Contents. Meet the Toxicology Team. Who's New on the APCC Hotline? What's new on the APCC Website? Did You Know? Summer Hazards for Pets

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1 Contents Meet the Toxicology Team Who's New on the APCC Hotline? What's new on the APCC Website? Did You Know? Summer Hazards for Pets Useful Websites Toxicant Update Case Study Hot Link Meet the Toxicology Team Welcome to Client Services! We are staffed by a team of 21 employees who manage a variety of responsibilities. A main focus of the team is to provide support to the Animal Poison Control Center. In that capacity, we manage outbound follow up calls and support the databases utilized by our medical records system, Antox. Follow up calls allow staff to connect with VLPP members. They also serve a vital role in helping expand our medical knowledge through outcome data collection. This information is then used during future consultations. Client services staff members also maintain Antox databases and update product information, veterinary clinics and shelter contacts, and VLPP account information. We manage new VLPP enrollments and send welcome packets and other requested materials. Team members also provide diagnostic support, manage technical support services programs, and perform quality assurance of medical records. In addition to supporting the Animal Poison Control Center, Client Services staff members play a vital role in other ASPCA programs. Client Services team members manage the Mobile Spay/Neuter Clinic post operative line. This line provides post operative care recommendations to pet parents and rescuers whose animals have been spayed or neutered on the mobile clinics that serve New York City s five boroughs. The team also operates the Trap, Neuter and Return (TNR) scheduling center creating and confirming appointments for

2 certified rescuers participating in the TNR program. Schedulers also assist pet owners with questions regarding the mobile clinics. You can contact the Client Services staff by phone at or by at Who's New on the APCC Hotline? Now that the summer season has officially started, we have a new group of veterinary students who have now begun working in the call center. What this means to clients that you refer is that when they call the APCC this summer, they may initially speak with a staff member who will ask for basic information on the case, then transfer the case to the appropriate veterinary staff after assigning a case number and follow-up number. In times of high-call volume, this may mean a wait time between speaking with these newer staff members and speaking with a veterinary professional if all of our veterinary staff are engaged in calls. We appreciate your patience during these busy times and hope this new procedure will help us answer calls as quickly and efficiently as possible. For veterinary clinics themselves, likely you will not see a change in how your calls are handled. What's New on the APCC Website? Need a new app for your iphone? Check out our Poisonous plant Pet Safe app on itunes! It is compatible with the iphone and the ipod touch and includes toxic plant information. This is a great tool to have with you when you re out shopping. Check it out at: Another great help for your clients is the ability to order a Free Pet Safety Pack containing an emergency pet rescue window decal to alert rescue personnel to the presence of pets in the home as well as an ASPCA Animal Poison Control Center Magnet a great way to keep the APCC's toll-free emergency number handy at all times! The order form is available here. Your clients love their pets and often think of them as surrogate children. But cats and dogs (and birds and turtles) are not little people and often pet owners are not aware of some of the hazards that 'people food' may pose to pets. Steer them to our website on People Foods to Avoid Feeding Your Pets to help educate them on what they should not be sharing with their four legged (or winged) family members. The ASPCA is proud to introduce our free ASPCA Animal Poison Control Center Banner, which will allow direct access from your website to ours! With the click of a mouse, your clients have access to information about the ASPCA Animal Poison Control Center, in

3 addition to endless amounts of information regarding potentially harmful substances. We look forward to working with you to improve the lives of animals. For access to the free link, click here. For additional information, please feel free to contact the ASPCA at Did you know? That you can access a large source of veterinary and medical literature online? Just go to PubMed at and type in you search parameters. You can view abstracts, order reprints, and in some cases view entire documents online. And did you know? Ever have trouble identifying a plant? There are various websites that provide lists of toxic and non-toxic plants, including the genus species name and the common name, as well as photos of these plants. One is ASPCA website, and another is Summer Hazards for Pets Summer brings days of fun in the sun, but summer can also bring hazards to our pets. Lawn and garden products, toxic plants and mushrooms, and other outdoor hazards such as charcoal lighter fluid and pool chemicals, can pose problems if pets get into them. Below is a list of relative toxicity of various summer hazards to which a pet may be exposed. Low toxicity (may cause gastrointestinal upset, but unlikely to cause serious problems unless very large amounts are ingested): - Glow jewelry - N-P-K fertilizers (no added insecticide or herbicide; iron level <1%) - Bone meal (no added insecticide or herbicide) - Mosquito coils (foreign body potential from coil material) - Mosquito Dunks (Thuringiensin, Bacillus thuriniensis) - Charcoal briquettes (unused, no added lighter fluid) - Termite stakes, ant baits, yard insecticides, and roach baits containing sulfluramid (N-- ethylperfluorooctanesulfonamide) or hydramethylnon (2% or less)

4 Moderate toxicity (may cause significant signs beyond mild gastrointestinal upset): - Charcoal lighter fluids - Moldy items from trash, yard or compost pile (tremorgenic mycotoxins) - Diazinon or chlorpyrifos (Dursban) granules (>2%) - DEET-containing insect repellants - Citronella lamps/torches - Spring blooming bulbs (see our website under Publications for more information) High toxicity (potential for very serious or life-threatening signs): - Pool chemicals (concentrated hypochlorites, cationic detergents) - Metaldehyde containing snail/slug baits - Zinc phosphide-containing systemic insecticides - Methomyl-containing fly baits - Disulfoton-containing insecticides (found in some rose and flower care products) - Rodenticides (anticoagulants, bromethalin, cholecalciferol) Useful Websites As everyone starts to plant, it s time to remind clients of the potential hazards some plants may pose to pets. Below are some links to articles that veterinary staff may find useful in answering pet owners questions. How Dangerous are Winter and Spring Holiday Plants to Pets? (pdf) Easter Lily Toxicosis in Cats (pdf) Spring-Blooming Bulbs: A Year-Round Problem (pdf) Potentially Toxic Garden Plants (pdf) And, of course, listings of nontoxic and toxic plants may be found on our web page.

5 Join the Paws to Click Movement - Help Keep Pets Safe on the Road this Summer As many of your clients will be hitting the road this summer with their pets, be sure to remind them how to travel safely. Learn about the Paws to Click movement, sponsored by the ASPCA, Bergan and Red Lion Hotels (redlion.com). Developed in recognition that an estimated 30,000 car accidents are caused by unrestrained pets, this movement was created to increase awareness of the importance of restraining your pet in the car to help keep people and pets safe. Red Lion Hotels joined the Paws to Click movement at inception and is spreading the word and educating their hotel guests about traveling safely and responsibly with their pets. Red Lion is a pet friendly chain of full service hotels your clients should know about, with 43 west coast locations where pets stay free and even earn Red Lion R&R Club points. With over 8,000 traveling pets in the Club, we hope all their pet parents will become ambassadors for Paws to Click. We encourage you and your clients to join this important nationwide pet safety movement as well and help keep more pets and people safer on the road this summer. Toxicant Update - Acetaminophen Acetaminophen is a non-opiate derivative of p-aminophenol that is used to treat pain and fever. It comes in a large variety of preparations including liquids, tablets and long acting compounds, both in over-the-counter and prescription only type products. Acetaminophen is also found in a great many combination products. Peak plasma is usually reached in less than 30 minutes and up to 4 hours. There is a therapeutic dose in dogs of 10mg/kg reported in Great Britain, but use in dogs is generally not recommended. Cats are especially sensitive to the effects of acetaminophen due to their inability to glucuronidate the drug to its non-toxic metabolite, coupled with eight reactive sulfhydryl groups on feline hemoglobin, which are targeted by the toxic acetaminophen metabolites. In cats, the primary effect seen with acetaminophen exposures is methemoglobinemia (+/- Heinz bodies), resulting in dyspnea, cyanosis, weakness, depression and death. Facial and paw edema may also occur, although the mechanism of this effect is not known. Cats can develop liver injury from acetaminophen but generally succumb to methemoglobinemia before liver damage becomes apparent. Dogs are somewhat more resistant to the effects of acetaminophen compared to cats, but overdoses may cause serious hepatic and hematologic effects, depending on the dose ingested. Keratoconjunctivitis sicca has been reported in dogs at levels below those that are typically associated with liver toxicosis (less than 100 mg/kg). The development of KCS occurs typically within 72 hrs of exposure. At dosages of acetaminophen over 100 mg/kg, there is risk of hepatic injury from acetaminophen. Dosages over about 200 mg/kg may result in methemoglobinemia in addition to hepatic injury. Facial and paw edema may be seen in dogs but is more commonly seen in cats with acetaminophen toxicosis. Metabolic

6 acidosis, renal damage, myocardial damage, CNS signs, thrombocytopenia and pancreatitis have occasionally been reported with large dosages of acetaminophen in dogs. Treatment involves emesis induction (when medically safe and appropriate in a non symptomatic patient) and activated charcoal administration. Oftentimes repeated doses of activated charcoal are helpful since acetaminophen is thought to undergo enterohepatic recirculation. Monitoring of liver values and for methemoglobinemia is also of primary importance. Administration of N-acetylcysteine ( mg/kg loading dose followed by 70 mg/kg q 6 hrs for minimum of 7 treatments; continue if evidence of hepatic injury, methemoglobinemia occurs) in patients at risk for methemoglobinemia and liver dysfunction is also important. Fluid therapy is usually instituted, especially in large acetaminophen exposures where nephrotoxicosis can be a concern. Monitoring of tear production in the form of a Schirmer tear test is recommended at baseline and then again at 72 hrs. Adjunctive therapies of ascorbic acid and SAM-E are also used in some cases. Case Study A 65 pound, MC, German shepherd mix (Buggs) presented to the clinic with a history of vomiting three times. While in the waiting room, Buggs vomited up pieces of an autumn crocus bulb. Owner said that Buggs must have gotten into the crocus bulbs left over from last year. 1. You call the ASPCA-APCC and reach Dr. Maggie Thornburg, who can quickly assess the risk. What would her initial advice be? Answer: D a. Induce vomiting again and let the owner monitor at home, since all Crocus species primarily only causes GI upset. b. Give an antiemetic and let the owner monitor at home, since all Crocus species primarily only causes GI upset. c. Give one dose of activated charcoal and release the dog for owner to observe at home. d. Hospitalize the dog, as this is potentially a serious toxicity 2. What is the toxic principle in autumn crocus (also called meadow saffron) a. Ricin interferes with protein synthesis, leading to cell death b. Estrogen causes bone marrow suppression c. Colchicine antimetabolite which inhibits spindle formation in the microtubules during normal cell division d. Disulfides causing hemolysis, Heinz body formation, and methemoglobinemia Answer: C. The source is usually ingestion of ornamental bulbs, frequently grown as a house or garden plant. Autumn crocus grows wild in meadows in Europe. Glory lilies are especially grown in Florida and Hawaii, or pot plants anywhere. The toxic principle in these plants is colchicine.

7 Colchicine is an antimetabolite. The greatest concerns are for severe GI signs (vomiting and diarrhea, possibly with blood), bone marrow suppression (anemia, leucopenia), generalized organ failure (hepatic, renal), and coagulopathies subsequent to liver damage. Hot Link We value you, and want you and your clients to have a good experience when calling the ASPCA Animal Poison Control Center. As we approach our busiest season, we want to help each of you in the most efficient and professional way possible. In order to accomplish that goal we've compiled the following suggestions that we hope will help your clients feel more comfortable when calling our center. When triaging a phone call from a client, try to determine if life-threatening signs are present. If so, have them bring the animal in immediately; the client can be calling us while you are stabilizing the animal. Ask client what their pet was exposed to, if their pet has prior health concerns, and if their pet is showing any signs before recommending they induce vomiting at home. Please let your client know there may be a fee for the poison center consultation. Obtain information about the agent involved in the exposure (product name, ingredients, EPA registration number for pesticides, etc.). Have the patient s medical record available when calling. Have as detailed a history of the exposure as possible. Know what signs the patient is showing and when the signs started. Our triage sheet(.pdf) can be helpful in collecting the information we need to assist you with a poisoning case. Please print copies to keep next to the phone. Not a VLPP Member? If you are not a member of the Veterinary Lifeline Partner Program and would like to join, please click here or call (888) to be prepared for any poison emergency. Authors: Sharon Welch, DVM, DABVT, DABT, Senior Toxicologist, APCC Linda Dolder, DVM, Consulting Veterinarian in Clinical Toxicology, APCC

8 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.