Eyes Instead of Ears: Eye Injuries Following Ocular Exposure to Otic Medications.

To determine the epidemiology of ocular exposures and toxicoses in dogs and cats from otic products, 79 dog and cat cases with an ocular exposure to a topical otic medication were retrieved from the American Society for the Prevention of Cruelty to Animals Animal Poison Control Center database. Prescription products were involved in 75/79 (95%) of cases, and over-the-counter products in 4 (5%). Clinical signs included conjunctivitis, blepharospasm, epiphora, ocular discharge, and corneal ulceration. Medication error, specifically involving mistaken identification (i.e., an otic product confused with an ophthalmic product), occurred in 68/79 (86%) of cases. In 4 of these 68 cases, an otic instead of an ophthalmic medication was mistakenly dispensed to the pet owner. Unintentional delivery (i.e., accidental ocular exposure in the course of an otic application) occurred in 9/79 (11%) of cases, and 2 (3%) cases involved intentional delivery of otic products to the eyes. Because mistaken identification was the most common cause of ocular toxicoses from otic products, separate storage and/or distinctive packaging for ophthalmic versus otic products could reduce medication errors. Animal poison control center epidemiological data can be used as a source of information regarding veterinary medication errors.

Topical Minoxidil Exposures and Toxicoses in Dogs and Cats: 211 Cases (2001-2019).

Topical minoxidil is a medication for hair loss, initially available in the United States by prescription only and available since 1996 as an over-the-counter product. To determine the epidemiology of minoxidil exposures and toxicoses in dogs and cats, 211 dog and cat cases with topical minoxidil exposure were identified from the American Society for the Prevention of Cruelty to Animals Animal Poison Control Center database. In 87 cases with clinical signs of toxicosis (62 cats, 25 dogs), case narratives were reviewed and coded for exposure-related circumstances. Unintentional delivery, especially while pet owners applied minoxidil for his/her own hair loss (e.g., pet licked owner's skin or pillowcase, pet was splashed during a medication spill), was the most common cat exposure circumstance. Exploratory behavior (e.g., searching through trash) was the most common dog exposure circumstance. Clinical signs occurred in dogs and cats even with low exposure amounts, such as drops or licks. In patients that developed clinical signs, most developed moderate or major illness (56.0% dogs, 59.7% cats). Death occurred in 8/62 (12.9%) cats that developed clinical signs after the pet owner's minoxidil use. Pet owners should be educated on the risk of dog and cat toxicosis from accidental minoxidil exposure.

Dermatological topical products used in the US population and their toxicity to dogs and cats.

BACKGROUND: Many dermatological topicals are available for human use and may be toxic to dogs and cats. No epidemiological studies have been performed in the US population on the use of dermatological topical prescription drugs, and their toxicosis to dogs and cats. OBJECTIVES: Summarize the variety of dermatological topical prescriptions potentially used by pet owners in the United States (US), and describe the epidemiology of dog and cat exposures and toxicities. ANIMALS/SUBJECTS: A dataset of 10,170 individuals from the National Health and Nutrition Examination Survey (NHANES) representative of 311,065,381 US residents. There were 61,169 dog and cat cases with exposure to dermatological topicals from the American Society for the Prevention of Cruelty to Animals (ASPCA) Animal Poison Control Center (APCC) database. METHODS AND MATERIALS: Prescription medication data were analyzed from NHANES 2011-2014 survey respondents. The APCC database was searched for records of dermatological topical drug cases between January 2001 and January 2018. RESULTS: Prescription dermatological topical medications were used by 1.33 ± 0.21% of the US population. Dermatological topical products (177, veterinary and human) resulted in 61,169 exposure calls to the APCC. Clinical signs developed in 38% (22,910). A human-labelled product was involved in 15% (3,463) with 74% (2,545) involving a prescription product. CONCLUSIONS AND CLINICAL SIGNIFICANCE: Pets in households with humans receiving dermatological prescription topicals may be at risk for toxicosis. Multiple human-labelled dermatological topicals can cause death or major illness to dogs and cats at low dosages. Increased public awareness, especially attention to home storage practices for human-labelled dermatological topicals, may reduce the risk of exposure and toxicosis to dogs and cats.

Intravenous Lipid Emulsions in Veterinary Clinical Toxicology.

Use of intravenous lipid emulsion (ILE) as an antidote for severe cardiotoxicity and neurotoxicity has expanded in the veterinary world in the past decade. Despite advances in understanding of potential mechanisms of action of antidotal ILE, knowledge gaps remain in efficacy, appropriate dosing rates for various toxicants, and potential adverse reactions. Use of ILE in management of toxicoses of veterinary patients should be considered investigational, and should not be first-line treatment of most toxicoses, especially where established treatment protocols have good likelihood of positive outcomes. Use of ILE in veterinary toxicology cases requires judicious assessment of individual cases and proper informed consent of clients.

Use of intravenous lipid emulsions for treating certain poisoning cases in small animals.

Intravenous lipid emulsion (ILE) infusions have become an emerging treatment modality in managing intoxications of veterinary patients. The advantages of ILE include an apparent wide margin of safety, relatively low cost, long shelf-life, and ease of administration. Based on limited case and anecdotal reports, ILEs have shown promise in the management of toxicoses from a variety of lipophilic agents, including drugs and pesticides. More studies are needed to determine optimum dosing regimens and identify potential adverse effects from the antidotal use of ILE in veterinary medicine.

Exposure circumstances and outcomes of 48 households with 57 cats exposed to toxic lily species.

Ingestion of Lilium or Hemerocallis spp. by cats can result in renal failure. The objectives of this study were to determine the foreknowledge of lily toxicity of owners of cats that were exposed to lilies and to obtain historical, clinical and outcome information on the exposures. A survey was done of cat owners reporting indoor exposures to lilies to the Animal Poison Control Center (APCC) during April 2009. Forty eight individuals, (57 cats) were included. Sixty nine percent of cat owners said they could recognize a lily and 27% knew that lilies were toxic prior to their cats' exposures. Most lilies were obtained from grocery or other stores, and were purchased by the owners or as gifts to the cat owners. Owners who were unaware of lily toxicity frequently left the flowers where the cats had access to them, whereas in households where the toxicity was known the cats actively sought out the flowers. Of the cats in this study 93% received prompt veterinary care, and 87% either developed no signs or had brief signs that resolved. Five percent had evidence of renal insufficiency at final follow-up and another 5 percent of cats were euthanized due to renal failure.

Methylphenidate toxicosis in dogs: 128 cases (2001-2008).

OBJECTIVE: To determine clinical signs and outcomes of methylphenidate hydrochloride (MPH) toxicosis in dogs; to assess effects of amount (ie, dose) and formulation (immediate or extended release) of ingested MPH on onset, duration, and severity of clinical signs; and to describe management of MPH intoxication. DESIGN: Retrospective case series. ANIMALS: 128 dogs with MPH toxicosis or exposure. PROCEDURES: Data from an Animal Poison Control Center (APCC) database from November 1, 2001, to November 30, 2008, were reviewed. Records of dogs were searched for APCC classifications of confirmed (n = 71) or suspected (39) MPH toxicosis; dogs (18) that ingested MPH but did not develop clinical signs of toxicosis were also included. Signalment, dose, clinical signs, treatment, and outcome were evaluated. RESULTS: Clinical signs of toxicosis were reported in 107 of 128 (84%) dogs that ingested MPH; these included hyperactivity in 42 (33%), tachycardia in 27 (21%), vomiting in 19 (15%), agitation in 16 (13%), and hyperthermia in 13 (10%). Doses ranged from 0.36 mg/kg (0.164 mg/lb) to 117.0 mg/kg (53.18 mg/lb). Severity of clinical signs was not strongly associated with dose. More severe and prolonged clinical signs were associated with ingestion of extended-release formulations of MPH; 3 dogs that consumed these formulations (doses, 10.2 mg/kg [4.64 mg/lb], 15.4 mg/kg [700 mg/lb], and 31.1 mg/kg [14.14 mg/lb]) died. Favorable outcomes were reported for most (31/34 [91%]) dogs. CONCLUSIONS AND CLINICAL RELEVANCE: Ingestion of even small amounts of MPH can cause severe clinical signs in dogs. Monitoring and supportive care are recommended regardless of dose.

Ivermectin toxicosis in dogs: a retrospective study.

Ivermectin is a commonly used veterinary drug that may cause serious problems in overdose situations. A retrospective study was completed, which evaluated canine exposures to ivermectin from 1998 to 2005. The cases were evaluated based on ivermectin dosage, clinical signs seen, signalment of the animal involved, and the potential that the animal could have a p-glycoprotein defect. Results showed that clinical signs may be seen in some animals at doses lower than previously reported. Some dogs may have p-glycoprotein defects or other reasons for increased susceptibility to ivermectin toxicosis. The clinician should be aware that clinical signs may develop even at dosages previously thought to be of little risk (e.g., 0.2 to 2.5 mg/kg in breeds historically considered to have normal p-glycoprotein function).

Acute hepatic failure and coagulopathy associated with xylitol ingestion in eight dogs.

CASE DESCRIPTION: 8 adult dogs were evaluated for treatment of lethargy and vomiting after ingestion of xylitol, a sugar alcohol used as a sweetener in various products. CLINICAL FINDINGS: In addition to vomiting and lethargy, 5 of the dogs had widespread petechial, ecchymotic, or gastrointestinal tract hemorrhages. Common clinicopathologic findings included moderately to severely high serum activities of liver enzymes, hyperbilirubinemia, hypoglycemia, hyperphosphatemia, prolonged clotting times, and thrombocytopenia. Necropsies were performed on 3 dogs and severe hepatic necrosis was found in 2. In the third dog, histologic examination revealed severe hepatocyte loss or atrophy with lobular collapse. TREATMENT AND OUTCOME: Treatments varied among dogs and included IV administration of fluids; plasma transfusions; and, if indicated, administration of dextrose. Three dogs were euthanatized, 2 dogs died, 2 dogs made a complete recovery, and 1 dog was recovering but was lost to follow-up. CLINICAL RELEVANCE: Although xylitol causes hypoglycemia in dogs, hepatic failure after ingestion has not previously been reported. Because an increasing number of consumer products contain xylitol, clinicians should be aware that ingestion of xylitol can have serious, life-threatening effects.

Acute renal failure in dogs after the ingestion of grapes or raisins: a retrospective evaluation of 43 dogs (1992-2002).

A review of records from the AnTox database of the American Society for the Prevention of Cruelty to Animals Animal Poison Control Center identified 43 dogs that developed increased blood urea nitrogen concentration, serum creatinine concentration, or both as well as clinical signs after ingesting grapes, raisins, or both. Clinical findings, laboratory findings, histopathological findings, treatments performed, and outcome were evaluated. All dogs vomited, and lethargy, anorexia, and diarrhea were other common clinical signs. Decreased urine output, ataxia, or weakness were associated with a negative outcome. High calcium x phosphorus product (Ca x P), hyperphosphatemia, and hypercalcemia were present in 95%, 90%, and 62% of the dogs in which these variables were evaluated. Extremely high initial total calcium concentration, peak total calcium concentration, initial Ca x P, and peak Ca x P were negative prognostic indicators. Proximal renal tubular necrosis was the most consistent finding in dogs for which histopathology was evaluated. Fifty-three percent of the 43 dogs survived, with 15 of these 23 having a complete resolution of clinical signs and azotemia. Although the mechanism of renal injury from grapes and raisins remains unclear, the findings of this study contribute to an understanding of the clinical course of acute renal failure that can occur after ingestion of grapes or raisins in dogs.

General toxicologic hazards and risks for search-and-rescue dogs responding to urban disasters.

In large-scale disasters, it is not always possible to identify every potential toxic agent to which SAR dogs may be exposed. However, an understanding of the basic means by which dogs may be exposed to toxic agents can aid veterinarians in determining basic risks for particular SAR sites and allow veterinarians to institute general preventive measures (eg, frequent eye washes) to minimize exposure. Discussions with public health and other authorities on-site may aid in identifying site-specific risks for SAR dogs. Finally, ensuring that SAR dog handlers are aware of basic risks, precautions, and decontamination measures is essential, as handlers are the first line of defense in preventing illness or injury to SAR dogs as they work a disaster area.

Newer antidotal therapies.

Although the availability of an antidote for a toxic agent does not take away the primary responsibility of the clinician to manage the patient's clinical signs, the use of antidotes in appropriate situations can result in a more rapid recovery with potentially fewer long-term complications. Recent advances in pharmacology and molecular biology have resulted in the development of new and safer antidotal therapies for the management of toxicosis. The progress in immunotoxicotherapy over the last two decades continues and may ultimately lead to an era when the clinical toxicologist has a vast array of antibody fragments available for use with specific toxic agents. Development of specific pharmacologic antagonists for other agents should also enable the clinician to more reliably manage toxicoses. In spite of all these potential advances, the management of most toxicoses still relies on the application of sound veterinary medical principles.

Clinical syndrome associated with zolpidem ingestion in dogs: 33 cases (January 1998-July 2000).

Zolpidem is a nonbenzodiazepine hypnotic of the imidazopyridine class that is used to treat insomnia in humans. Zolpidem binds selectively to the benzodiazepine omega-1 receptor and increases the frequency of chloride channel opening, which results in inhibition of neuronal excitation. A retrospective study was conducted of zolpidem ingestion in dogs that were reported to the ASPCA Animal Poison Control Center (APCC) between January 1998 and July 2000. Data analysis included amount ingested, clinical effects, and time of onset of signs. Thirty-three reports of zolpidem ingestion in dogs (ranging in age from 5 months to 16 years) were evaluated. Approximate ingested dosages ranged from 0.24 to 21 mg/kg. Clinical signs reported included ataxia (18 dogs; 54.5%), hyperactivity (10 dogs; 30.3%), vomiting (7 dogs; 21.2%), and lethargy (5 dogs; 15.2%), as well as panting, disorientation, nonspecific behavior disorder, and hypersalivation (4 dogs each sign; 12.1%). Other signs reported include tachycardia, tremors, apprehension, vocalization, hypersalivation, weakness, and hyperesthesia. In 85% percent of reports, clinical signs developed within 1 hour and usually resolved within 12 hours. Although central nervous system (CNS) depression is reported as a primary effect of zolpidem in humans and would also be expected in dogs, information obtained from this study indicates that some dogs may exhibit a paradoxical excitation reaction. This effect appears to vary among individual dogs.