Successful treatment of ivermectin overdose in a bearded dragon (Pogona vitticeps) using gastric lavage and intravenous lipid emulsion.

OBJECTIVE: To describe the clinical signs and outcome following ivermectin overdose in a bearded dragon. This case also describes the novel use of intravenous lipid emulsion (ILE) as a rescue therapy in reptiles, as well as the use of aggressive gastrointestinal decontamination. CASE SUMMARY: A 4-year-old female intact bearded dragon (Pogona vitticeps) (0.6 kg) was admitted to the ICU at a specialty hospital following accidental overdose of 40 mg (66.7 mg/kg) of ivermectin enterally. The patient was physically inverted to allow passive reflux of the medication, then sedated for gastric lavage. A 20% ILE was administered intravenously due to the high risk for fatality. Additional treatments included 2 doses of activated charcoal, as well as SC fluids, enteral nutrition, and sucralfate. The patient was profoundly sedate until day 4 when mild improvements in mentation were noted. The patient started ambulating on its own on day 6 and was discharged from the hospital on day 13. The patient was alive 720 days postdischarge. NEW OR UNIQUE INFORMATION PROVIDED: This is the first case report describing the events following ivermectin overdose and the use of ILE therapy and activated charcoal in a bearded dragon. These therapies were tolerated with no adverse effects noted in this patient. This report provides evidence that complete recovery from ivermectin overdose is possible.

Clinical manifestations, laboratory findings, treatment and outcome of acute organophosphate or carbamate intoxication in 102 dogs: A retrospective study.

Organophosphates (OP) and carbamates are commonly used insecticides and important intoxication sources of humans and animals. Nevertheless, large scale studies of these intoxications in dogs are unavailable. The medical records of dogs presented to a veterinary hospital were reviewed retrospectively. The study included 102 dogs definitely diagnosed with acute OP or carbamate intoxication. The most common presenting clinical signs included muscle tremor, hypersalivation, miosis, weakness, vomiting and diarrhea. Hypersalivation, muscle tremor and tachypnea were significantly (P < 0.05) associated with survival to discharge; while weakness, mental dullness, anorexia, pale mucous membranes and paddling were significantly associated with death. Common laboratory abnormalities included decreased butyrylcholine esterase activity, acidemia, increased total plasma protein, leukocytosis, hypochloridemia, hyperbilirubinemia, increased creatinine and alanine transaminase (ALT), aspartate transaminase (AST) and creatine kinase activities, and prolonged activated partial thromboplastin time (aPTT). Compared to the survivors, the non-survivors showed significantly: higher frequencies of thrombocytopenia, hypocarbemia, prolonged prothrombin time (PT), hypernatremia, hyperkalemia, hypocholesterolemia, hypoproteinemia, hypertriglyceridemia, increased ALT activity and increased urea concentration; lower median concentrations of venous blood bicarbonate, serum chloride and total CO2; and higher medians of PT, serum total bilirubin and urea concentrations, and ALT and AST activities. Intoxicated dogs were commonly treated with diphenhydramine, atropine-sulfate, antibiotics, diazepam and pralidoxime, while some (19.2%) required general anesthesia and mechanical ventilation. The survival rate of dogs treated by gastric lavage was higher (P = 0.041) compared to that of the remaining dogs. Development of respiratory failure and mechanical ventilation requirement were significantly associated (P < 0.001) with death. The mortality rate was 17%.

Emergency management and treatment of the poisoned small animal patient.

This article reviews management of the acutely poisoned veterinary patient, including initial telephone triage, appropriate communication and history gathering from the pet owner, decontamination methods (including the use of appropriate emetic agents and dosing of activated charcoal), and general treatment of the poisoned patient. Symptomatic and supportive care of the poisoned patient includes the use of fluid therapy, gastrointestinal support (eg, antacids), central nervous system support (eg, muscle relaxants, anticonvulsants), sedatives/reversal agents (eg, phenothiazines, naloxone, flumazenil), hepatoprotectants, and miscellaneous antidotal therapy.

Nematodes collected by gastric lavage from live American alligators, Alligator mississippiensis, in Florida.

Stomach nematodes were collected from 151 live American alligators, Alligator mississippiensis, from 3 lakes (Apopka, Griffin, and Woodruff) in north-central Florida using a gastric lavage technique. Four species were identified: Dujardinascaris waltoni, Ortleppascaris antipini, Brevimulticaecum tenuicolle, and larvae of Contracaecum sp. Of these, D. waltoni was the most prevalent species in all 3 lakes and was more prevalent in Lake Apopka than in the other 2 lakes. This is the first record of Contracaecum larvae in the American alligator and the second record of O. antipini.

Five common toxins ingested by dogs and cats.

When a dog or cat ingests a common household toxin, rapid decontamination is critical. This article provides treatment recommendations for some of the most common toxicoses in dogs and cats, along with a summary table for quick reference.

The effect of topical treatment on esophageal pH during acid reflux in dogs.

OBJECTIVE: To determine the effect of suction, lavage and instillation of sodium bicarbonate solution on esophageal pH during acidic gastro-esophageal reflux (GER) in anesthetized dogs. STUDY DESIGN: Prospective, clinical trial. ANIMALS: Ten healthy dogs, 4.8 +/- 2.4 years old, and weighing 37.1 +/- 7.9 kg. METHODS: Dogs were admitted to the study if they were under general anesthesia and regurgitation occurred. A sensor-tipped catheter was used to measure esophageal pH. On study entry the esophagus was suctioned. After an interval of at least 5 minutes, if the esophageal pH was still less than 4 the esophagus was lavaged with tap water and again suctioned. In 6 dogs 20 mL of dilute bicarbonate solution was instilled into the esophageal lumen. RESULTS: Suctioning fluid from the esophagus did not change the pH significantly. Lavage with tap water caused the pH to increase above 4 in four dogs, with the average pH increasing from 1.2 +/- 0.5 to 3.5 +/- 4.9. In all dogs where dilute bicarbonate solution was instilled, esophageal pH increased to above 6 for up to 180 (mean +/- SD, 89 +/- 81) minutes. CONCLUSIONS AND CLINICAL RELEVANCE: Suctioning refluxate from the esophagus does not change the pH of the esophageal lumen. Instillation of a small volume of bicarbonate solution predictably increased the pH above 4 following an episode of acidic GER. Care must be taken that fluid is instilled into the lumen of the esophagus, and not into the trachea.

Clinical management of potential ibuprofen toxicosis in a South American red-footed tortoise (Geochelone carbonaria).

This article describes the clinical management of potential ibuprofen toxicosis in South American red-footed tortoise (Geochelone carbonaria). A 2.5-year-old, 0.78-kg Geochelone carbonaria tortoise was presented to the emergency clinic after ingesting solubilized ibuprofen (200 mg) in a gelatin capsule. Treatment on initial presentation consisted of esophagostomy tube placement for gastric lavage and activated charcoal administration, intravenous and intraosseous fluid therapy, and administration of gastrointestinal protectants (sucralfate and famotidine). The tortoise was discharged to the owners. Although follow-up diagnostic monitoring was minimal because of owner compliance, the patient was noted to be alive and in reasonable health 1 year after initial presentation. This is the first report on the management of potential nonsteroidal anti-inflammatory drug toxicosis in any chelonian species.

Mushroom toxicity in a horse with meningioangiomatosis.

We describe a fatal case of mushroom intoxication in an 18-y-o horse presumably due to Amanita verna. Horses are normally regarded as too fastidious to eat the ill-flavored toadstools. In this case, the horse had a rare benign brain tumor, meningioangiomatosis, which may have altered the horse's normal eating behavior resulting in consumption of the mushrooms.

Therapeutic efficacy of hyperimmune bovine colostrum treatment against clinical and subclinical Cryptosporidium serpentis infections in captive snakes.

Therapy based on the protective passive immunity of Hyperimmune Bovine Colostrum (HBC) (raised against Cryptosporidium parvum in dairy cows immunized during gestation) was tested for heterologous efficacy in subclinical and clinical infections of 12 captive snakes with C. serpentis. Six gastric HBC treatments of 1% snake weight at 1-week intervals each, have histologically cleared C. serpentis in three subclinically infected snakes, and regressed gastric histopathological changes in one of these snakes. In all snakes, each subsequent HBC treatment significantly decreased the number of oocysts recovered in gastric lavage eluants (P < 0.03). The treatments induced oocyst-negative gastric eluants and stools in all snakes, and improved clinical signs of infection. Clinically infected snakes displayed severe histopathological changes in the gastric region; however, the numbers of developmental stages of C. serpentis were moderate. Considering the severity of pathology, much lower than expected pathogen numbers were observed, and it is believed that clinically infected snakes did not have enough time to repair tissue damage that had occurred over the years of infection. As the HBC treatment was safe and highly efficacious, it is recommended to gastrically administer the HBC therapeutically to snakes that are clinically or subclinically infected with C. serpentis. Hyperimmune bovine colostrum can also be used in snake supportive therapy or prophylaxis.

Effect of drug formulation and feeding on the pharmacokinetics of orally administered quinidine in the horse.

Quinidine is the drug of choice for the treatment of cardiac arrhythmias in horses. The plasma concentrations vs. time profiles following oral administration of two formulations of quinidine sulphate, an oral solution and an oral suspension paste, were evaluated in nine horses. They received multiple administrations of the oral solution under fed and non-fed conditions and of the paste under non-fed conditions. A loading dose of 20 mg.kg-1 and a maintenance dose of 10 mg.kg-1 quinidine with dosing interval of 6 h were used. The relative bioavailability of the oral solution under fed conditions in comparison to the solution under non-fed conditions was 75.0 +/- 10.2% for the loading dose and 97.18 +/- 31.66% after the fourth dose. For the paste formulation the relative bioavailability values are not reported, as steady-state levels were not reached. There was a large variation in plasma quinidine levels when the paste formulation was administered. Feeding conditions had a significant influence on the Cmax values after administration of the loading dose. The Tmax values were not affected by food intake. It was concluded that an oral solution has to be preferred because of the variable drug bioavailability from the paste formulation and the poor acceptability of the paste by the horse.

Plasma disposition of amikacin and interactions with gastrointestinal microflora in Equidae following intravenous and oral administration.

Amikacin was detectable (> 0.02 micrograms/ml) in plasma for 12 h in horses and donkeys and for 8 h in ponies following intravenous (i.v.) administration at a dose rate of 6 mg/kg bodyweight. The elimination half-life (harmonic mean) of amikacin was 2.8, 1.6 and 1.9 h in horses, ponies and donkeys, respectively, and the mean body clearance was relatively slow (45.2, 82.4 and 58.0 ml/h.kg, respectively). A suitable dosage interval for the i.v. administration of amikacin sulphate to horses, ponies and donkeys, at a dose rate of 6 mg/kg, would be every 8 h in horses, and every 6 h in ponies and donkeys. Following i.v. administration there were no marked alterations in caecal liquor pH, the number of viable bacteria isolated, or the short chain fatty acid (SCFA) concentrations in caecal liquor and faeces. Amikacin was not detected (< 0.02 micrograms/ml) in plasma following administration by nasogastric tube to ponies with cannulated caecal fistulae; however, there were high concentrations of amikacin measured in caecal liquor (maximum 16.2-99.4 micrograms/ml). Despite the high drug concentrations in caecal liquor, there were only slight alterations in the number of viable bacteria isolated. However, there was a reduction in caecal liquor pH to < 6.6, but few changes in caecal liquor SCFA concentrations. Faecal SCFA concentrations, dry matter content and consistency did not alter markedly.

Use of a pilocarpine-based lavage procedure to study secretory immunoglobulin concentration in the alimentary tract of White Leghorn chickens.

A lavage procedure was used to study the kinetics of alimentary fluid IgA concentration in 15 specific-pathogen-free white leghorn chickens for 8 weeks post-hatch. Lavage solution was administered orally and collected from the distal alimentary tract following an intraperitoneal injection of pilocarpine. Concentrations of IgA, quantitated by enzyme-linked immunosorbent assay, were more than 0.04 mg/ml by 3 weeks and were negligible before this age. This level gradually increased over the next 5 weeks, peaking at nearly 0.4 mg/ml at 8 weeks of age. Alimentary lavage was easy to perform, required no necropsy or surgical manipulation, and facilitated repeated collection of alimentary fluid from live birds. Repeated lavage did not alter concentrations of IgA and IgG in alimentary fluid, and concentrations of IgA and IgG in alimentary fluid were stable during incubation at 37 C for 24-48 hr.

A device and technique for gastrointestinal lavage in the horse.

A device and technique for intra-operative gastro-intestinal lavage was developed to remove ingesta from the stomach, large intestine and caecum of horses. The Gastro-Intestinal Lavage System (GILS) is composed of a nozzle connected to both water under pressure and suction. Water jets across an intake portal in the nozzle, breaks up food and debris within the nozzle and is evacuated under negative pressure into the aspirating tube which is connected to a collection drum. The GILS nozzle was introduced at the pelvic flexure through a sterile enterotomy cuff and plastic sleeve. Water was first added through the GILS nozzle to mix intestinal ingesta to form a slurry and then the effluent was evacuated into the storage container by engaging the vacuum. Comparisons of this technique were made with the standard garden hose lavage technique. The GILS enables removal of 8.1 kg of large intestinal ingesta in less than 20 mins. Cleansing of the large bowel with the GILS was rapid, complete and a contamination free procedure which should prove applicable and beneficial for surgical treatment of small colonic, caecal, rectal and gastric impactions as well as sand colic and colonic torsions.