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88 PRACTICAL TOXICOLOGY PEER REVIEWED Penitrem A is believed to be a lipid-soluble compound, making it a potential candidate for ILE therapy. However, information regarding the use of ILE with tremorgenic mycotoxin intoxication is limited. 14,15 ILE therapy may be indicated in patients with a lipophilic toxicosis that does not respond to standard therapy and when signs are serious or life-threatening. Evaluation of liver, pancreas, and kidney functions, as well as correction of any electrolyte abnormities, is best done before administration of ILE. 15-17 Adverse effects of and contraindications to ILE therapy include: • Allergic or anaphylactoid reactions to components in the lipid emulsion • Inability or decreased ability to clear lipids from the bloodstream • Volume overload • Pancreatitis • Hemolysis • Interference with common laboratory testing • Interference with other treatment modalities (the "lipid sink" is not selective and may affect lipophilic drugs as well as toxins) • Recurrence of clinical signs if lipid emulsion is eliminated prior to the toxin IN SUMMARY Because many dogs have indiscriminate eating habits, tremorgenic mycotoxicosis is an intoxication small animal veterinarians may see in practice. Ingestion of moldy foods may not be witnessed; therefore, it is important for veterinarians to be familiar with clinical signs and differential diagnoses commonly associated with tremorgenic mycotoxin intoxication. In addition, because of the potential for rapid onset and potentially life-threatening signs, prompt care may affect the outcome in these cases. References 1. Evans TJ, Gupta RC. Tremorgenic mycotoxins. In: Gupta RC, ed. Veterinary Toxicology Basic and Clinical Principles. 2nd ed. San Diego: Elsevier; 2012:1231-1237. 2. Eriksen GS, Jaderlund KH, Moldes-Anaya A, et al. Poisoning of dogs with tremorgenic Penicillium toxins. Med Mycol 2010;48(1):188-196. 3. Arp LH, Richard JL. Intoxication of dogs with the mycotoxin penitrem A. JAVMA 1979;175(6):565-566. 4. Boysen SR, Rozanski EA, Chan DL, et al. Tremorgenic mycotoxicosis in four dogs from a single household. JAVMA 2002;221(10):1441- 1444. 5. Lowes NR, Smith RA, Beck BE. Roquefortine in the stomach contents of dogs suspected of strychnine poisoning in Alberta. Can Vet J 1992;33(8):535-538. 6. Tiwary AK, Puschner B, Poppenga RH. Using roquefortine C as a biomarker for penitrem A intoxication. J Vet Diagn Invest 2009;21(2):237-239. 7. Barker AK, Stahl C, Ensley SM, Jeffery ND. Tremorgenic mycotoxicosis in dogs. Compend Contin Educ Vet 2013;35(2):E2. 8. Moldes-Anaya A, Rundberget T, Faeste CK, et al. Neurotoxicity of Penicillium crustosum secondary metabolites: tremorgenic activity of orally administered penitrem A and thomitrem A and E in mice. Toxicon 2012;60(8):1428-1435. 9. Crandell D. Toxicological emergencies. In: Mathews KA, ed. Veterinary Emergency and Critical Care Manual. 2nd ed. Guelph: Lifelearn Publishers; 2006:630-640. 10. Plumb DC. Plumb's Veterinary Drug Handbook. 8th ed [online]. plumbsveterinarydrugs.com. Accessed February 2017. 11. Plumb DC. Plumb's Veterinary Drug Handbook. 7th ed. Ames: Wiley-Blackwell; 2011. 12. Mathews KA. Hyperthermia, heatstroke, and malignant hyperthermia. In: Mathews KA, ed. Veterinary Emergency and Critical Care Manual. 2nd ed. Guelph: Lifelearn Publishers; 2006:297-303. 13. Fettiplace MR, Weinberg G. Past, present and future of lipid resuscitation therapy. J Parenter Enteral Nutr 2015;39(1 Suppl):72S- 83S. 14. Eriksen GS, Moldes-Anaya A, Faeste CK. Penitrem A and analogues: toxicokinetics, toxicodynamics including mechanism of action and clinical significance. World Mycotoxin J 2013;6(3):263-272. 15. Robben JH, Dijkman MA. Lipid therapy for intoxications. Vet Clin North Am Small Anim Pract 2016;47(2):435-450. 16. Gwaltney-Brant S, Meadows I. Use of intravenous lipid emulsions for treating certain poisoning cases in small animals. Vet Clin North Am Small Anim Pract 2012;42(2):251-262. 17. Marwick PC, Levin AI, Coetzee AR. Recurrence of cardiotoxicity after lipid rescue from bupivacaine-induced cardiac arrest. Anesth Analg 2009;108(4):1344-1346. Kirsten Waratuke Kirsten Waratuke, DVM, DABT, received her degree in biology and doctorate of veterinary medicine from the University of Illinois. After working at a small animal practice and emergency clinic, she joined the ASPCA Animal Poison Control Center (APCC) as a consulting veterinarian in clinical toxicology. In addition to answering calls on the APCC hotline, Dr. Waratuke also co-authors the Tox Insider, a monthly e-newsletter for veterinarians and veterinary staff, and has published several papers and book chapters. She received her Diplomate of the American Board of Toxicology credential in 2016.