A confirmed toxicological diagnosis rests upon the following; the goal is to focus down on a reasonable list of differentials.
A confirmed toxicological diagnosis rests upon the following – goal is to focus down on a reasonable list of differentials:
Signalment, history, and circumstances of exposure
Questions to consider in quizzing the client in regards to SA-companion animal poisoning suspect cases: TEMPLATE ONLY
Owner's telephone number:
Date of interview:
I. Present History
Species of Animal Affected:
Neutered? Yes or No
Pregnant? If yes, how far along? Lactating?
No. animals on premises:
No. animals sick:
No. animals dead:
A. Onset / Duration of signs:
B. Progression of signs:
C. Prior treatment:
D. Specific questions to ask about different systems
II. Past History
A. Diet: list brand names
A. Current vaccination status: list what was used or what diseases were vaccinated for and approximately when
B. List all current medications:
It is essential to obtain a complete set of specimens for chemical analysis as well as a complete set of specimens for histopathology and other studies (bacteriology, virology, serology, etc.). Many toxicologic diagnoses rely not only on residue of the toxicant but also on compatible lesions and/or the absence of lesions. Just the presence of a particular chemical in body tissues does not make a diagnosis.
Specimens for toxicological analysis should be individually chilled orfrozen (except whole blood, brain, and dry forage material) and double bagged with the appropriate label (date, place, collector, specimen type). Specimens routinely collected should include: (recommended volumes - obviously dependent on animal size and test(s) desired): YOU CAN NEVER SAMPLE TOO MUCH! MAKE TOXICOLOGY TESTING COUNT - WHAT IS RIGHT FOR ONE TEST MAY RUIN ANOTHER!! REMEMBER – LARGE VOLUMES IF POSSIBLE.
Stomach, rumen, intestinal contents/vomitus/gastric lavage wash/feces - 500 g
Liver/kidney/body fat/lung/skeletal muscle/pancreas - 100 g
Urine - 50 ml
Serum/plasma/whole blood - 10 ml (blood should be chilled) / serum and plasma separated
Ocular fluid - enucleate and submit intact eye
Brain - complete hemisphere (remainder fixed)
Skin/Hair (for dermal exposures) - 200 g
Feed/baits - 2 kg - should be representative and may be a composite from several areas
Water - 1 pint
Soil - 1 pint
Milk - 1 pint
For feeds, if moisture content is < 13% they can be shipped as is with no special requirements. Higher moisture feeds should be kept frozen. Water and milk samples can be stored in plastic containers and frozen. Soil samples can be submitted in ziplock bags or white paper bags with plastic lining available from the laboratory. All samples should be accompanied with as much history as possible - please note any unusual odor, color, or foreign substance (granules, capsules, powders, grains) present in the samples.
CALL WHEN IN DOUBT!
When sampling, think about:
1. Correct sample
2. Sample size
3. Maintain integrity
6. Selecting a laboratory / Communication
Work-up of simple straight forward or complicated cases is often a multi-disciplinary approach: individuals consulted can include specialty clinicians, pathologists, toxicologists, extension personnel, bacteriologists, epidemiologists, state/federal authorities, etc.
Two important points:
1. It is very important that sample gathering at the time everything is occuring is adequate and that a clinical history be written by the submitting veterinarian. If you send a complete history, the diagnostic laboratory can utilize other expertise within the laboratory or college.
2. The veterinarian or owner may have too narrow a view of testing or, more likely, too broad a view, such as requesting that the laboratory "test for all possible toxicants". The case history needs fine-tuning to avoid excessive costs and enhance the probability that the correct assays are chosen.
Common pitfalls include
1. Insufficient or no history
2. Inappropriate sample for test requested
3. Small sample size