Poisoning
Basic Treatment
Basic Information 
Overview and Goal(S)
Six general steps should be considered when treating poisoned horses.
1 Stabilize the patient if necessary. Goal: keep the animal alive long enough to make a diagnosis and begin more specific treatment. This step should be addressed first if needed. All other steps can be performed concurrently once the patient is stable.
2 Evaluate the patient. Goal: to determine what is wrong with the patient, the severity of the condition, treatment required, and how aggressive treatment should be. The clinical evaluation is based on a combination of:
3 Decontaminate the patient if appropriate. Goal: to decrease the amount of toxin absorbed into the body. This step is unique to the treatment of poison cases and must be done soon after exposure. Decontamination methods depend on the route of exposure:
4 Enhance elimination of absorbed toxin. Goal: to hasten the removal of toxin that has been absorbed systemically to diminish the severity and duration of toxic effects. Methods:
Other methods such as dialysis are impractical in most settings and are not discussed in this entry.5 Administer an antidote if available and appropriate. Goal: to inactivate or otherwise prevent the toxin from causing adverse effects. Very few poisons have specific antidotes, which is why other treatment steps are so important for most cases.
6 Provide symptomatic and supportive care. Goal: to restore or preserve homeostasis for all organ systems. This step is often the only treatment possible because many cases present too late for decontamination and no specific antidote exists.
Indications
• Stabilization: Indicated for patients with immediately life-threatening conditions such as severe airway, breathing and circulation abnormalities, or seizures, shock, severe hypothermia or hyperthermia, or life-threatening electrolyte abnormalities.
• Clinical evaluation: Indicated in all cases.
• Decontamination: Indicated only if unabsorbed toxin is still present on the body or in the GI tract. Guidelines:
Gastric lavage: Indicated only if some of the toxin might still be in the stomach, if the toxin is of a size and consistency that can be removed via nasogastric tube, and if the amount and type of toxin might pose a serious risk to the patient. Liquid toxins can quickly pass through the stomach; forages, grains and other solid substances can remain in the stomach for many hours but may be too large to pass through a stomach tube. As a general rule, lavage may be indicated if:
The sooner after toxin exposure that activated charcoal is administered the better, but it is never too late as long as any toxin remains in the GI tract.
Activated charcoal does not adsorb to all toxins and is not necessarily useful in all poison cases. The following toxins are reportedly NOT well bound by activated charcoal: acids and alkalis, cyanide, detergents, ethanol and other alcohols, ethylene glycol, iron, fluoride, nitrate, petroleum distillates, sodium, and other salts and metals. However, lack of efficacy is generally NOT a contraindication for the use of activated charcoal, with a few exceptions (see Contraindications).
• Enhanced elimination of absorbed toxin: Indicated if systemically absorbed toxin still remains in the body.
Diuresis is indicated if the toxin is excreted renally, is in high concentration in the plasma, and is not highly protein bound. Diuresis can be considered even if the toxin is unknown.
• Antidotes: Indicated if an antidote for the particular toxin exists, its use in horses is appropriate, and the risks from the toxin outweigh risks from the antidote.
• Symptomatic and supportive care: Indicated in any patient that has clinical signs resulting from toxin exposure. Treatments should address abnormalities with all systems, including cardiovascular, respiratory, renal, digestive, musculoskeletal, cutaneous, and central nervous systems. Also address thermoregulation, electrolyte imbalances, patient comfort, hydration, and nutrition status.
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