Basic principles, diagnosis and management of toxic exposures (Proceedings)

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Basic principles, diagnosis and management of toxic exposures (Proceedings)

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Aug 01, 2010

Oral exposure to toxicants among small animals (pets) is the most common. Biological activities are graded, and, are based on toxicants reaching their sites of action (effectors) in biological system at a sufficient concentration and duration. Intensity of a biological effect is dose related. Basic pharmacokinetic/toxicokinetic principles of toxicants become essential in addressing toxicity.

Toxicant concentrations at effector sites are based on absorption, distribution, metabolism, and excretion of individual toxicants.

This presentation addresses prevention, patient stabilization, diagnostic measures, diagnosis and management of toxic exposures.

     Toxicology is the study of adverse effects of poisons (toxins, toxicants, xenobiotics) on living organisms.

          "All substances are poisons; there is none which is not poison. The right dose differentiates a poison from a remedy"

               Philippus Aureolus Theophrastus Bombastus Von Hohenheim-Paracelcus 1493-1541

Prevention

Educating clients and animal handlers alike on the need to control the animals' environment (reduce risk of exposure to toxicants) is a must.

Initial evaluation

All cases of reported possible toxicant (s) exposures should be regarded as, and handled as an emergency. Assuming toxicity from limited initial information received from clients without a complete case work-up is wrong. Most often, animals are presented to the veterinarian already showing clinical signs.

Check for and treat all life threatening conditions – airway, breathing, temperature, hemorrhaging, cardiovascular, state of consciousness etc. Prior to administering any medication, collect specimens (un-clotted/clotted blood, vomitus, stomach contents etc.) for later analysis.

Stabilization

The important thing is to first stabilize the patient (treat the patient not the toxin). A complete history, thorough physical examination, collecting and analyzing the appropriate specimens, interpreting analytical results, and, evaluating all relevant facets in the case at hand, determines patient management with possible diagnoses, a workable effective treatment plan (subjected to modifications as new information permits) should be in place.

General Approaches to Treatment/Management of Poison Cases

     Prevents Further Toxin Exposure and Absorption
          • Decontamination
          • Ocular exposure – Flush eyes with tepid water or Saline solution for 20-30 minutes.
          • Dermal Exposure – Repeated baths in warm water with mild liquid dishwashing detergent (Dawn is frequently recommended)
          • Oral Exposure – Dilution (milk or water), induce emesis, gastric lavage, endoscopic and/or surgical intervention, adsorbent, and/or cathartics and/or enemas).

Approaches

Prevent Further Toxin Absorption; Promote removal of absorbed toxin; Administered appropriate antidotal therapy, and Supportive Therapy