Episode 11 - EXTRA Bonus Episode! Toxicology in Dogs and Cats

1.The GP hook

Chocolate gobblers, hot cross bun raiders, daffodil munchers, lily-sniffing cats and the compost-bin connoisseurs. This GP-speed article walks through stabilisation, when and how to decontaminate, and where intralipid and charcoal fit, then tackles the big seasonal toxins you’ll actually see.

Chocolate gobblers, hot‑cross‑bun raiders, daffodil chewers, lily‑sniffing cats and compost‑bin connoisseurs — toxicology cases turn up year‑round, and around Easter the calls spike. This GP‑speed guide pulls together the practical approach Charlotte and Brendan talk through on the pod: stabilise, get the history, decontaminate sensibly, and know where activated charcoal and IV lipid fit. Use poison‑info services for product‑specific advice and always check product datasheets and your clinic protocols before giving treatments.

2.First five minutes: stabilise and get the story straight

What to do straight away

Quick check

Tremor or seizure? If the patient tracks you, has a normal menace/PLR and is responsive, you’re more likely dealing with tremors than a generalised seizure.

Practice talking point

“This emetic/eye drop may make your pet sleepy. There’s a small aspiration risk, especially in short‑nosed breeds. We’ll watch them closely and balance safety and effectiveness.”

• ABCs first. If the patient is unstable, treat the emergency before chasing the toxin.
• Focused history is gold: medications in the house (including human meds), how meds are stored, other pets’ meds, plants (house and garden), access to compost/food waste, recent walks (public footpaths = possible cannabis), access to rodenticides/slug bait, and what’s already been vomited.
• Tremor vs seizure: tremoring patients are usually conscious and hyperaesthetic; seizures cause impaired awareness. Treat what you see while you work up the cause.
• Oxygen, IV access, tailored fluids if clinically required (treat shock/hypovolaemia rather than “flushing the kidneys”), analgesia as appropriate.
• Tremors: consider an antitremor agent such as methocarbamol (discussed in the pod as an effective option for tremorgenic toxins). Check current product advice and local protocols for route, dose and repeat intervals.
• Seizures: benzodiazepines are first‑line; escalate per your seizure protocols (phenobarbital, propofol CRI, etc.).
• Control severe nausea/vomiting (maropitant, metoclopramide, ondansetron) — note these are lipophilic and may interact with later lipid therapy.

3.Emesis decisions without regrets

Dogs

Cats

When NOT to induce emesis

• Apomorphine (various trade names) is commonly used to induce emesis in dogs. It causes sedation and there’s an aspiration risk in patients with impaired airway protection — warn owners.
• Important safety note from the pod: follow the manufacturer’s datasheet and your local protocols. The presenters discuss different practical approaches (some clinicians give a smaller initial dose and top up if needed), but the datasheet guidance varies and some manufacturers advise against ad‑hoc topping up. If you use a fractionated approach locally, document the plan and the owner discussion clearly.
• Ropinirole eye drops (licensed option) are an alternative — follow manufacturer guidance. They can be used in combination with apomorphine in urgent cases.
• Timing: consider toxin type and patient status rather than a fixed cut‑off. Raisins/grapes and some slow‑transit items may justify a longer window for emesis.
• Inducing emesis is harder and riskier. Alpha‑2 agonists (xylazine, medetomidine, dexmedetomidine) are commonly used as emetics in cats; onset, efficacy and sedation depth vary. Use doses from your clinic protocols, warn owners about sedation and monitor closely; reversal agents exist.
• “Carrier spinning” (agitating the cat to induce vomiting) is controversial and welfare‑compromising. The presenters accept it may be considered rarely when the risk of ongoing toxin exposure outweighs the welfare cost — document rationale and consider alternatives first.
• Caustics (acids/alkalis), foaming detergent/washing capsules, sharp objects, patients with impaired airway protection, actively seizuring or in respiratory compromise.

4.Decontaminate more than the stomach

• Mouth: flush visible residues (rodenticide paste in the mouth) while avoiding aspiration.
• Coat and paws: clip and wash cats exposed to lilies — be ruthless. Pollen on the coat is an ongoing exposure via grooming.
• Gastric lavage: consider under anaesthesia only for life‑threatening retained toxins or large concretions when emesis isn’t possible or safe. It’s technically challenging, aspiration risk remains and yields can be limited — weigh benefit vs risk.

5.Activated charcoal and IV lipid — pragmatic use

Activated charcoal

IV lipid emulsion (Intralipid)

Clinical pearl

If you give IV lipid expect it to bind some of your helpful lipophilic meds — reassess antiemetic and antiseizure plans after administration.

Monday‑morning move

• Useful for many oral toxins and for repeat dosing when enterohepatic recirculation is a concern. Check your local product info (Carbodote and similar manufacturers provide toxin‑by‑toxin guidance and posters). Not all toxins bind charcoal — check a toxin‑specific resource before routine use.
• Mechanism: acts as a “lipid sink” for lipophilic toxins and can be lifesaving in selected severe cases.
• It is not benign. Risks discussed on the pod include fat embolism, pancreatitis, effects on coagulation and interference with lab assays.
• Critically, IV lipid will also bind lipophilic drugs you’ve already given (emetics, antiemetics, sedatives, some anticonvulsants and propofol). Reassess antiemetic and antiseizure plans after administration.
• Practical regimen (as discussed): a bolus followed by a CRI is commonly used and clinicians monitor response quickly; Charlotte describes an initial bolus (e.g. over 5–15 minutes) and a CRI for 30–60 minutes, with the option to repeat if needed. Always use a recognised regimen from up‑to‑date references and your emergency protocol — and prefer a separate IV line where practical.
• Use lipid when benefits outweigh risks (severe lipophilic toxicosis) and be prepared to re‑dose or stop based on clinical response.
• Keep a toxin–charcoal quick‑reference poster in the treatment room so you can check “use/repeat/avoid” at 02:00.

6.The seasonal and common big hitters (practical snippets)

Chocolate (methylxanthines/theobromine)

Grapes, raisins, sultanas

Lilies (cats)

Daffodils

Marijuana/cannabinoids

Rodenticides (anticoagulants and others)

NSAID overdoses

Tremorgenic mycotoxins (compost‑bin special)

• GI signs first; higher exposures → hyperexcitability, tachyarrhythmias, tremors/seizures. Severity correlates with chocolate type, amount and patient size.
• Practical approach: induce emesis if safe, consider activated charcoal (repeat dosing for enterohepatic recycling), monitor ECG and supportive care. Encourage urination in hospitalised patients (methylxanthines can be reabsorbed). Use a reputable chocolate toxicity calculator to triage owner calls.
• Concern is acute kidney injury (dogs; rare in cats). Clinical deterioration can be delayed (24–72 hours).
• Practical stance: don’t reflexively put well, decontaminated dogs on high‑rate “flush” fluids — tailor fluid therapy to hydration/clinical status, get baseline renal bloods and repeat monitoring; discuss conservative options with owners when exposure is small and reliable.
• All parts — pollen included — are highly nephrotoxic to cats. Clip and wash pollen off the cat, induce emesis if safe, hospitalise for monitoring and IV fluids where indicated, and closely monitor renal indices and urine output.
• All parts are toxic (bulbs most so). Expect oral irritation and GI upset; manage with decontamination, consider single dose charcoal and supportive fluids for rehydration where needed.
• Classic: reduced mentation, ataxia, urinary incontinence; many remain cardiovascularly stable.
• Management: emesis if safe, charcoal, supportive fluids and observation. IV lipid is an option for selected severe cases. Mild cases can often be managed at home with good safety‑netting.
• Identify product if possible. For vitamin‑K antagonists: bleeding typically occurs days after ingestion. Decontaminate, check baseline coag tests and repeat monitoring; start vitamin K if coagulation times prolong or clinical bleeding occurs. Stabilise actively bleeding patients and consider plasma/transfusion support as indicated.
• Expect GI signs and risk of gastric ulceration; AKI risk with high exposures or secondary hypovolaemia.
• Manage with appropriate IV fluids (supportive), antiemetics, gastroprotectants and renal monitoring. Prognosis usually good unless severe azotaemia with oliguria/anuria develops.
• Sources: mouldy food/compost, mouldy bread/dairy, some mushrooms. Signs range from violent whole‑body tremors and hyperaesthesia to seizures and severe panting; aspiration risk is real.
• Management: low‑stimulus environment, antitremor therapy (methocarbamol), emesis if safe, consider charcoal and IV lipid in very sick cases, and treat seizures aggressively if they occur. Early decontamination and close monitoring are key.

7.When in doubt, phone a friend

Practice intake prompt for your PMS

• Use poison‑info services: Veterinary Poisons Information Service (VPIS) for vets and owner‑facing services (e.g. Animal Poison Line). These services give product‑specific advice, risk assessment and suggested monitoring/treatment — invaluable when the product is unknown.
• What, how much, when, any vomit (appearance), access to compost/rodenticide/plants/meds, other pets and their meds, recent walks.

8.Take‑home points

Final short take

Stick to first principles, decontaminate smartly, document owner conversations, and call poison‑info services when you need product‑specific advice. Most patients do well when we prioritise the right things at the right time.

• Stabilise first; treat the presentation in front of you while you gather the toxin story.
• Emesis can be useful beyond the immediate window for many ingestions — weigh risks; never induce for caustics, foaming detergents or sharps.
• Clip and wash lily‑exposed cats; pollen anywhere = ongoing exposure.
• Charcoal helps for many oral toxins and repeat dosing matters for enterohepatic recirculation — check toxin‑specific guidance.
• IV lipid emulsion can be transformative in selected severe lipophilic toxicoses but is not benign and will bind lipophilic meds too.
• Tailor fluids to the patient’s status; routine “high‑rate flushing” is not a universal solution.
• Use VPIS/poison‑info services when you need a second brain.