By Loren W. Noblitt DVM, MS
1) Chocolate: Chocolate contains theobromine and caffeine (both methylxanthines), a chemical that is toxic to dogs' and cats' hearts, causing it to beat too fast and subsequently can cause arrhythmias (unorganized heart beats) that can be fatal if ingested in significant doses. Other signs of ingestion include seizures, tremors, hyperactivity, lethargy and vomiting. Call your veterinarian with the specifics of the ingestion-amount of chocolate ingested in ounces, information about the type of chocolate (milk chocolate vs. dark, semisweet chocolate vs. baker's chocolate), whether or not wrappers were consumed as well, and when the ingestion occurred. Pancreatitis (inflammation of the pancreas) can occur as a consequence of chocolate ingestion, especially if your pet has had an episode of pancreatitis in the past. Often time, treatment will consist of induction of vomiting and coating the stomach with activated charcoal or similar compound to prevent absorption of the theobromine into the blood. Theobromine cause central nervous system and muscular stimulation, including the heart muscle. In some cases, beta-blockers or lidocaine to control problematic fast and irregular heartbeats. 2) Cocoa Bean Mulch: When planting your garden or landscaping your yard this year, pay close attention to the type of mulch that you buy. There is a type called Cocoa Bean Mulch and can lead to toxicosis if your dog (or cat) ingests it. A retrospective study released by the ASPCA Animal Poison Control Center (APCC) confirms that this commonly used fertilizer may deter slugs and snails, but it also attracts dogs, who can be poisoned by eating it. Made from spent cocoa beans used in the production of chocolate, cocoa bean mulch still contains caffeine and theobromine. Comments Dr. Steven Hansen, the APCC Senior Vice President, "Since the updated data confirms that dogs can exhibit certain clinical effects after consuming cocoa bean shell mulch fertilizer, the ASPCA advises pet owners that they should avoid using this fertilizer around unsupervised dogs, and dogs with indiscriminate eating habits."
3) Grapes and Raisins: Although the mechanism is unknown, fruits of Vitis vinifera cause kidney impairment and failure in dogs. Reported fatal doses are widely variable and there appears to be no dose-response relationship, and hence any ingestion should be considered dangerous. Vomiting is a frequent early sign. Prognosis is poor in animals with oliguria (small amounts of urine) or anuria (inability to urinate).
Management should be aggressive and include decontamination, aggressive IV fluid therapy, and monitoring kidney function closely. What exactly the toxic component of grapes and raisins is is currently unknown, but it is felt to be water-soluble, and within the flesh of the grape/raisin, not the seed. The prognosis remains guarded once renal failure develops.
4) Xylitol/Sugar-free Gum and Candy: Xylitol is an artificial sweetener and sugar alcohol. In people, xylitol generally has no effect on blood insulin or blood sugar levels. Dogs metabolize xylitol much differently than people. In dogs, xylitol triggers a large release of insulin that causes a sudden drop in blood sugar (hypoglycemia) and is evidenced by unsteadiness, depression, dilated pupils and, in severe cases, seizures. If ingested in high enough quantity, xylitol may lead to liver failure. Signs are subtle and include lethargy, vomiting, loss of appetite, and diarrhea.
The toxic dose of xylitol for dogs is 75-100 mg/kg of body weight. That being said, actually knowing how much xylitol the dog ate is another matter completely because most gum manufacturers consider the level of xylitol in their products to be proprietary information and refuse to disclose it. The amount may differ not only from manufacturer to manufacturer, but from flavor to flavor. The xylitol in one piece of gum ranges from 0.9 mg to 1,000 mg-obviously a HUGE difference. That being said, products that list xylitol as the first ingredient tend to be the most toxic to dogs.
Treatment typically consists of IV fluids, close blood glucose monitoring, and/or glucose/dextrose administration to correct low blood sugar. S-adenosyl-L-methionine (SAMe) has been used as a liver protectant in some cases. Also, the form of xylitol used in a product affects its toxicity. For instance, xylitol used in candies and mints is in a powder form that's absorbed quickly into the blood stream, causing signs of illness in ~30 minutes. Gum is different because it has to be chewed to release the xylitol. Dogs tend to swallow gum whole without chewing it. The xylitol still leaches out into the stomach but it takes much longer. If no side effects have been seen by 8-12 hours of ingesting gum, toxicity shouldn't be an issue, according to one veterinary toxicologist. This same toxicologist commented that "ABC-gum" (already-been-chewed-gum :)) poses much less risk to dogs and that the more thoroughly chewed up the gum is, the less sweetener is present.
5) Fatty Table Scraps: Fatty foods and scraps from the table can lead to an extremely painful and scary condition in dogs and cats called Pancreatitis (see previous Pancreatitis blogspot).
6) Onions and Garlic: The toxic dose of onions in dogs is about 5 g/kg and garlic is ~ 5 times more potent, so 1 g/kg-and cats are far more sensitive. Unfortunately with these supplements, the levels can vary considerably and be well above or below what's listed on the label. ANY amount of garlic is going to cause some RBC damage-it's only when the amount of garlic is sufficient to damage enough RBCs that we see clinical signs. We know that onions and garlic will decrease an important enzyme which then leads to low levels of glutathione, a critical antioxidant and enzyme. These and other changes in the RBC lead to decreased deformity of the erythrocyte membrane and increased microviscosity. Since these cells lose the ability to "flex," hemolysis (rupture) results. Unfortunately, there is no low-end dose published. We know that most animals will not have issues with small amounts of onions/garlic, but they do become more susceptible with other underlying disease processes.
7) Lillies: Did You Know that Lilies are poisonous plants for cats?
The lily leaves, petals, flowers, and pollen can cause a type of kidney failure in cats which is nearly irreversible a few days after the ingestion of the plant. It may be treatable if the cat is brought in shortly after the plant eating has been discovered so do not wait until the cat is sick. Or better yet, decorate for Spring in other ways. In dogs, Easter Lilies cause a nasty upset stomach but no kidney failure. Asiatic Lilies, Day Lilies, Tiger Lilies, and Stargazer Lilies are ALL TOXIC.
Easter Lily
8) Macadamia Nuts: The exact cause of the clinical signs of toxicosis resulting from macadamia nut ingestion by dogs is unknown. Since toxicity has only been seen in dogs, the actual mechanism of action could be specific to the dog and may involve constituents of the nuts themselves, contaminants from processing, mycotoxins, or other unidentified causes. In most cases-and for an unknown reason-dogs develop an inability to stand or use their hind limbs within the first 12 hours, post-macadamia ingestion. Depression, vomiting, ataxia, tremors, and fever can also be present. The prognosis in most cases is extremely good, as most dogs return to normal within 24 to 48 hours. Potential complications could be GI obstruction, pancreatitis, gastritis (inflammation of the stomach) or enteritis (inflamed intestines).
9) Cigarettes: Tobacco products contain varying amounts of nicotine, with cigarettes containing 13-30 mg of nicotine and cigars containing 15-40 mg. Clinical signs often develop quickly (usually within 15-45 minutes) and include excitation, tachypnea, salivation, emesis, and diarrhea. Muscle weakness, twitching, depression, tachycardia, shallow respiration, collapse, coma, and cardiac arrest can follow the period of excitation.
10) Pennies: Ingestion of coins by pets, especially dogs, is not uncommon. Of the existing US coins currently in circulation, only pennies pose a significant toxicity hazard. Pennies minted after 1983 contain 99.2% zinc and 0.8% copper, making ingested pennies a rich source of zinc. Other potential sources of zinc include hardware such as screws, bolts, nuts, etc., all of which may contain varying amounts of zinc. In the stomach, gastric acids leach the zinc from its source, and the ionized zinc is readily absorbed into the circulation, where it causes red blood cells to rupture. The most common clinical signs of penny ingestion are vomiting, depression, anorexia, hemoglobinuria, diarrhea, weakness, collapse and icterus/jaundice. Secondarily, acute kidney failure may develop. Laboratory abnormalities will be suggestive of ruptured RBC's (hemolysis)-including elevated bilirubin, hemoglobinemia, hemoglobinuria, and regenerative anemia) and may also indicate the development of kidney failure. X-rays of the abdomen may reveal the presence of coins within the stomach or intestine.
Treatment for recently ingested pennies should include induction of vomiting. Activated charcoal is not indicated, as it is of little benefit in binding metals. Removal of zinc-containing foreign bodies via endoscopy or gastrotomy/enterotomy may be required. Treatment for symptomatic animals should include blood replacement therapy as needed, intravenous fluids, and other supportive care. The use of metal chelators (binders) may not be necessary in cases where prompt removal of the zinc source is accomplished. If chelation therapy is instituted, careful monitoring of kidney parameters is important for the duration of therapy.
10a.) Knives: Don't let your animals play with knives!
11) Bread Dough: Raw bread dough made with yeast poses mechanical and biochemical threats to animals ingesting it. The warm, moist gastric environment stimulates yeast growth, resulting in expansion of the dough mass, resulting in gastric distention, which, if severe, can result in respiratory and vascular compromise. Perhaps more significant is the release of alcohol from yeast fermentation, resulting in profound blood acidosis, central nervous system depression, and even death. Early clinical signs may include unproductive attempts at vomiting, abdominal distention, and depression. As alcohol intoxication develops, the animal becomes ataxic and disoriented. Eventually, profound CNS depression, weakness, recumbency, coma, and hypothermia may occur. Management includes decontamination and treatment for alcohol toxicosis. Because emesis is often unsuccessful, gastric lavage is initially recommended. The veterinarian should be prepared to perform gastrotomy should the lavage fail to remove the bulk of the dough mass due to the glutinous nature of the dough. Treatment for alcohol intoxication should proceed as previously described.
12) Human/Animal Prescription Medications. The most commonly seen group of medications that animals seem to have a propensity to "get in to" around the house are their owners.' "Serotonin Syndrome" is the term used to describe behavioral changes seen when toxicity is seen. Clinical signs are typically rapid (within 1-2 hours of ingestion) and are behavioral and/or neuromuscular in nature. The exception being some of the extended release products (i.e., Effexor XL) in which signs are seen 8-12 hours later, typically. The behavioral changes commonly seen are agitation and depression/lethargy and neuromuscular signs include ataxia (drunken walking), muscle jerking, tremors, erratic eye movements and increased sensitivity to pain. Elevated temperatures (due to excessive muscle activity and a resetting of the brain's thermoregulatory center), vomiting, diarrhea, panting, accelerated heart rate, and increased blood pressure are all common, as well. Treatment must be prompt. Decontamination is sometimes possible, but regular monitoring and cooling measures are vital. Cyproheptadine, a non-specific serotonin antagonist, has been used successfully in many cases and is the treatment of choice.
The following is a compiled list of drugs known to be associated with elevated Serotonin levels. If you have/use any of these medications at home, take every precaution when storing them:
Amphetamines
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Buproprion (Wellbutrin)
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Buspirone
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Chlorpheniramine
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Clomipramine
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Robitussin
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Venlafaxine (Effexor)
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Fentanyl
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Fluoxetine (Prozac)
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Ginseng
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L-tryptophan
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Lithium
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LSD
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Methamphetamine
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Metoclopramide (Reglan)
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Ondansetron (Zofran)
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Paroxetine (Paxil)
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Pentazocine
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Selegiline
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St. John’s Wort
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Tramadol
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Trazadone
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Tryptophan
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Mirtazapine (Remeron)
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13) Anticoagulant Rodenticides: These are coumarin and similar compounds that inhibit the critical enzyme, vitamin K1-2,3-epoxide reductase, thereby depleting the body's vitamin K1 supply needed for synthesis of blood clotting factors II, VII, IX and X-the 4 factors required for clot formation. Clinical signs of clinical coagulopathy (bleeding) develop usually 3-5 days post ingestion. Diagnosis is generally possible before signs of coagulopathy develop (bleeding from orifices or hemorrhaging seen under the skin). Lethargy and/or respiratory distress upon exercise are both important early visual signs.
Another test called the "PIVKA" ("Proteins Induced by Vitamin K Antagonism") test is more specific. The PIVKA test detects inactive serine proteases. If an unusually high amount of inactive serine proteases are circulating that would indicate something is wrong with Vitamin K recycling. Long-term (3-4 weeks) oral vitamin K1 therapy is not needed in all cases, and should only be instituted once coagulopathy is confirmed analytically, unless hemorrhage is already evident. Cases already presenting with severe bleeding will require fresh whole blood transfusions to deliver activated clotting factors, and many units of fresh (or frozen) plasma may be needed.
Follow this link to see why clotting factors are so important:
http://youtu.be/uBvpE5ia2LE
14) Vitamin D analogues (Human Psoriasis medications: Vectical, Dovonex, Taclonex): The toxicity of vitamin D compounds to dogs has long been known. However, some analogues used in the management of psoriasis and also hyperparathyroidism in humans have been found to be extremely toxic. These include calcipotriol, calcitriol and tacalcitol. It is the metabolite calcitriol that mediates the toxicity by enhancing absorption and retention of calcium leading to elevated calcium levels, tissue deposition of calcium, and related secondary effects. Measurement of serum phosphorus, calcium, blood urea nitrogen (BUN), creatinine, and urine specific gravity, together with good history-taking, can confirm the diagnosis. Management is aimed at early decontamination, promotion of calcium excretion with IV saline and furosemide, together with the use of bisphosphonate drugs.
16) Mycotoxins: This poisoning syndrome arises through ingestion of fungal metabolites present in moldy foods, silage and compost. Several tremorgenic mycotoxins have been identified including penitrem A and roquefortine, though their mechanisms of action have not been elucidated. Clinical signs are rapid in onset and include vomiting, ataxia, rigidity, tachycardia, tremors and convulsions. Mainstays of management include decontamination, close monitoring, control of convulsions and cooling measures. Full recovery may take 48 hours or longer. Tremorgenic mycotoxins produced by molds on foods are a relatively common, and possibly under-diagnosed, cause of tremors and seizures in pet animals. Because of their relatively indiscriminate appetites, dogs tend to be most commonly exposed to tremorgens. These toxins are produced from a variety of fungi, however tremorgens produced by Penicillium spp. are the most commonly encountered. These molds grow on practically any food, including dairy products, grains, nuts, and legumes; compost piles may also provide a source of tremorgens. Tremorgens have several different mechanisms of actions: some alter nerve action potentials, some alter neurotransmitter action, while others alter neurotransmitter levels. The overall affect is the development of muscle tremors and seizures. Clinical signs include fine muscle tremors that may rapidly progress to more severe tremors and seizures. Death generally occurs in the first 2 to 4 hours and is usually secondary to respiratory compromise, metabolic acidosis or hyperthermia. Other signs that may be seen include vomiting (common) hyperactivity, depression, coma, behavior alterations, tachycardia, and pulmonary edema.
Asymptomatic animals exposed to moldy foods should be decontaminated via emesis or lavage followed by activated charcoal and cathartic. In symptomatic animals, control of severe tremors or seizures has priority over decontamination. Supportive care should include IV fluids, thermoregulation, and correction of electrolyte and acid-base abnormalities. In severe cases, signs may persist for several days, and residual fine muscle tremors may take a week or more to fully resolve. Testing of stomach content, suspect foods, or vomitus for tremorgens is available through the Animal Health Diagnostic Laboratory at Michigan State University (517-355-0281).
If your pet has been exposed to, or known to ingest any of the above items, contact your local veterinarian or the Zionsville Animal Hospital for advice and/or treatment.
OTHER MISCELLANEOUS HOUSEHOLD HAZARDS:
a) Ant Baits: Ant and roach baits are common objects found in households. They are also referred to as hotels, traps, or stations. The insecticides used most commonly in these baits are chlorpyrifos, sulfluramid, fipronil, avermectin, boric acid, and hydramethylnon. The baits usually contain inert ingredients such as peanut butter, breadcrumbs, sugar and vegetable or animal, which could be attracting to pets. Exposures to these types of ant baits usually do not require decontamination or treatment. Most often, if signs are seen at all, they are mild in nature and self-limiting and are usually attributed to the inert ingredients instead of the active ingredient.
b) Silica Gel Packets: Silica gel is used as a dessicant (drying agent) and often come in paper packets or plastic cylinders. They are used to absorb moisture with leather, medication, and in some food packaging. Silica is considered "chemically and biologically inert" upon ingestion. However, with ingestion, it is possible to see signs of GI upset, such as nausea, vomiting, and inappetence.
c) Toilet Water and Tank Drop Ins: Tank "drop in" products typically contain corrosive agents (alkali or cationic detergents.) However, when a tank "drop in" cleaning product is used in a toilet, the actual concentration of the cleaner is very low in the bowl. With dilution by the bowl water, the cleaning agent is just a gastric irritant. Common signs seen with ingestion include mild vomiting and nausea.
d) Birth Control Pills: Each packet of oral contraceptives contains 21 tablets of estrogen and/or progesterone and possibly 7 placebo pills. Estrogen could cause bone marrow suppression at levels greater than 1 mg/kg. Some oral contraceptives also contain iron. Decontamination is not necessary unless the level of estrogen is greater than 1mg/kg or the level of iron is greater than 20mg/kg.
e) Liquid Potpourri: Liquid potpourri may contain essential oils and cationic detergents; because product labels may not list ingredients, it is wise to assume that a given liquid potpourri contains both ingredients. Essential oils can cause mucous membrane and gastrointestinal irritation, central nervous system depression, and dermal hypersensitivity and irritation. Severe clinical signs can be seen with potpourri products that contain cationic detergents. Dermal exposure to cationic detergents can result in redness, intense pain, and ulceration. Ingestion of cationic detergents may lead to tissue necrosis and inflammation of the mouth, esophagus, and stomach. Treatment is symptomatic and supportive.
Blog Information Sources:
Veterinary Information Network www.vin.com
Poison Control Center http://www.apcc.aspca.org/
Marvistavet: www.marvistavet.com
Veterinary partner: www.veterinarypartner.com
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