Zinc Toxicosis in a Boxer Dog Secondary to Ingestion of Holiday Garland

Retrospective evaluation of the clinical course and outcome of zinc toxicosis due to metallic foreign bodies in dogs (2005-2021): 55 cases

OBJECTIVE

To describe the overall clinical course of zinc toxicosis in dogs including source, time to source control, incidence of hemolytic anemia, acute liver injury (ALI), acute kidney injury (AKI), and pancreatitis.

DESIGN

Retrospective case series from 2005 to 2021.

SETTING

Six university veterinary teaching hospitals.

ANIMALS

Fifty-five client-owned dogs with known zinc toxicosis due to metallic foreign body (MFB) ingestion.

MEASUREMENTS AND MAIN RESULTS

The most common source of zinc was US pennies minted after 1982 (67.3%). Forty-five of 55 (81.8%) dogs survived and 10 of 55 (18.2%) died or were euthanized. Median length of hospitalization for survivors and nonsurvivors was 3 days. The most common clinical sequelae of zinc toxicosis were anemia (87%), ALI (82%), coagulopathy (71%), thrombocytopenia (30.5%), AKI (26.9%), and acute pancreatitis (5.5%). Most dogs (67.3%) required blood products and 83% of dogs achieved a stable HCT or PCV in a median of 24 hours after MFB removal. The median duration of illness prior to presentation was 48 hours for both survivors and nonsurvivors and there was no impact of time to presentation on the incidence of ALI, AKI, or pancreatitis.

CONCLUSIONS

Zinc toxicosis secondary to MFB ingestion should be considered a differential diagnosis for dogs with gastrointestinal signs, hemolytic anemia, ALI, hemostatic abnormalities, AKI, and pancreatitis. AKI may be a more common sequela of zinc toxicosis than previously suspected. Acute pancreatitis is a rare but potentially serious sequela to zinc toxicosis.

Zinc Concentration in Blood Serum of Healthy Dogs

The objective of this study was to establish a reference interval for serum zinc in dogs and to determine the factors that affected it. We collected samples from 197 clinically healthy animals of various breeds and ages and obtained information about their sex, neuter status, age, breed, diet, lifestyle, weight, and body condition score. Serum zinc concentration was measured by a colorimetric method using a clinical chemistry analyzer. We established the reference interval for serum zinc as 4.9-19.7 µmol/L. When assessing the relationship of zinc with various biochemical parameters, we found significant correlation with albumin and triacylglycerols. The only observed factor that significantly influenced serum concentration was sex. Female dogs had higher levels (median 11.0 µmol/L) than males (median 8.9 µmol/L). The difference between intact females and intact males was also significant (medians 11.6 and 9.0 µmol/L respectively), but it was only numerical for neutered animals (median of neutered females 10.7 µmol/L and of neutered males 8.7 µmol/L). Despite the general belief that homemade food for dogs contains a lower amount of zinc than a commercial one, diet did not influence zinc serum levels significantly. There was also no impact of age, breed, lifestyle, weight, or body condition score on serum zinc concentration.

Zinc toxicosis in a cat associated with ingestion of a metal screw nut

Case summary

A 3-year-old female neutered domestic shorthair cat was presented for vomiting, inappetence and weight loss. The cat developed moderately regenerative anaemia, moderately increased alanine transaminase and alkaline phosphatase activities, hyperbilirubinaemia and prolonged activated partial thromboplastin time. Abdominal ultrasound identified gastric wall thickening and changes suggestive of pancreatitis. Gastroduodenoscopy identified a metal screw nut in the pylorus, which was removed with rat tooth forceps. Metal analysis and serum zinc concentration using leftover serum collected at admission were performed after screw nut removal. Serum zinc concentration was markedly elevated, confirming a diagnosis of zinc toxicosis. Metal analysis of the screw nut showed that the major metal component was zinc. The cat recovered after screw nut removal and supportive care. Clinical signs resolved and the serum zinc concentration reduced significantly after screw nut removal.

Relevance and novel information

Reports of zinc toxicosis in cats are scarce, possibly due to the more discriminating eating habits of this species. To our knowledge, this is the first report of zinc toxicosis causing haemolytic anaemia, liver enzyme activity increases, gastrointestinal signs and pancreatitis in a cat associated with ingestion of a zinc-containing metal object.

Blood concentrations of potentially toxic trace elements (PTEs) and correlation with biochemical and hematological parameters in dogs from thrace region, Turkey

Environmental exposure to potentially toxic trace elements (PTEs) leads to health problems in animals as well as in humans. Dogs can be used as bioindicators for health status of both environment, animals and humans. The study material consisted of a total of 140 dogs from Thrace region in Turkey. Essential (Co, Cr, Cu, Fe, Zn) and non-essential (As, Cd, Hg, Ni, Pb) PTEs concentrations of blood samples were determined by ICP-MS. In addition, hemogram (RBC, MCV, MCH, MCHC, HCT, WBC, HGB, PLT) and biochemical parameters (Glucose, total protein, albumin, globulin, total bilirubin, triglyceride, cholesterol, BUN, AST, ALT, ALP, GGT) levels were determined. The possible correlations between PTEs and blood parameters were investigated. The results were compared according to gender, age (<2, 2-5, >5 years), sampled location with hemogram and biochemistry data. Essential element concentrations (ppb) were sorted as Zn > Fe > Cu > Cr > Co, and non-essentials were As > Ni > Pb > Hg > Cd. There were statistically important negative or positive correlations between elements and hematological (except Fe and Cd), and biochemical parameters (except Ni) (p < 0.05, p < 0.01). It was determined that Pb concentrations (9.34-23.30 ng ml^-1) were below the concentrations considered to be toxic in all locations, Cu concentrations (475.35-521.98 ng ml^-1) were within the normal reference range, Zn (3229.65-4.265.00 ng ml^-1) were higher than the reference values in all locations. Since the concentrations of elements and correlations between hematological, biochemical parameters as well as gender, age, and location in an area with heavy urban and industrial activity; indicate that the situation may be similar for other living things in the region, it constitutes a starting point for studies to be carried out in this direction.

Suspected hemolytic anemia secondary to acute zinc toxicity after ingestion of "max strength" (zinc oxide) diaper rash cream

OBJECTIVE

To describe the clinical presentation of a dog with hemolytic anemia secondary to zinc toxicosis after 1-week use of "max strength" 40% diaper rash cream.

CASE SUMMARY

A 2-year-old female neutered Maltese presented for vomiting, lethargy, pigmenturia, and pale mucous membranes. "Max Strength" zinc oxide cream had been applied to the patient daily for a week prior to presentation. Clinical examination revealed light pink to pale mucous membranes and tachycardia. Hematology demonstrated large numbers of spherocytes and a strongly regenerative anemia. Plasma zinc concentrations were markedly increased. A diagnosis of hemolytic anemia secondary to subacute zinc toxicosis was made and supportive therapy was instigated. The patient ultimately recovered uneventfully. Acute or subacute zinc toxicosis resulting in hemolytic anemia is not frequently observed, and this case was also unusual in that the zinc source was diaper cream, which historically has been thought to require very large quantities to cause toxicosis.

NEW OR UNIQUE INFORMATION PROVIDED

To the authors' knowledge, there is only one previously reported case of hemolytic anemia secondary to diaper cream use in a hospital setting but no previous reports involving toxicosis secondary to prolonged application at home by owners. Most commercial diaper creams contain zinc oxide, which historically was thought to have poor gastrointestinal absorption and would require a large quantity to cause significant toxicosis and hemolytic anemia. Moreover, this case emphasizes the potential risks associated with zinc oxide cream use, the significance of client education if using these creams, as well as the importance of history in elucidating the underlying cause of hemolytic anemia.

Zinc in Dog Nutrition, Health and Disease: A Review

Simple Summary

This work compiles the current state of knowledge regarding zinc requirements of healthy dogs and biomarkers of zinc status. To ensure an adequate zinc status, it is important to know the zinc content of foods and their bioavailability to assess the need and the ideal supplementation strategy regarding levels and sources of additives in complete dog foods. As zinc is required for enzymatic, structural, and regulatory functions in the animal body, its nutritional status has been associated with several pathologies that may be due to, or exacerbated by, a deficit of dietary zinc supply.

Abstract

Zinc is an essential trace element, required for enzymatic, structural, and regulatory functions. As body reserves are scarce, an adequate zinc status relies on proper dietary supply and efficient homeostasis. Several biomarkers have been proposed that enable the detection of poor zinc status, but more sensitive and specific ones are needed to detect marginal deficiencies. The zinc content of commercial dry dog foods has great variability, with a more frequent non-compliance with the maximum authorized limit than with the nutritional requirement. The bioavailability of dietary zinc also plays a crucial role in ensuring an adequate zinc status. Despite controversial results, organic zinc sources have been considered more bioavailable than inorganic sources, albeit the zinc source effect is more evident after a restriction period of dietary zinc. Many disorders have been associated with inadequate zinc status, not being clear whether the occurrence of the disease is the consequence or the cause. This review presents data on zinc requirements and biomarkers for zinc status, that can be applied for the development of supplementation strategies of zinc in complete pet foods. Moreover, it provides an understanding of the role zinc plays in the health of dogs, and how altered zinc status affects diseases in dogs.

Zinc toxicosis - Associated hemolytic anemia and pancreatic disease in 2 dogs

Two cases of canine zinc toxicosis with pancreatic disease are reported. Both dogs had pigmenturia, pallor, regenerative anemia, an inflammatory leukogram, hyperbilirubinemia, hyperamylasemia, and hyperlipasemia. Zinc toxicosis was diagnosed post-mortem in patient 1 based on the discovery of a metallic gastric foreign object, pancreatic necrosis, nephrosis, and high tissue zinc concentrations. Survey radiographs of patient 2 allowed identification and prompt removal of coins from the stomach with resolution of anemia, hyperamylasemia, and hyperlipasemia 3 days post-gastroscopy. Plasma zinc concentration was markedly elevated in patient 2. Zinc toxicosis should be considered in dogs with concurrent hemolytic anemia and pancreatic disease.

Zinc toxicosis in a dog secondary to prolonged zinc oxide ingestion

Zinc toxicosis is commonly associated with ingestion of metallic zinc objects. This report documents an uncommon presentation of zinc toxicosis, secondary to prolonged ingestion of a zinc oxide cream. A 5.6 kg 6-year-old ovariohysterectomised female Poodle cross presented as a transfer to an emergency practice for severe anaemia, pigmenturia, weakness, and inappetence. She had a history of vomiting and nine days of diarrhoea. Amongst other supportive treatments, a zinc oxide cream had been applied to her hind end due to severe diarrhoea scalding, and in hindsight, the owners realised she had ingested large quantities of this cream. She developed a severe Heinz body haemolytic anaemia, along with spherocytosis, left-shift neutrophilia, prolonged activated partial thromboplastin time, and mildly elevated blood urea nitrogen. The serum zinc concentration was markedly elevated. She was treated supportively and made a full recovery. This case illustrates the importance of a thorough medical history. Zinc toxicosis can have a good prognosis when diagnosed and treated promptly.