Misconceptions of toxic ingestions

In recognition of Pet Poison Prevention Month, The Vet Blast Podcast, presented by dvm360, is kicking off the month with Renee Schmid, DVM, DABT, DABVT. Schmid joins the podcast to dispel misconceptions about veterinary toxicology and reveal the true science behind the myth.

Schmid, a senior veterinary toxicologist and director of veterinary medicine at Pet Poison Helpline, and host Adam Christman, DVM, MBA, discuss activated charcoal and when to use it, when inducing vomiting is the right choice, and when to hospitalize patients. Below is a transcript of a key moment, edited lightly for clarity.

Transcript

Adam Christman, DVM, MBA: Another misconception is that all toxin ingestions need to be hospitalized. Now, some of these can be done outpatient, and maybe through a consultation…as well. Share with the listeners a little bit more about that.

Renee Schmid, DVM, DABT, DABVT: You bet. I always say to treat the patient, not the toxin…. Let's go back to ibuprofen, where we could have a patient that has a [potential] risk for [gastrointestinal] ulceration or acute kidney failure. We also might have an ibuprofen ingestion where that patient is not at risk for acute kidney failure. What I think is really important for us to remember is that it's very difficult to [reduce toxicology to] black and white, and it's very difficult to put an algorithm toward toxicology. You have to really look at all of the situations that are there.

There are many cases where amphetamines, for example…we really don't expect to see any laboratory changes. So doing a lot of blood work for these patients isn't necessarily helpful for them or helping you as a clinician, either. And sometimes these patients—[sure, they] would benefit from [intravenous] fluids. But if we have a cost issue, a financial concern, or just an inability to keep them in the hospital—maybe the animal is extremely aggressive in the hospital—then maybe some fluids would be warranted and valid in those cases. Then there are also medications that we can give them at home, that the pet parent can give by mouth. So instead of having them in the hospital getting injectables, if they're not chronically vomiting and all the factors are OK, then they may be able to be treated at home.

Christman: That's so good to hear. And along those lines, another misconception is that all toxin injections need to have laboratory diagnostics done.

Schmid: Yes. That's a big misconception, and we get calls on that. It's not uncommon for us to say we don't need to do XYZ lab work, and the person on the other end of the line says, “OK, I'm going to do a [complete blood count], a chemistry in [urinalysis].” And there are many things, as I mentioned, like with amphetamines, [where] we don't see those particular changes. We don't typically expect to see red cell/white cell abnormalities or any other type of organ dysfunction. Is there? Usually, cardiovascular and [central nervous system] stimulants. So lab work isn't going to really help us much. We see this a lot with our anticoagulant rodenticides, where someone may say, “Well, I'm going to do a clotting profile. And this just happened 2 hours ago.”

We have to slow down and think that it actually takes time for that process to work. So checking a clotting profile now and an animal that isn't actively bleeding is doing a disservice to that pet parent because of the financial constraint that gets added to their burden…plus it just adds more stress to the patient by handling them, manipulating them, and trying to grab that lab work.

Christman: I love that we're talking about this. And listeners, Renee and I were talking offline about this…spectrum of care. We know it's a very hot topic, and if you understand the toxins, it's so important to really sit and continue education, to really know the “why” behind the medicine and the toxic ingestion.

You can listen to this full episode here, or wherever you listen to podcasts. Schmid will also be presenting toxicology lectures at Fetch Charlotte.