Today's Veterinary Practice

JUL-AUG 2017

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.

Issue link: http://todaysveterinarypractice.epubxp.com/i/840151

Contents of this Issue

Navigation

Page 77 of 79

76 PRACTICAL TOXICOLOGY PEER REVIEWED are no data on how often acidosis occurs in pets, about 45% of intoxicated humans become acidotic. 17 • Monitor for hypoglycemia. If dietary and hepatic (glycogenolysis) sources of glucose are exhausted, hypoglycemia may result. During the oxidation of ethanol, the ratio between oxidized and reduced forms of nicotinamide adenine dinucleotide increases, which increases the conversion of pyruvate to lactate. This leads to a lack of the key intermediate in gluconeogenesis, pyruvate, and hypoglycemia ensues. 18 Hypoglycemia, which can result in seizures and coma, is a serious complication of acute alcoholic intoxication. 10 Dextrose may need to be added to IV fluids. • IV fluids do not accelerate ethanol clearance in intoxicated patients but should be started for supportive purposes. 19 Use isotonic solutions. Sodium bicarbonate (0.5 × kg body weight × base deficit = deficit in mEq) can be added to combat metabolic acidosis. Give half the sodium bicarbonate dose over 3 to 4 hours. 20 • Treat any arrhythmias symptomatically (atropine for bradycardia, lidocaine for ventricular premature contractions). Control seizures not related to hypoglycemia with diazepam. If the animal is comatose, pass an endotracheal tube and position the patient to prevent aspiration. In cases of severe intoxication, monitor oxygen saturation and be prepared to mechanically support the animal's breathing. Yohimbine (0.11 mg/kg IV), atipamezole (100 mcg/kg IV), or naloxone (0.1 mg/kg IV) can be tried to reverse severe CNS depression or coma. 20 This reversal effect does not appear to be predictable or consistent in animals. 21 Animals that are mildly affected may be monitored at home. Patients with significant CNS depression, those requiring airway protection or ventilatory support, and those with seizures, acid-base disturbances, or hypoglycemia should be admitted for monitoring and supportive care. In severe cases, hemodialysis may be considered. Keno and Langston reported using hemodialysis in a dog with rapid clinical recovery. 22 Hemodialysis can eliminate ethanol approximately 3 to 4 times more rapidly than liver metabolism alone. Although ethanol levels may be determined from blood, serum, plasma, and urine, they are seldom measured in pets. 23 In most cases, such measurements need to be performed at a human hospital. In humans, blood ethanol concentrations between 150 and 300 mg/dL (32.6 to 65.2 mmol/L) generally cause obvious signs and symptoms. Death is usually associated with blood ethanol levels >400 mg/dL (86.8 mmol/L). 3 In the case report by Kammerer et al, the dog that ingested rotten apples exhibited vomiting, ataxia, tremors, and dehydration and died 48 hours later with an alcoholemia of 300 mg/dL. 12 If the blood ethanol level cannot be measured, serum or plasma osmolality may be used to estimate it, using the following formula 24 : Blood ethanol level [g/L] = Osmolal gap/27 DIFFERENTIAL DIAGNOSIS Most ethanol intoxications are unmistakable because of the odor of alcohol on the pet's breath. However, other toxic differentials for intoxicated patients include salicylates, marijuana, toluene, ethylene glycol, methanol, isopropanol, benzodiazepines, barbiturates, opiates, and gamma-hydroxybutyric acid. 7–9 Nontoxic differentials include lactic acidosis, uremia, diabetic ketoacidosis, cardiovascular accident, hypoglycemia, and hypoxia. 7–9 PROGNOSIS In most cases of ethanol ingestion, the prognosis is good. Cases complicated by aspiration of gastric contents, presence of other ingested material, or preexisting disease have a more guarded prognosis. Intoxicated animals are also predisposed to traumatic injuries. To see the references for this article, please visit tvpjournal.com. Tina Wismer Tina Wismer, DVM, DABVT, DABT, is responsible for overseeing medical recommendations made by the veterinary staff at ASPCA Animal Poison Control Center (APCC). She is also highly involved in lecturing, making media appearances, and writing, and she coordinates the APCC's extern program. Dr. Wismer earned her undergraduate degree from Ohio's University of Findlay and received her DVM from Purdue University. Her first job was in a small animal practice in Michigan. She then worked for an emergency practice in South Bend, Indiana, before joining the APCC. Dr. Wismer has written several peer-reviewed toxicology articles and book chapters. She is an adjunct instructor at the University of Illinois, previously a visiting professor at St. Matthews University (Cayman), a consultant for VIN (Veterinary Information Network), and a Master Gardener.

Articles in this issue

Links on this page

Archives of this issue

view archives of Today's Veterinary Practice - JUL-AUG 2017