Initial Management of the Acutely Poisoned Patient

Acute onset of generalized tremors, mild ataxia, and hyperesthesia in a young dog after presumptive ingestion of a giant sea hare belonging to the genus Aplysia

“…Gastric emptying methods are most effective if performed within the first 60 minutes of exposure of toxin ingestion; otherwise, the efficacy of the procedure is greatly reduced . Emesis has been reported to be more effective at emptying the stomach than gastric lavage; however, there is an inherent risk of aspiration with inducing emesis in patients that are already exhibiting neurological symptoms. In this case, the patient still had a strong gag reflex on examination and the neurological symptoms were deemed to be only mild at the time of emesis.…”

“…A decision was therefore made to induce emesis as it was considered the more effective and less risky method of emptying the stomach contents (compared with gastric lavage under general anesthesia). Apomorphine is a synthetic opiate that stimulates dopamine receptors in the chemoreceptor trigger zone to induce emesis . It can be administered at a dose of 0.02 to 0.04 mg/kg either via the IV, IM, SC, or subconjunctival route .…”

“…Activated charcoal is a carbonaceous compound that is activated by an oxidizing gas at high temperatures to break down the carbon into smaller granules with larger surface areas. The larger surface area allows many binding sites for adsorption of toxins . Activated charcoal can be given every 4 to 8 hours and could potentially be given for several days.…”

“…Activated charcoal administration may cause constipation and if the activated charcoal movement through the gut is delayed, the adsorbed toxins can move off the charcoal and can be absorbed by the gut. The benefits of using activated charcoal is threefold—it directly adsorbs any potential toxins ingested in the stomach, it may also help reduce enterohepatic recirculation of toxins and finally, it helps to adsorb any toxins that may have moved down their concentration gradient from the bloodstream back into the gut lumen . A cathartic (sorbitol) was used to speed gastrointestinal transit time and subsequent elimination.…”

Poisonous plants

“…Once a determination is made that an animal or a person has been exposed to a toxic plant or is intoxicated, a general approach to case management should adhere to the following principles: (1) stabilize vital signs (this may include administration of an antidote if sufficient information concerning a specific toxicant exposure is immediately available), (2) obtain a history and clinically evaluate the patient, (3) prevent continued systemic absorption of the toxicant, (4) administer an antidote if indicated and available, (5) enhance elimination of absorbed toxicant, (6) provide symptomatic and supportive care, and (7) closely monitor the patient [76][77][78]. Obviously, each situation is unique and one or more of the steps may be eliminated.…”