By Dr. I. Elizabeth Borgmann. Let’s face it. None of us who own dogs will escape the inevitable ingestion of some undesirable item by our dogs at some point in time. Regardless of how careful we are, they will find something, somewhere. In the garage. In the garden. In the park. Behind a closed door that wasn’t perfectly latched. In the animal proof garbage can that wasn’t.
What are commonly ingested items that we see in dogs? Where to start? The list is huge!
• The bathroom – razor blades, dropped medications, tissues, tampons, disposable diapers.
• The bedroom – creams on dressers, underwear (thongs are a favourite), socks, the underside of the mattress
• The living room – scented candles, decorative rocks, ornamental plants, the couch, children’s toys, the cat’s toy.
• The kitchen – garbage, kitchen knives, kitchen cleaning cloths, corn cobs, skewers, chocolate, yeast dough, grapes, raisins, onions, garlic, avocado.
• The garage and garden shed – insecticides, herbicides, antifreeze, fertilizer, slug bait.
• The garden – rhododendrons, lilies, onion and garlic bulbs, and about 400 other possible plants, rocks, bark mulch.
• The park – various drugs and their paraphernalia, other dog’s poop, stale tossed food, rocks, mulch.
Ok – I think you get the idea. It could be anything! No location is safe! In this article we will be focussing on the ingestion of chemicals and toxins rather than solid foreign objects.
Your investigative and observation skills will be key to saving your dog. Try to find out as quickly as possible what your pet ingested and how much. It will help determine the best and safest course of action.
As soon as you know your pet ingested something, call your veterinarian. If they are closed, call the emergency clinic. Still stuck? Call Poison Control. Keep these numbers on your fridge or programmed into your phone. Let them know what they ate, how much and what your pet weighs. If you are going into your vet’s office, bring the packaging.
Why call before starting to initiate first aid treatment? Because not everything can be treated the same way and not everything needs to be treated with equal aggressiveness. You need some guidance.
The basic concepts of toxicity treatment are:
1) removal of the offending agent from the stomach
2) preventing absorption of the remaining compounds
3) speeding the passage of binding agents through the intestinal tract
4) flushing out and supporting the body systems with IV fluids
5) treating symptomatically any symptoms that occur (such as seizures)
6) treating with an antidote if one is known.
Let’s start by discussing removal of the offending agent from the stomach. In some cases you want your pet to vomit. You want to bring up that horrible stuff they swallowed. In other cases this would be too dangerous. Depending on the item, your vet may recommend inducing vomiting, giving a thick creamy agent like yogurt, or going to the emergency clinic to have the stomach pumped or endoscopy to remove a foreign object.
If your dog ate a toxic plant, chemical or drug that is safe to regurgitate, they can be given hydrogen peroxide 3%, concentrated salt water, syrup of ipecac or apomorphine to induce vomiting. If they vomit up the stomach contents within 20 minutes your treatment success rate will be excellent most of the time. You should have either hydrogen peroxide or syrup of ipecac in your first aid kit. Your vet may want you to induce vomiting before heading to the hospital depending on what he ingested and how much he ingested.
Hydrogen peroxide is dosed at 5-15 mls per 10 lbs of body weight, preferably on a stomach with food in it. It can be erosive. Using salt is of questionable effectiveness and should only be used as a last resort. It works 25% of the time and there is a risk of salt toxicity – but if you have nothing else and you are hours away from a vet hospital, you could give it a try. The dose of Syrup of Ipecac is 1-2 mls/kg (0.5-1 ml per lb) to a maximum of 15 mls.
Because of possible complications, it is best to have vomiting induced at a veterinary hospital, assuming you are reasonably close to one.
Do not try to induce vomiting in a cat. It won’t work. Your vet will use injectable medications to achieve this. And cats have more side effects from things such as hydrogen peroxide.
If it is a substance or object that will create damage or risk getting caught on the way up, you do not want to induce vomiting. Caustic chemicals should not be vomited up. In this case you may be asked to give a creamy or chaulky item to your pet to eat to neutralize the acidity or alkalinity while you head to the hospital. Yogurt, ice cream, milk, and other such items can be found in most fridges!
If the stomach cannot be emptied through vomiting because the item is caustic, your pet is resistant to vomiting or because they are unconscious, they may need a stomach tube and lavage, or rinsing of the stomach. If they are conscious, they may need sedation or anesthesia to accomplish this.
Once the agents are out of the stomach, the next step is to bind any further chemicals. This is accomplished with activated charcoal. This might be presented to your pet in food (labs will eat anything), given by syringe, or given via stomach tube. Some health food stores carry capsules of concentrated activated charcoal and this is a good thing to keep in your first aid kit in case you are a significant distance from a veterinarian’s office. The capsules are easier to administer than the liquid.
Here is where some debate is occurring. Some vets advise giving activated charcoal before inducing vomiting to bind what is in the stomach until you can get the substance out. This concept certainly has some merit. As well, if you are uncomfortable inducing vomiting, you can administer the activated charcoal so there is some binding until you can get to a hospital. Other vets warn of the risk of electrolyte abnormalities with activated charcoal. Again, this is why you want to talk to your vet about what your dog ate and how much. Regardless, always carry activated charcoal in your first aid kit. The dose is 1-3 g/kg. As already mentioned above, there is a risk of electrolyte disturbances with the use of activated charcoal. They need access to water or to be on IV fluids (ideally).
Once the activated charcoal is administered, it is time to move the activated charcoal and whatever it binds out of the intestinal tract as quickly as possible. A laxative is often given to speed things along. Your vet is most likely to use Sorbitol administerd at 1-2 ml/kg. Lactulose and PEG laxatives are an alternative that can be used as well.
Activated charcoal isn’t pretty going in, and it’s not pretty coming out. It stains and is hard to clean up. If your pet has been sent home, then make sure you keep them in a part of the house that is easy to clean up. Avoid carpets. If you are a significant distance from a vet’s office, this is something that should be in your kit as well. To give a laxative, a pet should be well hydrated. Do not give a laxative if your pet is dehydrated.
Once the decontamination is completed your pet may need to be hospitalized for IV fluid therapy and observation. Some toxins will produce seizures. Some cause kidney failure or liver damage. Flushing out the system can help minimize the damage. Additionally, IV fluids help reduce the risks associated with the administration of emetics , activated charcoal and laxatives.
If problems arise from the toxin ingested, these need to be treated along the way. The most common problem is seizures and tremors. Some toxins cause anxiety and hallucinations and these signs need to be managed as well.
Somewhere along the way, if an antidote is known, your pet will receive this. For example, antifreeze poisoning is treated with 100% alcohol given IV (or if that is not available, then IV vodka). The danger of antifreeze is not the compound itself, but rather the metabolite. By giving IV alcohol the ADH enzyme that metabolizes the antifreeze is occupied, allowing the antifreeze to be excreted unchanged. Regrettably, though some toxins have antidotes, most do not
Though prevention is always best, it is good to be prepared to deal with toxicities. My own lab has pushed open the door to my daughter’s room to devour her dark chocolate Christmas gifts. Luckily, she knew what to do. She gave me a call and then took our dog out to the deck to induce vomiting. She did leave the seven large piles of chocolate vomit for me to clean up. (It was winter, so they had frozen nicely and the clean up was easy.)
In summary, your first aid kit should contain the numbers for your vet, the local emergency clinic and Poison Control; hydrogen peroxide, or syrup of ipecac; activated charcoal capsules, bottles or tubes; and a laxative. Call your vet before you administer these. And remember, it is always safer to treat toxicities in a veterinary hospital rather than at home or at the cottage.
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Dr. Borgmann lives in Chilliwack and has been practicing in the Fraser Valley for over 13 years and can be reached at the Whatcom Road Veterinary Clinic