2002_2 MAR Toxicology.pdf

Vet Clin Small Anim 32 (2002) 307–308

Preface

Toxicology

Robert H. Poppenga, DVM, PhD

Petra A. Volmer, DVM, MS

Guest Editors

The last issue of Veterinary Clinics of North America: Small Animal

Practice devoted to toxicology was published in March of 1990. Since that

time, several toxicants traditionally of concern to the small animal practi-

tioner such as strychnine, organophosphorus and carbamate insecticides,

and lead are less frequently encountered as causes of intoxication in pets.

For example, the introduction and marketing of newer, safer, and more con-

veniently administered insecticides such as ﬁpronil, imidacloprid, the macro-

lide endectocides, and nitenpyram for use on pets, combined with increasing

concern about both the health and environmental impacts and limited avail-

ability of organophosphorus and carbamate insecticides, has led to a lower

incidence of intoxication from the latter chemicals.

However, the potential for intoxication from newly introduced chemicals

and better diagnosis of previously unrecognized intoxications have signiﬁ-

cantly changed and expanded what toxic etiologies should be included on

diﬀerential lists. Two major factors have contributed to the professions

enhanced ability to recognize and document small animal intoxications.

The establishment of dedicated animal poison control centers allows for

the recognition of new and emerging toxicants by tabulating and comparing

large volumes of call-related data over an extended period of time. In addi-

tion, the increasing sophistication of veterinary toxicology analytical labora-

tories has greatly enhanced our ability to detect and quantify a broad array

of chemical substances from both antemortem and postmortem samples.

While this issue of Veterinary Clinics of North America: Small Animal

Practice reviews several traditional toxicants, many new toxicants, along

with appropriate management of intoxicated animals, are discussed. The

ﬁrst two chapters of this issue are devoted to treatment of intoxicated

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R.H. Poppenga, P.A. Volmer / Vet Clin Small Anim 32 (2002) 307–308

animals. Chapter One discusses approaches to decontamination and Chapter

Two discusses several newer antidotal agents that have become available in

recent years. Chapter Three is devoted to a discussion of how to perform a

proper exposure assessment so that appropriate case management can

occur. Chapter Four focuses on the collection and submission of ﬂuid, tis-

sue, and environmental samples to assist in the diagnostic process. Chapters

Five through Eight focus on naturally-occurring toxins including herbs and

dietary supplements, household and ornamental plants, mushrooms, and

mycotoxins. The discussion of herbs and dietary supplements is especially

timely given the increasing popularity of complementary and alternative

medical modalities in veterinary medicine.

Hazards associated with prescription and over-the-counter (OTC) human

and veterinary medications are discussed in Chapters Nine and Ten. It is

always interesting to see the incidence of pet intoxications parallel the popu-

larity of human prescription and OTC drugs. For example, the number of

pets exposed to and intoxicated by amphetamine derivatives used to treat

attention deﬁcit hyperactivity disorder in children has increased in conjunc-

tion with their increasing use in human medicine.

Insecticides and rodenticides account for the greatest number of animal

intoxications, although the overall incidence of intoxication from insecti-

cides is undoubtedly lower today than a decade ago due to the introduction

of newer and safer products. Several of the newer insecticides are discussed

in Chapter Eleven. As a group, the anticoagulant rodenticides are likely to

be the most commonly encountered toxicant in practice. However, with

early diagnosis and appropriate treatment, most intoxicated animals will

make a full and complete recovery. The anticoagulant rodenticides and

other, chemically diverse rodenticides such as cholecalciferol, bromethalin,

strychnine, and zinc phosphide are discussed in Chapter Twelve.

The highly qualiﬁed authors come from both poison control center and

diagnostic laboratory backgrounds. Hopefully, this edition of the Veterinary

Clinics of North America will provide a valuable, updated resource for the

small animal practitioner with the dual goals of successfully preventing

and treating the intoxicated pet.

Robert H. Poppenga, DVM, PhD

Guest Editor

Toxicology Laboratory New Bolton Center

382 W. Street Road

Kennett Square, PA 19348, USA

Petra A. Volmer, DVM, MS

Guest Editor

Department of Veterinary Biosciences

Veterinary Diagnostic Laboratory

University of Illinois

2001 S. Lincoln Ave.

Urbana, IL 61802, USA

Vet Clin Small Anim 32 (2002) 309

DEDICATIONS

To my wife, Amy, for all of her support and understanding.

Robert H. Poppenga

I would like to dedicate this volume to my parents, Alois and Maria

Volmer, who, by their example, have instilled in me the satisfactions of

hard work and perseverance, to my husband George R. Hornbrook, for his

support and encouragement, and, above all, to my son, George Heinrich,

who makes everything in life worthwhile.

Petra A. Volmer

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Vet Clin Small Anim 32 (2002) 311–321

Decontamination strategies

Marcy E. Rosendale, DVM*

American Society for the Prevention of Cruelty to Animals

Animal Poison Control Center, 1717 South Philo Road, Suite 36,

Urbana, IL 61802, USA

There is no one correct approach to the decontamination of an animal

that has been exposed to a toxin or potentially toxic substance. Each expo-

sure should be treated as a unique incident, with the circumstances of the ex-

posure, the nature of the toxic substance, and the condition and signalment

of the pet determining the best decontamination strategy. There are usually

several basic decontamination procedures available to the practitioner,

allowing the process to be tailored to meet the need of the individualpatient.

Ocular decontamination

Toxic insults to the eyes of companion animals usually involve only the

more superﬁcial tissue: the conjunctiva and the cornea. Insults to ocular tis-

sues can range from mild irritation to severe tissue destruction with subse-

quent blindness. Ocular exposures in small animals often involve minimal

contact with common household products resulting in mild irritation to

the eye and nearby structures. Solvents such as alcohols, detergents, and

hydrocarbons usually cause only superﬁcial injury to the eye, although

strong acid and alkaline corrosive agents may cause more extensive damage.

Immediate irrigation of the eye isnecessary to limit the exposure to the toxin

and any subsequent damage to the eye. If possible, the initial decontamina-

tion should be performed at home by the pet owner. The veterinarian may

then perform a more thorough irrigation. Body-temperature tap water,

lactated Ringer’s solution, or normal saline may be used for irrigation.

No attempt should be made to neutralize acidic or alkaline substances.

The eye should be rinsed with copious amounts of an appropriate ﬂuid

for 20 to 30 minutes [11].

* E-mail address: mrosend@napcc.aspca.org (M.E. Rosendale).

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M.E. Rosendale / Vet Clin Small Anim 32 (2002) 311–321

Dermal decontamination

Bathing is the standard method of decontamination for dermal exposures

to most toxic substances. In most cases, bathing should not be performed

until the animal is in stable condition. The stimulation of bathing may

exacerbate some disorders such as cardiovascular collapse and seizures.

Debilitated animals and individuals with serious preexisting health condi-

tions may not tolerate bathing as well as the healthy patient. The risks asso-

ciated with bathing the individual patient should be assessed in relation to

the beneﬁt expected from the removal of the toxin.

Appropriate measures should be taken to avoid human exposure to the

toxicant during the bathing process. Liquid hand dishwashing detergents

are usually recommended over shampoo or hand soap because of their

superior ability to disperse greasy substances. Detergents designed for auto-

matic dishwashing machines and insecticidal shampoos should never be

used for dermal decontamination. In some cases, bathing must be repeated

to completely remove the substance. After bathing, the patient should be

thoroughly rinsedtoremove any soapfrom theskinandcoatand dried well.

Some viscous or sticky substances may be diCcult to remove using deter-

gentalone.Goop(CritzasIndustries,St.Louis,MO)orGoJo(GoJoIndus-

tries, Akron, OH) hand cleaner may be used to remove some of the more

viscouspetroleumdistillates.Handcleaneruseshouldbefollowedbyadeter-

gentbath.Citrus-basedhandcleanersmaycausedermalirritationandshould

be avoided. In some instances, shaving or clipping may be the best way to

removesubstancessuchastheinstant-bondingadhesivesor‘‘superglue’’that

has hardened on the coat. Polyoxyethylene sorbitan in Neosporin ointment

(Warner-LambertConsumerHealthCare,MorrisPlains,NJ)reportedlyaids

inthetopicalremovaloftheinstant-bondingadhesivesinhumanbeings[11].

Sticky or tacky glues or similar substances may be removed using vegetable

oil or peanut butter, followed by a detergent bath. Oily substances should

only be used to remove nontoxic materials such as many of the glues. Oils

should not be used routinely in the decontamination process, as they may

enhance the dermal absorption of some toxins [4].

Some chemicals used in industrial settings require special decontamina-

tion procedures. A poison control center should be contacted before decon-

tamination is initiated in the unlikely event of small animal exposure to

uncommon industrial chemicals [11].

Dilution

A variety of substances may cause irritation to the gastrointestinal tract.

Immediate dilution with small amounts of water or milk may help to

decrease the irritating eﬀects of these substances. Dilution is usually recom-

mended after the ingestion of compounds that are capable of causing ulcera-

tion of the oral cavity and esophagus such as cationic detergents, strong

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