Toxicology Cases That I've Known and Loved – Part 2 (Proceedings)


Toxicology Cases That I've Known and Loved – Part 2 (Proceedings)

Nov 01, 2010

The following cases will be discussed:

Case One

"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

Owners elected euthanasia and necropsy. Necropsy findings were limited to severe diffuse hepatic sinusoidal congestion and severe renal medullary vascular congestion.