Don't sweat it! Toxicology cases that can be handled at home (Proceedings)

First, a word of caution.... Assess each individual situation carefully and remember that anything can be dangerous in the right quantity (even water). Also, consider health status of patient. Once you take all these into account, there are many exposures that you may be able to talk clients through managing at home.

Silica Gel packets are commonly ingested or chewed on by dogs. Silica gel is considered chemically and biologically inert. When silica gel is ingested, mild GI signs are possible. There is the potential for a foreign body obstruction if the whole packet is eaten.

Oxygen Absorbers are found in packaged foods. They contain iron powder, sodium chloride and carbon. By the time they are eaten by your patient the iron powder has been converted to ferric oxide (rust). The risk is for GI upset and irritation and foreign body obstruction is possible. Systemic iron toxicity is not likely. You can recommend giving MgOH to bind with the iron and monitor for more than mild GI signs (diarrhea can develop from MgOH).

Ant and Roach Traps contain multiple active ingredients including chlorpyrifos, sulfluramid, fipronil, propoxur, boric acid, and hydramethylnon at very low concentrations. These are not likely to cause any significant clinical effects. Bait containing avermectins and arsenic are potentially more serious (avermectins in Collie breeds or dogs with microfilaria and arsenic in cats). Baits also contain inert ingredients such as peanut butter, breadcrumbs, sugar and vegetable or animal fats to attract the insects. These may cause GI upset and the plastic or metal may pose a foreign body hazard.

Birth Control Pill packets contain 21 tablets of estrogen and/or progesterone and possibly 7 placebo pills. The hormone pills contain low estrogen levels <0.04 mg/tablet and some oral contraceptives contain iron. The levels of concern for estrogen are dosages > 1mg/kg (which could lead to bone marrow suppression) and for iron are dosages > 20 mg/kg (which could lead to iron intoxication). These levels are not often reached by ingestion of birth control pills. If a 25 lb (11.4 kg) dog eats 21 days worth of pills, the dosage is 21 x 0.04 mg/tablet = 0.84 mg. 0.84 mg divided by 11.4 kg = 0.07 mg/kg. So we wouldn't be worried in this dog until he ingested 1 mg/kg or 300 tablets! The ingestion of plastic could cause a gastrointestinal foreign body. NuvaRing® is a contraceptive intravaginal insert containing 11.7 mg of etonogestrel (a progesterone) and 2.7 mg of ethinyl estradiol (an estrogen). Ingestion of this product rarely reaches 1mg/kg, the level of concern for estrogen but can present a possible foreign body risk.

Soaps and Anionic/Nonionic Detergents are found in many bar soaps, hand dishwashing detergents and many household cleaners. They are GI irritants. No corrosive injury or systemic effects are expected with ingestion. Treatment included symptomatic and supportive care.

Toilet Water (Tank "Drop-Ins") can be corrosive in their concentrated forms (gels, tablets) but are only GI irritants once diluted in toilet water. Treatment includes dilution and symptomatic and supportive care.

Fertilizer contains Salts of nitrogen, phosphorus, potassium (N-P-K). In most exposures, they are GI irritants. Be sure to check for added iron, insecticides or pesticides which could increase the toxic potential. If the iron level >5%, more significant effects may occur. "Organic" Fertilizer/Bone Meal/Blood Meal are very attractive to dogs and cats. Primary concern is if any mixed in insecticides (e.g. disulfoton). If the product is moldy or rancid, bacterial gastroenteritis or tremorgenic mycotoxins are a concern. There is also a risk of possible impaction if a large amount is ingested.

Herbicides in general, do not cause severe systemic signs when the cat or dog has access to an appropriately treated yard. May note mild GI upset, less likely after the product has dried.

Fire Logs generally contain sawdust, wood chips, peanut shells, petroleum wax, ammonium chloride, and potentially a metal such as copper to produce flame color. Systemic toxicity is not expected but can cause GI upset and pose a foreign body risk.

Poinsettia ingestion causes mild GI upset only. The myth of "deadly" nature of the Poinsettia evolved from a 1900's rumor of an Army officer's child dying after eating one leaf. Later, human studies revealed that a MTD for a 50# child is >600 leaves.

Glow Jewelry contains Dibutyl phthalate which has a very unpleasant taste. Clinical signs include drooling, hyperactivity and head shaking. Treatment includes giving a taste treat and wiping off any liquid; use dark room to find any on fur.

Glue Traps are commonly used to kill rodents and insects. Some contain attractants such as pheromones and they are considered non-toxic. Make sure that other substances have not been added (such as rodenticides). If ingested, the risk is for foreign body. If the patient has a dermal exposure, the main concern is the method of dermal decontamination. Solvents should not be used. Instead use vegetable or mineral oil or peanut butter to work the glue out of the fur and then bathe with hand dish soap.

Statin Medications: HMG-CoA Reductase Inhibitors include Atorvastatin (Lipitor), Fluvastatin, Lovastatin, Pitavastatin, Pravastatin, Rosuvastatin (Crestor), Simvastatin (Zocor) and Cerivastatin (off market). They are inhibitors of cholesterol synthesis and acute overdose may lead to GI upset and flatulence.

Proton Pump Inhibitors include esomeprazole, omeprazole, lansoprazole, pantoprazole, and rabeprazole. Acute dosages < 20 mg/kg may cause lethargy, anorexia and GI upset. The H2 Blockers include ranitidine, famotidine, cimetidine and nizatidine. Acute oral exposures <10X the therapeutic dosage may result in mild GI upset.

Antacids commonly contain calcium carbonate, magnesium hydroxide and aluminum hydroxide. Main concern is for vomiting, diarrhea and constipation. Verify that the agent does not contain salicylates.

Human Thyroid Supplement acute overdoses are well tolerated by dogs due to poor intestinal absorption, alternative metabolic pathways, buffering organs and protein binding. Don't be fooled by human supplements with strengths in "mgs" – they convert to only "mcgs" of levothyroxine. For example: Armour brand thyroid: 1 grain (65 mg) = 100 mcg of levothyroxine. Severe signs are not expected at dosages below 1 mg/kg (levothyroxine) in dogs. Higher dosages can result in GI upset, hyperactivity, hypertension, lethargy, tachycardia, and tachypnea.

Triple Antibiotic and Steroid Creams may cause mild clinical signs. These are poorly absorbed orally. Vomiting and diarrhea may occur and may see signs from the steroids (PU/PD, polyphagia, panting). There is also a foreign body obstruction risk from the tube or cap.