Wednesday, January 22, 2014

Case Study of the Month

Fido, a 10 lb, 1 year old Jack Russell Terrier was presented to us after ingestion of some Nicotine gum.  With the ingestion of this type of gum in dogs we worry about TWO different toxicities, nicotine and a sugar called Xylitol.  A physical examination was performed and all was within normal limits.  

Fido's blood work was all within normal limits as well.  The idea behind bringing pets into the clinic after toxin ingestion is to decontaminate or help them vomit ASAP to prevent absorption into the blood stream, along with controlling any symptoms as a result of ingestion.  Pets are hospitalized in order to monitor them for the development of symptoms as a result of toxin ingestion.  Outlined below were the steps taken in Fido's case:

Step 1:  Since ingestion occurred less than 1 hour prior to Fido’s arrival and the patient was stable, we attempted to make him vomit to rid the stomach of its contents and prevent absorption into his blood stream.  We gave Fido several doses of hydrogen peroxide.  With no such luck we tried another emetic agent called apomorphine, which can only be obtained at a veterinary clinic.  Unfortunately, we were unable to induce vomiting. 

Step 2:  Since there is no antidote for either Nicotine or Xylitol toxicity, the next step is to give the patient activated charcoal.  This is performed if ingestion of the toxic substance occurred over an hour after presentation or after the patient stops vomiting.  Activated charcoal binds to the toxin and prevents absorption from the gut.  It is recommended that multiple doses be given. 

Step 3:  Fido was then put on intravenous fluids to flush/filter out the toxin (diuresis) more quickly. 
Step 4: Hospitalization and observation for any clinical signs associated with either toxin exposure as listed below was the final step for Fido.

·         Nicotine initially causes excitement, excess salivation, vomiting, diarrhea, and/or muscle tremors.  Symptoms can rapidly progress to muscle weakness, depression, shallow respiration and paralysis.  The ingestion of this toxin can lead to death because the respiratory muscles can't do their job.  The lethal dose is very little = 2-3mg/kg.  In Fido's case 3 pieces of gum could have been lethal! 

·         Xylitol causes a drop in blood sugar less than 60 minutes after ingestion causing depression, lethargy/weakness, muscle tremors, coma and possibly seizure.  This toxin causes liver damage within 8-12 hours after ingestion leading to vomiting, diarrhea, seizures and possibly death. 

Outcome:  Fido was very fortunate and he never showed any adverse symptoms as a result of the toxin ingestion due to our fast action in decontamination.  His blood sugar remained normal and we kept him on fluids in the hospital for 24 hours.  He was released to his owners the next day.  We followed up a week later to check blood work to make sure his liver wasn't affected by the Xylitol.  His lab work remained normal!  Fido is continuing to live a happy and healthy life with his loving family!