Fatal metaldehyde poisoning in a dog confirmed by gas chromatography

BACKGROUND

Metaldehyde is a toxic pesticide used mainly as a molluscicide, responsible for intoxication and deaths in both humans and animals. Accidental exposure to metaldehyde in dogs is considered rare, but severe. Data concerning clinical and veterinary forensic toxicology are largely incomplete, especially regarding case reports in dogs. The present work reports a complete and detailed description of a case from the history, clinical evolution, pathological exams and toxicological diagnosis in an accidental case of metaldehyde poisoning in dog.

CASE PRESENTATION

An eleven-month-old, 3.0 kg, male German Spitz was presented for emergency care with acute vomiting and seizures 3 hours after suspected accidental ingestion of commercial molluscicide containing 3% metaldehyde (Lesmax®). The animal was in lateral recumbency and showed stuporous mentation, salivation, tonic-clonic status epilepticus, systemic tremors, bilateral miosis, absent palpebral, corneal, oculovestibular and gag reflexes, severely depressed spinal reflexes, dyspnea and tachycardia. Despite treatment, the patient progressed to comatose mentation and died. Necropsy examination revealed discrete lesions in the liver and central nervous system, while stomach examination revealed content of feed, activated charcoal and blue-green granules, compatible to the commercial formula of metaldehyde. Histology examination revealed extensive hemorrhage and severe centrolobular necrosis of the liver and tumefaction of Kupfer cells. Brain samples showed discrete hemorrhage and hyperemia. In order to confirm the diagnosis, samples from feces, stomach content, spleen, liver, heart, kidneys and brain were submitted gas chromatography analysis. Results confirmed the presence of metaldehyde in all samples. We describe clinicopathological abnormalities of a fatal case of metaldehyde poisoning in a dog, as well as postmortem diagnosis using gas chromatography.

CONCLUSION

Metaldehyde poisoning is rarely reported, since the diagnosis is often difficult and the notifications scarce. To our knowledge, this is the first report describing clinical signs, pathological findings and chromatographic diagnosis. This report aims to contribute to the understanding of the pathogenesis of metaldehyde intoxication, to further explore veterinary forensic toxicology diagnosis.

Persistence of metaldehyde during acute molluscicide poisoning

A case is presented in which a 37-year-old man took an overdose of Slugit, liquid containing metaldehyde. Significant concentrations were found in his serum and urine for several days afterwards. Acetaldehyde and ethanol were not detected. The significance of these findings is discussed.

Clinical, neurological and clinicopathological signs, treatment and outcome of metaldehyde intoxication in 18 dogs

OBJECTIVES

To describe the clinical signs, clinicopathological abnormalities and outcome of metaldehyde intoxication in dogs.

METHODS

Medical records of dogs presenting between 1989 and 2005 with a diagnosis of metaldehyde toxicity were reviewed retrospectively. Data obtained from the medical record included signalment, history, clinical signs, laboratory tests results, hospitalisation period length, treatments and outcome.

RESULTS

Eighteen dogs fulfilled the inclusion criteria. The most prevalent clinical signs were seizures, hyperthermia, tachycardia and muscle tremors. Serum biochemistry abnormalities included increased serum muscle enzymes activities, acidaemia (six dogs) and decreased blood bicarbonate (eight dogs). Treatment was symptomatic and supportive. Hyperbilirubinaemia was observed in two dogs. Diazepam was the most commonly used anticonvulsant followed by phenobarbitone and pentobarbital. General inhalant anaesthesia was required in nine of 18 dogs with seizures unresponsive to anticonvulsants. The survival was 83 per cent (15 of 18 dogs).

CLINICAL SIGNIFICANCE

This clinical study recorded, for the first time in the veterinary literature, several clinicopathological abnormalities from severely intoxicated dogs. Metabolic acidosis was common, while acute or delayed hepatotoxicity was an uncommon complication.

Acute metaldehyde poisoning in Taiwan

Metaldehyde, a cyclic tetramer of acetaldehyde, is a widely used molluscicide. Although cases with acute metaldehyde poisoning have been reported, the occurrence of severe poisoning is uncommon. To provide more information on human metaldehyde poisoning, we reviewed 15 cases of metaldehyde exposure reported to the Taiwan National Poison Control Center at the Taipei Veterans General Hospital between 1991 and 2002. While 7 patients were asymptomatic, the other 8 patients, including 4 who coingested alcohol or other poisons, exhibited toxic manifestations of abdominal pain, dizziness, nausea, irritation of oral mucosa, and seizures after oral exposure. One patient died after ingesting 12 g (or 258.6 mg/kg) of metaldehyde. Although the toxicity from metaldehyde is largely mild, the clinical course of metaldehyde poisoning may be rapidly deteriorating and fatal on rare occasions. Physicians should therefore be cautious in managing patients with metaldehyde poisoning, and vigorous supportive measures should be promptly instituted in patients who manifest severe toxicity.

[Case report-fatal snail bait (metaldehyde) overdose presenting aspiration pneumonia]

A-55-year-old man ingested unknown amount of snail poison bait containing metaldehyde. He was mentally retarded and presented pica. On admission, his vital sign was stable, and the extremeties were spastic. Then, gastric lavage was unsuccessful because of massive unbited food. Activated charcoal and cathartic were administrated. On the next day, general convulsion occurred and respiratory distress advanced, so he was intubated. On the 3rd day, infiltration shadow appeared on chest roentogenogram and, his respiration was assisted mechanically. Thereby, acute lung injury advanced regardless of tracheostomy, kinetic therapy, antibiotics and steroid pulse therapy. He died of respiratory failure on the 33rd day. Serum test showed HBs and HBe antigen, CT scan revealed ascites and splenomegaly; the clinical course might be worsened by liver cirrhosis. HPLC revealed metaldehyde in the serum (total 80.6 microg/ml). He ingested 2.7 g of metaldehyde maximally estimated. Although Japan Poison Information Center reported that snail poison bait poisoning is often in dogs in Japan, human poisoning is rare.

Pesticide toxicosis in the horse

Toxicosis from pesticides rarely occurs in horses and is usually the result of inappropriate pesticide use or handling by humans. Organophosphorus and carbamate insecticides inhibit acetylcholinesterase and are the insecticide class most frequently associated with toxicosis in domestic animals. Metaldehyde is a molluscicide, and zinc phosphide is a rodenticide, both of which have caused toxicosis in horses. All three of these pesticides affect the nervous system of horses and can be fatal if not treated promptly.

[Pesticide poisoning]

Pesticide intoxications are mainly accidental with a benign course, such as ingestions of diluted fertilizers or low concentration antivitamin K rodenticides, ant-killing products or granules of molluscicides containing 5% metaldehyde. Voluntary intoxications by chloralose, strychnine, organophosphorus or organochlorine insecticides, concentrated anti-vitamin K products, herbicides such as paraquat, chlorophenoxy compounds, glyphosate or chlorates may be severe. Toxicity is due to active substances but also to solvents or surfactants included in the composition. Analysis done in a toxicology laboratory help in establishing diagnosis, prognosis and treatment. Poison centres may be called constantly to help for the evaluation of these intoxications.

Epidemiological features of snail and slug bait poisoning in dogs and cats

Snail and slug baits were the most common cause of poisoning in dogs and cats in a survey of 34 veterinary practices. During a 7-month period, 280 dogs and 12 cats were poisoned by metaldehyde (57%) or methiocarb (43%) containing baits with case fatality rates of 8.1% and 9.1% in dogs and 16.7% and 50% in cats, respectively. The ages of poisoned dogs ranged from 2 months to 17 years and cats from 3 months to 5 years. There was no decrease in frequency of poisoning or case fatality rate demonstrated with increasing body size in dogs. Poisoning was most frequent in the month of October. Baits were eaten off the ground or obtained from storage areas, often despite a variety of preventive measures. It is suggested that these products should be reformulated to make them less attractive to domestic pets.

Pharmacological aspects of metaldehyde poisoning in mice

Metaldehyde, when administered orally to mice at a dose of 1 g kg-1, produced convulsions and death within 2 h. Brain concentrations of noradrenaline (NA) 5-hydroxytryptamie (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA) were significantly reduced in these animals relative to controls. Treatment with either intraperitoneal clonidine or diazepam 20 min after administration of metaldehyde reduced the mortality rate and in mice surviving for 5 h, the decrease in brain NA and 5-HT concentrations were significantly reduced.

Palatability studies of snail and slug poison baits, using dogs

In 1975, the California Department of Food and Agriculture required registered manufacturers of snail and slug baits to present data showing the unattractiveness of these products to dogs, in order to reduce the number deaths in dogs due to poisoning by eating these baits. A cooperative project involving the University of California, the California Department of Food and Agriculture, and the snail and slug bait manufacturers was designed to assist the manufacturers in assessing the palatability of their products by dogs and to develop criteria for the regulatory agencies to use to ensure that the products they were registering were unattractive to dogs. The studies showed that most recently formulated baits were relatively unpalatable for dogs. A 2-panel consumption testing procedure was developed and is being used by the California Department of Food and Agriculture and the Environmental Protection Agency as criteria for registration. Current reports indicate a dramatic decrease in snail and slug bait poisonings in California after these criteria were established as requirements for registration of snail and slug baits.

Three cases of metaldehyde poisoning in cattle

Poisoning of dairy cows and of calves by metaldehyde is reported. The clinical signs, post mortem and toxicological findings are described. Confirmations of the diagnoses was obtained by biochemical estimations. It would appear that a dose as low as 0.2 g/kg in adult cattle, and even less in calves, can be lethal.

Metaldehyde poisoning in three horses

Three horses exhibited nervous and cardiopulmonary signs after ingestins small amounts of metaldehyde, and 2 died in 3 to 5 hours. A colt given 0.1 mg/kg was similarly affected and died.