Chapter 20 Use of Human Poison Centers in the Veterinary Setting

Each year poison centers receive an increasing number of veterinary calls. The majority of these are for exposures to household pets, especially dogs and cats (Table 20-1). From 1999 to 2003, the Washington Poison Center received an average of 5895 animal exposure calls per year.¹ This represents an increase in overall animal exposures from 6.86% to 8.26% during that 5-year period.² These numbers reflect actual exposures and do not include calls from owners, zoos, or veterinarians that were for poison information only (Table 20-2). Information calls relating to animals and requests for prevention materials from veterinary call sites and owners increased from 4.36% to 6.70% over the same period.²

Table 20-1 Veterinary Exposure Calls to the Washington Poison Center by Species⁸

Table 20-2 Veterinary Calls to the Washington Poison Center⁹

ASSESSMENT AND EXPOSURE

Specialists in Poison Information (SPIs) receiving poisoning calls from owners or veterinarians triage animal exposures just as they do for exposure calls from the parents of toddlers. Animals can be poisoned by human or veterinary medications, plants, chemicals, or cleaning agents as a result of an accidental ingestion, spill, or therapeutic error. The animal, like the toddler, is unable to tell what happened, and acute poisoning requires as accurate an assessment as possible. The threat is not only related to the potency of the poison, but also to the quantity involved, the duration of exposure, and to the presence of other ingredients, such as propellants and solvents. The degree of danger and the necessity for decontamination, or other treatment, are able to be determined only after a thorough assessment on the part of the SPI.

The SPI must seek specific information concerning the exposure. Exact product identification, the estimated amount and concentration of the product involved, the time and route of the exposure, the species and weight of the animal, any signs the animal demonstrates, and any treatment already given are all obtained. Accurate identification of the product or medication involved is essential because of variations in formulations and the inherent toxicity of the ingredients. The specific product name, manufacturer, and ingredients need to be verified by the SPI and confirmed with the original product container, if available. This includes the strength or concentration of the medication or chemical and the form (solid, liquid, etc.) of the product. Tablets, liquids, solids, gases, and granules all pose different risks. Aerosol sprays pose an additional risk from the propellant, which can be more toxic than the active ingredient.

Medication toxicity is highly dependent on the species and weight of the animal and the specific dose of medication ingested. Cleaning products can vary from simple irritants to dangerous corrosives; even similarly named products by the same manufacturer can have many different ingredients and thus contrasting management guidelines. Soaps and detergents may be anionic or nonionic, representing little risk, or cationic, with the potential for greater harm.

The species, breed, age, gender, weight, and number of animals involved are all part of the history taken by the SPI. These data are all important in assessing risk factors with regard to increased or decreased sensitivity to various toxic agents and ought to be considered when recommending decontamination, treatment, referral, and follow-up. Differences in physiology and metabolic pathways exist between species, which may alter the range of toxicity, time to onset of signs, and treatment. It cannot be assumed that an exposure that is determined to be nontoxic for humans will also be nontoxic for other animals.

Frequently the amount of toxin in a veterinary exposure is unknown. Together the SPI and the caller try to estimate the amount of product missing or the amount available to the animal. This is not the toxic amount for the particular animal, but is an estimate of the amount of product actually involved in the exposure. The following questions may be asked to assist the caller to remember:

• Who used the product last and when?

• Do you remember the level in the container before the animal disturbed it?

• Is this container ever refilled from a larger container, and if so, was it refilled with the exact product?

• When was the container purchased?

• What was a usual dose or amount used?

• Is there a spill or are there pill fragments around the animal?

If it is possible to calculate a toxic dose, successful questioning can often determine that a toxic amount was not actually available before the exposure. Having the owner reapply the product and measuring what he or she just used or having the owner apply the amount calculated to be toxic and comparing it with what was applied before the exposure are two methods used by the SPI to estimate the amount involved. For example:

• A toxic dose of this product for your animal is approximately 1 oz, or 6 tsp; did you apply 6 tsp to the area or are there 6 tsp missing from the area where you applied it?

• Can you sweep the product up and put it back in the original container or a measuring cup? Is the difference between what was in the container originally and what you have now greater than the amount calculated to be toxic?

It is important to determine if the product was diluted, and if so, how was it diluted? Dilution decreases the concentration or strength, and possibly the pH, of many toxins, making the exposure less harmful. A dog lapping full strength antifreeze from a spilled container is at more risk than a dog lapping diluted antifreeze that was then rinsed off the driveway and collected into a puddle. If the product was mixed with anything, it may be necessary to determine the toxicity of the additive as well.

The time of the call to the poison center can be from minutes to hours after the time of the exposure. Owners may actually witness the exposure and call immediately or, not realizing that it is a potential problem, may delay calling for several hours after the incident. They may return home to discover that their pet has been exposed. An animal left alone all day while the owner is at work has more time to chew through a container and ingest a toxin than an animal left alone while the owner went out to get the mail. The time since the exposure may affect treatment advice or the necessity for a veterinary referral.

• How long was the animal alone with the product?

• Did he have time to lap up 2 oz?

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