Toxicity

Albuterol toxicity in Pets: Where's your inhaler?

ventolin-inhaler-02-1 Millions of people in the United States suffer from asthma.  Many of these people have inhalers to use during an attack.   These inhalers are composed of a small pressurized canister that contains a solution of asthma medicine fitted into a plastic casing that releases a precise dose of the medicine in an aerosol form.  The medicine contained in many asthma inhalers is albuterol, a drug used to relax the muscles in the lungs and allow the air passages to open.

The size and (we think) the smell of the inhalers make them very attractive and interesting to our dogs.  Dogs are easily able to puncture the canister if they chew on it. Since the canister is pressurized, the entire contents are released instantly, resulting in almost certain overdose of the medication. In an overdose, these drugs affect both the muscles of the lungs as well as the muscles of the heart. The results are immediate, severe, and include the following:

  • Increased heart rate
  • Abnormal heart rhythms
  • Red gums
  • Increased respiratory rate / excessive panting
  • Abnormal behavior (restlessness/agitation, hiding, tremors, shaking, lethargy, weakness, collapse)
  • Low or high blood pressure
  • Vomiting
  • Severe changes in blood electrolytes (particularly potassium)
  • Seizures
  • Shock
  • Acute death

If you know that your pet has bitten into an inhaler, you should seek care at the nearest emergency veterinary facility.  Bring the inhaler and the original packaging if it is available, as well as any medications that your pet is currently taking. Do not induce vomiting at home.

cute-albuterol-toxicity-patient

Dogs suffering from albuterol toxicity will typically need to stay in the hospital for 12 - 48 hours.  Treatment will include sedation, aggressive IV fluids, blood work (to monitor the electrolyte levels), drugs to slow the heart rate down, and heart and blood pressure monitoring. With prompt and appropriate treatment, albuterol toxicity is rarely fatal, although pets with heart conditions and pets on medications that interact poorly with albuterol are at higher risk for serious complications.

Veterinary Medical Center of CNY's Emergency veterinarians are available 24/7/365 to help you and your pet through these types of emergencies, but we will be just as happy if you can avoid them!  Keep these and all other medications out of reach of your pets.  Also avoid disposing of used canisters in trash cans that are accessible to pets. Used inhalers can still contain enough medication to be dangerous.

Christmas Pet Safety Tips

Cat-in-Christmas-Tree
Cat-in-Christmas-Tree

No one wants to end up in our emergency room over the holidays!  Consider these risks to reduce the likelihood that we will need to see you!

Holiday Ornaments: Consider any new decoration you put out! This is especially important with young dogs and cats who are typically more boisterous and curious, and also with any pets new to the household.

  • Candles are an obvious risk. Place carefully and always supervise or consider flameless candles.
  • Ornaments pose several risks. How breakable? How dangerously chewable? Are they toxic? Homemade salt dough ornaments are extremely toxic.
  • New cords (for lights, etc.) can and will be investigated by a curious young dog or cat. Also assess risk of entanglement.
  • Tinsel: If you own a cat, forgo the tinsel. What looks like a shiny toy to your cat can prove deadly if ingested. Tinsel does not pose a poisoning risk, but is thin and sharp and can easily wrap itself around the intestines or ball up in the stomach once ingested. Many unfortunate cats have required emergency surgery to save them once the tinsel has caused obstruction or other problems.
  • Imported Snow Globes: Recently, imported snow globes were found to contain antifreeze (ethylene glycol.) As little as one teaspoon of antifreeze when ingested by a cat or a tablespoon or two for a dog (depending on their size), can be fatal. Be sure snow globes are placed where they cannot be knocked over and broken.
  • Liquid Potpourri: Filling your house with holiday scents is wonderful, but heating your scented oils in a simmer pot can pose risks. Scented oils can cause serious harm to your cat, with just a few licks resulting in severe chemical burns in the mouth, fever, difficulty breathing, and tremors. Dogs aren’t as sensitive, but it’s still better to be safe than sorry. Simmer natural scents (orange, cinnamon, etc.) on the stove, or scent your home with a non-toxic candle kept safely out of your pet’s reach.
thanksgiving-dog-dinner-dogvacay-300x225
thanksgiving-dog-dinner-dogvacay-300x225

Holiday Foods: With the holiday season comes a delightful variety of baked goods, chocolates, and other rich, fattening foods. Do your best to keep your pet on his or her regular diet over the holidays and do not let family and friends sneak in treats.

  • Chocolate and cocoa contain theobromine, a chemical highly toxic to dogs and cats. Ingestion in small amounts can cause vomiting and diarrhea but large amounts can cause seizures and heart arrhythmias.
  • Holiday baked goods are typically too high in sugar to be good for our pets in any form. Increasingly, many sugarless gums and candies also contain xylitol, a sweetener which is toxic to dogs. It causes a life-threatening drop in blood sugar and potential liver failure. It is also contained in some brands of peanut butter.
  • Grapes and raisins can result in kidney failure in dogs -- another check against fruitcake!
  • Alcohol: Because alcohol is rapidly absorbed into the bloodstream, it affects pets quickly. Ingestion of alcohol can cause dangerous drops in blood sugar, blood pressure and body temperature. Intoxicated animals can experience seizures and respiratory failure.
  • Yeasted dough: Raw dough can expand in a pet’s stomach and require emergency surgery. It may also cause alcohol poisoning as the yeast reacts in the stomach. Make sure that rising dough is well out of reach.
  • Overfeeding and “Garbage Gut”: A very common reason for a holiday trip to the veterinary emergency room unfolds innocently in a busy holiday household. The meal is over and everyone is too full to pay attention to where the leftover food is in relation to your pets. Your pets have been waiting literally all day for such an opportunity, and are busily helping themselves to the overstuffed trash container and/or the leftovers on the counter. While dogs are usually the main offenders in cases of “garbage gut,” cats are not immune! Within a few hours some combination of vomiting and diarrhea requires a trip to the emergency room. Leftover, fatty meat scraps can produce severe inflammation of the pancreas (pancreatitis) leading to abdominal pain, vomiting and bloody diarrhea. It’s one thing if you occasionally give a little nibble of something to your pet, but if all 20 party guests decide to do the same, you can wind up with a seriously ill pet.
poinsettia
poinsettia

Holiday Plants:  Cats are usually most apt to "sample" your houseplants.  Veterinary advice should be sought if any of these plants are suspected of being ingested!

  • Lilies (including tiger, Asiatic, Stargazer, Easter and Day lilies) are the most dangerous plants for cats. The ingestion of one to two leaves or flower petals is enough to cause sudden kidney failure. We do NOT recommend any lilies in cat owning households!
  • Daffodils (including paperwhites) can cause severe vomiting, diarrhea, abdominal pain, and even possible cardiac arrhythmias or respiratory depression. The bulb, plant, and flower are all toxic.
  • Holly is toxic, and can cause severe gastrointestinal upset and even heart arrhythmias.
  • Mistletoe: Both berries and leaves are toxic, and symptoms of toxicity include gastrointestinal upset, difficulty breathing, slowed heart rate, low blood pressure, and odd behavior (possible hallucinations).
  • Amaryllis causes vomiting, diarrhea, abdominal pain, lethargy, and tremors. The entire plant including the bulb is dangerous
  • Christmas tree and tree water: Bacteria, molds, and fertilizers can cause your pet to become ill with only a few laps, and both dogs and cats are at risk. Chewing on the tree itself can cause some more mild oral and gastrointestinal upset, and there is a small chance that needles can cause punctures and other gastrointestinal problems.
  • Though they have a bad rap, poinsettia plants are only mildly toxic. The effects are typically “self limiting” – chewing them is unpleasant, they taste bad, and then whatever little amount is eaten is fairly quickly thrown up. Pesticides on the plants are likely of more concern.

Houseguests and Holiday Hustle and Bustle Any time you stray from your normal routine or introduce people unfamiliar with your routine into your household, there is the possibility of your pets finding some trouble, including:

  • Escape
  • Overfeeding of unfamiliar or inappropriate foods
  • Ingesting guest’s medication
  • Stress!

Gates and doors left open, dietary indiscretion, guests leaving their medications in a place where your pet can “investigate”, and a host of other scenarios can create problems for your pets.

Keep your pet’s ID tags current and on your pet, and help your guests “Pet Proof” their belongings. This is the time to alert your guests of any “special” habits your pet may have (sock stealing/eating, etc.) so they can prepare.

Also remember that changes in routine can stress your pets, especially cats and older pets. Consider giving them a quiet space of their own to get away from the festivities if they don’t seem relaxed and content.

A little bit of prevention can help ensure that your holidays are happy, healthy, and spent at home!

Handling a Pet Toxin or Poisoning Emergency

VMC092

My pet just got into something he shouldn’t have. What should I do?

 

This could be the shortest blog post ever.  The answer:

1) Call your veterinarian or the nearest emergency veterinary hospital.

2) If #1 is not possible, call Poison Control.     ASPCA Animal Poison Control (888) 426-4435

Perhaps you’ve been through a similar situation in the past. Perhaps your sister has. Perhaps your neighbor’s son’s friend worked in a veterinary practice for a few months three years ago. This is what we’ll tell you: Unless the advice you are given is the two steps above -- DON’T USE IT.

What your pet ate may be fine, and we get plenty of false alarms here. A call will never hurt, and is certainly quicker and more accurate than getting several dozen opinions from your friends, family, neighbors, and Dr. Google.

When you call, your vet (or Poison Control) will need to know:

• the name of the substance • the strength of the product if known (medication, chemical, etc.) • how much was consumed • how long since you think the consumption occurred • age, breed, and approximate weight of your pet

Can’t I just make my pet vomit?

No.

Do not give your pet any ‘antidotes’ unless instructed to do so by your veterinarian or poison control. Some substances will cause even more harm if you make your pet vomit. Some have even more risk if your pet inhales some of the substance while vomiting. Once, memorably, we encountered a substance that, when mixed with the stomach acid of the dog, could potentially have created a gas that was extremely dangerous to all of us in the hospital if we had released the gas by making the dog vomit. Some substances will need to be neutralized with specific antidotes that a veterinary hospital will have access and the tools to administer.

Here at VMC, poisonings and toxicities are what we deal with day in and day out. We are very comfortable handling these cases and are easily able to properly guide a pet owner through this process. While some cases are very routine and we know exactly what to do immediately, we commonly utilize the resources of Animal Poison Control. New products, drugs, and chemicals are created all the time, and so the potential toxins and combinations of toxins in common household items can change so rapidly. So can the antidotes and treatments. The ASCPA Animal Poison Control service stays current with the newest information that can make all the difference in saving a pet’s life.

WORTH REPEATING ONE MORE TIME: DO NOT MAKE YOUR PET VOMIT UNLESS YOU HAVE EXPLICIT INSTRUCTIONS FROM YOUR VETERINARIAN OR POISON CONTROL.

iStock_000001641367Small

Some general tips:

Be Honest. We know what a dog that ate marijuana looks like and acts like. We can run a whole bunch of tests that will tell us what we already suspect (and waste time and cost you money you don’t really need to spend), or you can just tell us the truth. It’s OK. We won’t judge. We just want to help your pet, and the sooner we can do that the better. And no, it is not, not, NOT OK to intentionally “share” with your pet. They do not react the same way to recreational drugs, and it is cruel to do that on purpose. Not funny. Not ever.

Drugs and Chemicals (rodent poisons, insecticides, antifreeze, recreational drugs, human pharmaceuticals) are potentially the most harmful poisons as they are often in a very concentrated form. Your pet may only need to consume a small amount for it to have a significant effect.

Cats tend to be more susceptible to poisons than dogs. Fortunately, cats are normally less likely to eat something unfamiliar. If toxic exposure does occur, cats may be more at risk, as their metabolism is less able to process many toxins (acetaminophen, permethrin, and plant poisons) that are somewhat less dangerous for dogs. Be aware that cats are at high risk for ingesting contaminants on their fur, however, due to their grooming habits.

The most common sources of toxins for pets, according to the ASPCA are: prescription and over-the-counter drugs (both human and pet drugs), insecticides and insect baits, common household plants, rodenticides and baits, and common household cleaners including bleach, detergents, and disinfectants. We see all of those problems at VMC, and would also add chocolate, xylitol, and recreational drugs to the list.

What should I include specifically for this in my pet's first-aid kit?

The ASPCA Animal Poison Control Center experts recommend the following to keep on hand in case of toxins:

• Fresh bottle of hydrogen peroxide, 3 percent USP (to induce vomiting) • Turkey baster, bulb syringe or large medicine syringe (to administer peroxide) • Saline eye solution • Artificial tear gel (to lubricate eyes after flushing) • Mild grease-cutting dishwashing liquid (for bathing an animal after skin contamination) • Forceps (to remove stingers) • Muzzle (to protect against fear- or excitement-induced biting) • Can of your pet's favorite wet food • Pet carrier

Always consult a veterinarian or the APCC for directions on how and when to use any emergency first-aid item. We also suggest that you keep the telephone number of the ASPCA Animal Poison Control Center—(888) 426-4435—as well as that of your local veterinarian in a prominent location.

Antifreeze Toxicity

Snow_Dog

When the cold weather returns antifreeze becomes a more common danger to our pets.   Pet owners need to take precautions against the life threatening toxic effects this chemical can have on our pets.  Prevention is key as death can occur in as little as 12 hours after ingestion.  Early recognition of exposure and prompt veterinary attention is essential!

12569240-adding-antifreeze

Antifreeze toxicity occurs when a pet ingests a chemical containing ethylene glycol.  Antifreeze often has a sweet taste, unfortunately attracting pets and encouraging them to taste and consume it.  Ethylene    glycol is not only found in antifreeze, but can also be found in radiator coolant, windshield deicing agents, brake fluid, motor oil, developing solutions for hobby photographers, wood stains, solvents, and paints.  The concentration of ethylene glycol in these compounds varies.

Only a small amount of ethylene glycol needs to be ingested to have toxic effects.  For cats, just a few licks can be fatal.  A teaspoon can be enough to kill a small dog.  The reason ingestion of this chemical can be fatal is the secondary effects the chemical has on the body.   Once ingested, the liver breaks down ethylene glycol into other toxic compounds that damage other organs.  The primary organs affected include the brain and the kidneys, with kidney failure being the ultimate cause of death.  The lungs and GI tract can also be affected.

The toxic effect of these chemicals can be broken down into the following 3 stages:

  • Stage 1:  Occurs 30 minutes to 12 hours after ingestion.  Signs usually indicate toxic effects on the brain as well as signs of intestinal irritation.  Symptoms include the following: vomiting, depression, walking with a wobbly gait, falling over, tremors, seizures, coma, and sometimes death.
  • Stage 2:  Occurs within 12-24 hours after ingestion.   Signs usually include increased breathing rate or effort and “open mouth breathing”.  A fast heart rate may also be detected in this stage.
  • Stage 3: Usually occurs within 24-72 hours after ingestion, but can occur as early as 12 hours depending on the amount of toxin ingestion.  Signs in this stage usually reflect damage to the kidneys and include vomiting, diarrhea, loss of appetite, oral ulcers, and decreased urination.

VMC092

Because a pet’s likelihood for recovery worsens with each stage, the earlier a pet is treated for antifreeze ingestion, the better the prognosis.  Pets that are evaluated  and treated appropriately by a veterinarian within minutes to even 1-2 hours after ingestion have a good chance for a full recovery.  Pets that are not diagnosed until kidney damage has occurred have a much more guarded prognosis, need much more intensive care and treatment, and are at greater risk for developing permanent kidney damage or death.

What do you do if you think your pet ingested antifreeze?

If you suspect your pet ingested antifreeze, please take your pet immediately to your veterinarian for evaluation and treatment.  Antifreeze toxicity is diagnosed by a history of exposure, blood work and urine tests.  Ethylene glycol tests are available, but false negatives and false positives are possible.  If possible, please bring the antifreeze product with you so the veterinarian can determine if the antifreeze contains ethylene glycol.

How is ethylene glycol toxicity treated?

Treatment depends on the stage at which the toxicity is diagnosed.  Initially your veterinarian will need to perform some tests to identify how advanced the problem is, such as blood work and urine tests.  If ingestion or exposure was recent, your veterinarian may recommend making your pet vomit to remove any of the toxin from the stomach.   Your veterinarian may also give activated charcoal, an oral medication that binds to any toxin remaining in the intestines.

Based upon test results and the stage of presentation, your pet may be hospitalized to receive IV fluids and a medication (4-Methylpyrazole or 4-MP) to help prevent the liver from converting ethylene glycol to the toxic agents that cause kidney damage.   This medication needs to be given by injection and the complete course of treatment can take 2- 3 days.

If your pet has developed evidence of kidney damage by the time of presentation to your veterinarian, the recommended treatment plan may also include additional medication and hospitalization to help treat kidney damage.  In these cases, continuous nursing care and monitoring is recommended and gives your pet the best chance for positive outcome.  Your veterinarian may refer your pet to a 24-hour veterinary facility, and may also recommend referral to a specialty hospital where dialysis can be performed.  This procedure will help remove any remaining toxins from your pet’s blood as well as assist with treatment of kidney failure.   Because only a few hospitals offer dialysis in the United States, and because this treatment can be expensive, dialysis is often not pursued.

VMC249

How can you prevent your pet from ingesting antifreeze?

  • Always keep your pet contained safely on your property – do not allow your pet to wander without supervision.  You can't control where antifreeze is spilled, cleaned up, or stored when off your property.
  • Keep pets away from areas containing these chemicals, such as garages and driveways where spills are most common
  • Store antifreeze containers in a place not accessible to pets or wildlife
  • Clean up antifreeze spills promptly
  • Check your car for antifreeze leaks regularly
  • Do not allow your pet to drink out of toilets containing antifreeze solutions

 2249350194_9e88fa3cbd

What about “pet friendly” antifreeze?

Most “pet friendly” antifreeze solutions contain propylene glycol instead of ethylene glycol.  Although propylene glycol can still be toxic to your pet, it does not cause kidney damage.  Ingestion of propylene glycol-containing chemicals should still prompt evaluation by a veterinarian.  Signs of toxicity include the following: severe sedation, walking as if drunk, seizures, tremors, panting, pale gums, and lethargy.

As always, be prepared – know where your closest emergency veterinary facility is located, just in case your pet needs care!

This blog post was written by the VMC’s Medical Director, Maureen Luschini, VMD, DACVECC