GROUP 3 CASE STUDY 1012-15

Dog Ingests Antifreeze

By: Michelle Pham, Gerri Pritt, Marlene Purden & Rachel Romo

Scenario
You receive a phone call one
morning at your clinic from a
client, Mrs. West. She is
concerned because she just
caught her 2-year-old neutered
male beagle, Skip, drinking from
the gutter. Her neighbor is
working on a car and thinks that
the liquid Skip ingested was
antifreeze. She is unsure how
much Skip ingested and wants
to know if she should bring him
into the clinic or try making him
vomit or maybe giving him
some milk.

QUESTIONS 1-3
By: Gerri Pritt

Question 1
What advice
should you give
Mrs. West?
If Skip had some
of the Antifreeze
on his feet or
coat, what should
you advise Mrs.
West to do?

The proper advice to give

Mrs. West regarding her
situation would be to bring
Skip in immediately. The
clinic will induce vomiting
using Apomorphine and
monitor for neurological
signs associated with
antifreeze ingestion.
Antifreeze, ethylene glycol,
toxicity signs can occur
within 6 to 12 hours of
ingestion. If vomiting is
induced within 30 minutes of
ingestion, there is a less
likely chance for it to be
absorbed into the
bloodstream (Grauer, 2013).
Skip may have gotten some
antifreeze on his feet or

Question 2

How long can it

take for
Apomorphine to
be effective?

Apomorphine is a drug
commonly used to induce
vomiting in dogs. In Skips
case, he would get the dose
of 0.04mg/kg (intramuscular)
and 0.03mg/kg
(intravenously) which makes
his total dose 0.2mg IV
(Plumb,2011). Apomorphine
comes at a 2mg/mL
concentration which will give
Skip a total volume of
medication 0.1mL IV. The
Apomorphine has an almost
immediate effect when
administered IV and about 5

Question 3

What should be done

after the dog vomits
when using
Apomorphine
conjunctively?

Apomorphine can also be

given in the conjunctiva of
the eye and Skip can receive
1.7mg, of 6mg tablet which
should start to work after
about 5 minutes of
administration. Once Skip
vomits after conjunctival
administration, rinse the
conjunctiva to rid the eye of
remaining medication (Plumb,
2011).

Question 3
When would
induction of
vomiting be
contraindicated?

If a sharp foreign body was

ingested, it is not advised
to induce vomiting to avoid
additional potential trauma
to the oral, esophageal and
gastric tissues.
Since Skip did not ingest
any caustic, acidic,
alkaline, or hydrocarbons,
it will be safe to induce
vomiting at this time (Allen
& Richardson, n.d.).

QUESTIONS 4-6
By: Marlene Purden

Scenario Addendum
You administer the
Apomorphine and wait for
Skip to vomit. After 30
minutes, there is still no
emesis although the dog is
acting nauseous. The
veterinarian then orders
gastric lavage followed by
activated charcoal
administration. He asked you
to place an IV catheter,
administer Meditomidine IV
and intubate Skip.

Question 4
Why is intubation
important when
performing a
gastric lavage?

Describe the
equipment needed
for this procedure
and how to perform
a gastric lavage.
Flexible plastic or rubber

tubing ~ 4-8 in length.

1 roll of any type of white

Aspiration is when any fluid

enters the trachea, bronchi
and lungs which can cause
aspiration pneumonia. Placing
an endotracheal tube into
Skips trachea is needed to
prevent the aspiration of
lavage solution or stomach
contents during the procedure.

tape
Sterile lubricant
Mouth spectrum
Stomach pump/funnel
Bucket for gastric & rinse

contents.
Lavage fluids (body

temperature water) (Cote

Gastric Lavage Preparation &

Procedure
Preparation:
After intubating and

inducing Skip under

anesthesia, place him in
sternal recumbancy if he
isnt already.

Procedure:
Using a mouth speculum, pass

Choose an appropriate size

gastric tube (flexible

plastic/rubber tubing), for a
medium size dog; a 1.5
inch diameter should
suffice.

Measure from the tip of the

nose to the xiphoid process

and mark the plastic tube
with tape.

lubricated tube through mouth

gag to the point marked on the
tube.
Administer lavage solution (body
temperature water) into the
tube, holding the tube higher
than the animals head.
Massage fluids in the stomach
mixing the stomach content with
the lavage solution.
Lower stomach tube below head
and allow stomach contents
(efflux) to empty.
Repeat process until efflux is
clear (Cote 2006).

Question 5
If Skip weighs 15
pounds, how much
lavage solution can be
administered at a time?
According to Clinical
Veterinary Advisor, lavage
solution (usually luke
warm water) should be
administered at 5-10
ml/kg. For a 15 lb dog, the
maximum amount of
lavage solution used at a
time is 68 ml (2006).

Question 6
How can activated
charcoal be
beneficial when
treating for
toxicities?
Activated Charcoal is used
in cases of toxicities since
the toxin ingested will
bind to the activated
charcoal and prevent
systemic absorption
(Plumb, 2008).

QUESTIONS 7-9
By: Rachel Romo

More Treatment Orders

He orders the following
dosage regime:

It is 11:00 a.m. on 1-1012.

The veterinarian decides
to start Skip on 4methylpyrazole. The
concentration of 4methylpyrazole is 5%.
The veterinarian also
wants Skip to receive a
continuous IV drip of
75mL/kg/day of 0.9%
NaCl.

Immediate administration of
20mg/kg.
At 11:00 p.m. administer
15mg/kg.
At 11:00 a.m. on 1-11-12
administer 15mg/kg.
At 11:00 p.m. administer
5mg/kg.

Question 7
Calculate the amount
of 4-methylpyrazole
Skip would get at each
of the dosing times.
Skip weighs 15 pounds (#s or
lbs).
2.2lbs = 1kg (kilogram):
15
1 kg
= 6.8 kg
lbs
2.2
The1 concentration
of 4lbs
methylpyrazole is 5%. For a solid
in liquid solution, the percent
concentration is the weight in
grams per 100 volume parts in
milliliters (Rockett, p 158).

Therefore, the concentration can

be translated as:
5g

=
50 mg/ mL
1000
mg

100
1administration
g
Immediate
of
mL
20mg/kg.
6.8
20
1 mL
=
2.72
mL
kg
mg

mg 50
1or 136
1 kg
mg
At 11:00 p.m. administer
15mg/kg.
6.8
15
1 mL
kg
mgmL
= 2.04
1or 102
1 kg
mg 50
mg

At 11:00 a.m. on 1-11-12

administer
6.8
1515mg/kg.
1 mL
kg
mgmL
= 2.04
1or 102
1 kg
mg 50
mg
At 11:00 p.m. administer 5mg/kg.
6.8
5 mg 1 mL
= 0.68 mL
or 34 mg
kg
1

1 kg

50

Question 8

You plan to use an IV

pump to regulate the
amount of IV Fluids
for Skip.

Remembering that the

veterinarian ordered for
Skip to receive 75
mL/kg/day;
6.8
kg

75 mL

1
/day

1 kg

510 mL

OR

How many mL/hr

should Skip receive?

510
mL

1 day

1 day

24 hr

21.25 mL/hr

Question 9
What are three technician
evaluations related to
ethylene glycol toxicity?

Before developing technician

evaluations, data must be
gathered from the patients
initial presentation, any
diagnostic results and possibly
throughout the treatment plan
(Rockett, 2010).

Nausea, vomiting, abdominal

pain, calcium oxalate crystals
found in the urine, CNS
depression, and dehydration
all qualify as technician
evaluations in relation to EG
toxicity.

More Technician Evaluations

Dogs with ethylene glycol
(EG) toxicity may present
with a mentation ranging
from lethargy to coma.
They will also present with
tachypnea, abdominal pain,
ataxia or stumbling. Also, it
is understood that early
clinical signs appear within
the first 30 minutes of EG
ingestion and commonly
include nausea and
vomiting due to the gastric
irritation (Peterson, 2013).

Given this information from the

Case Study, it is assumed that
Skip was given Apomorphine
between 20 to 30 minutes after
his supposed EG ingestion. It is
noted that after 30 minutes of an
unproductive Apomorphine
induction, Skip still seems
nauseous. Apomorphine is given
because of its nausea creating
properties in order to induce
vomiting (Plumb, 2008). Knowing
that, Skips nausea is not likely
from the EG ingestion and
considering that he presented as
normal in all parameters and is
acting fine (Rockett, p 325).

Question 9
A second technician evaluation
could encompass the urinary
tract. EG ingestion causes the
growth of calcium oxalate crystals
in the urine and is a popular
diagnosis method (Peterson,
2013). Since crystals in the urine
may be painful, abdominal pain or
dysuria may be included as a
possible technician evaluation.
Renal failure is the most profound
consequence of EG toxicity in cats
and dogs (Peterson, p 553).
Formation of calcium oxalate
monohydrate crystals in the renal
tubules, which may also be
painful and potentially cause a
depressed mentation or
abdominal pain.

CNS depression could present

with EG ingestion. As CNS
depression increases in
severity dogs will consume
less water, yet urine
production remains the same.
This causes the body to lose
excess water presenting as
dehydration in EG ingestion.
(Peterson, 2013)

QUESTIONS 10-12
By: Michelle Pham

Question 10 & Client Curiosity

After Skip is finished with his
treatments Mrs. West then tells
you that she has heard that
chocolate is poisonous to dogs
and she wonders what other
human foods are toxic to dogs.

How would you answer

Mrs. Wests question?
Unfortunately, Mrs. West there
are a vast number of human
foods that are toxic to dogs.
Most include nuts and fruits,
some vegetables and other
miscellaneous substances.
For example:

Avocados
All parts are toxic
Will cause vomiting and
diarrhea
Grapes/raisins
Vomiting, diarrhea,
kidney failure and
dehydration
This can be made worse
if patient already has
issues with kidneys
Death can occur in 3 to 4
days
Ethanol-alcoholic beverages
Vomiting, diarrhea,
ataxia, dyspnea, tremors,
coma and even death

sweetener)
Causes insulin release
leading to liver failure
Hypoglycemia, vomiting,
lethargy, loss of
coordination leading to
recumbency and seizures

More Toxic Human Foods

Onions and Garlic
GI irritation
RBC damage;
diagnostically Heinz
bodies are seen on
blood smears
Garlic is more toxic
than onions
Chocolate, Coffee & Caffeine
Vomiting, diarrhea,
panting, excessive
thirst and urination
Hyperactivity,
arrhythmias, tremors,
seizures and in some
cases death

Macadamia nuts
Vomiting, weakness,
depression, tremors,
hyperthermia
Signs appear with in 12
hours and can last up to
48 hours
Vomiting, weakness,
depression, tremors,
hyperthermia
Signs appear with in 12
hours and can last up to
48 hours

Question 11: Toxic Chemicals

Mrs. West then asks you what
other chemicals she should
be concerned about around
her house and garage.

How would you

answer Mrs. Wests
question?
Mrs. West, I am elated that
you are so interested in
educating yourself on this
subject for your dogs safety;
not enough pet owners take
advantage of their
veterinarians and technicians
as well as you have today! I

Rodenticides
Symptoms can vary
depending on type:
Vomiting, depression,
anorexia, internal
bleeding, epistaxis, brain
swelling & kidney failure
Eating dead rodents can
also cause toxicity
Bromethalin products are
the worst
NSAIDs
Such as ibuprofen and
naproxen
Stomach and intestinal
ulcers and possibly
kidney failure

More Toxic Chemicals

Nicotine
Severe vomiting,
depression tachycardia,
low blood pressure,
tremors
Potential for seizures,
respiratory failure and
even death
Fertilizers
Can cause pancreatitis
and in some cases can
cause an obstruction
they may require
surgery

Household Cleaners
Most will cause skin and
eye irritation, mild
stomach upset
Harsher chemicals can
irritate the lungs such as
Bleach
Always follow directions
on product and keep pets
out of area until dry
Remember to always consult
with your Veterinarian before
giving any medications to
your pet.

Question 12: Toxic Plants

Mrs. West then tells you that
she once heard that
rhododendrons were
poisonous to dogs and she
wants to know if that is true
and what other plants can be
toxic to dogs.

How would you

answer Mrs. Wests
question?
Yes. Rhododendrons, or
Azaleas, are toxic to dogs and
can cause salivation,
lacrimation, vomiting,
diarrhea, dyspnea, muscle

What are five plants

that can be fatal if
ingested by dogs?
Oleander
All parts of plant are toxic
Stomach upset, abnormal
heart rate, hypothermia
and even death
Cyclamen
Salivation, vomiting,
diarrhea
In large amounts can cause
abnormal heart rhythms,
seizures and even death

More Toxic Plants

Mistletoe
Vomiting, profuse diarrhea,
dilated pupils, rapid and
labored breathing and
shock
With a toxic dose death can
occur with in hours due to
cardiovascular collapse
Cannabis sativa- Marijuana
Ataxia, vomiting, mydriasis,
depression, salivation and
low blood pressure
Tachycardia, bradycardia,
hyperexcitability, tremors,
hypothermia
Death (rare)

Sago Palm
Vomiting, increased thirst,
hemorrhagic gastroenteritis,
bruising, coagulopathy, liver
damage and failure, and
death

What are five plants

that are not fatal but
can cause irritation or
other chemical signs?
Tulips
Vomiting, depression,
diarrhea and hypersalivation
The highest concentration of
toxin in the bulb

Begonias
Irritation and burning to
mouth, tongue and lips
Drooling, difficulty
swallowing and
vomiting
Tubers are most toxic

Toxic, Non-fatal Plants

Poinsettias
The sap is irritating to
mouth and stomach
Can cause excessive
salivation and vomiting
Lilies
Vomiting, diarrhea,

abdominal pain, cardiac

irregularities
Acute cases can present
with hyperkalemia and
petechial hemorrhage
Carnations
Mild stomach upset
Mild skin irritation

The ASPCA Poison Control

Hotline is also an excellent
resource. They have Board
Certified Toxicologists
available 24 hours a day
365 days a year and you
can reach them by calling
1-888-426-4435. There is
a $65 dollar consultation
fee.

Conclusion
As we have proven, technicians play
an important role with client
communication and patient care. From
the phone call with Mrs. West,
throughout Skips treatment orders and
all the way to educating Mrs. West on
other pet toxicities; we carry out a great
portion of influence for pet health. For
these reasons, it is our duty to continue
to educate ourselves and each other in
the veterinary community to better
veterinary medicine as a team. We hope
that this case study presentation has
accomplished just that.

References
Allen, C. & Richardson, J.A. (n.d.). ASPCA Tips to Manage Poison

Emergency. VSPN. Retrieved from

http://www.vspn.orgLibrary/misc/VSPN_M01158.htm
Cote, E. (2006). Clinical Veterinary Advisor: Dogs and Cats. St. Louis,
MO: Elsevier Mosby.
Grauer, G.F., (2013, May). Overview of Ethylene Glycol Toxicity. The
Merck Veterinary Manual. Retrieved from
http://www.merckvetmanual.com/mvm/toxicology/ethylene_glycol_tox
icity/overview_of_ethylene_glycol_toxicity.html
Peterson, DVM, MS, Michael E., Talcott, MS, DVM, PhD, DABVT, Patricia
A. (2013). Small Animal Toxicology (3rd ed). Saunders, an imprint of
Elsevier Inc., (p 551-562).
Plumb, Donald C. (2008). Plumb's Veterinary Drug Handbook (6th ed).
Blackwell Publishing, (p 91-93).
Rockett, D.V.M., Jody (2010). Case Studies in Veterinary Technology: A
Scenario Based Critical Thinking Approach. Rockett House Publishing
LLC, (p 1-3, 325-326).

Photograph References

Nikolett (2010) The Cutest Beagle Girl [Online image]. Retrieved October 07,
2015 from http://nikkancs01.deviantart.com/art/The-Cutest-Beagle-Girl177038866

Antifreeze1 [Online image]. Retrieved October 07, 2015 from

http://www.baldockvets.com/wp-content/uploads/2012/10/antifreeze1.jpg

[Untitled photo of dog hiding face]. Retrieved October 12, 2015 from
http://pinterest.com

Leslie (2011). [Untitled photo of dog in gown with activated charcoal on

muzzle]. Retrieved October 12, 2015 from http://1.bp.blogspot.com/4KAa1hO8NTw/TqC0ZgawxfI/AAAAAAAABgI/u5ozCfgB4Js/s1600/IMG_3636.jp
g

Cara (2008). Intubation [Online image]. Retrieved October 12, 2015 from
https://www.flickr.com/photos/30022421@N06/2943667458

Goodavage, M. (2013). Jake the Lab ate a hug hunk of chocolate and wound
up at the vet [Online Image]. Retrieved October 08, 2015 from
http://www.dogster.com/lifestyle/dog-health-tips-ate-chocolate

Dr Clouthier (2014). [Untitled photo of dog with icepack on head]. Retrieved

October 12, 2015 from http://www.drclouthier.com/wpcontent/uploads/2014/03/Puppy-Problems-5-Tell-Tale-Signs-That-Your-PetMight-Be-Sick.jpg