Interesting Cases from the Toxicology Archives or cases that I’ve known and loved Robert H Poppenga, DVM, PhD, DABVT California Animal Health and Food Safety Laboratory System SVM, University of California at Davis, Davis, CA May 12, 2015 Did you know? The amount spent by pet owners to treat common toxicities Compare 2012 and 2013 data
cases in which to employ analytical methods With few exceptions, such murders are solved in the laboratory with skill that is uncanny to the layman "Forensic analysis" sounds harmless enough, but it is the science of toxicology brought to a high state of development at the Philadelphia College of Pharmacy and Science Through it, the
Commonly used for acetaminophen toxicosis; can be given along with SAMe for other hepatotoxins Dilute to 5 solution and give orally or intravenously through a filter Note: If given orally, further dilute with something sweet to mask sulfur smell and taste Naloxone Along with reversing opioid exposure, can be used to reverse severe
15 7 of cases, a decrease from the previous 3 years 2–4 Hispanic ethnicity was reported in 12 5 of cases; 19 1 of cases reported ethnicity as unknown/uncertain Race and ethnicity are self-reported by patients, or in cases in which a patient is unable to report, it may be determined by the examining medical toxicologist to the best of
overdose cases the intact tablet s or capsules of drugs are found in the stomach at the time of autopsy and present a concentrated supply of the agent that can be readily identified Even when no tablets or capsules are seen, their solubilized remains on the stomach walls may still present the best sample for identification
Figure 1 shows the number of drugs present in the homicide victims When toxicology tests were positive for one drug that drug was most likely to be marijuana or alcohol Multiple drugs were found in 21 of cases With the exception of one victim who tested positive for three drugs, the other multiple drug cases involved two drugs
42573_7aspca_musthavedrugsposter_2019.pdf
Cholestyramine
Useful for several
toxins that undergo enterohepatic recirculation: cholecalciferol (vitamin
D3), sago palm,
cyanobacteria (blue green algae), digitoxin and some NSAIDs.
Note: Some human
formulations contain xylitol and those must not be used in dogs.
Acepromazine
Used in animals as a
sedative; much higher doses than normal may be needed when dealing with amphetamine toxicosis.Note: Can also be used to help control hypertension caused by stimulants when nitroprusside is not available - start with small doses and titrate to a?ect. Always monitor blood pressure.
Cyproheptadine
Should be an additional
treatment for overdoses of serotonergic drugs such as SSRIs, amphetamines, tramadol,
5-HTP and marijuana
when signs persist despite treatment with first-line drugs.
Note: Only administer while
signs of serotonin syndrome are present - most toxicity cases only require 1-3 doses.
Diazepam/
Midazolam
For controlling mild agitation or seizures from
a variety of toxins.
Note: Should not be
used for overdoses of amphetamines as it can actually worsen clinical signs. Also contraindicated for seizures caused by muscimol (isoxazole) mushroom ingestions.
Methocarbamol
For patients presenting
with tremors instead of seizures. Though expensive, there is nothing that will control tremors as well.
Note: If you have only tablet
form, it can be crushed, mixed with water and given rectally, though it will take significantly longer to work.
N-AcetylcysteineCommonly used for
acetaminophen toxicosis; can be given along with SAMe for other hepatotoxins. Dilute to 5% solution and give orally or intravenously through a filter.
Note: If given orally, further
dilute with something sweet to mask sulfur smell and taste.
Naloxone
Along with reversing
opioid exposure, can be used to reverse severe
CNS depression from
some other toxins. High dose (0.1 mg/kg) works well to reverse coma in large doses of ibuprofen, ethanol toxicity and bradycardia due to cyclobenzaprine.
Note: If first dose helps, you
can repeat as signs return.
Propranolol
Primarily used to treat
sinus tachycardia from chocolate, amphetamines, SSRIs,
5-HTP and other
stimulants.
Note: In albuterol toxicosis,
propranolol is virtually an antidote that will slow heart rate and correct hypokalemia without the need to supplement potassium.
Atipamezole
Commonly used to
reverse dexmedetomidine and xylazine.
Note: Can reverse
signs from other alpha agonists such as clonidine, guanfacine, tizanidine, imidazoline and oxymetazoline decongestants; eye drops, and tick collars that contain amitraz.
Maropitant
Very e?ective at both
stopping and preventing vomiting.
Note: Administration in
recumbent or neurologic animals before giving activated charcoal may reduce aspiration risk.
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