Get the drop on toxicology emergencies

Erik Zager, DVM, DACVECC, discusses toxicology emergencies on an episode of dvm360® Live!™

Content sponsored by Vetoquinol

Pet toxicity cases are on the rise in the United States, with the ASPCA Animal Poison Control Center reporting that it handled 401,550 such cases in 2021, a 22% increase from 2020.¹ To help clinicians address this issue, Erik Zager, DVM, DACVECC, joined dvm360 Live!™ to discuss animal toxicity treatment options. Zager is a board-certified emergency and critical care specialist and co–department head of the emergency and critical care services at Philadelphia Animal Specialty & Emergency in Pennsylvania. Zager and host Adam Christman, DVM, MBA, examined common pet toxins and explored a new FDA-approved drug called Clevor (ropinirole ophthalmic solution) from Vetoquinol for inducing vomiting in dogs.

Common toxicity emergencies

Zager began with a primer on some common categories of toxicities for which veterinary professionals should be prepared. Nearly half of all calls received by Pet Poison Helpline involve animals ingesting human medication,² but Zager added that veterinary medication can also cause an emergency: “We see human medications that dogs ingest accidentally. [We see] veterinary medications also. Sometimes a dog is supposed to be on 1 tablet of a pain medication and gets into the whole bottle.”

Adding to the list of common toxicities he sees in practice, Zager stated, “We see plants around the house that have certain toxicities. Recreational drugs can be a big thing, especially with legalization of marijuana [being] prevalent, and we see a lot of marijuana ingestion.”

Poison control and response time

Christman commented on the importance of response time in emergency cases and asked Zager about when to involve a third-party poison control service. Zager said, “As an emergency doctor, [if] someone calls [about] chocolate [toxicity], I know exactly how to calculate how much chocolate [their dog has ingested]. I can have them come right [in] and get [the dog] to vomit.” However, Zager said, “Certain types of human prescription drugs or other types of chemical products, cleaning things [are also toxic to dogs]....As much as I’d like to know all the things in the world, I don’t have a complete repository of every toxin in my brain. So having them call poison control is sometimes helpful because they can calculate the toxic dose and figure out what the treatment steps are.”

New and traditional emetic agents for decontamination

On treating a toxiciology emergency in the clinic, Zager said, “Decontamination is one of our first steps, and so [we induce] emesis or vomiting...Traditionally, apomorphine was the go-to, but luckily now there’s an FDA-approved drug [called] Clevor. It’s actually an eye drop, so [it is] very easy to administer [with] very good efficacy to induce emesis.”

Diving into the details of the drug, Zager added, “[Clevor] comes in little individual packets, open them right up, and then it’s just a little eye dropper. The packets tell you exactly how many eye drops go in [and] whether to split it between the 2 eyes, if the patient has 2 eyes. Emesis usually happens within 20 to 30 minutes. You can [administer the dose] a second time if they don’t vomit, but [it’s] pretty quick [and] efficacious in getting them to vomit. Again, [it’s a] very important step in the decontamination process.”

He also explained how to stop vomiting after it has been induced: “Similar to morphine, [Clevor] does have ability for reversal [with] just a dose of metoclopramide. And luckily, you get them to stop vomiting because oftentimes the next treatment is activated charcoal. Giving a patient who’s already vomiting activated charcoal can sometimes be difficult, so it’s important to be able to get them to stop vomiting as quickly as you get them to start.”

Closing words

To wrap up his thoughts on the new drug, Zager said, “We’re past syrup of ipecac at this point. We got into apomorphine, [but] having an FDA-approved drug [now] is great. Sometimes it’s a little difficult to get [away from] what you’re used to, but veterinary medicine is about making sure you’re up to date, embracing new products, and advancing your practice every day.”

References

1. ASPCA Animal Poison Control Center reaches 4 million cases of pet toxicity, a significant milestone in keeping animals safe in emergency situations. News release. American Society for the Prevention of Cruelty to Animals. March 9, 2022. Accessed May 25, 2022. https://www.aspca.org/about-us/press-releases/aspca-animal-poison-control-center-reaches-4-million-cases-pet-toxicity
2. Top 10 human medications poisonous to pets. Pet Poison Helpline. Accessed May 25, 2022. https://www.petpoisonhelpline.com/pet-owners/basics/top-10-human-medications-poisonous-to-pets/