Macadamia Nuts are Toxic to Dogs

As a veterinarian, I caution people about giving human food to dogs. That’s because dogs and people metabolize food differently. Macadamia nuts, raisins, grapes and sugar-free gums are some of the human foods that are toxic dogs. Although the exact mechanism for the toxicity is not known, it is thought to be from a serotonin like compound that may come from the nut, processing the nut or a contaminate associated with the nut. More information on serotonin syndrome may be found by visiting Dr. Nelson’s prior post or clicking here. Clinical signs start with weakness of the rear legs, vomiting and lethargy. As the toxin builds, the dogs often experience muscle tremors and weakness. The hind leg weakness progresses until the dog cannot stand.

Like most toxicities, treatment focuses on removing the toxin and treating the symptoms. If the dog isn’t vomiting already, this is one of those toxins in which it is recommended to remove the nuts from the stomach. If too much time has passed since ingestion, then activated charcoal is given to absorb toxins from the gastrointestinal system. To avoid aspiration into the lungs, charcoal is only given to conscious animals that can swallow. Enemas may also be needed to evacuate the nuts. Symptomatic treatment is tailored to the individual patient but often includes intravenous fluids and cooling with tepid baths, fans and  ice packs wrapped in towels on abdomen, neck and paws.

Unlike other compounds, the toxic effects of macadamia nut poisoning are relatively short-lived. With prompt medical attention, most dogs will make a full recovery within two days.

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Source:

-Shell, Linda. ‘Macadamia Nut Toxicosis’ Associate Database, VIN, 01/02/2006.

 

Chocolate Toxicity In Pets

Chocolate is one of the most common toxicities I see, especially around Christmas and Valentine’s Day. Pets climb counters to get to candy dishes and desserts. They also rip open boxes of chocolates wrapped as gifts. One of my patients, a cocker spaniel, ate a 5 pound box of dark chocolate that was left under the tree.  They found him unconscious on his doggy bed.

Chocolate contains caffeine and theobromine which are toxic to animals.  This fact surprises a lot of people because humans are fairly resistant to this class of drugs. We can drink a lot of coffee and eat chocolate without too many problems. But dogs are much more sensitive to the effects of these chemicals. The half life of caffeine in dogs is 4.5 hours while the half life of theobromine is 17.5 hours!

The amount of these two chemicals varies with the type of chocolate. Milk chocolate contains the least amount of caffeine and theobromine while the bitter chocolate used in cooking contains the most. Dark chocolate falls in between. The general rule that I was taught in veterinary college is the more bitter the chocolate, the more of these chemicals and the greater the danger of poisoning.

Clinical signs of chocolate toxicity depend upon the amount of theobromine and caffeine ingested i.e., the type and amount of chocolate and the size of the pet. A golden retriever who steals a dark chocolate candy bar may show no signs of toxicity whereas a Chihuahua may develop seizures. In general, signs of mild toxicity include an increased heart rate and hyperactivity which many people wrongly attribute to the sugar high.  After the initial rush, some dogs will develop gastrointestinal signs including vomiting and diarrhea. Others drink and urinate excessively. Dogs who ingest large amounts of chocolate often seizure and may die.

Treatment of chocolate toxicity usually starts with ‘decontamination’ which means removing the toxin. If the dog is conscious, vomiting is induced to get rid of as much of it as possible. After the stomach is empty, the dog is given charcoal to absorb the remaining chocolate once they have stopped vomiting. The rest of therapy is tailored to the patient. Seizures are treated with anticonvulsant medications, life threatening ventricular tachycardia is slowed with heart drugs such as lidocaine or propranolol and stomach ulcers are given gastrointestinal protectants. The cocker spaniel mentioned above spent 3 days in the hospital on IV fluids and anticonvulsant therapy. For the first day, diarrhea poured out of his anus.  It looked and smelled like chocolate. He was one of the lucky ones. Unfortunately, he still liked chocolate. His family said he managed to grab a brownie about a week after his ordeal.

If your pet ingests chocolate, contact your veterinarian or the Pet Poison Helpline right away. Have the type of chocolate, quantity of chocolate and weight of the pet ready when you call. The number for Pet Poison Helpline is: 800.213.6680. More helpful information on poison of all kinds can be found at www.petpoisonhelpline.com.

Source:

-Shell, Linda. “Xanthine Toxicosis” VIN Associate, Lasted updated 1/17/2006.

 

 

This Is Why Your Dog Needs A Dental With Anesthesia

Dental disease is the most common problem I see in dogs and cats. During physical examination, I look for large accumulations of tartar, inflammation of the gums, masses, fractured teeth and other problems. Pictured below is the mouth of a dog before having a complete oral examination including dental X-rays and treatment.

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See the severe accumulation of tartar on the upper premolar and molar?  The tip of the large canine tooth as well as the back surface is worn creating a large defect in the enamel.  Now look on the inside of the teeth on the other side of the jaw. The premolars and molars located on the right side of the picture are stained and covered with tartar.

After dental X-rays were taken to look for problems below the gum line, the treatment could finally begin. The first step was to remove the large chunks of tartar or calculus from the surface of the teeth. (Calculus is pictured below.)

Tartar Snip

Then an ultrasonic scaler was used to remove smaller pieces of tarter. The tip must be kept moving at all times to prevent damage to the enamel surface of each tooth. After the crowns (exposed surface of each tooth) is cleaned, the area below the gums are scaled by hand to remove calculus and infection. In my opinion, if this step is not performed, the dental is worthless. The last step in the dental  is polishing all the surfaces and treating all problems that were found. This dog has periodontal pockets of infection that were cleaned, polished and packed with an antibiotic gel.

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In this ‘after’ picture, note the bleeding along the gum line of the premolar and molar. The tartar extended under the gums causing severe inflammation and infection. The damage gums bleeds after treatment but will heal if kept clean. If the area under the gums had not been cleaned, the infection would have spread up the root. The dog would have been in extreme pain until the tooth was removed. That is why I consider anesthesia-free dentals malpractice. Cleaning the crowns make the teeth look good but does nothing for the areas under the gums – the roots. Also, without anesthesia it is very difficult to clean the inside surfaces of the crowns and polish. I have seen an image of a cat who had their tongue almost ripped-off during an anesthesia-free dental. The damage was so severe that the cat couldn’t eat and was euthanized.

 

Firestarter Logs Are Dangerous For Pets

With the return of cold weather, stores are stocking firestarter logs again. Although this product is great for the fireplace, it can be dangerous for pets. Firestarter logs are not toxic per se, in that they do not directly poison an animal who ingests it. (Please note that logs that burn with special colors may contain heavy metals resulting in direct toxicity. Also, the fumes may be dangerous to birds.) The danger comes from the log ingredients causing an obstruction in the stomach or intestines. Firestarter logs are made from saw dust and wax. These products do not breakdown in the stomach becoming foreign bodies instead. Common signs include drooling, anorexia, vomiting and abdominal distention.

When an animal ingests a firestarter log, I recommend abdominal X-rays to look for obstruction of the gastrointestinal system and chest films to look for material in the esophagus. If the material is still in the stomach,  I will induce vomiting to help the animal get rid of it. If the pieces are small, they have already passed out of the stomach and there are no signs of obstruction, I recommend a high fiber diet to help them pass. This approach requires careful monitoring as the material may still form a foreign body. I perform X-rays on a daily basis to make sure the material is moving through the intestines and have the family watch closely for vomiting. When animals, usually dogs, eat a large amount of a firestarter logs and/or swallow large chunks, surgical removal is required.

As mentioned in the first paragraph, some firestarter logs contain heavy metals (usually thallium) that create colors when burned. If ingested, signs of heavy metal poisoning may occur. Clinical signs of toxicity vary slightly for each metal but usually include vomiting, diarrhea and/or seizures.

Please seek immediate veterinary attention for any pet who ingested a firestarter log. The Pet Poison Helpline is a wonderful resource for only $49.00 per incident. Their number is (855) 764-7661.

Sources:

-Lee, Justine. “Top Ten Small Animal Toxins: Recognition, Diagnosis, Treatment. ACVIM 2010. Proceedings Library VIN.com.

-Firestarter Logs, PetPoisonHelpline.com

 

5-fluorouracil and Pets

5-fluorouracil (5-FU) is an anti-cancer medication commonly prescribed by dermatologists to treat basal cell carcinoma and actinic keratosis on the skin of humans. Unfortunately, this medicine is highly toxic to animals. Pets develop gastrointestinal and neurologic symptoms. Gastrointestinal signs include vomiting, bloody diarrhea, intense abdominal pain and sometimes, sloughing of the intestinal lining. The neurologic signs include ataxia which means the pet walks like a drunk and seizures. I was part of a team of veterinarians who treated a dog who developed seizures after ingesting 5-FU. None of the normal medications for seizures, diazepam or phenobarbital, stopped the seizures. We had to anesthetize the dog to stop them.

Once 5-FU is ingested, it is absorbed quickly making barium or inducing vomiting, useless. Treatment is supportive which means we treat the clinical signs and support body function with fluids until the pet can fight it off. Unfortunately, the dog I mentioned above did not make it – which is not uncommon. If a pet can survive the initial phase of clinical signs, they often die from secondary effects on the bone marrow.

To protect your pet from 5-FU and other hazardous medications, please keep them in a secure location. Although it is tempting to leave the 5-FU cream on the counter, put it in your medicine cabinet. Don’t let your pet fall victim to this common toxin.

5-FU is sold under the following trade names: Efudex, Carac, Adrucil and Fluoroplex.

Source:

-Lee, Justine. ‘Top Ten Small Animal Toxins: Recognition, Diagnosis, Treatment’, ACVIM2010 Proceedings, VIN.com library.

Battery Toxicity in Dogs

With more and more battery powered gadgets in our homes, battery ingestion is becoming a bigger and bigger problem. The family comes home to find their remote control chewed into several pieces, the battery is missing. Unfortunately, batteries are very dangerous.  Alkaline dry cell batteries ( 9-volts, D, C, AA, etc) and button or disc batteries contain hazardous chemicals that can destroy tissue. The chemical causes severe ulcers. If a dog punctures the battery and then swallows it, they usually sustain severe damage to the mouth, esophagus and stomach. I often find a black powdery material on the lips and in the mouth of these patients.

The goal of treatment is to remove the battery as quickly as possible with either an endoscope or during surgery. DO NOT INDUCE VOMITING! When the battery is vomited back up, more damage will occur. If you think your pet may have eaten a battery, seek veterinary care immediately. In my experience, quick action is critical for this type of toxicity.

Source:

Lee, Justine. Tope Ten Small Animal Toxins: Recognition, Diagnosis, Treatment. ACVIM 2010.

 

Watch Out For Cane Toads

This morning I was out walking my dog when we came across a toad sitting under a bush. In Arizona, the Sonoran Desert toad comes out during our summer monsoon season. These toads are part of the Bufo genus of toads commonly called cane toads. The marine variety are found in Florida and Hawaii while the Colorado River toad, the other common name for the Sonoran Desert toad,  is found in the desert southwest. Unfortunately, these toads were also introduced into Australia.

Bufo toads secrete toxic substances from their salivary glands. I have read reports of teenagers in Arizona dying after they licked a toad to get high. When a dog licks or picks up a toad, the dog absorbs the toxins through the mucous membranes of the mouth. It must burn because dogs will whine, paw at their mouths and salivate excessively. Their gums are bright red. After about 20 to 30 minutes, the dogs start to have problems walking. As the full effects of the toxin are felt, dogs start to seizure. The toxin can also cause life-threatening cardiac arrhythmias. Thankfully, the toxin is short lived, usually about an hour.

If your pet contacts a cane toad of any variety, flush the area immediately with water. For the mouth, I have my clients use a garden hose to run water through their pet’s mouth for ten minutes before coming into the clinic. ***Caution: Never place anything in an unconscious animal’s mouth as it may aspirate.*** I always recommend monitoring the pet with an EKG for at least an hour to check for abnormal arrhythmias.

Sources:                                                                                                                                -Shell, Linda. Bufo Intoxication, Toad Poisoning, VIN Associate Database, 3/25/2010.                                                                                      -Wooden, Bill and Wooden, Beth. Sonoran Desert Toad (Bufo alvarius), Arizona-Sonora Desert Museum, https://www.desertmuseum.org/books/nhsd_desert_toad.php

Call the Pet Poison Helpline for Toxin Information

One of the great resources available to pet owners and veterinarians is petpoisonhelpline.com.  Their number is (800) 213-6680.  For a small fee (around $40) you can receive 24/7 assistance if you have concern that your pet has come in contact with toxins.  Upon receiving your case number, please provide it to your veterinarian who can call and get valuable insight into the proper dosing and treatment best practices for your animal.

The website also contains a great deal of useful information for pets. I really like the comprehensive toxin list that covers plants, chemicals, drugs and even venomous reptiles. The section for pet owners tells people how to make up a poison first aid kit, how to poison proof you home and how to protect your pet during the holidays.  They even have a top ten list of the most common poisons.  I subscribe to the newsletter. My clients and I have experienced tremendous help from Pet Poison Helpline so I wanted to pass this information along.  More info at http://www.petpoisonhelpline.com/.

Ingested Batteries Are Harmful to Pets

Everything these days seems to have some sort of battery.  Smoke detectors, hearing aids, computers, mobile phones, remote controls and even car keys all have batteries. Unfortunately, batteries are extremely toxic to animals. Most batteries contain a strong acid or alkaline material that will burn any tissue it contacts. Some batteries emit an electrical current that causes severe electrical burns. Batteries may also contain heavy metals such as zinc, mercury and lead which are poisonous. 

When I examine a dog for possible battery toxicity, I start with a thorough physical exam paying special attention to the mouth.  If the ingestion is recent, I often see a black chalky material in the mouth.  I also look for ulcers which are areas where the normal gingiva is burned away exposing the underlying tissues.  Next, I take X-rays of the entire gastro-intestinal tract of the animal. Because of the metal, batteries show up well on X-rays. In my experience, dogs who bite a battery will usually spit it out without swallowing any of the battery.

Treatment centers around removing the battery and then treating the damage.  In most cases, I do not induce vomiting for fear of causing more burns to the esophagus, stomach or mouth.  Instead, I remove the battery as quickly as possible through surgery or endoscopy then I treat the patient with anti-ulcer medications, analgesics to help with the pain and a special diet. 

If you think your pet may have ingested batteries, please bring them to a veterinarian right away.  Waiting may cause gastro-intestinal ulcers to perforate. 

Source:
-Lee, Justine A. Top Ten Small Animal Toxins: Recognition, Diagnosis, Treatment. ACVIM 2010 Proceedings


5-FU (Efudex, Carac, Adrucil and Fluoroplex) Cream Will Poison Animals

As a veterinarian, I always worry about my patients coming into contact with medicated creams from their owners.  One of the worst is 5-Fluorouracil (5-FU) which is used in humans to treat basal cell carcinoma and actinic keratosis of the skin. The patient applies a cream containing 5-FU to the affected area. Unfortunately, 5-FU is highly toxic to animals. Common brand names include Efudex®, Carac®, Adrucil® and Fluoroplex®.

Dogs and cats are exposed when they lick the cream off the human or get the cream on their fur and then lick it. I have also heard of people who forget to wash their hands after applying 5-FU and accidentally transfer it to their pets. Once 5-FU gets into an animal’s gastrointestinal system, it is rapidly absorbed. Common early symptoms include vomiting, bloody diarrhea, severe abdominal pain, problems with balance and seizures. With time, this toxin will destroy the animal’s bone marrow resulting in anemia, leukopenia (lack of white blood cells used to fight infection) and thrombocytopenia (lack of platelets used to clot blot.)  Death often results from infection, failure of several organs or bleeding into the brain.

Please be extremely careful with 5-FU around animals. Most cats will die from exposure to a small amount. Dogs have a slightly better prognosis with 25% survival. To prevent accidental exposure:

1) Keep all medications in a safe, animal-proof cabinet.
2) Wash your hands thoroughly after handling. 
3) Keep the area covered with a waterproof bandage to prevent accidental exposure.
4) Dispose of all bandages, packaging supplies, etc., immediately in an animal-proof container.
5) Do not let your pet lick your skin after application. 

Source:
-Lee, Justine A. Top Ten Small Animal Toxins: Recognition, Diagnosis, Treatment. ACVIM 2010 Proceedings
-Peterson, ME, Talcott PA. Small Animal Toxicology. Elsevier, St. Louis, Missouri, 2006.