Algorithm for When and How to Induce Emesis in Small Animals After Toxin Ingestion

Induction of emesis in the veterinary hospital can be an important tool in preventing or decreasing the risk and severity of expected clinical signs when a dog or cat has ingested a potentially toxic substance. However, induction of emesis is not benign and can have potentially serious side effects, such as protracted vomiting, aspiration pneumonia, intussusception, or death.¹

Before emesis is induced, the potential benefits should always be evaluated to ensure that they outweigh the potential risks. The pet’s medical history and a full toxicologic history, including full information (if available) about the agent, amount ingested, and timeframe of the ingestion (TABLE 1), should always be taken prior to making the decision to induce emesis. These data, in addition to the procedural risk to the pet, will help in accurately assessing the risk and benefit of the procedure. If the expected risk is only for mild clinical signs (such as mild gastrointestinal upset or lethargy) and the toxic agent was ingested at a dosage below the level of concern or is unlikely to cause significant signs at any dosage, emesis is not indicated. Always follow the algorithm in its entirety when determining whether to induce emesis.

In dogs, apomorphine (intravenous, subcutaneous, conjunctival, or gingival), ropinirole (ophthalmic), or 3% hydrogen peroxide (oral) is commonly used for emesis induction.^4-6

In ferrets and pigs, 3% hydrogen peroxide has been recommended, but controlled studies are lacking.⁷

In cats, dexmedetomidine (intramuscular or oral) or xylazine (intramuscular) is commonly used for induction of emesis.^8,9 However, the use of 3% hydrogen peroxide is considered to be contraindicated in cats, due to the potential for severe gastrointestinal signs, including necroulcerative hemorrhagic gastritis.¹⁰