Today's Veterinary Practice

SEP-OCT 2018

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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PEER REVIEWED 70 SEPTEMBER/OCTOBER 2018 Margin of safety: Variable, depending on the substance. Mechanism for hypoglycemia: Direct and indirect. Hypoglycemia may result from increased use of glucose 14 and possibly increased release of insulin. 15 Treatment Tip Treatment with acepromazine is very effective because of its α-adrenergic and dopaminergic-blocking effects. 14 Cyproheptadine may be used in conjunction with acepromazine if signs of serotonin syndrome (e.g., mydriasis, vocalization, hyperthermia, hyperesthesia, agitation, tachycardia, or fasciculation) are seen. 4. NSAIDs Description: Therapeutic doses of veterinary use approved NSAIDs (e.g., carprofen or deracoxib) or low doses of human use–labeled NSAIDs (e.g., ibuprofen or celecoxib) are not expected to cause hypoglycemia in dogs. However, it is possible to see hypoglycemia with large overdoses of NSAIDs. Ibuprofen accounts for almost half of the documented cases of NSAID-associated hypoglycemia at the Animal Poison Control Center. 2 These cases may be overrepresented because of the popularity of ibuprofen. Clinical signs: Overdoses of NSAIDs can lead to ulceration of the gastrointestinal tract and renal damage. Clinical signs may include vomiting, diarrhea, depression, melena, hematemesis, polydipsia, and polyuria. Ingestion of more than 350 mg/kg of ibuprofen can lead to neurologic signs, such as ataxia, tremors, seizures, and coma. Margin of safety: Variable. Most dogs that demonstrate signs of ibuprofen toxicosis with hypoglycemia had ingested more than 350 mg/kg. 2 Mechanism for hypoglycemia: Direct and indirect. NSAIDs are thought to cause hypoglycemia because of their effect on pancreatic β cells, causing increased insulin secretion. 16 Increased metabolic use of glucose (seizure activity) can lead to hypoglycemia. Treatment Tip Naloxone may help reverse ibuprofen- induced central nervous system depression or coma. 17 MUSHROOM POISONING Mushrooms most likely to cause hypoglycemia are those that contain amatoxins. Pictured here is Amanita phalloides [death cap]. Siaber

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