Toxicology Cases That I've Known and Loved – Part 2 (Proceedings)
The following cases will be discussed:
"Arthur", a 9 month-old, male (N), American Bulldog, was admitted to the ES with a complaint of refractory neuromuscular disease. At 5:30 PM, he walked into the house from outside, stumbled and collapsed in the rear. Almost immediately thereafter, he started exhibiting muscle tremors, paddling, foaming at the mouth and urinary incontinence. Within approximately 1 hour, he was taken to the rDVM. At that time the dog had a body temperature of 104.6 F and was obtunded. He was given diazepam, LRS, and methocarbamol. There was no known access to a toxicant. The dog had been healthy and was not on any medications prior to the onset of clinical signs.ER Physical Examination
• T= 100.6, HR=PR= 140, RR= Panting
• MENTATION: Stuporous. Non-responsive to visual, auditory or tactile stimuli. Mild response with noxious stimulus.
• INTEGUMENT: Clean, short hair coat. No fecal staining around the perineum. No ectoparasites found.
• HEAD: (Eyes)- Cornea, sclera, anterior chamber and lens clear OU. Pupils miotic and non-responsive to light. No ocular discharge. Absent menace response. (Ears)- Clean AU with smooth otic epithelium. (Nose)- Clean and moist; no discharge. (Oral)- Foaming at the mouth. Full oral examination not performed.
• CV: No murmur or arrhythmia noted. MM= pink/moist. CRT= 1 sec. Femoral pulses= adequate, symmetrical, synchronous.
• RESP: Soft breath sounds in all lung fields. No crackles or wheezes.
• ABDOMEN: Soft to palpate. No fluid wave. No obvious masses or organomegaly.
• MS: BCS= 5/9. Laterally recumbent. Tonic/clonic muscle tremors.
• NEURO (brief):
• Mentation: Stuporous
• CNs: Miotic pupils and absent PLRs. Menace response absent.
• Gait/posture: Laterally recumbent. Constant tonic/clonic muscle tremors.
• Segmental reflexes unable to be assessed.
• LN: Mandibular, superficial cervical and popliteal LNs approximately 1.0cm in diameter.
• RECTAL: Small amount of grit/gravel filled feces in rectum; no blood.
Problem: status epilepticus