A suspected case of intermediate syndrome in a dog with carbamate toxicosis

Suspected intermediate syndrome in a dog after organophosphate poisoning

OBJECTIVE

To discuss the clinical presentation and successful treatment of a suspected case of intermediate syndrome due to organophosphate (OP) poisoning in a dog.

CASE SUMMARY

Two dogs presented with acute cholinergic signs after ingesting an OP insecticide containing 50% acephate. Clinical signs consistent with acute cholinergic crisis resolved in both dogs within 24 hours postingestion. One dog developed an onset of neurological signs consistent with intermediate syndrome approximately 24 hours postingestion. This patient's clinical signs resolved with the use of pralidoxime chloride.

NEW OR UNIQUE INFORMATION PROVIDED

OP poisoning most commonly presents as an acute cholinergic crisis, with rare instances of animals developing intermediate syndrome. Few reports of successful treatment and recovery from intermediate syndrome exist in the veterinary literature, particularly with instances in which 2 dogs within the same exposure setting were treated for acute cholinergic signs and only 1 progressed to an intermediate syndrome. This report also highlights the importance of early intervention with pralidoxime chloride prior to the onset of aging.

Prevalence, clinical manifestations, laboratory findings, treatment, and outcome of intermediate syndrome in anticholinesterase pesticide intoxication of dogs: A retrospective study

Organophosphates and carbamates are important anticholinesterase intoxicants of humans and dogs. Intermediate syndrome (IMS) typically occurs 7-96 h following a toxicity-associated acute cholinergic crisis (ACC), and manifests clinically as weakness of the proximal limb, respiratory, and neck flexor muscles. The aim of this study was to describe the prevalence, clinical findings, and outcome of IMS in dogs. The medical records of a veterinary teaching hospital were searched for dogs diagnosed with ACC, IMS, or both, between 2017 and 2021. Case files were retrospectively reviewed. Six historical IMS cases were additionally reviewed. Thirty-two dogs were diagnosed with anticholinesterase intoxication during the search period, of which 23 (72 %) were only diagnosed with ACC, seven (22 %) progressed from ACC to IMS, and two (6 %) were only diagnosed with IMS. Duration of hospitalisation was longer in the IMS group compared to the ACC only group (P = 0.005). When all dogs with IMS (n = 15, including the six historical cases) were considered, survival was 100 %, including four (27 %) that required positive pressure mechanical ventilation following respiratory failure. Serum butyrylcholine esterase activity, a marker of cholinesterase activity, was below reference interval when first measured in 14 (93 %) of dogs; however, was not a useful as a recovery marker. IMS should be suspected in dogs demonstrating respiratory, neck, and proximal limb muscle paresis or paralysis, especially following clinical signs consistent with ACC. Absence of clinical signs consistent with ACC or butyrylcholine esterase activity within the reference interval does not exclude IMS as a differential.

Uso de pralidoxima en la intoxicación con metomilo en pastor collie en Medellín (Colombia). Reporte de caso

Se describe el uso de la pralidoxima en el tratamiento de una intoxicación con metomiloen un canino en la ciudad de Medellín (Colombia). Un macho de raza pastor colliesufrió intoxicación accidental con metomilo, presentó cuadro colinérgico, con miosis,sialorrea, delirio, excitación y emesis, fue sometido a descontaminación con carbónactivado y terapia con atropina (0,04 mg/kg IM) cada 30 minutos hasta atropinizar,difenhidramina (2 mg/kg EV) y pralidoxima (10 mg/kg EV) cada 8 horas y pentobarbital(12 mg/kg EV) por 24 horas, además de terapia de sostén. Se realizaron pruebashematológicas, creatinina, alanino aminotrasferasa, tiempo de protrombina y tiempoparcial tromboplastina que resultaron normales para la especie. Después de una terapiade 7 días el paciente presentó mejoría total de los signos nerviosos y se dio de alta encondición normal. El uso de pralidoxima como activador de la acetilcolinesterasa es unaopción en el tratamiento de la intoxicación grave por metomilo en la especie canina quemuestra sensibilidad a los carbamatos.