1
|
Braun V, Kanstinger A, Dahlem D. [Mycotoxin intoxication in 54 dogs after ingestion of walnuts]. TIERARZTLICHE PRAXIS. AUSGABE K, KLEINTIERE/HEIMTIERE 2024; 52:211-219. [PMID: 39173649 DOI: 10.1055/a-2344-6146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
OBJECTIVE The aim of this retrospective study was to decribe the intoxication with tremorgenic mycotoxins subsequent to the ingestion of walnuts in a large population of dogs and the evaluation of the development of the clinical signs under the initiated treatment. MATERIAL AND METHODS The study included 54 dogs exhibiting signs of tremor, hyperesthesia, hyperthermia and ataxia, in particular a few hours following observed ingestion of walnuts or its justified suspicion. RESULTS The patients were presented to the clinic mostly during winter and spring. Fifty-three of 54 dogs were hospitalized for symptomatic, decontaminating and eliminating therapy (98%). Symptomatic treatment comprised of anticonvulsant therapy in 14 dogs (26%) and an antiemetic therapy in for half of the patients (n=27; 50%). A forced emesis for decontamination was undertaken in only 6 patients due to the severity of their neurological symptoms (11%). For further decontamination, an oral administration of activated charcoal after improvement of clinical signs (n=39; 72%). The majority of dogs (n=45; 83%) additionally received an intravenous lipid therapy for toxin elimination and isotonic crystalloid solution to compensate fluid losses. There were no side effects observed following the administration of intravenous lipid therapy. The majority of dogs were hospitalized for a duration of 2 days (n=44; 81%). In most dogs, examination was unremarkable on the day of their release (n=39; 72%). Potential long-term sequelae of the intoxication were not recorded in any patient. CONCLUSION Due to the lipophilic nature of mycotoxins, the use of intravenous lipid therapy may considered for toxin elimination purposes. The prognosis of mycotoxin intoxication following walnut ingestion is good with decontamination and elimination measures. CLINICAL RELEVANCE In the case of unspecific neurological signs such as tremor, ataxia and hyperesthesia as well as a corresponding preliminary report, an intoxication with mycotoxin-containing walnuts should be considered.
Collapse
Affiliation(s)
- Vanessa Braun
- Abteilung Innere Medizin, Kleintierklinik Ettlingen, Tierärztliche Klinik für Chirurgie, Praxis für Kleintiere, Ettlingen
| | - Alina Kanstinger
- Abteilung Innere Medizin, Kleintierklinik Ettlingen, Tierärztliche Klinik für Chirurgie, Praxis für Kleintiere, Ettlingen
| | - Dorothee Dahlem
- Abteilung Innere Medizin, Kleintierklinik Ettlingen, Tierärztliche Klinik für Chirurgie, Praxis für Kleintiere, Ettlingen
| |
Collapse
|
2
|
Kiwitz D, Markert C, Dörfelt R. Clinical effects and adverse effects of intravenous lipid emulsion treatment in dogs and cats with suspected poisoning. PLoS One 2024; 19:e0298828. [PMID: 38809887 PMCID: PMC11135785 DOI: 10.1371/journal.pone.0298828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/30/2024] [Indexed: 05/31/2024] Open
Abstract
This retrospective study aimed to evaluate the effects on the clinical signs of poisoning and adverse effects of intravenous lipid emulsion treatment in 82 animals (dogs and cats) with suspected poisonings over 18 months. Physical examination parameters and state of consciousness were documented every hour after the intravenous administration of a bolus of 2 ml/kg and 0.25 ml/kg/min over 60 minutes of a 20% intravenous lipid emulsion. The modified Glasgow coma scale and laboratory findings (blood gas analysis, triglyceride, lactate) were evaluated initially and three hours after discontinuing intravenous lipid emulsion administration. A statistical evaluation of the occurrence of adverse effects and the development of laboratory values was performed. A decrease in respiratory rate in the second control (8-12 hours) after ILE was observed. Three hours after completing of the intravenous lipid emulsion, triglyceride concentration increased about 10 times (p <0.001). Venous carbon dioxide partial pressure, bicarbonate, base excess, as well as the electrolytes sodium, potassium and ionized calcium decreased significantly (p <0.001). Patients who experienced a worsening of the modified Glasgow coma scale had a higher increase in triglyceride concentrations (p = 0.041) and plasma lactate (p = 0.034) and a larger decrease in bicarbonate concentrations (p = 0.053) compared to others. About 54% (n = 44) of the patients showed adverse effects which could be attributed to the administration of intravenous lipid emulsion and may be associated with a higher triglyceride increase. All of them were completely reversible within 33 hours. Adverse effects associated with intravenous lipid emulsion therapy were observed in half of the patients and were associated with a higher increase in triglycerides.
Collapse
Affiliation(s)
- Dschaniena Kiwitz
- Veterinary Clinic for Small Animals, Tierklinik Hofheim, Tierärzte IVC Evidensia GmbH, Hofheim am Taunus, Hessen, Germany
| | - Carina Markert
- Veterinary Clinic for Small Animals, Tierklinik Hofheim, Tierärzte IVC Evidensia GmbH, Hofheim am Taunus, Hessen, Germany
| | - René Dörfelt
- LMU Small Animal Clinic, LMU München, München, Germany
| |
Collapse
|
3
|
Lundgren S, Dreimanis K, Engdahl K, Windahl U, Tegner C. Alpha-chloralose poisoning in 25 cats: clinical picture and evaluation of treatment with intravenous lipid emulsion. J Feline Med Surg 2024; 26:1098612X241235776. [PMID: 38687210 PMCID: PMC11103310 DOI: 10.1177/1098612x241235776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
OBJECTIVES The aims of this study were to describe the clinical picture and progression in cats with alpha-chloralose (AC) intoxication and to determine if treatment with intravenous (IV) lipid emulsion (ILE) influenced either the serum concentration of AC or the clinical signs. METHODS Cats with suspected AC poisoning admitted to a university small animal hospital were included. The cats were randomised into two groups: one receiving 20% ILE at a dose of 300 mg/kg as a 2 min bolus, followed by a 1500 mg/kg continuous rate infusion over 30 mins (IL+ group) and the other receiving IV fluid therapy with Ringer's acetate (IL- group). Serum samples were drawn at 0, 2, 12 and 24 h after admission. Samples were tested for AC with a novel validated, quantitative, ultra-high-performance liquid chromatography-tandem mass spectrometry method. Vital and predefined clinical signs were noted at the times of sampling and patients were scored using a previously described intoxication severity score. Telephone interviews were conducted after discharge to assess outcome. RESULTS A total of 25 cats were enrolled: 13 cats in the IL+ group and 12 in the IL- group. The most common clinical signs at presentation were tremor (n = 22, 88.0%), cranial nerve deficits (n = 20, 80.0%) and bradycardia (n = 19, 76.0%). No significant difference in AC concentration or change in intoxication score over time was found between the IL+ and IL- groups at any time point (P >0.05). All cats recovered within 72 h. CONCLUSIONS AND RELEVANCE ILE did not have any effect on the AC serum concentration or clinical signs in AC-poisoned cats. All cats survived until follow-up. In cats with an acute onset of the described neurological signs, AC intoxication is an important differential diagnosis with an excellent prognosis.
Collapse
Affiliation(s)
- Sandra Lundgren
- University Animal Hospital, Swedish University of Agricultural Sciences, Uppsala, Sweden
- AWAKE Animal Hospital, Stockholm, Sweden
| | - Kristoffer Dreimanis
- University Animal Hospital, Swedish University of Agricultural Sciences, Uppsala, Sweden
- Evidensia (Uppsala Veterinary Clinic), Uppsala, Sweden
| | - Karolina Engdahl
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Ulrika Windahl
- Swedish National Veterinary Institute (SVA), Uppsala, Sweden
| | - Cecilia Tegner
- University Animal Hospital, Swedish University of Agricultural Sciences, Uppsala, Sweden
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| |
Collapse
|
4
|
Markert C, Heilmann RM, Kiwitz D, Doerfelt R. Intravenous lipid emulsion for the treatment of poisonings in 313 dogs and 100 cats (2016-2020). Front Vet Sci 2023; 10:1272705. [PMID: 37841477 PMCID: PMC10568331 DOI: 10.3389/fvets.2023.1272705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/13/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction The aim of this retrospective study was to analyze the effect and potential adverse effects of intravenous lipid emulsion (ILE) in poisoned dogs and cats over a 5 years period. Methods Medical records of 313 dogs and 100 cats receiving ILE between 2016-2020 were analyzed for suspected toxicant, clinical signs, ILE dosages and frequency, the effect and adverse effects of ILE, and patient outcome. Results Dogs and cats were poisoned with mostly unidentified toxicants (48%), rodenticides (8%), recreational drugs and nuts (7% each) and other toxicants. Clinical signs included neurologic deficits (63%), cardiovascular signs (29%), thermoregulation (21%) or gastrointestinal abnormalities (17%). Treatment with ILE was initiated within a median of 6.0 h (1.0-91.0 h) after poisoning. Dogs and cats received a total amount of median 8.0 mL/kg (1.5-66.6 mL/kg) and 15.8 mL/kg (1.8-69.4 mL/kg) ILE, respectively. A positive effect was observed in 74% of the patients, whereas clinical signs worsened in 4% of the patients after ILE administration. No subjective effect was detected in 22% of the patients. Suspected or possible adverse effects of ILE occurred in 6% of the patients, including neurological signs (temporarily reduced consciousness and ataxia), bradycardia, hyperthermia, vomiting, diarrhea, respiratory distress, worsening of the general behavior, facial swelling, and thrombophlebitis. The overall survival rate was 96%. One dog who potentially experienced adverse events was euthanized. Conclusion ILE treatment was successful in most patients but can be associated with adverse effects. Administration of ILE should be carefully selected on an individual basis after weighing the possible benefits against potential adverse effects.
Collapse
Affiliation(s)
- Carina Markert
- Veterinary Clinic for Small Animals, Hofheim, Germany
- Department for Small Animals, College of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | - Romy Monika Heilmann
- Department for Small Animals, College of Veterinary Medicine, University of Leipzig, Leipzig, Germany
| | | | - René Doerfelt
- LMU Small Animal Clinic, Ludwig-Maximilians-Universität München, Munich, Germany
| |
Collapse
|
5
|
Markert C, Heilmann RM, Kiwitz D, Dörfelt R. A retrospective evaluation of confirmed and suspected poisonings in 166 cats between 2016 and 2020. Vet World 2023; 16:1940-1951. [PMID: 37859962 PMCID: PMC10583876 DOI: 10.14202/vetworld.2023.1940-1951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/29/2023] [Indexed: 10/21/2023] Open
Abstract
Background and Aim Poisonings commonly bring cats and dogs to veterinary emergency facilities. This retrospective study aimed to analyze clinical signs, confirmed or suspected toxicants, treatments, and outcomes of feline poisoning cases presented over 5 years to the emergency service of a small animal referral center. Materials and Methods Medical records of 166 cats were evaluated for a history of confirmed or presumed poisoning, suspected toxicant, clinical signs, treatment, and outcome. Poisoning probability was determined using patient history, clinical findings, observation, toxicologic examination, and, in some cases, gastric contents. Results Most cats were hospitalized (94.0%) due to poisoning with mostly unknown toxicants (48.2%), rodenticides (21.1%), and various toxic plants (12.0%), followed by antiparasitics (6.0%), chemicals (6.0%), drugs (4.2%), tetrahydrocannabinol (1.2%), or inhaled smoke (1.2%). Patients presented predominantly with neurologic deficits (68.7%), reduced general condition (60.2%), and hypothermia (43.4%). The survival rate was 88.6%. Most cats (93.2%) showed no apparent complications at the time of discharge from the hospital. Toxicant-related complications (48.2%) included thermodysregulation (22.9%), central nervous system signs (18.7%), respiratory issues (7.2%), nephrotoxicity (6.0%), gastrointestinal complications (4.8%), evidence of hepatic failure (4.8%), and hemorrhage (1.8%). Conclusion In this study, the causative toxicant remained unidentified in many cases. Known poisonings were mostly caused by rodenticides. Neurological signs were the most common clinical presentation. Survival rates were high and comparable with those reported by others.
Collapse
Affiliation(s)
- Carina Markert
- Department for Small Animals, Tierklinik Hofheim, 65719 Hofheim am Taunus, Germany
- Department for Small Animals, University of Leipzig, 04103 Leipzig, Germany
| | | | - Dschaniena Kiwitz
- Department for Small Animals, Tierklinik Hofheim, 65719 Hofheim am Taunus, Germany
| | - René Dörfelt
- Clinic of Small Animal Medicine, LMU Munich, 80539 Munich, Germany
| |
Collapse
|
6
|
Di Pietro S, Falcone A, Arfuso F, Pennisi M, Piccione G, Giudice E. Treatment of Permethrin Toxicosis in Cats by Intravenous Lipid Emulsion. TOXICS 2022; 10:toxics10040165. [PMID: 35448426 PMCID: PMC9029646 DOI: 10.3390/toxics10040165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 12/10/2022]
Abstract
Background: In this study, the clinical response to treatment with intravenous lipid emulsion (ILE) for nine cats intoxicated with permethrin has been described. Methods: The enrolled cats showed acute onset of seizures, tremors and hypersalivation that were partially controlled with the administration of benzodiazepines and intravenous fluid therapy. Due to worsening clinical signs, intravenous lipid emulsion (intralipid 20%; 1.5 mL/kg in bolus, followed by 15 mL/kg for 1 h in infusion) was administered. Results: After ILE treatment, all cats recovered rapidly and were discharged within 24–54 h. Intravenous lipid emulsion appears to be a relatively safe and inexpensive alternative, with a short hospitalization time. Conclusions: Intravenous lipid emulsion could be an interesting therapeutic option in emergency and critical care protocols for permethrin toxicosis.
Collapse
|
7
|
Bergamini I, Mattavelli C, Grossi G, Magagnoli I, Giunti M. Conventional treatment of a metaldehyde-intoxicated cat with additional use of low-dose intravenous lipid emulsion. JFMS Open Rep 2020; 6:2055116920940177. [PMID: 32913659 PMCID: PMC7444139 DOI: 10.1177/2055116920940177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Case summary An adult male intact domestic shorthair cat was presented for acute onset of generalised tremors, stupor, horizontal nystagmus, anisocoria and bilateral absence of pupillary light and palpebral reflexes. Response to intravenous (IV) administration of benzodiazepines was minimal; thus, the induction of general anaesthesia with propofol, midazolam and dexmedetomidine was necessary to control clinical signs. Following a clinical suspicion of neurotoxicosis, a low-dose constant rate infusion (CRI) of IV lipid emulsion (ILE) was started. Phenobarbital and a low-dose CRI of ketamine were also used for neuroprotective purposes. Metaldehyde intoxication was confirmed by qualitative faecal toxicological analysis after discharge. Anaesthetic drugs were progressively tapered and stopped after 28 h and extubation was possible after 44 h. The cat was discharged 8 days after admission with a complete recovery of the clinical signs. Relevance and novel information To the authors’ knowledge, this is the first report to describe a case of metaldehyde toxicosis in a cat treated with intensive supportive care and an additional low-dose CRI of ILE.
Collapse
Affiliation(s)
- Ilaria Bergamini
- Department of Veterinary Medical Sciences, Alma Mater Studiorum-University of Bologna, Ozzano dell'Emilia, Bologna, Italy
| | - Clara Mattavelli
- Department of Veterinary Medical Sciences, Alma Mater Studiorum-University of Bologna, Ozzano dell'Emilia, Bologna, Italy
| | - Giorgio Grossi
- Department of Veterinary Medical Sciences, Alma Mater Studiorum-University of Bologna, Ozzano dell'Emilia, Bologna, Italy
| | - Ilaria Magagnoli
- Department of Veterinary Medical Sciences, Alma Mater Studiorum-University of Bologna, Ozzano dell'Emilia, Bologna, Italy
| | - Massimo Giunti
- Department of Veterinary Medical Sciences, Alma Mater Studiorum-University of Bologna, Ozzano dell'Emilia, Bologna, Italy
| |
Collapse
|
8
|
Lyons BM, Poppenga RH, Thawley VJ, Waddell LS. Successful Management of Severe Bromethalin Toxicosis in a Dog. J Am Anim Hosp Assoc 2020; 55:e55502. [PMID: 31433221 DOI: 10.5326/jaaha-ms-6921] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
ABSTRACT The use of bromethalin rodenticides has risen since 2011, and in some states, it is the most common rodenticide ingestion reported to poison control. Although intravenous lipid emulsion (ILE) has been previously reported to lower serum desmethylbromethalin levels in an asymptomatic dog, and repeated mannitol has been investigated in a laboratory setting, there are no published reports of successful treatment of symptomatic bromethalin toxicosis in dogs. A 9 yr old castrated male Norwich terrier was evaluated for obtunded mentation, seizures, cranial nerve deficits, and tetraparesis secondary to bromethalin toxicosis. The patient was treated with ILE, mannitol, and ginkgo biloba and returned to normal neurological function. Bromethalin exposure was confirmed by serum desmethylbromethalin levels. Previous literature indicates that the prognosis for patients who suffer from symptomatic bromethalin toxicosis is poor to grave, and the return to normal neurological function after severe toxicosis has not been reported. ILE, mannitol, and ginkgo biloba are readily available and relatively inexpensive, and in combination may be of benefit in symptomatic bromethalin intoxication.
Collapse
Affiliation(s)
- Bridget M Lyons
- From the Department of Clinical Sciences and Advanced Medicine, Emergency & Critical Care Service, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (B.M.L., V.J.T., L.S.W.); and the Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, Davis, California (R.H.P.)
| | - Robert H Poppenga
- From the Department of Clinical Sciences and Advanced Medicine, Emergency & Critical Care Service, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (B.M.L., V.J.T., L.S.W.); and the Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, Davis, California (R.H.P.)
| | - Vincent J Thawley
- From the Department of Clinical Sciences and Advanced Medicine, Emergency & Critical Care Service, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (B.M.L., V.J.T., L.S.W.); and the Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, Davis, California (R.H.P.)
| | - Lori S Waddell
- From the Department of Clinical Sciences and Advanced Medicine, Emergency & Critical Care Service, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (B.M.L., V.J.T., L.S.W.); and the Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, Davis, California (R.H.P.)
| |
Collapse
|
9
|
Kopke MA, Yozova ID. Management of presumptive canine permethrin toxicosis using intravenous lipid emulsion as an adjunctive therapy. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2019-001041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Matthew A Kopke
- School of Veterinary ScienceMassey UniversityPalmerston NorthNew Zealand
| | - Ivayla D Yozova
- School of Veterinary ScienceMassey UniversityPalmerston NorthNew Zealand
| |
Collapse
|
10
|
Romans CW, Day TK, Smith JJ. Oxidative red blood cell damage associated with propofol and intravenous lipid emulsion therapy in a dog treated for 5-fluorouracil toxicosis. J Vet Emerg Crit Care (San Antonio) 2020; 30:481-486. [PMID: 32407575 DOI: 10.1111/vec.12958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 10/31/2018] [Accepted: 11/12/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the first documented case of oxidant-induced anemia in a dog associated with propofol and IV lipid emulsion (IVLE) treatment for 5-fluorouracil (5-FU) toxicosis. CASE SUMMARY A 2-year-old male intact mixed breed dog was presented for evaluation after ingestion of 5% 5-FU cream. Refractory reactive seizures rapidly developed, and treatment with benzodiazepines, propofol, levetiracetam, and IVLE was initiated. The dog was euthanized due to development of marked oxidant-induced anemia. NEW INFORMATION PROVIDED This report documents the first instance of oxidant-induced anemia in the dog, associated with propofol and IVLE infusion therapy prescribed for treatment of 5-FU toxicosis.
Collapse
Affiliation(s)
- Cory W Romans
- Veterinary Emergency Service, Veterinary Specialty Center, Middleton, Wisconsin
| | - Thomas K Day
- Veterinary Emergency Service, Veterinary Specialty Center, Middleton, Wisconsin
| | - Joshua J Smith
- Veterinary Emergency Service, Veterinary Specialty Center, Middleton, Wisconsin
| |
Collapse
|
11
|
Chumbler NS, Schildt JC, Mawby DI, Papich MG. Use of intravenous lipid therapy in a cat with carprofen overdose. Clin Case Rep 2020; 8:653-657. [PMID: 32274029 PMCID: PMC7141744 DOI: 10.1002/ccr3.2772] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 12/08/2019] [Accepted: 12/18/2019] [Indexed: 11/06/2022] Open
Abstract
Intravenous lipid emulsion (ILE) was administered to a cat with no adverse effects. This case report postulates that ILE can be used for the treatment of carprofen toxicity in cats and supports the lipid sink theory as the main mechanism of action.
Collapse
Affiliation(s)
- Nathan S Chumbler
- University of Tennessee College of Veterinary Medicine Knoxville TN USA
| | - Julie C Schildt
- University of Tennessee College of Veterinary Medicine Knoxville TN USA
| | - Diane I Mawby
- University of Tennessee College of Veterinary Medicine Knoxville TN USA
| | - Mark G Papich
- North Carolina State University College of Veterinary Medicine Raleigh NC USA
| |
Collapse
|
12
|
Tinson E, Cook S. Supporting the intoxicated patient: toxicants affecting the neurological and cardiovascular systems. IN PRACTICE 2020. [DOI: 10.1136/inp.l7080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
13
|
Abstract
Introduction Pyrethroid compounds are widely used as insecticides. These compounds not only have a versatile application, but also have favourable toxicological profiles with high selectivity and toxicity to insects and low toxicity to humans. Despite this, there have been several reports of toxicity to humans in both occupational exposure and deliberate ingestional poisoning. Classical presentation and treatment Two classical syndromic presentations are described. Type I syndrome is characterised predominantly by tremors and is seen with exposure to type I pyrethroids. Type II pyrethroids, which are structurally modified type I pyrethroids with the addition of a cyano group, can result in type II syndrome characterized by choreo-athetosis and salivation. Mega-dose poisoning and mixed poisoning, particularly with organophosphorus compounds, is associated with significant toxicity and death. Treatment is supportive and symptomatic. A favourable outcome can be expected in most patients. How to cite this article Ramchandra AM, Chacko B, Victor PJ. Pyrethroid Poisoning. Indian J Crit Care Med 2019;23(Suppl 4):S267–S271.
Collapse
Affiliation(s)
- Atul M Ramchandra
- Department of Medical Intensive Care Unit, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Binila Chacko
- Department of Medical Intensive Care Unit, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Peter J Victor
- Department of Medical Intensive Care Unit, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| |
Collapse
|
14
|
Pelizzola M, Mattavelli C, Troìa R, Murgia E, Giunti M. Low‐dose intravenous lipid emulsion as a safe treatment for lipophilic intoxications in five cats. VETERINARY RECORD CASE REPORTS 2018. [DOI: 10.1136/vetreccr-2018-000663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Marco Pelizzola
- Department of Veterinary Medical SciencesUniversity of BolognaBolognaItaly
| | - Clara Mattavelli
- Department of Veterinary Medical SciencesUniversity of BolognaBolognaItaly
| | - Roberta Troìa
- Department of Veterinary Medical SciencesUniversity of BolognaBolognaItaly
| | - Elsa Murgia
- Department of Veterinary Medical SciencesUniversity of BolognaBolognaItaly
| | - Massimo Giunti
- Department of Veterinary Medical SciencesUniversity of BolognaBolognaItaly
| |
Collapse
|
15
|
|
16
|
Building the evidence for lipid resuscitation therapy. Hum Exp Toxicol 2017; 36:534-535. [DOI: 10.1177/0960327117701987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
17
|
Hassdenteufel E, Lehmann H, Schneider M, Moritz A. [Emergency management of intoxications in the dog and cat]. TIERARZTLICHE PRAXIS. AUSGABE K, KLEINTIERE/HEIMTIERE 2016; 44:438-449. [PMID: 27849101 DOI: 10.15654/tpk-160889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/07/2016] [Indexed: 06/06/2023]
Abstract
Intoxications may lead to life-threatening emergencies. While stabilising the patient, therapy should focus on a rapid and effective elimination of the toxin. General measures for decontamination (gastrointestinal, dermal, ocular) aim to effectively decrease the absorption of the poisonous substance. Further classification of the substance and its properties can assist with the choice of specific treatment options, including dialysis and specific antidotal therapy. In recent years, treatment with lipid emulsions for enhanced elimination of lipophilic substances has become an important therapeutic option. In affected patients, it can rapidly improve clinical signs while side effects and complications are rarely encountered with this form of therapy.
Collapse
Affiliation(s)
- Esther Hassdenteufel
- Dr. Esther Hassdenteufel, Klinik für Kleintiere, Justus-Liebig-Universität Gießen, Frankfurter Straße 126, 35392 Gießen, E-Mail:
| | | | | | | |
Collapse
|
18
|
Gosselin S, Hoegberg LCG, Hoffman RS, Graudins A, Stork CM, Thomas SHL, Stellpflug SJ, Hayes BD, Levine M, Morris M, Nesbitt-Miller A, Turgeon AF, Bailey B, Calello DP, Chuang R, Bania TC, Mégarbane B, Bhalla A, Lavergne V. Evidence-based recommendations on the use of intravenous lipid emulsion therapy in poisoning. Clin Toxicol (Phila) 2016; 54:899-923. [DOI: 10.1080/15563650.2016.1214275] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Sophie Gosselin
- Department of Emergency Medicine, McGill University Health Centre, Montréal, Québec, Canada
- Centre Antipoison du Québec, Montréal, Québec, Canada
- Province of Alberta Drug Information Services, Calgary, Alberta, Canada
| | - Lotte C. G. Hoegberg
- Danish Poisons Information Centre, Anaesthesiology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Robert. S. Hoffman
- Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, NY, USA
| | - Andis Graudins
- Monash Clinical Toxicology Service, Program of Emergency Medicine, Monash Health and School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Christine M. Stork
- Upstate NY Poison Center, Syracuse, NY, USA
- Department of Emergency Medicine, Upstate Medical University, Syracuse, New York, USA
| | - Simon H. L. Thomas
- National Poisons Information Service (Newcastle) and Medical Toxicology Centre, Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | | | - Bryan D. Hayes
- Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD, USA
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael Levine
- Department of Emergency Medicine, Section of Medical Toxicology, University of Southern California, Los Angeles, CA, USA
| | - Martin Morris
- Schulich Library of Science and Engineering, McGill University, Montréal, Québec, Canada
| | - Andrea Nesbitt-Miller
- Schulich Library of Science and Engineering, McGill University, Montréal, Québec, Canada
| | - Alexis F. Turgeon
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, and CHU de Québec, Université Laval Research Center, Population Health and Optimal Health Practices Unit, Université Laval, Québec City, Québec, Canada
| | - Benoit Bailey
- Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Montréal, Québec, Canada
- Centre Antipoison du Québec, Quebec, Canada
| | - Diane P. Calello
- Medical Toxicology, Department of Emergency Medicine, Morristown Medical Center, Emergency Medical Associates, Morristown, NJ, USA
| | - Ryan Chuang
- Department of Emergency Medicine, Division of Clinical Pharmacology and Toxicology, University of Calgary, Poison and Drug Information Service, Calgary, Alberta, Canada
| | | | - Bruno Mégarbane
- Department of Medical and Toxicological Intensive Care, Lariboisière Hospital, Paris-Diderot University, INSERM UMRS1144, Paris, France
| | - Ashish Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Valéry Lavergne
- Department of Medical Biology, Sacré-Coeur Hospital, University of Montréal, Montréal, Québec, Canada
| |
Collapse
|
19
|
Chan DL. Chewing the fat on veterinary toxicology: The path to discovery. J Vet Emerg Crit Care (San Antonio) 2016; 25:591-3. [PMID: 26460527 DOI: 10.1111/vec.12408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Daniel L Chan
- Professor of Emergency and Critical Care Medicine and Clinical Nutrition, Section of Emergency and Critical Care, Department of Clinical Science and Services, The Royal Veterinary College, University of, London, UK
| |
Collapse
|
20
|
Bates N. Lipid infusion in the management of poisoning. Vet Rec 2016; 179:22. [DOI: 10.1136/vr.i3609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Nicola Bates
- Medical Toxicology and Information Services; Veterinary Poisons Information Service; Mary Sheridan House; 13 St Thomas Street London SE1 9RY
| |
Collapse
|
21
|
Fettiplace MR, Weinberg G. Past, Present, and Future of Lipid Resuscitation Therapy. JPEN J Parenter Enteral Nutr 2015; 39:72S-83S. [DOI: 10.1177/0148607115595979] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/22/2015] [Indexed: 01/18/2023]
Affiliation(s)
- Michael R. Fettiplace
- Department of Anesthesiology, University of Illinois College of Medicine, Chicago, Illinois
- Research & Development Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois
- Neuroscience Program, University of Illinois at Chicago, Chicago, Illinois
| | - Guy Weinberg
- Department of Anesthesiology, University of Illinois College of Medicine, Chicago, Illinois
- Research & Development Service, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois
| |
Collapse
|