Wellness Wednesday – Worst of the Worst Toxins | All Four Paws Veterinary Relief - Veterinary Relief Services

This presentation is free and available for viewing on the Pet Poison Helpline’s website!

Cycad (Sago) Palms

Sago palms are gaining popularity as houseplants, so this is no longer just a regional issue!
Risk factors – dogs are more likely than cats to consume part of the plant, patients with underlying hepatic or CNS disease processes are more likely to have significant issues.
Clinical effects can start within 15 minutes to 3 days after ingestion. Symptoms start with GI signs, then evolve into CNS abnormalities. Liver enzymes will elevate within 48-72 hours.
Lab changes – Increase in ALP (AST, ALP), increase in bile acids, decrease in albumin, electrolyte abnormalities, increased PT & PTT, anemia, azotemia.
Treatments – Decontamination, IVF support (avoid LRS), anticonvulsants, antiemetics, GI protectants, hepatoprotection
It is recommended to treat all Sago Palm ingestion as life threatening, even if the patient is asymptomatic.

Ethylene Glycol (Anti-Freeze)

Risk factors – Dogs are more likely to ingest than cats, but livestock and small ruminants are also at risk. Cats require early intervention at less than 8 hours after ingestion.
Minimum lethal dose:

Dogs 4.2-6.6mL/kg
Cats 1.5mL/kg

Clinical effects – GI symptoms, CNS abnormalities, metabolic acidosis, acute renal failure within 12-24 hours for cats and 36-72 hours for dogs.
Treatment – Decontamination, IVF support, correct acid base imbalance, antidote (Fomepizole), monitoring blood chemistry, A/B status, and glucose.
It is recommended to start treatment as soon as possible.

5-Fluorouracil (5-FU)

Comes in a topical and parenteral forms. This is a human chemotherapy drug, and is ingested by house cats and dogs by licking the topical form off of their owner or chewing on the line during an infusion.
Doses of concern:

6.8mg/kg – minimum dose to clinical sings
10.3mg/kg – seizures, death possible
40mg/kg – lethal across the board if untreated.

Clinical effects occur within 30-60 minutes. They begin with GI upset and abdominal pain, and then can include tremors, seizures, lethargy, ataxia, non cardiogenic pulmonary edema, and can suppress bone marrow cells within 1-21 days.
There is no confirmatory test, it is typically diagnosed by witness exposure.
Treatment – aggressive IVF support, antiemetics, GI protection. Avoid valium for seizures – consider levetiracetam, propofol phenobarbital, in-house anesthesia. Oxygen support and antidote may be necessary.

Minoxidil (hair growth simulator and refractory hypertension treatment for humans)

DEADLY for cats. One drop can be life-threatening. Severe cardiotoxicity. Can cause pleural effusion and pulmonary edema. Prognosis is poor to grave without early intervention.
Clinical effects can appear within 45 minutes to a few hours. Can present as lethargy, dyspnea, cyanosis, hypothermia, hypotension, tachycardia.
If it is a topical exposure, wash the area and prevent grooming. If a tablet is ingested, induce vomiting within 45 minutes.
Treatments: Judicious use of fluids, possible vasopressors, oxygen, thoracocentesis, ventilation, sedation, appetite stimulant .
Dog’s clinical effects peak within 4-8 hours, present as lethargy, vomiting, bounding pulses, hypotension, and tachycardia. Treatment for dogs can include IVF, beta blockers, vasopressors, antiemetics.

Bufotoxicosis (Cane toad)

Geographically limited – in North America, it is prevalent in FL, TX, HI, CA, AZ, NM, S Texas
100mg is the lethal dose for a medium dog– a regular sized toad will have up to 590 mg of secretions!
There can be residual toxin in the water from soaking. This is dangerous for all outdoor animals!
Clinical effects – immediate: salivation, frothing. 15 minutes: respiratory distress, tachypnea. 20 minutes: Seizures, ataxia
Treatment: Immediate oral rinse at home, repeat at DVM. Lavage/endoscopy to remove ingesta from GI tract. Do not induce emesis. IVF support, antiemetic, antidote, atropine, lidocaine, beta blocker, anti convulsant, dexamethasone.

Written by: Morgan Guiffre

Wellness Wednesday – Worst of the Worst Toxins

This presentation is free and available for viewing on the Pet Poison Helpline’s website!

Cycad (Sago) Palms

Sago palms are gaining popularity as houseplants, so this is no longer just a regional issue!

Risk factors – dogs are more likely than cats to consume part of the plant, patients with underlying hepatic or CNS disease processes are more likely to have significant issues.

Clinical effects can start within 15 minutes to 3 days after ingestion. Symptoms start with GI signs, then evolve into CNS abnormalities. Liver enzymes will elevate within 48-72 hours.

Lab changes – Increase in ALP (AST, ALP), increase in bile acids, decrease in albumin, electrolyte abnormalities, increased PT & PTT, anemia, azotemia.

Treatments – Decontamination, IVF support (avoid LRS), anticonvulsants, antiemetics, GI protectants, hepatoprotection

It is recommended to treat all Sago Palm ingestion as life threatening, even if the patient is asymptomatic.

Ethylene Glycol (Anti-Freeze)

Risk factors – Dogs are more likely to ingest than cats, but livestock and small ruminants are also at risk. Cats require early intervention at less than 8 hours after ingestion.

Minimum lethal dose:

Dogs 4.2-6.6mL/kg

Cats 1.5mL/kg

Clinical effects – GI symptoms, CNS abnormalities, metabolic acidosis, acute renal failure within 12-24 hours for cats and 36-72 hours for dogs.

Treatment – Decontamination, IVF support, correct acid base imbalance, antidote (Fomepizole), monitoring blood chemistry, A/B status, and glucose.

It is recommended to start treatment as soon as possible.

5-Fluorouracil (5-FU)

Comes in a topical and parenteral forms. This is a human chemotherapy drug, and is ingested by house cats and dogs by licking the topical form off of their owner or chewing on the line during an infusion.

Doses of concern:

6.8mg/kg – minimum dose to clinical sings

10.3mg/kg – seizures, death possible

40mg/kg – lethal across the board if untreated.

Clinical effects occur within 30-60 minutes. They begin with GI upset and abdominal pain, and then can include tremors, seizures, lethargy, ataxia, non cardiogenic pulmonary edema, and can suppress bone marrow cells within 1-21 days.

There is no confirmatory test, it is typically diagnosed by witness exposure.

Treatment – aggressive IVF support, antiemetics, GI protection. Avoid valium for seizures – consider levetiracetam, propofol phenobarbital, in-house anesthesia. Oxygen support and antidote may be necessary.

DEADLY for cats. One drop can be life-threatening. Severe cardiotoxicity. Can cause pleural effusion and pulmonary edema. Prognosis is poor to grave without early intervention.

Clinical effects can appear within 45 minutes to a few hours. Can present as lethargy, dyspnea, cyanosis, hypothermia, hypotension, tachycardia.

If it is a topical exposure, wash the area and prevent grooming. If a tablet is ingested, induce vomiting within 45 minutes.

Treatments: Judicious use of fluids, possible vasopressors, oxygen, thoracocentesis, ventilation, sedation, appetite stimulant .

Dog’s clinical effects peak within 4-8 hours, present as lethargy, vomiting, bounding pulses, hypotension, and tachycardia. Treatment for dogs can include IVF, beta blockers, vasopressors, antiemetics.

Geographically limited – in North America, it is prevalent in FL, TX, HI, CA, AZ, NM, S Texas

100mg is the lethal dose for a medium dog– a regular sized toad will have up to 590 mg of secretions!

There can be residual toxin in the water from soaking. This is dangerous for all outdoor animals!

Clinical effects – immediate: salivation, frothing. 15 minutes: respiratory distress, tachypnea. 20 minutes: Seizures, ataxia

Treatment: Immediate oral rinse at home, repeat at DVM. Lavage/endoscopy to remove ingesta from GI tract. Do not induce emesis. IVF support, antiemetic, antidote, atropine, lidocaine, beta blocker, anti convulsant, dexamethasone.

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