The specialty of toxicology, the study of poisons, has evolved in veterinary medicine to now play a key role in pet health and safety regarding exposure to medications, environmental agents, foods, and chemicals.<\/p>\n
If a pet presents to the clinic exhibiting potential toxicosis or following a likely toxin exposure, a toxicology evaluation will be performed. This will usually include an in-depth history with inquisitive and open-ended questioning with the client, identification of potential toxin exposure, determination of toxicity risk in regard to body systems, and, if necessary, treatment of toxicosis. Often, this requires a consultation with a third party specializing in toxicology, such as the Pet Poison Helpline, or the direct medical line for the potential toxin.<\/p>\n
To assist veterinary nurses in advising pet owners on how to maximize their knowledge and minimize risk, this article will cover 10 common poisons seen in and around the home, their effects on body systems, and general recommendations for client education.<\/p>\n
This class includes methamphetamines, amphetamines, and other similar products. These products are used primarily to combat diagnoses such as attention deficit disorder and binge eating disorder, but can also be used as recreational drugs in the form of crystal meth, which can also be \u201ccut\u201d or combined with other illicit substances. Overdoses with this class of medication are weight- and dose-dependent, and the symptoms typically worsen as the overall dose\/kg body weight increases. The body systems affected by this class of medication are the central nervous, cardiovascular, and respiratory.1<\/sup><\/p>\n Treatment of overdoses is often based on clinical signs and includes emesis, one or more doses of activated charcoal, and IV fluid therapy, especially in asymptomatic patients.2<\/sup> Symptomatic patients may require hospitalization, which may become extensive depending on the severity of the symptoms. With exposures to these medications used for recreational purposes, any additives or fillers will need to be individually identified, if possible, and considered in addition to a full treatment plan.<\/p>\n THC, formally known as tetrahydrocannabinol, is the psychoactive component of the drug cannabis, commonly known as weed, pot, marijuana, or grass. It is a cannabinoid that is one of the products derived from the cannabis plant. This product is available in multiple forms, including wax, vape oil, food products, creams, or crushed for joints or cigars. It can be inhaled, ingested, applied topically, or absorbed sublingually.<\/p>\n Pets are particularly sensitive to this product and even small amounts can cause symptoms. Clinical signs typically worsen with increased THC concentration or amount of exposure. The body systems affected by this product are the central nervous, gastrointestinal, cardiovascular, and urinary.1 <\/sup>Diagnosis is often history-driven with inquisitive questioning. Over the counter human urine drug tests for THC are generally not useful in dogs as false negatives and a few false positives from drugs like ibuprofen or CBD may occur.\u00a0<\/span><\/p>\n Recovery with good supportive care usually occurs 12 to 24 hours postexposure, dose depending.2 <\/sup>Symptomatic patients can be treated either in-patient or out-patient depending on the severity of signs and owner wishes. Things to consider for treatment are emesis in asymptomatic animals, one or more doses of activated charcoal, and supportive care.2<\/sup><\/p>\n It is important to note that CBD (cannabidiol) products that are advertised as THC-free in their manufacturing process are not federally regulated by any government body and product contents cannot be guaranteed.<\/p>\n Acetaminophen, also known as paracetamol, is a medication used to treat fever and mild to moderate pain. Common brand names include Tylenol and Panadol. This medication is readily available in over-the-counter forms both in stand-alone form and in a combination medication, such as with caffeine, aspirin, dextromethorphan hydrobromide, guaifenesin, and phenylephrine hydrochloride. Acetaminophen is also available in a prescription form at higher doses and again in combination medication form, including with narcotics.2 <\/sup><\/p>\n The body systems affected by this product are the gastrointestinal, circulatory (e.g., methemoglobinemia, secondary anemia), and hepatic.1<\/sup> This product has a minimum toxic dose in mg\/kg form but can see gastrointestinal signs even at subtoxic doses. Any exposure to combination versions of this medication will need individual calculations of all active ingredients included for a full treatment guideline.<\/p>\n Treatment to consider includes emesis (if exposure is early enough for tablets to not have dissolved), multiple doses of activated charcoal, bloodwork monitoring (monitoring can be prolonged due to the hepatic component), fluid therapy, hepatoprotectants, and supportive care.2<\/sup><\/p>\n Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that is generally used as an analgesic, antipyretic, and anti-inflammatory. Common brand names include Nurofen, Advil, and Motrin. This medication is readily available in over-the-counter forms both in stand-alone form and in a combination medicine including other medications, such as diphenhydramine, phenylephrine hydrochloride, and chlorpheniramine maleate. Ibuprofen is also available in a prescription form at higher doses and again in combination medication form.<\/p>\n The body systems affected by this product are the gastrointestinal (both upset and ulceration), renal, and central nervous.1 <\/sup>This product has a minimum mg\/kg toxic dose for each body system affected but gastrointestinal signs can occur at subtoxic doses. Individual calculations for all the active ingredients will be needed for any exposure to combination versions of this medication and included in the full treatment plan.\u00a0<\/span><\/span><\/p>\n Treatment to consider includes emesis (if exposure is early enough for tablets to not have dissolved), multiple doses of activated charcoal, bloodwork monitoring (monitoring can be prolonged due to the renal component), fluid therapy (especially with renal toxic doses), and supportive care, depending on clinical signs.2<\/sup><\/p>\n Carprofen is a NSAID that is currently only available for use in dogs. It is used in the treatment of conditions such as arthritis, postoperative care, soft tissue injury, and more. Not to be confused and used the same as ibuprofen, carprofen is available in several forms, including palatable chewable tablets under the trade name Rimadyl (Zoetis, zoetisus.com) or unflavored tablets, and comes in a variety of dosages.3<\/sup> The body systems affected by this product are gastrointestinal (both upset and ulceration) and renal.1<\/sup><\/p>\n This product is quick to dissolve especially with the palatable chewable tablets; therefore, emesis can be considered for treatment if the exposure was witnessed. Other treatments to consider include multiple doses of activated charcoal, bloodwork monitoring (monitoring can be prolonged due to the renal component), fluid therapy (especially with renal toxic doses), and supportive care, depending on clinical signs.2<\/sup><\/p>\n The first foods covered by this list are grapes and raisins, including foods that contain these items as ingredients, such as certain cereals, trail mix, granola mix, baked goods, and others. The toxic component of grapes and raisins is currently unknown, but recent theories suspect it to be tartaric acid, which is also found in tamarinds and cream of tartar. Unfortunately, there is no well-established toxic dose so any exposure should be evaluated for potential risk.\u00a0<\/span><\/span><\/p>\n Keep in mind, the risk of toxicity increases as the amount of ingested product increases, but this risk is not necessarily linear as pets have individual sensitivities toward grapes and raisins. What is toxic for 1 dog may not cause symptoms for another dog in the same weight class. History is also extremely important since toxicity risk is removed or lessened once the grapes are recovered through emesis.\u00a0<\/span>However, caution should be taken with owners guessing on how many grapes are ingested. If in doubt, treat exposure as an unknown quantity and treat accordingly. The body systems affected by this product are the gastrointestinal and renal.1<\/sup><\/p>\n Treatment to consider is emesis within 3 to 6 hours of ingestion, activated charcoal, monitoring blood work (for renal values), fluid therapy, antiemetic therapy, and supportive care.2<\/sup><\/p>\n In companion animals, this product is primarily toxic only to dogs, as cats have been shown not to have sensitivity to this substance.\u00a0<\/span>Xylitol is a white sugar alcohol that has a sweet taste and is often used as a sugar substitute in substances such as chewing gum, baking goods, candy, and more. The amounts of xylitol used vary significantly from product to product; therefore, best practice is to carefully monitor any sugar-free products in the home and to double check ingredients. There are alternative sugar-free additives that do not present the same toxicity risk to dogs and cats, including mannitol and sorbitol.<\/p>\n The body systems affected by xylitol are the gastrointestinal (e.g., vomiting), endocrine (e.g., hypoglycemia), and hepatic.1 <\/sup>As hypoglycemia can occur within 15 minutes of ingestion, emesis at home is usually not recommended unless ingestion is witnessed. The dog may also decontaminate itself by vomiting. Another important note is xylitol is included in the outer coating of most chewing gum so even if the gum is recovered, toxicity is still present since one cannot accurately determine how much xylitol has already been absorbed.<\/p>\n Diagnostics will be incredibly important in xylitol exposures to determine blood glucose levels and monitor hepatic values depending on the amount of exposure. Xylitol toxicity should be considered for any animals presenting for severe and acute lethargy and tremors as these are added side effects that can be seen with hypoglycemia.<\/p>\n Treatment to consider is emesis (if asymptomatic and if exposure is witnessed), bloodwork monitoring, fluid therapy with dextrose additives to combat hypoglycemia until stabilized, and liver protectants.2<\/sup><\/p>\n Lilies in the Lilium <\/i>or Hemerocallis <\/i>genus are primarily toxic for only one species: cats.\u00a0<\/span>For cats, any exposure can be extremely dangerous and life threatening, affecting primarily the kidneys. Toxicity depends on the type of lily; therefore, prompt and accurate identification of the specific lily is paramount for treatment. If professional identification is not possible, or the lily is no longer available for photo identification, it is recommended that any lily exposure to cats be considered toxic. It is also important to note that ingestion of the water the lilies are placed in and dermal exposure to the leaves, pollen, or flower are considered equally toxic and can also result in renal failure. The body systems affected by this plant include the gastrointestinal and renal.1<\/sup><\/p>\n Treatments to consider include early emesis, bathing off pollen, doses of activated charcoal, fluid therapy, monitoring bloodwork, gastrointestinal support, and symptomatic care based on any other presenting symptoms over the course of treatment.2<\/sup><\/p>\n Dogs who are exposed to lilies and ingest them can experience gastrointestinal upset, such as vomiting, diarrhea, hypersalivation, and appetite loss, but such ingestion can usually be handled with palliative care at home.1<\/sup><\/span><\/p>\n This product can be split into multiple classes based on its active ingredients. The 3 most common classes are bromethalin, long-acting anticoagulants (LAAC), and cholecalciferol.<\/p>\n The important thing about rodenticides is the correct identification of the specific product ingested. Many products look very similar, especially after exposure to the sun, but will have a variety of different active ingredients. Treating a rodenticide exposure without original packaging, or with an owner pulling packaging up from an internet search, could result in the wrong treatment, which can prove fatal. If in doubt, treat exposures as unknown and seek professional treatment guidelines from a toxicity center and professional.<\/p>\n Identification of rodenticide products is done using the Environmental Protection Agency (EPA) registration number available on all original packaging including bait traps.<\/p>\n Bromethalin<\/strong> products affect the central nervous system causing cerebral edema otherwise known as brain swelling.1 <\/sup>There is no antidote for this product and the treatment to consider for known exposure is aggressive emesis, including but not limited to gastric lavage; activated charcoal; and supportive care (in terms of anticonvulsants and other central nervous system support) based on symptoms.2<\/sup><\/p>\n LAAC<\/strong> refers to a collection of various active ingredients, all of which inhibit the pet\u2019s clotting pathway. This product affects only the hematologic system.1<\/sup> Treatments to consider with known exposure are emesis, vitamin K1<\/sub>, and a PT (prothrombin) test which can be done 48 to 72 hours after suspected exposure, but before administration of Vitamin K1, to confirm toxicity. A follow-up PT test is always recommended after a completed course of Vitamin K1<\/sub> to ensure that extension of treatment is not needed.\u00a0<\/span>As this group of rodenticides includes an extended number of active ingredients, some products have more narrow margins of safety than others. Original packaging is paramount to the successful treatment and management of these cases.2<\/sup><\/p>\n Cholecalciferol<\/strong> products can cause severe effects to the gastrointestinal and renal systems.1 <\/sup>There is no antidote for this product and treatment to consider for known exposure is aggressive emesis, including but not limited to gastric lavage; multiple doses of activated charcoal; monitoring bloodwork; fluid therapy; and symptomatic treatment. This particular product is dangerous due to the narrow margin of safety.2<\/sup><\/p>\n Unsurprising to most, coming in first on the list of common toxins is chocolate. Chocolate comes in more forms than we can count, being split into white, milk, dark, semi-sweet, and baking chocolate. These are determined by the amount of cocoa included in them and this also changes the toxicity concern each holds. White chocolate is the least toxic and dark and baker\u2019s chocolate are the most toxic. In general, this product is a spectrum toxicity in which the more ingested, the higher the toxicity risk. Keep an eye out for additions to chocolate exposure that would incur other toxicity risks, including macadamia nuts, raisins, xylitol, and THC, to name a few. The body systems affected by this product are the gastrointestinal, cardiovascular, and central nervous.1<\/sup><\/p>\n Treatment to consider with chocolate exposures are emesis (can be performed 3 to 4 hours after exposure), activated charcoal, fluids (IV\/SC depending on dose), monitoring for symptom development, bloodwork, and supportive care.2<\/sup><\/p>\n Now that we have established a better foundational knowledge of common toxins and how they can affect an animal\u2019s systems, let’s discuss how to expand on this knowledge in terms of client education.<\/p>\n Common products that packaging should be kept for include fertilizers, rodenticides, pesticides, ant or roach baits, paints and paint products, automotive supplies, and cleaning products. This is by no means an exhaustive list but includes anything in the house and garden that is not meant for consumption.<\/span><\/p>\n Keeping original packaging can be as easy as designating a section of the house where physical packaging is kept or documenting with clear photos and notes. If clients elect to document their products in any way other than by keeping the original packaging, they will need to ensure they note the details in BOX 1<\/strong>.<\/p>\n If clients are not applying the product themselves (i.e., pest control company, apartment complex services), encourage your clients to reach out specifically to those companies at the time of application to document the necessary details. Toxin exposures do not always occur during business hours. They will give information on what product they are using\/applying\u2013be sure to get this information from the company representative before they apply the potential toxin.<\/p>\n Not having the correct information on what your pet has potentially been exposed to can cause unnecessary and detrimental delays in treatment.<\/p>\n This is an excellent opportunity for client education material development. A nonexhaustive list of potential toxins in the home includes various foods, medication, various plants, rodenticides, pesticides, and insecticides. Knowing what items in the home can present a potential toxicity concern will enable homeowners to better prepare their home and themselves to prevent potential toxin exposure and in the event of exposure, to be better equipped to react to such a circumstance.<\/p>\n After identifying potential toxins in the home, the next step is to educate the pet owner on how to minimize or eliminate any potential risks. This can include switching out plants that are deemed toxic to animals for a pet-friendly variety, digging up mushrooms that sprout in the yard, ensuring any rodenticides are never left loose around the house no matter how hidden.<\/p>\n The author also recommends closing off a room when dealing with any medication in the event of dropped pills, especially when refilling pill organizers or larger medication bottles. Spilled bottles can happen in the blink of an eye and it is often impossible to accurately determine potential exposure with spilled bottles or pill organizers. It is also recommended to never combine medication refills. Even though this can be considered a space saver and more convenient, it eliminates any possibility of accuracy in the event of bottle spills.<\/p>\n Other recommendations to minimize risk include never leaving pills unattended on any surfaces and separating pets while giving them preventives or medications to ensure the correct pet receives the product.<\/p>\n Although these measures do take more planning and more time, they are measures that in the long run ensure the safety of your pet by decreasing and\/or eliminating these risks in the home as realistically as we can.<\/p>\n Even with the best planning and prevention, accidents do happen. Having a plan and knowing your options and available resources will ensure prompt toxicity evaluation and associated treatment recommendations; whether that be at-home or in-clinic recommendations.<\/p>\n For clinics, this can include adding emergency clinic and toxicology service numbers to all social media platforms and on your answering services to help direct clients.<\/p>\n For clients, this should include an at-home emergency kit including things such as hydrogen peroxide 3%, a syringe in case emesis is recommended by a veterinary professional, as well as other medications that may be recommended by veterinary professionals such as bismuth subsalicylate and omeprazole. Clients should also have an accessible record of their veterinary clinic\u2019s name and phone number, as well as the phone number for their state\u2019s poison control center, the ASPCA Poison Control<\/a>, and\/or the Pet Poison Helpline<\/a>.<\/p>\n9. THC<\/h2>\n
8. Acetaminophen<\/h2>\n
7. Ibuprofen<\/h2>\n
6. Carprofen<\/h2>\n
5. Grapes and Raisins<\/h2>\n
4. Xylitol<\/h2>\n
3. Lilies<\/h2>\n
2. Rodenticide<\/h2>\n
1. Chocolate<\/h2>\n
Discussion<\/h2>\n
Encourage clients to keep all original packaging.<\/h3>\n
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Identify potential toxins in the home.<\/h3>\n
Minimize risk.<\/h3>\n
Know your resources.<\/h3>\n
\nhttps:\/\/www.petpoisonhelpline.com\/<\/a>
\n(855) 764-7661<\/p>\n