March is Pet Poison Prevention Awareness Month! A good start to poison prevention is knowing what toxins you have in your home. Some toxins may be obvious to you, and some might not. After attending a business conference earlier this week, it was clear that the toxicities veterinarians see depend widely on the regions they practice and the demographics they serve. I’ll start with the most common toxicities I see in pets, and then maybe discuss some stories of other practitioners in other areas of the country. Most common dog toxicity: Rodenticide This is by far the most common toxicity I see in dogs. Rodenticides (rat or mouse poison) are anticoagulants, meaning they cause internal bleeding. Most of them do so by blocking the synthesis of vitamin K, which is an essential component to blood clotting. There are lots of different types of rat poisons, including warfarin, hydroxycoumadin, brodifacoam, bromadiolone, diphacinone, diphenadione, pindone, and chlorohacinone. Anticoagulants like warfarin and hydroxycoumadin take multiple feedings and kill rodents over several days. The other ingredients listed can be 50 to 100 times more deadly as they’re designed to kill in one feeding. If a dog ingests mouse or rat poison without the owner noticing, it usually takes several days to show symptoms. Symptoms include weakness, pale mucous membranes (from blood loss), nose bleeds, blood in vomit, blood in stool or bleeding from rectum, hemorrhages or hematomas on skin, and coughing/difficulty breathing from blood in lungs. Oftentimes once these symptoms are noticed, patients have to be hospitalized, given blood transfusions and started on vitamin K supplementation. Depending on how advanced or anemic they are at diagnosis, they don’t always make it. If you notice your dog eating rat poison or suspect they have, take them to the veterinarian right away so vomiting can be induced. After vomiting is induced, your animal can be placed on a vitamin K supplement that they take for three weeks. When this immediate treatment is done, you can prevent the illness and the problems listed in the paragraph above. If you have pets in your home or around your home, I advise against using rat or mouse poison. I see cases of toxicity even when owners feel like the poisons are well hidden. I recommend the snap mouse traps or sticky traps. Oftentimes, a cat that is a good mouser (or a few cats depending on your mouse population) works better than anything else. Bear in mind that female cats are generally better mousers than males. Most common cat toxicity: Spot-on flea/tick medication for dogs The most common toxicity I see in cats is from flea/tick medication meant for dogs when owners have accidentally applied it to their cats, or owners that have applied such medication on purpose not realizing that it is toxic to cats. Generally, this is from a pyretherin or pyrethroid toxicity, an ingredient used in many over-the-counter spot-on flea/tick products for dogs. There’s a reason why cats are more sensitive to these products. One of them is their high surface area to weight ratio. Because cats are smaller, they receive a much higher dose of the active ingredient. In addition, cats do not excrete or metabolize pyrethrins or pyrethroids as efficiently. These products usually affect the central and peripheral nervous system, acting at the sodium channels which causes continuous firing of the nerve fibers. Symptoms are often immediate after application, but can take up to 72 hours to appear. Symptoms are usually tremors/muscle fasciculations, twitches, seizures, stumbling, and drooling. If you notice this, immediately give your cat a bath in warm water and dish soap, wrap them in a towel, and then take them to your veterinarian or closest emergency center. Once the product is bathed off, medications often have to be given to control the twitching. The best way to prevent this from happening is to clearly separate flea/tick products from your dogs versus your cats. Make sure you look at the boxes carefully before application so you are aware what products you are applying to whom. In one of my patients with this toxicity, the client had removed the tubes from all of the flea/tick products for their cats and dogs from the boxes and put them all in the same drawer. I do not recommend doing that as it is even easier to mix products up. Even more troubling is a couple of cases I have had in application of a product that is actually labeled for cats. The product in question is Sargeant’s Silver for cats. Sadly, you can still buy it on the Internet: http://www.ebay.com/itm/like/401431460398 If you look closely at the box, it gives the main ingredient, and then lists “OTHER INGREDIENTS: 45%.” This is a huge red flag. In this case, that other ingredient is a pyrethrin or pyrethroid, which is toxic to cats. In both cases of toxicity, I contacted the EPA (who regulates that product). Clearly, it did not do any good as it is still available online. It is troubling that products online or on store shelves are dangerous for pets, even if used by label directions. Even if you do not buy your flea and tick products for your pets from your veterinarian (and I highly recommend doing so), I highly recommend contacting your veterinarian or discussing what products they recommend during your pet’s appointment. Sure, certain over-the-counter products can be enticing because they are cheap. But often, they are ineffective. And even worse, they can be dangerous. I understand the draw of buying online more than anyone. I try my best to buy a lot of products locally, sometimes I simply don’t have time, or certain items like diapers and wipes can be bought so much cheaper from big box stores or Amazon Prime. Since those big box stores are a bit of a drive for me in a rural area, I often opt for Amazon Prime for a lot of purchases. If you’re going to purchase products online, I am going to put in a brief plug for my clinic’s online store. All products are shipped from a reputable veterinary distributor, and there is no risk of counterfeit products. Many people purchase flea and tick products or other pet medication from websites and it looks very similar to the real thing...but it’s not. Buying online, if you are not familiar with the source, can be dangerous for that reason. If you buy from your veterinarian’s online pharmacy, you know that the source of these products is safe, and the products are stored correctly. Oftentimes, products from your veterinarian’s pharmacy may be cheaper than in the clinic as the veterinarian doesn’t have the added expense of stocking that medication. In addition, you’re keeping your business local, which is always a plus. Okay, that concludes my soap box discussion of purchasing pet products online or from big box stores. “Other” Toxicities: Recreational or Non-recreational drugs While attending a business workshop earlier this week, there was a discussion of certain toxicities that are increasing in certain areas of the country. Some of my colleagues in Colorado and California are seeing an increased incidence of marijuana toxicity (or cannabis sativa). Dogs are most often affected by this (96% of cases), but it can be seen in cats. As you know, many states are passing laws allowing the medical or recreational use of these drugs. There are many forms, whether the plant form or various edibles. In many cases, owners are carelessly leaving these products in places that are accessible to their curious pets. I spoke to one colleague in California that sees at least one case per week. A few veterinarians described quite entertaining scenarios of a veterinarian in an exam room with a patient with obvious signs of such toxicity, and usually the mother and a teenage son. In one case, the mother and the son had a 20-minute conversation over where their stashes were hid, and how they didn’t have any left in those various spots (the possibility that there was none left because the dog ate it must have been lost on them). In other cases, it likely results in the teenage son being grounded. One veterinarian even said, “It appears like your dog is acting like some of my buddies in college. Is it possible he could have ingested some marijuana?” Symptoms can vary based on the amount consumed. In mild cases, you usually notice lethargy, altered response to visual and verbal stimuli, and other behavior changes. More severe cases can result in stumbling, low body temperature, low heart rate, low blood pressure, engorged or red tissue around the eyes, lack of appetite, diarrhea, or dysphoria (vocalization). Coma and death can result in very severe cases. Treatment is usually successful and usually involves supportive care and treatment of various symptoms. I personally have never seen a marijuana toxicity case (that I know of). I have, however, seen an amphetamine toxicity (probably more Missouri’s style). However, regardless on your thoughts of the legalization of such products, it’s important for owners and veterinarians to be aware and keep these drugs out of reach of animals. While there has been an increase in marijuana toxicities due to changes in laws, toxicities of other prescription drugs are far more common. Anti-inflammatory medications, antidepressants, and stimulant medications like ADHD medications are most common. Nicotine and amphetamine toxicities can often be seen. The hardest part of diagnosing a drug toxicity for a veterinarian is often getting the client to be honest with them. Most of us try to ask questions from a place of caring for the pet and wanting to treat them. While prevention and keeping drugs out of accessible locations is the best prevention, if an ingestion does happen, please be honest with your veterinarian. If your pet has ingested a recreational or illegal drug, remember that as veterinarians, we are not the DEA. We just need to know what your pet ate so we can target our treatment toward whatever drug was ingested. When it comes to toxicities, prevention is key. So as a pet owner, educate yourself on products that are toxic to pets and keep them out of their reach. If you think your pet has ingested a poison, please contact your veterinarian immediately. The Pet Poison Helpline can also be extremely helpful. Follow the link below for their phone number, information, and the top 10 most common toxicities for dogs and cats: http://www.petpoisonhelpline.com/pet-owners/basics/top-10-pet-poisons/
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Jessica Stroupe, DVM
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August 2017
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