Zinc Toxicosis in a Boxer Dog Secondary to Ingestion of Holiday Garland

Abstract

Ingestion of holiday tinsel garland made from metal-coated plastic film has not previously been implicated in zinc toxicosis. Zinc toxicosis has a good prognosis in veterinary medicine when diagnosed and treated promptly, but the unique source of zinc in this dog contributed to the delay in diagnosis and grave outcome in this case.

Zinc in Dog Nutrition, Health and Disease: A Review

“…According to Gurnee and Drobatz, who reviewed 19 cases of zinc intoxication, the most common clinical signs, by order of frequency, are anemia, vomiting, pigmenturia, hyperbilirubinemia, lethargy, decreased appetite (anorexia), and diarrhea [ 178 ]. Hemolytic anemia resembling an immune-mediated was often present, thus laboratory testing might reveal regenerative anemia, hemoglobinemia, hemoglobinuria, and, in some cases, Heinz bodies and spherocytes [ 179 , 180 ]. Lethargy and gastrointestinal signs (vomit and diarrhea) are likely to reflect abdominal discomfort, due to irritation and possibly ulceration caused by the physical presence of the foreign body or the release of zinc, facilitated by the acidic environment of the stomach [ 178 ].…”

“…Lethargy and gastrointestinal signs (vomit and diarrhea) are likely to reflect abdominal discomfort, due to irritation and possibly ulceration caused by the physical presence of the foreign body or the release of zinc, facilitated by the acidic environment of the stomach [ 178 ]. Bilirubinemia is associated with hemolysis, but also with liver dysfunction, which can also be reflected by high serum activities of liver-associated enzymes (e.g., alkaline phosphatase, alanine aminotransferase) [ 180 ]. Indeed, the extension of liver lesions, the occurrence of pancreatitis (pancreatic fibrosis and acinar necrosis), coagulopathies [ 178 ], and acute kidney failure (associated with diffuse tubular degeneration with focal epithelial necrosis) [ 181 ] dictate the prognosis of zinc toxicosis.…”

“…Indeed, the extension of liver lesions, the occurrence of pancreatitis (pancreatic fibrosis and acinar necrosis), coagulopathies [ 178 ], and acute kidney failure (associated with diffuse tubular degeneration with focal epithelial necrosis) [ 181 ] dictate the prognosis of zinc toxicosis. In addition to the clinical symptoms described, the diagnosis is usually achieved through radiographic visualization of the foreign body and determination of zinc in serum [ 180 , 181 , 182 ]. The treatment of zinc toxicosis aims to remove the foreign body (e.g., surgery or emesis if adequate), provide stabilization and support (e.g., intravenous fluids administration for rehydration, whole blood or specific blood constituents transfusion depending on the severity of anemia and coagulopathy), administration of antibiotics, gastroprotection drugs, and zinc chelators [ 178 ].…”

Zinc toxicosis in a dog secondary to prolonged zinc oxide ingestion

“…Other common biochemical changes are elevations in urea, most likely from gastrointestinal haemorrhage, and hyperbilirubinaemia, most consistent with haemolysis (Gurnee and Drobatz, 2007). Treatment of zinc toxicosis involves removal of the zinc source and supportive therapies, including blood transfusion, intravenous fluid therapy, gastroprotectants, anti-nausea medications, antioxidants, antibiotics, and sometimes chelation (Torrance and Fulton, 1987;Hammond et al, 2004;Gurnee and Drobatz, 2007;van der Merwe and Tawde, 2009;Talcott, 2013;Bischoff et al, 2017). When a metallic zinc object is ingested, increasing gastric pH with antacids and gastroprotectants helps to reduce the rate of zinc dissolution until the object can be removed (van der Merwe and Tawde, 2009).…”

“…Zinc toxicosis appears to be most commonly associated with ingestion of metallic zinc objects, including pennies minted in the United States after 1982, pennies minted in Canada between 1997 to 1999, Euro cents, toys, identification tags, galvanised products, nuts and bolts, garland, and even toilet paper holders (Torrance and Fulton, 1987;Latimer et al, 1989;Luttgen et al, 1990;Norman et al, 1990;Robinette, 1990;Shaw et al, 1991;Gandini et al, 2002;Mikszewski et al, 2003;Borst et al, 2004;Volmer et al, 2004;Bexfield et al, 2007;Gurnee and Drobatz, 2007;Weingart and Kohn, 2009;Adam et al, 2011;Clancey and Murphy, 2012;Blundell and Adam, 2013;Bischoff et al, 2017). This report documents a case of zinc toxicosis resulting from ingestion of a zinc oxide cream.…”