How to take a systematic approach to potentially poisoned patients

When a potential toxin exposure comes into the veterinary clinic, it can be an overwhelmingly stressful time for patients, clients, and the veterinary team. Making sure you ask the right questions, including what they were possibly exposed to, when, and how much, needs to be addressed very early on to provide the appropriate therapy plan for that patient.

During her lecture at the 2026 Fetch Nashville Veterinary Conference in Tennessee, Renee Schmid, DVM, DABT, DABVT, explained to attendees what questions they need to be asking and when to help pets become healthy and toxin-free.

“I know that in the moment, these owners, these pet parents, [are] panicked. They're afraid that their pet is going to die. They've gotten into something that could be potentially fatal to them, or to the owner's perception, is potentially fatal,” Schmid said.

“‘Why are you asking all these questions? You need to be saving my pet.’ And the answer is that we need to ask those questions so that we can better assess and better treat that particular pet,” she continued.

Where to start?

Right off the bat, Schmid recommends asking whether the pet is stable, as patient stability is always the priority. Checking vitals and overall health status before anything else gives the team a clear baseline and shapes every decision that follows.

From there, signalment matters more than many clinicians realize. A dog's species, breed, age, and weight can significantly alter how a toxin behaves in the body. Certain breeds carry the ABCB1 (MDR1) gene mutation, which increases sensitivity to drugs like ivermectin. Brachycephalic breeds are at increased risk of aspiration during emesis, making veterinary supervision critical. Very young and geriatric animals may metabolize toxins differently, as hepatic function in dogs and cats is not fully mature until approximately 12 to 16 weeks of age.

Before treatment begins, the veterinary team should collect a thorough patient history, including current and past medical conditions, medications, the specific toxin involved, route of exposure, amount ingested or contacted, and the time elapsed since exposure. Each of these factors can dramatically shift the risk level and treatment plan. Not every exposure leads to toxicity. Assuming every exposure requires aggressive intervention can result in unnecessary stress and mismanagement.

Knowing where the exposure occurred can also reveal confounding factors. It is equally important to consider whether the poisoning was accidental or intentional, as this context can affect the investigation and response.

“[History] is a big one, because they [may] have long-standing medical diseases like cardiovascular disease. And did they get into a cardiovascular stimulant that could worsen that disease? Or are they on medications for any certain type of medical illness that may make the exposure worse from the clinical signs, or maybe it would mask some of the clinical signs?

“Do they have chronic pancreatitis, and they just got into macadamia nuts, or maybe a toxic dose of chocolate? And we have a concern for pancreatitis in those cases, even if we don't necessarily have that toxic concern,” she continued.

Schmid also reminded attendees that, in the case of a toxin emergency, do not forget about staff safety, as it may not be the most forefront concern when dealing with toxicology cases. In the case of a skin exposure, dermal decontamination requires gloves, goggles, and protective gowns. Staff should also be aware that phosphide pesticides release phosphine gas upon ingestion, which can trigger respiratory symptoms, nausea, and headaches in anyone nearby. Similarly, animals showing neurologic stimulatory signs may display sudden aggression even when they initially appear calm.

“Treat the patient, not the toxin”

Managing a poisoned patient is rarely straightforward, but a calm and systematic approach makes all the difference. By taking the time to fully assess the patient, gather a complete history, and match treatment to the specific toxin and exposure, veterinary teams can avoid missteps that come from reacting before thinking.

“I always say treat the patient, not the toxin. It's really important that we look at the toxin. The toxin guides us, but it's the patient that dictates what it needs. So we may have 5 ibuprofen cases, and we may prove that we [can] treat them in 5 different ways. So certainly that particular toxin is something we need to look at and helps to guide us, but it's that patient that really dictates what it needs,” Schmid concluded.

Reference

1. Schmid R. How to approach the poisoned patient right from the start. Presented at: 2026 Fetch Nashville Veterinary Conference; May 28-30, 2026; Nashville, TN.