Lead ingestion in a puppy

17 Lead ingestion in a puppy




Initial presentation


Vomiting and seizures


Signalment: 5-month-old entire male West Highland white terrier, body weight 3.1 kg



Case history


The puppy had been vomiting bile and occasionally digested food once a day for 4 weeks. Two weeks prior to consultation he had a seizure which was described as beginning with barking and running around the room before becoming recumbent, unconscious, salivating and paddling. The episode was thought to have lasted about 10 minutes. There had been no further seizures.


The owner thought that the puppy’s appetite was reduced and the puppy was reportedly more flatulent. His stools were reported as normal in consistency, but only passed every other day. The puppy’s drinking and urination were unchanged.


The puppy did play with toys and the owner did not know if he could have ingested any of them.


The owner had owned the patient and his litter mate since they were 12 weeks old and the other puppy appeared healthy. The affected puppy was smaller than his littermate. Both puppies were fully vaccinated and had been de-wormed with fenbendazole several weeks prior to presentation. Both puppies were fed a commercial puppy food supplemented with commercial ‘puppy milk’, chicken and rice. They had not travelled out of the United Kingdom.



Physical examination


The puppy was alert and responsive, but quieter than normal for a 6-month-old terrier puppy. His body condition score was 4/9. His mucous membranes were pink and moist with a capillary refill time of <2 seconds. His heart rate was 152 beats per minute with matched good quality pulses. Respiratory rate was 28 breaths per minute and thoracic auscultation revealed no abnormalities. Abdominal palpation was unremarkable, as were his peripheral lymph nodes. Rectal temperature was 38.6° C.



Problem list and discussion of problems



• Seizure

• Vomiting


Differential diagnosis



Differential diagnoses for vomiting



• Disorders of the stomach
• foreign body

• gastritis

• ulceration

• chronic partial dilatation-volvulus

• neoplasia (unlikely at this age)

• Disorders of the small intestine
• foreign body

• inflammatory bowel disease

• neoplasia (again, unlikely at this age)

• parasites

• intussusception

• Disorders of the large intestine
• obstipation

• Systemic disorders
• pancreatopathy

• hypoadrenocorticism

• diabetes mellitus

• porto-systemic shunt (PSS) and other liver disorders

• renal disease/uraemia (unlikely, no concurrent signs)

• Toxins
• NSAIDs

• lead

• mercury

• organochlorines. organophosphates, carbamates

• toxic plants, e.g. philodendron, diffenbachia, daffodil bulbs

• Dietary causes
• adverse reaction to food (allergy or intolerance)

• dietary indiscretion


Differential diagnoses for seizures



• Intracranial disorders
• congenital and hereditary disorders, e.g. brain malformations, Chiari-like malformations of the foramen magnum, hydrocephalus, inborn errors of metabolism (the puppy was probably too normal after the seizure for these differential diagnoses to be highly likely)

• inflammation, e.g. encephalitis, vascular disease, granulomatous meningioencephalopathy (GME), neoplasia, abscess/granuloma (other than a resolving vascular disorder or GME), the puppy was too normal after the seizure for most of these differential diagnoses

• epilepsy – possible, as can start at a young age

• intracranial haemorrhage – possible if resolving

• Extracranial (systemic) disorders affecting the brain
• Infectious agents, e.g. distemper, Parvovirus, Anaplasma/Ehrlichia, rabies, bacterial, tetanus; there was no evidence of these in the history or at physical examination

• Metabolic disease – many of these are possible as other than hypothyroidism, sometimes the signs are intermittent
• hypoglycaemia

• congenital hypothyroidism (usually presents as cretinism in puppies)

• hypocalcaemia

• hypernatraemia

• Toxins
• lead

• organophosphate

• metaldehyde

• Hepatic encephalopathy, e.g. with portosystemic shunt (PSS)

• Parasites – Toxoplasma, migrating larvae of Cuterebra (unlikely in the UK) or Toxocara

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Sep 22, 2016 | Posted by in SMALL ANIMAL | Comments Off on Lead ingestion in a puppy

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