Common Toxins 1

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kris10leejmu
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167058
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Common Toxins 1
Updated:
2012-08-22 22:54:26
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Clinical Practice ll
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Clinical Practice ll
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  1. What are the  basic classes of toxins?
    • organic
    • inorganic
  2. What is an organic toxin?
    • derived from living things
    • carbon based
    • usually containing C-H bonds
  3. What is an inorganic toxin?
    • not organic
    • not containing C, C-H
  4. What are the three different types of treatments for toxicity?
    • supportive care
    • decontamination
    • drugs and antidotes
  5. What are the different types of toxins?
    • acetaminophen
    • botulism
    • carbon monoxide (CO)
    • chocolate and caffeine
    • ethylene glycol
    • grapes and raisins
  6. Which toxin is the worst toxin?
    acetaminophen
  7. What is acetaminophen?
    Tylenol
  8. Is acetaminophen organic or inorganic?
    organic
  9. What three enzyme systems can acetaminophen be metabolized?
    • sulfatranferases
    • glucuronyl transferase
    • cytochrome P-450
  10. Are sulfatranferases toxic or non-toxic metabolites?  Is this pathway significant in dogs and cats?
    • non-toxic
    • no
  11. Are glucuronyl transferase toxic or nontoxic metabolites?  Is this pathway significant in dogs and cats?
    • non-toxic metabolite
    • cats lack this enzyme, making them more susceptible
  12. Are cytochrome P-450 toxic or non-toxic metabolites?  What is the toxic metabolite called?
    • toxic metabolite
    • NAPQI (N-acetyl-para-benzequinoneimine)
  13. How does NAPQI work?
    • partially binds with glutathione
    • forms a non-toxic product that is eliminated in the urine
    • when glutathione, an antioxidant, is used up, methemoglobin is formed - cats are more sensitive to metHg
  14. What are the clinical signs of acetaminophen toxicity?
    • cyanosis or dark mucous membranes
    • dyspnea
    • facial edema
    • anorexia
    • depression
    • hypothermia
    • vomiting
    • increased ALT
    • weakness
    • coma
    • death
  15. What is the supportive treatment for acetaminophen toxicity?
    • airway
    • oxygen
    • collect lab samples
    • IV catheter
    • fluids
    • Oxyglobin
    • plasma
  16. What is the decontaminate treatment for acetaminophen toxicity?
    • emesis or gastric lavage
    • cathartics
    • activated charcoal
  17. What are the drugs and antidotes you can use to treat acetaminophen toxicity?
    • acetylcysteine
    • ascorbic acid
    • cimetidine
  18. How is acetylcysteine given for acetaminophen toxicity?
    PO or IV
  19. Why is by mouth administration preferred for treating acetaminophen with acetylcysteine?
    reaches the liver quickly through portal circulation
  20. How is ascorbic acid given to treat acetaminophen toxicity?
    IV
  21. What does ascorbic acid do for treating acetaminophen toxicity?
    converts methemoglobin to oxyhemoglobin
  22. What is methemoglobin?
    bad for of hemoglobin
  23. How does cimetidine (Tagamet) or ranitidine (Zantac) treat acetaminophen toxicity?
    ties up the cytochrome P-450 enzyme system so less NAPQI is formed
  24. How can we prevent acetaminophen toxicity?
    client education
  25. What is botulism?
    toxins produced by Clostridium botuinum
  26. Where can Clostridium botuinum be found?
    • in garbage and decaying animal carcasses
    • also ingestion of spores, wound contamination by spores
  27. Is botulism organic or inorganic?
    organic
  28. How does botulism cause toxicity?
    • toxins bind to receptors in nerve endings
    • this inhibits a release of acetylcholine - nusculoskeletal and parasympathetic neurotransmitter
  29. Where are the clinical signs usually seen with botulism toxicity?
    seen 24 - 48 hours after ingestion
  30. What are the clinical signs of botulism toxicity?
    • generalized weakness
    • ascending paresis
    • flaccid paralysis
    • mydriasis
    • poor jaw tone
    • dysphagia
    • failure to swallow causing salivation
    • vomiting
    • death due to respiratory paralysis
  31. What do we need to rule out before diagnosing botulism?
    • tick paralysis
    • rabies
    • polyradiculoneuritis (coon hound paralysis)
  32. What is the supportive treatment for botulism toxicity?
    • airway
    • oxygen
    • collect lab samples
    • IV catheter
    • fluids
    • deep bedding
    • physical therapy (to keep muscles from contracting)
    • frequent turning
  33. What is the decontamination treatment for botulism toxicity?
    • emesis
    • gastric lavage
    • activated charcoal
  34. What are the different drugs and antidotes to treat botulism toxicity?
    • botulism antitoxin (available, but unsure how effective)
    • penicillin or amoxicillin
  35. What is the prognosis for botulism toxicity?
    • most pets recover good wtih nursing care
    • can take several weeks
  36. What is carbon monoxide and where does it come from?
    • CO is odorless and colorless
    • it is a byproduct in incomplete combustion of hydrocarbon fuels
    • fires, smoke inhalation, improperly ventilated vehicles and houses
  37. Is carbon monoxide organic or inorganic?
    inorganic
  38. What are the clinical signs for carbon monoxide toxicity?
    • cherry red blood
    • red or dark pink mucous membranes
    • tachypnea
    • dyspnea
    • ataxia
    • deafness
    • lethargy
    • confusion
    • shock
    • collapse
    • seizures
    • coma
    • death
  39. What kind of readings do we get on the pulse oximeter when there is carbon monoxide toxicity?
    falsely normal
  40. What is the supportive treatment for carbon monoxide toxicity?
    • airway
    • ventilate
    • oxygen
    • collect lab samples
    • IV catheter
    • fluids
    • control seizures
  41. What is the decontamination treatment for carbon monoxide toxicity?
    remove patient from the source of the CO
  42. What are the drugs and antidotes used to treat carbon monoxide toxicity?
    • Oxyglobin
    • fresh blood transfusion
  43. What is the prognosis for carbon monoxide toxicity?
    depends on the amount of exposure
  44. Which is more toxic, dark chocolate or milk chocolate?
    dark chocolate
  45. What in chocolate makes it toxic?
    theobromine and caffeine
  46. Is theobromine and caffeine organic or inorganic?
    organic
  47. How does theobromine cause toxicity?
    inhibits phosphodiesterase, resulting in the release of catecholamines (epinephrine, norepinephrine)
  48. How does caffine cause toxicity?
    directly stimulates the myocardium and CNS
  49. What are the clinical signs of theobromine toxicity?
    • vomiting
    • diarrhea
    • PU
    • urinary incontinence
    • mild hypertension
    • bradycardia/tachycardia
    • dysrhythmias
    • nervousness
    • excitement
    • hyperthermia
    • seizures
    • panting
    • coma
    • death
  50. What are the clinical signs of caffeine toxicity?
    • tachycardia
    • tachypnea
    • vomiting
    • restlessness
    • hyperexcitability
    • hyperthermia
    • tremors
    • seizures
    • cyanosis
    • dysrhythmias
    • generalized congestion or hemorrhage
  51. What is the supportive treatment for theobromine and caffeine toxicity?
    • airway
    • oxygen
    • collect lab samples
    • IV catheter
    • fluids
    • control seizures
    • treat hyperthermia
    • monitor EKG - treat dysrhythmias
  52. What is the decontamination treatment for theobromine and caffeine toxicity?
    • emesis
    • gastric lavage with warm water
    • activated charcoal
    • saline cathartic
  53. What drugs and antidotes can we use to treat theobromine and caffeine toxicity?
    • no specific antidote
    • cardiac drugs
  54. How do we enhance elimination of theobromine and caffeine from the system?
    • fluid diuresis
    • urinary catheter
  55. What is the prognosis for theobromine and caffeine toxicity?
    depends on the amount of exposure
  56. What is ethylene glycol?
    antifreeze
  57. What does antifreeze taste like?
    tastes sweet
  58. How does ethylene glycol cause toxicity?
    • partially eliminated unchanged through the kidneys and does not do damage
    • the rest of the ethylene glycol is eliminated through the liver, broken down by alcohol dehydrogenase, and toxic metabolites are formed
  59. What are the toxic metabolites with ethylene glycol?
    • glycoaldehyde
    • glycolate
    • oxalate
  60. Is ethylene glycol organic or inorganic?
    organic
  61. How does glycoalhyde cause problems?
    causes CNS and respiratory depression
  62. How does glycolate cause problems?
    causes metabolic acidosis
  63. How does oxalate cause problems?
    combines with calcium to corm calcium oxalate crystals which precipitate in renal tubules causing kidney damage
  64. How many clinical sign stages are there for ethylene glycol toxicity?
    3
  65. How long does it take for ethylene glycol to get to stage 1?
    30 minutes to 12 hours after ingestion
  66. What are the clinical signs in stage 1 of ethylene glycol toxicity?
    • PU/PD
    • nausea
    • vomiting
    • depression
    • ataxia
    • seizures
    • low urine specific gravity
    • calcium oxalate crystals may be present in urine
  67. How long does it take for ethylene glycol to get to stage 2?
    12 to 24 hours after ingestion
  68. What are the clinical signs of stage 2 in ethylene glycol toxicity?
    • tachycardia
    • tachypnea
  69. How long does it take for ethylene glycol to reach stage 3?
    • 24 to 72 hours after ingestion in dogs
    • 12 to 24 hours after ingestion in cats
  70. What are the clinical signs of stage 3 in ethylene glycol toxicity?
    oliguric renal failure:  severe depression, vomiting, diarrhea, dehydration, azotemia, oliguria, painful kidneys, hypothermia
  71. What kind of supportive care can we do for ethylene gylcol toxicity?
    • airway
    • oxygen
    • collect lab samples
    • IV catheter
    • fluids
    • monitor urine output
    • control seizures
  72. What are the decontamination treatments for ethylene gylcol toxicity?
    • emesis
    • gastric lavage (only if ingestion occurred within the last 15-30 minutes and the patient is showing no clincial signs)
    • repeated doses of activated charcoal unless the patient is to receive oral ethanol
  73. Which types of drugs and antidotes can we use for ethylene glycol toxicity?
    • fomepizole
    • ethanol
    • sodium bicarbonate
  74. What is fomepizole?
    alcohol dehydrogenase inhibitor
  75. How does fomepizole work?
    prevents ethylene glycol from being broken down to toxic metabolites
  76. How do we administer ethanol and when should we administer ethanol?
    • IV
    • very effective if started within 1 hour of ingestion
  77. How does ethanol work to treat ethylene glycol toxicity?
    ethanol competes with ethylene glycol for alcohol dehydrogenase and alcohol dehydrogenase has a much higher affinity for ethanol than ethylene glycol
  78. What is ethanol?
    alcohol (like what we drink)
  79. Can we use ethanol and fomepizole together?
    no
  80. How do we administer sodium bicarbonate to treat ethylene glycol?
    IV
  81. When do we use sodium bicarbonate to treat ethylene glycol toxicity?
    for severe metabolic acidosis
  82. How do we enhance the elimination of ethylene glycol?
    • hemodialysis
    • peritoneal dialysis
  83. What is the prognosis for ethylene glycol toxicity?
    good if treatment starts soon after exposure
  84. When is the prognosis for ethylene glycol poor?
    once azotemia occurs (24 - 48 hours after ingestion)
  85. How do we prevent ethylene glycol toxicity?
    • owner education
    • use propylene glycol-based antifreeze
  86. What happens to a dog if they ingest a large amount of grapes or raisins?
    develop kidney failure
  87. Are grapes and raisins organic or inorganic?
    organic
  88. Do we know how grapes and raisins create a toxicity in animals?
    no, still under investigation
  89. What are the clinical signs of an animal with grape or raisin toxicity?
    • vomiting
    • lethargy
    • anorexia
    • abdominal pain
    • diarrhea
    • polyuria
    • oliguria
    • anuria
  90. What is the supportive treatment for grape and raisin toxicity?
    • collect lab samples
    • IV catheter
    • fluids
  91. What are the decontamination treatments for grapes and raisin toxicity?
    • emesis
    • gastric lavage
    • activated charcoal
    • saline cathartic
    • peritoneal dialysis
  92. What are the drugs and antidotes to treat grapes and raisin toxicity?
    • no antidotes
    • antiemetics

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