{"id":2731,"date":"2018-01-17T17:19:05","date_gmt":"2018-01-17T22:19:05","guid":{"rendered":"http:\/\/phosdev.com\/todaysveterinarynurse\/?post_type=articles&#038;p=2731"},"modified":"2022-02-15T21:30:33","modified_gmt":"2022-02-15T21:30:33","slug":"winter-holiday-toxins","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/toxicology\/winter-holiday-toxins\/","title":{"rendered":"Winter Holiday Toxins for Pets"},"content":{"rendered":"<div id=\"contentsContainer\">\n<div id=\"contents\">\n<p id=\"E800\" class=\"qowt-stl-Body\"><span id=\"E801\" class=\"qowt-font5-Calibri\">The winter holiday season holds an abundance of dangers for domestic pets that could result in <\/span><span id=\"E803\" class=\"qowt-font5-Calibri\">toxicosis<\/span><span id=\"E805\" class=\"qowt-font5-Calibri\">. This article will focus on exposures to chocolate, grapes and raisins, and homemade playdough in dogs. Plants that dogs and cats are commonly exposed to during the winter months will also be discussed.<\/span><\/p>\n<h2 id=\"E812\" class=\"qowt-stl-B-Head\"><span id=\"E815\" class=\"qowt-font5-Calibri\">Chocolate<\/span><\/h2>\n<p id=\"E816\" class=\"qowt-stl-Body\"><span id=\"E817\" class=\"qowt-font5-Calibri\">The APCC received more calls about chocolate than any other agent in 2016, averaging over 41 cases per day. An influx of chocolate exposures is observed by APCC during the winter season because the agents are readily available to pets in the home. Examples of common forms of chocolate the APCC receives calls about are candy bars, snack mixes, chocolate desserts (brownies, cakes, and cookies), and baking goods such as chocolate chips and cocoa powder.<\/span><\/p>\n<p id=\"E818\" class=\"qowt-stl-Body\"><span id=\"E819\" class=\"qowt-font5-Calibri\">Chocolate contains 2 <\/span><span id=\"E821\" class=\"qowt-font5-Calibri\">methylxanthines<\/span><span id=\"E823\" class=\"qowt-font5-Calibri\"> of <\/span><span id=\"E825\" class=\"qowt-font5-Calibri\">toxicologic<\/span><span id=\"E827\" class=\"qowt-font5-Calibri\"> significance: theobromine and caffeine.<\/span><sup><span id=\"E828\" class=\"qowt-font5-Calibri\">1<\/span><\/sup><span id=\"E829\" class=\"qowt-font5-Calibri\"> The concentration of these <\/span><span id=\"E831\" class=\"qowt-font5-Calibri\">methylxanthines<\/span><span id=\"E833\" class=\"qowt-font5-Calibri\"> differs between products (<\/span><strong><span id=\"E834\" class=\"qowt-font5-Calibri\">T<\/span><span id=\"E835\" class=\"qowt-font5-Calibri\">ABLE<\/span><span id=\"E836\" class=\"qowt-font5-Calibri\"> 1<\/span><\/strong><span id=\"E837\" class=\"qowt-font5-Calibri\">). White chocolate has a very low concentration of <\/span><span id=\"E839\" class=\"qowt-font5-Calibri\">methylxanthines<\/span><span id=\"E841\" class=\"qowt-font5-Calibri\"> and has low <\/span><span id=\"E843\" class=\"qowt-font5-Calibri\">toxicologic<\/span><span id=\"E845\" class=\"qowt-font5-Calibri\"> significance. Milk chocolate, dark chocolate (semi-sweet chocolate), baking chocolate (unsweetened chocolate), and cocoa powder have much higher concentrations of <\/span><span id=\"E847\" class=\"qowt-font5-Calibri\">methylxanthines<\/span><span id=\"E849\" class=\"qowt-font5-Calibri\">, and exposures to these more commonly result in <\/span><span id=\"E851\" class=\"qowt-font5-Calibri\">toxicosis<\/span><span id=\"E853\" class=\"qowt-font5-Calibri\">. <\/span><\/p>\n<p><a href=\"http:\/\/tvn.tv-multi-theme.com.216-70-96-51.jvv2-rfnp.accessdomain.com\/wp-content\/uploads\/sites\/3\/2018\/01\/TVNURS_22.jpg\"><img fetchpriority=\"high\" decoding=\"async\" class=\"aligncenter wp-image-8078\" src=\"http:\/\/tvn.tv-multi-theme.com.216-70-96-51.jvv2-rfnp.accessdomain.com\/wp-content\/uploads\/sites\/3\/2018\/01\/TVNURS_22-300x194.jpg\" alt=\"Table 1: Concentration of methylxanthines in different types of chocolate\" width=\"476\" height=\"308\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2018\/01\/TVNURS_22-300x194.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2018\/01\/TVNURS_22-1024x661.jpg 1024w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2018\/01\/TVNURS_22-768x496.jpg 768w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2018\/01\/TVNURS_22.jpg 1027w\" sizes=\"(max-width: 476px) 100vw, 476px\" \/><\/a><\/p>\n<p id=\"E934\" class=\"qowt-stl-Body\"><span id=\"E936\" class=\"qowt-font5-Calibri\">Methylxanthine<\/span><span id=\"E938\" class=\"qowt-font5-Calibri\"> <\/span><span id=\"E940\" class=\"qowt-font5-Calibri\">toxicosis<\/span><span id=\"E942\" class=\"qowt-font5-Calibri\"> causes stimulation of the cardiovascular and central nervous systems. The degree of toxicity is dose dependent. With low doses of chocolate, only mild gastrointestinal (GI) upset is observed. At <\/span><span id=\"E944\" class=\"qowt-font5-Calibri\">cardiotoxic<\/span><span id=\"E946\" class=\"qowt-font5-Calibri\"> doses, more severe signs such as tachycardia, tachypnea, hyperthermia, cardiac arrhythmias, tremors, and seizures can develop. If exposure to chocolate is suspected or observed, an estimated dose of <\/span><span id=\"E948\" class=\"qowt-font5-Calibri\">methylxanthines<\/span><span id=\"E950\" class=\"qowt-font5-Calibri\"> should be calculated. In an asymptomatic patient, this dose will determine whether decontamination or treatment is necessary (<\/span><strong><span id=\"E951\" class=\"qowt-font5-Calibri\">B<\/span><span id=\"E952\" class=\"qowt-font5-Calibri\">OX<\/span><span id=\"E953\" class=\"qowt-font5-Calibri\"> 1<\/span><\/strong><span id=\"E954\" class=\"qowt-font5-Calibri\">).<\/span><\/p>\n<\/div>\n<\/div>\n<div id=\"contentsContainer\">\n<div id=\"contents\">\n<p><strong><div class=\"su-box su-box-style-default boxwidth100\" id=\"\" style=\"border-color:#000000;border-radius:0px;\"><div class=\"su-box-title\" style=\"background-color:#333333;color:#FFFFFF;border-top-left-radius:0px;border-top-right-radius:0px\"><\/strong><strong>BOX 1<\/strong> Chocolate Dose Calculations<strong><\/div><div class=\"su-box-content su-u-clearfix su-u-trim\" style=\"border-bottom-left-radius:0px;border-bottom-right-radius:0px\"><\/strong><\/p>\n<p>To calculate a dose of chocolate, 3 pieces of information are needed:<\/p>\n<ul>\n<li>The weight of the pet in kg<\/li>\n<li>The amount of the agent ingested in grams or ounces<\/li>\n<li>The estimated concentration of methylxanthines.<\/li>\n<\/ul>\n<p><strong>Milk Chocolate<\/strong><\/p>\n<p>For example, consider a 15-kg dog that has ingested a 3.5-oz solid milk chocolate bar (solid meaning there are no nuts or fillings). Milk chocolate contains an estimated methylxanthine concentration of 65 mg\/oz. To get the mg\/kg dose of chocolate, the weight of the chocolate bar is multiplied by the concentration of methylxanthines, which is then divided by the pet\u2019s weight in kg.<\/p>\n<p style=\"text-align: center\"><strong>3.5 oz \u00d7 65 mg\/oz = 227.5 mg \/ 15 kg = 15.166 mg\/kg<\/strong><\/p>\n<p>A 15-mg\/kg dose of chocolate would be expected to cause only mild GI upset with a low risk of pancreatitis. No veterinary treatment would be required for this exposure.<\/p>\n<p><strong>Dark Chocolate<\/strong><\/p>\n<p>However, if this chocolate bar were made of dark chocolate, then the concentration of methylxanthines would be 165 mg\/oz.<\/p>\n<p style=\"text-align: center\"><strong>3.5 oz \u00d7 165 mg\/oz = 577.5 mg \/ 15 kg = 38.5 mg\/kg<\/strong><\/p>\n<p>A 38.5-mg\/kg dose of chocolate is not cardiotoxic, but could cause moderate GI upset, polydipsia, pancreatitis, and mild agitation or hyperactivity. In an asymptomatic patient, emesis would be recommended. With successful emesis, further veterinary care would not be required.<\/p>\n<p><strong>Baking Chocolate<\/strong><\/p>\n<p>Some milk and dark chocolate bars show a percentage of cacao on the label, which is generally seen on the front of the bar and not in the ingredient list. Cacao is unsweetened (baking) chocolate. If this percentage is observed, then an extra calculation must be done to obtain the bar\u2019s estimated concentration of methylxanthines. A range of estimated concentrations exists, but the APCC uses those listed in<strong> TABLE 1<\/strong>. For example, if the label shows a 65% concentration of cacao, the APCC multiplies the percentage by 400 mg\/oz.<\/p>\n<p style=\"text-align: center\"><strong>0.65 \u00d7 400 mg\/oz = 260 mg\/oz<\/strong><\/p>\n<p>When substituted into the previous equation, the 15-kg dog that ingested a 3.5-oz dark chocolate bar containing 65% cacao has an estimated chocolate dose of 60.67 mg\/kg.<\/p>\n<p style=\"text-align: center\"><strong>3.5 oz x 260 mg\/oz = 910 mg \/ 15 kg = 60.67 mg\/kg<\/strong><\/p>\n<p>This dose is at a cardiotoxic level and can be expected to significantly stimulate the cardiovascular and central nervous systems. Hospitalization would be recommended.<\/p>\n<p>Calculating a dose of chocolate can be challenging, especially if the agent involved is a baked good such as a chocolate cake or brownie. Looking at the ingredients in the agent will help determine what concentration of methylxanthines should be used in the dosage calculation. With purchased baked goods or box mixes, the ingredients are commonly printed on the label. If the baked good was made from scratch, ask the owner what ingredients were used in the recipe, the amounts of each ingredient, and the amount of the baked good yielded.<\/p>\n<p><strong><\/div><\/div><\/strong><\/p>\n<h3 id=\"E1082\" class=\"qowt-stl-B-Head\"><span id=\"E1085\" class=\"qowt-font5-Calibri\">Decontamination and Treatment<\/span><\/h3>\n<p id=\"E1086\" class=\"qowt-stl-Body\"><span id=\"E1087\" class=\"qowt-font5-Calibri\">Decontamination through emesis is recommended in patients that have ingested &gt;35 mg\/kg of <\/span><span id=\"E1089\" class=\"qowt-font5-Calibri\">methylxanthines<\/span><span id=\"E1091\" class=\"qowt-font5-Calibri\">. Doses lower than this are not expected to cause serious clinical signs. With large exposures to chocolate that do not yield a toxic dose, emesis is recommended to prevent severe GI upset and to decrease the risk of pancreatitis. Emesis should be considered if the exposure occurred within the past 2 to 6 hours.<\/span><sup><span id=\"E1092\" class=\"qowt-font5-Calibri\">2<\/span><\/sup><span id=\"E1093\" class=\"qowt-font5-Calibri\"> <\/span><\/p>\n<p id=\"E1094\" class=\"qowt-stl-Body\"><span id=\"E1095\" class=\"qowt-font5-Calibri\">Activated charcoal can help in preventing absorption of <\/span><span id=\"E1097\" class=\"qowt-font5-Calibri\">methylxanthines<\/span><span id=\"E1099\" class=\"qowt-font5-Calibri\"> from the GI tract. However, charcoal can cause electrolyte changes and therefore is only recommended when a risk of severe <\/span><span id=\"E1101\" class=\"qowt-font5-Calibri\">toxicosis<\/span><span id=\"E1103\" class=\"qowt-font5-Calibri\"> exists. <\/span><\/p>\n<p id=\"E1104\" class=\"qowt-stl-Body\"><span id=\"E1105\" class=\"qowt-font5-Calibri\">There is no antidote for chocolate <\/span><span id=\"E1107\" class=\"qowt-font5-Calibri\">toxicosis<\/span><span id=\"E1109\" class=\"qowt-font5-Calibri\">; therefore, treatment consists largely of supportive and symptomatic care.<\/span><sup><span id=\"E1110\" class=\"qowt-font5-Calibri\">2<\/span><\/sup><span id=\"E1111\" class=\"qowt-font5-Calibri\"> Propranolol is recommended in treating moderate to severe tachycardia,<\/span><sup><span id=\"E1112\" class=\"qowt-font5-Calibri\">2<\/span><\/sup><span id=\"E1113\" class=\"qowt-font5-Calibri\"> whereas muscle tremors can be managed with methocarbamol or diazepam.<\/span><sup><span id=\"E1114\" class=\"qowt-font5-Calibri\">2<\/span><\/sup><span id=\"E1115\" class=\"qowt-font5-Calibri\"> Diazepam is also recommended for the management of seizure activity.<\/span><sup><span id=\"E1116\" class=\"qowt-font5-Calibri\">2<\/span><\/sup><span id=\"E1117\" class=\"qowt-font5-Calibri\"> IV fluids are recommended to help increase excretion of methylxanthines,<\/span><sup><span id=\"E1118\" class=\"qowt-font5-Calibri\">2<\/span><\/sup><span id=\"E1119\" class=\"qowt-font5-Calibri\"> and the bladder should be emptied regularly to prevent reabsorption of <\/span><span id=\"E1121\" class=\"qowt-font5-Calibri\">methylxanthines<\/span><span id=\"E1123\" class=\"qowt-font5-Calibri\"> through the bladder wall.<\/span><sup><span id=\"E1124\" class=\"qowt-font5-Calibri\">2<\/span><\/sup><span id=\"E1125\" class=\"qowt-font5-Calibri\"> <\/span><\/p>\n<p id=\"E1126\" class=\"qowt-stl-Body\"><span id=\"E1127\" class=\"qowt-font5-Calibri\">The prognosis for chocolate <\/span><span id=\"E1130\" class=\"qowt-font5-Calibri\">toxicosis<\/span><span id=\"E1132\" class=\"qowt-font5-Calibri\"> is generally considered good with successful decontamination and veterinary intervention.<\/span><sup><span id=\"E1133\" class=\"qowt-font5-Calibri\">1<\/span><\/sup><span id=\"E1134\" class=\"qowt-font5-Calibri\"> However, pets that present with seizures or <\/span><span id=\"E1136\" class=\"qowt-font5-Calibri\">tachyarrhythmias<\/span><span id=\"E1138\" class=\"qowt-font5-Calibri\"> have a more guarded prognosis.<\/span><sup><span id=\"E1139\" class=\"qowt-font5-Calibri\">2<\/span><\/sup><\/p>\n<h2 id=\"E1140\" class=\"qowt-stl-B-Head\"><span id=\"E1143\" class=\"qowt-font5-Calibri\">Grapes and Raisins<\/span><\/h2>\n<p id=\"E1144\" class=\"qowt-stl-Body\"><span id=\"E1145\" class=\"qowt-font5-Calibri\">Exposures to grapes and raisins are especially common during the winter season because these items are used in many holiday recipes and meals. <\/span><\/p>\n<p id=\"E1146\" class=\"qowt-stl-Body\"><span id=\"E1147\" class=\"qowt-font5-Calibri\">Grapes, raisins, and <\/span><span id=\"E1149\" class=\"qowt-font5-Calibri\">zante<\/span><span id=\"E1151\" class=\"qowt-font5-Calibri\"> currants belong to the genus <\/span><em><span id=\"E1153\" class=\"qowt-font5-Calibri\">Vitis<\/span><\/em><span id=\"E1155\" class=\"qowt-font5-Calibri\">, and ingestion can result in acute renal injury in dogs.<\/span><sup><span id=\"E1156\" class=\"qowt-font5-Calibri\">3<\/span><\/sup><span id=\"E1157\" class=\"qowt-font5-Calibri\"> The mechanism of action is unknown at this time. Although studies have evaluated these fruits for mycotoxins, pesticides, heavy metals, and vitamin D<\/span><sub><span id=\"E1158\" class=\"qowt-font5-Calibri\">3<\/span><\/sub><span id=\"E1159\" class=\"qowt-font5-Calibri\">,<\/span><sup><span id=\"E1160\" class=\"qowt-font5-Calibri\">3<\/span><\/sup><span id=\"E1161\" class=\"qowt-font5-Calibri\"> there have been no positive results for these <\/span><span id=\"E1163\" class=\"qowt-font5-Calibri\">nephrotoxins<\/span><span id=\"E1165\" class=\"qowt-font5-Calibri\">. <\/span><\/p>\n<p id=\"E1166\" class=\"qowt-stl-Body\"><span id=\"E1167\" class=\"qowt-font5-Calibri\">Not all dogs that ingest grapes or raisins develop acute renal injury. A dose-response relationship, common to <\/span><span class=\"qowt-font5-Calibri\">other toxic agents, has not been observed with <\/span><em><span id=\"E1169\" class=\"qowt-font5-Calibri\">Vitis<\/span><\/em><span id=\"E1171\" class=\"qowt-font5-Calibri\"> exposures.<\/span><sup><span id=\"E1172\" class=\"qowt-font5-Calibri\">4<\/span><\/sup><span id=\"E1173\" class=\"qowt-font5-Calibri\"> Therefore, the severity of <\/span><span id=\"E1175\" class=\"qowt-font5-Calibri\">toxicosis<\/span><span id=\"E1177\" class=\"qowt-font5-Calibri\"> does not depend on the <\/span><span id=\"E1179\" class=\"qowt-font5-Calibri\">amount<\/span><span id=\"E1181\" class=\"qowt-font5-Calibri\"> of grapes or raisins ingested. Also, grape seed extract, grape juice, grape jelly, and wine have not been shown to cause <\/span><em><span id=\"E1183\" class=\"qowt-font5-Calibri\">Vitis<\/span><\/em><span id=\"E1185\" class=\"qowt-font5-Calibri\"> toxicosis.<\/span><span id=\"E1186\" class=\"qowt-font5-Calibri\"><sup>5<\/sup><br \/>\n<\/span><\/p>\n<\/div>\n<\/div>\n<div id=\"contentsContainer\">\n<div id=\"contents\">\n<p id=\"E1187\" class=\"qowt-stl-Body\"><span id=\"E1188\" class=\"qowt-font5-Calibri\">Clinical signs may be delayed by several hours after the ingestion of <\/span><em><span id=\"E1190\" class=\"qowt-font5-Calibri\">Vitis<\/span><\/em><span id=\"E1192\" class=\"qowt-font5-Calibri\"> species. Vomiting is common within the first 24 hours,<\/span><sup><span id=\"E1193\" class=\"qowt-font5-Calibri\">4,6<\/span><\/sup><span id=\"E1194\" class=\"qowt-font5-Calibri\"> followed by diarrhea, anorexia, lethargy, and abdominal pain.<\/span><sup><span id=\"E1195\" class=\"qowt-font5-Calibri\">1,6<\/span><\/sup><span id=\"E1196\" class=\"qowt-font5-Calibri\"> Oliguria or anuria may be observed days to weeks after the exposure as renal injury progresses.<\/span><sup><span id=\"E1197\" class=\"qowt-font5-Calibri\">1<\/span><\/sup><span id=\"E1198\" class=\"qowt-font5-Calibri\"> Elevated creatinine, blood urea nitrogen, calcium, and phosphorus can be observed 24 hours after ingestion,<\/span><sup><span id=\"E1199\" class=\"qowt-font5-Calibri\">6<\/span><\/sup><span id=\"E1200\" class=\"qowt-font5-Calibri\"> whereas pathologic changes observed on blood chemistries may be delayed by several days.<\/span><sup><span id=\"E1201\" class=\"qowt-font5-Calibri\">1,6<\/span><\/sup><\/p>\n<h3 id=\"E1202\" class=\"qowt-stl-B-Head\"><span id=\"E1207\" class=\"qowt-font5-Calibri\">Decontamination and Treatment<\/span><\/h3>\n<p id=\"E1208\" class=\"qowt-stl-Body\"><span id=\"E1209\" class=\"qowt-font5-Calibri\">Any exposure to grapes or raisins should be considered significant, and decontamination via emesis and activated charcoal is recommended. Grapes and raisins have a tendency to sit in the stomach for prolonged periods of time<\/span><sup><span id=\"E1210\" class=\"qowt-font5-Calibri\">6<\/span><\/sup><span id=\"E1211\" class=\"qowt-font5-Calibri\">; therefore, emesis can be induced in asymptomatic patients up to 6 hours after the exposure.<\/span><sup><span id=\"E1212\" class=\"qowt-font5-Calibri\">5<\/span><\/sup><span id=\"E1213\" class=\"qowt-font5-Calibri\"> <\/span><\/p>\n<p id=\"E1214\" class=\"qowt-stl-Body\"><span id=\"E1215\" class=\"qowt-font5-Calibri\">Protection of the kidneys is critical with exposures to <\/span><em><span id=\"E1217\" class=\"qowt-font5-Calibri\">Vitis<\/span><\/em><span id=\"E1219\" class=\"qowt-font5-Calibri\"> species. IV fluid diuresis is recommended for 48 to 72 hours.<\/span><sup><span id=\"E1220\" class=\"qowt-font5-Calibri\">6<\/span><\/sup><span id=\"E1221\" class=\"qowt-font5-Calibri\"> A baseline blood chemistry should be obtained and rechecked every 12 hours for 72 hours to monitor renal function, and electrolytes should be monitored along with urinalysis. Furosemide, dopamine, or mannitol can be used to treat oliguria, while hemodialysis or peritoneal dialysis may be helpful in treating uremia.<\/span><sup><span id=\"E1222\" class=\"qowt-font5-Calibri\">1<\/span><\/sup><span id=\"E1223\" class=\"qowt-font5-Calibri\"> The prognosis is considered poor for pets that develop weakness, ataxia, oliguria, or anuria.<\/span><sup><span id=\"E1224\" class=\"qowt-font5-Calibri\">1,6<\/span><\/sup><\/p>\n<h2 id=\"E1225\" class=\"qowt-stl-B-Head\"><span id=\"E1228\" class=\"qowt-font5-Calibri\">Homemade Playdough<\/span><\/h2>\n<p id=\"E1229\" class=\"qowt-stl-Body\"><span id=\"E1230\" class=\"qowt-font5-Calibri\">Exposures to homemade playdough are not as common as exposures to chocolate or grapes and raisins. The ingestion of playdough, however, can result in rapid onset of a life-threatening <\/span><span id=\"E1232\" class=\"qowt-font5-Calibri\">toxicosis<\/span><span id=\"E1234\" class=\"qowt-font5-Calibri\"> called <\/span><em><span id=\"E1235\" class=\"qowt-font5-Calibri\">hypernatremia<\/span><\/em><span id=\"E1236\" class=\"qowt-font5-Calibri\">, an excessive amount of sodium in the blood. <\/span><\/p>\n<h3 id=\"E1237\" class=\"qowt-stl-B-Head\"><span id=\"E1242\" class=\"qowt-font5-Calibri\">Onset of Hypernatremia<\/span><\/h3>\n<p id=\"E1243\" class=\"qowt-stl-Body\"><span id=\"E1244\" class=\"qowt-font5-Calibri\">Homemade playdough, used to make salt ornaments and other holiday crafts, is made from dough consisting of flour, table salt (sodium chloride), and water. Other ingredients such as vegetable oil, cornstarch, and cream of tartar are also used in some recipes. Homemade playdough contains a high concentration of salt. Some dough formulations contain 8 g of salt per tablespoon of dough.<\/span><sup><span id=\"E1245\" class=\"qowt-font5-Calibri\">7<\/span><\/sup><span id=\"E1246\" class=\"qowt-font5-Calibri\"> When the dough is ingested, an increase in sodium in the vasculature results in a fluid shift in the body, causing cellular dehydration and vascular expansion.<\/span><sup><span id=\"E1247\" class=\"qowt-font5-Calibri\">7<\/span><\/sup><span id=\"E1248\" class=\"qowt-font5-Calibri\"> <\/span><\/p>\n<p id=\"E1249\" class=\"qowt-stl-Body\"><span id=\"E1250\" class=\"qowt-font5-Calibri\">Signs of salt <\/span><span id=\"E1252\" class=\"qowt-font5-Calibri\">toxicosis<\/span><span id=\"E1254\" class=\"qowt-font5-Calibri\"> can be observed at a dose of 2 g of <\/span><span id=\"E1256\" class=\"qowt-font5-Calibri\">NaCl<\/span><span id=\"E1258\" class=\"qowt-font5-Calibri\"> per kilogram of body weight, with the lethal dose at 4 g\/kg.<\/span><sup><span id=\"E1259\" class=\"qowt-font5-Calibri\">7<\/span><\/sup><span id=\"E1260\" class=\"qowt-font5-Calibri\"> A dog is considered to be <\/span><span id=\"E1262\" class=\"qowt-font5-Calibri\">hypernatremic<\/span><span id=\"E1264\" class=\"qowt-font5-Calibri\"> when the serum sodium concentration is &gt;156 <\/span><span id=\"E1266\" class=\"qowt-font5-Calibri\">mEq<\/span><span id=\"E1268\" class=\"qowt-font5-Calibri\">\/L.<\/span><sup><span id=\"E1269\" class=\"qowt-font5-Calibri\">7<\/span><\/sup><span id=\"E1270\" class=\"qowt-font5-Calibri\"> Clinical signs are commonly observed when the serum sodium concentration is &gt;170 <\/span><span id=\"E1272\" class=\"qowt-font5-Calibri\">mEq<\/span><span id=\"E1274\" class=\"qowt-font5-Calibri\">\/L.<\/span><sup><span id=\"E1275\" class=\"qowt-font5-Calibri\">7<\/span><\/sup><span id=\"E1276\" class=\"qowt-font5-Calibri\"> Vomiting develops within the first 2 hours of ingestion,<\/span><sup><span id=\"E1277\" class=\"qowt-font5-Calibri\">5<\/span><\/sup><span id=\"E1278\" class=\"qowt-font5-Calibri\"> followed by neurologic signs, including tremors and seizures.<\/span><sup><span id=\"E1279\" class=\"qowt-font5-Calibri\">8<\/span><\/sup><span id=\"E1280\" class=\"qowt-font5-Calibri\"> Signs most commonly observed by the APCC include vomiting, anorexia, diarrhea, ataxia, polydipsia, trembling, weakness, tremors, and seizures.<sup><span id=\"E1124\" class=\"qowt-font5-Calibri\">5<\/span><\/sup><\/span><\/p>\n<h3 id=\"E1282\" class=\"qowt-stl-B-Head\"><span id=\"E1287\" class=\"qowt-font5-Calibri\">Decontamination and Treatment<\/span><\/h3>\n<p id=\"E1288\" class=\"qowt-stl-Body\"><span id=\"E1289\" class=\"qowt-font5-Calibri\">The treatment for acute salt <\/span><span id=\"E1291\" class=\"qowt-font5-Calibri\">toxicosis<\/span><span id=\"E1293\" class=\"qowt-font5-Calibri\"> includes decontamination, management of clinical signs, and lowering serum sodium levels. With recent exposures (&lt;2 hours) and in patients that are asymptomatic, emesis is recommended. Baseline electrolytes should be obtained and frequently monitored. Asymptomatic patients with a normal serum sodium concentration should be allowed free access to water after emesis has been managed and monitored closely for clinical signs. <\/span><\/p>\n<p id=\"E1294\" class=\"qowt-stl-Body\"><span id=\"E1295\" class=\"qowt-font5-Calibri\">Patients that have clinical signs or elevations in serum sodium concentration should be started on IV fluids using a low-sodium fluid (D5W, 0.4% <\/span><span id=\"E1297\" class=\"qowt-font5-Calibri\">NaCl<\/span><span id=\"E1299\" class=\"qowt-font5-Calibri\">).<\/span><sup><span id=\"E1300\" class=\"qowt-font5-Calibri\">5<\/span><\/sup><span id=\"E1301\" class=\"qowt-font5-Calibri\"> Warm-water enemas at a dose of 5 to 10 mL\/kg can be used in addition to IV fluids.<\/span><sup><span id=\"E1302\" class=\"qowt-font5-Calibri\">5<\/span><\/sup><span id=\"E1303\" class=\"qowt-font5-Calibri\"> A loop diuretic, such as furosemide, can be administered to aid in sodium excretion and to help prevent pulmonary edema caused by fluid overload.<\/span><sup><span id=\"E1304\" class=\"qowt-font5-Calibri\">5<\/span><\/sup><span id=\"E1305\" class=\"qowt-font5-Calibri\"> Patients exhibiting mild to moderate clinical effects that <\/span><span id=\"E1306\" class=\"qowt-font5-Calibri\">receive timely and aggressive treatment generally have a favorable prognosis.<\/span><sup><span id=\"E1308\" class=\"qowt-font5-Calibri\">5<\/span><\/sup><span id=\"E1309\" class=\"qowt-font5-Calibri\"> The prognosis is guarded in patients that have developed severe neurologic signs.<\/span><sup><span id=\"E1310\" class=\"qowt-font5-Calibri\">5<\/span><\/sup><\/p>\n<h2 id=\"E1311\" class=\"qowt-stl-B-Head\"><span id=\"E1314\" class=\"qowt-font5-Calibri\">Plants<\/span><\/h2>\n<p id=\"E1315\" class=\"qowt-stl-Body\"><span id=\"E1316\" class=\"qowt-font5-Calibri\">There are several popular holiday plants that dogs and cats may have the opportunity to ingest during the winter season that may remain in the home several months.<\/span><\/p>\n<p id=\"E1317\" class=\"qowt-stl-Body\"><span id=\"E1318\" class=\"qowt-font5-Calibri\">They include: <\/span><\/p>\n<ul>\n<li id=\"E1319\" class=\"qowt-li-2_0 qowt-list qowt-stl-Body\"><span id=\"E1320\" class=\"qowt-font5-Calibri\">Christmas cactus <\/span><\/li>\n<li id=\"E1321\" class=\"qowt-li-2_0 qowt-list qowt-stl-Body\"><span id=\"E1322\" class=\"qowt-font5-Calibri\">Evergreen trees<\/span><\/li>\n<li id=\"E1323\" class=\"qowt-li-2_0 qowt-list qowt-stl-Body\"><span id=\"E1324\" class=\"qowt-font5-Calibri\">Holly<\/span><\/li>\n<li id=\"E1325\" class=\"qowt-li-2_0 qowt-list qowt-stl-Body\"><span id=\"E1326\" class=\"qowt-font5-Calibri\">Mistletoe<\/span><\/li>\n<li id=\"E1327\" class=\"qowt-li-2_0 qowt-list qowt-stl-Body\"><span id=\"E1328\" class=\"qowt-font5-Calibri\">Poinsettias<\/span><\/li>\n<li id=\"E1329\" class=\"qowt-li-2_0 qowt-list qowt-stl-Body\"><span id=\"E1330\" class=\"qowt-font5-Calibri\">Amaryllis<\/span><\/li>\n<li id=\"E1331\" class=\"qowt-li-2_0 qowt-list qowt-stl-Body\"><span id=\"E1332\" class=\"qowt-font5-Calibri\">Christmas <\/span><span id=\"E1334\" class=\"qowt-font5-Calibri\">kalanchoe<\/span><\/li>\n<\/ul>\n<p id=\"E1336\" class=\"qowt-stl-Body\"><span id=\"E1337\" class=\"qowt-font5-Calibri\">Exposures to Christmas cactus, evergreen trees, holly, mistletoe, and poinsettias commonly result in GI upset,\u00a0<\/span><span class=\"qowt-font5-Calibri\">but are unlikely to cause serious <\/span><span id=\"E1339\" class=\"qowt-font5-Calibri\">toxicosis<\/span><span id=\"E1341\" class=\"qowt-font5-Calibri\">. Amaryllis and Christmas <\/span><span id=\"E1343\" class=\"qowt-font5-Calibri\">kalanchoe<\/span><span id=\"E1345\" class=\"qowt-font5-Calibri\"> can cause more serious signs, depending on the part of the plant the pet is exposed to and the amount of the plant ingested. <\/span><strong><span id=\"E1346\" class=\"qowt-font5-Calibri\">T<\/span><span id=\"E1347\" class=\"qowt-font5-Calibri\">ABLE<\/span><span id=\"E1348\" class=\"qowt-font5-Calibri\"> 2<\/span><\/strong><span id=\"E1349\" class=\"qowt-font5-Calibri\"> lists the clinical signs that can be expected after ingestion of these plants.<\/span><\/p>\n<\/div>\n<\/div>\n<div id=\"contentsContainer\">\n<div id=\"contents\">\n<p><a href=\"http:\/\/tvn.tv-multi-theme.com.216-70-96-51.jvv2-rfnp.accessdomain.com\/wp-content\/uploads\/sites\/3\/2018\/01\/TVNURS_22_plants.jpg\"><img decoding=\"async\" class=\"aligncenter wp-image-8080\" src=\"http:\/\/tvn.tv-multi-theme.com.216-70-96-51.jvv2-rfnp.accessdomain.com\/wp-content\/uploads\/sites\/3\/2018\/01\/TVNURS_22_plants-300x222.jpg\" alt=\"Table 2 - Plant Quick Reference\" width=\"736\" height=\"545\" srcset=\"https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2018\/01\/TVNURS_22_plants-300x222.jpg 300w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2018\/01\/TVNURS_22_plants-1024x758.jpg 1024w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2018\/01\/TVNURS_22_plants-768x569.jpg 768w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2018\/01\/TVNURS_22_plants-1536x1137.jpg 1536w, https:\/\/navc.sitepreview.app\/todaysveterinarynurse.com\/wp-content\/uploads\/sites\/3\/2018\/01\/TVNURS_22_plants.jpg 2035w\" sizes=\"(max-width: 736px) 100vw, 736px\" \/><\/a><\/p>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>The winter holiday season holds an abundance of dangers for domestic pets that could result in toxicosis.<\/p>\n","protected":false},"author":1,"featured_media":2732,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"iawp_total_views":0,"footnotes":""},"categories":[114],"tags":[145],"class_list":["post-2731","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-winter-2018","tag-peer-reviewed","column-features","clinical_topics-toxicology"],"acf":{"hide_sidebar":false,"hide_sidebar_ad":false,"hide_all_ads":false},"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v24.7 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Winter Holiday Toxins for Pets | Today&#039;s Veterinary Nurse<\/title>\n<meta name=\"description\" content=\"Decontamination and treatment for exposures to chocolate, grapes and raisins, and homemade playdough in dogs; 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