well. In dogs, the half life is 17.5 hours, compared to 6-10 hours in people. The LD50 of theobromine in dogs is mg/kg with a potentially lethal dose being mg/kg. Authors: Linda Dolder, DVM, Consulting Veterinarian in Clinical Toxicology, APCC Kirsten Waratuke, DVM Consulting Veterinarian in Clinical Toxicology, APCC Editor: Tina Wismer, DVM, DABVT, DABT, Senior Director of Veterinary Outreach and Education - Unsubscribe or change your preferences. - Want to make sure you receive all of the ASPCA's latest newsletters and alerts? To prevent ASPCA from being caught by your spam filter, please put website@aspca.org in your address book. Learn how.

6