Episode 11 - EXTRA Bonus Episode! Toxicology in Dogs and Cats

Episode 11 - EXTRA Bonus Episode! Toxicology in Dogs and Cats

It’s Easter… which means chocolate, hot cross buns, daffodils… and a waiting room full of potential toxicology cases.

In this bonus episode, we’re diving into the common toxins we see in dogs and cats — with a seasonal focus on the Easter classics (yes, we’re looking at you, raisins, chocolate, and garden-loving puppies with a taste for daffodils).

We talk through how we approach these cases in real-world practice, including:

• The most common toxicities in dogs and cats
 • Easter-specific risks and why this time of year gets busy fast
 • How to identify toxic exposures early
 • Practical treatment approaches and monitoring decisions
 • When to escalate, when to admit, and when to breathe again
 • The mysterious world of intralipid therapy
 • Tremorgenic toxins and those slightly chaotic neurological presentations

As always, this isn’t textbook toxicology — it’s practical discussion from the consulting room and prep area, covering the cases we actually see and the decisions we actually have to make.

If you want a seasonal clinical refresher (before the Easter chocolate disappears into the wrong patient), this episode’s for you.

For more information in all the toxicities we mention within the podcast, please visit our BLOG post at https://www.chattyvets.com/blog      <-- Click here!

* To be clear, alcohol is NOT a chelating agent in ethylene glycol toxicity, it simply acts 'like' one by inhibiting alcohol dehydrogenase. In doing so it blocks the conversion of ethylene glycol into it's toxic metabolites. 

** Within the episode we say that we think Bromethalin is a vitamin K antagonist - CORRECTION: Bromethalin is not an anticoagulant rodenticide; it is a neurotoxin that kills rats and mice. It works by disrupting cellular energy production in the central nervous system (CNS), leading to brain swelling, paralysis, and death.

Transcript

SPEAKER_02 0:09

Welcome back to the Chatty Vetter Pod. I'm Brendan.

SPEAKER_01 0:12

And I'm Charlotte. Thank you for tuning in.

SPEAKER_02 0:14

Welcome to our extra podcast in March, our bonus episode. Oh, have we spoiled you this month?

SPEAKER_01 0:21

Yeah, we have. Today we have another one of our clinical deep dives into a specific type of presentation we see really commonly all times of year, but especially this time of year: toxins.

SPEAKER_02 0:33

With Easter just around the corner, we thought it would be sensible to think about those cases we're likely to see. The hot cross bun eaters, daffodil munchers, and chocolate gobblers.

SPEAKER_01 0:44

Yeah, we all know they're coming. So today we're going to try and cover all the common toxins we see in dogs and cats in practice, including a lot of ones that maybe aren't so common or things that you don't think are that common, but we see surprisingly often. So we're going to cover how they might present emergency treatment and diagnostics we might need to give, and how this differs in between the different types of toxins that we'll see. So let's get stuck in. So if you were going to have a toxicity that comes into practice, I think there's a couple of different ways that these guys can present. It's either that the owner comes in, classic, oh, I had a bar of chocolate on the side, the bloody dog's got up and nicked it, and you know exactly what's been eaten, how much, you know what it is that's missing, and you think, great, okay, you know what the toxin is, you know how to treat it because you have an idea of exactly what's gone on. But then equally you've also got those cases where you have no idea. The dog comes in and it's tremoring, or it's collapsed and it's been vomiting, whatever presentation it might be, sometimes toxicity is a diagnosis of sort of figuring out that that's what could have caused it, or sort of working on a we think it probably is this based on the clinical signs, but we can't be quite sure. So, I mean, how many toxicity cases do you think you see in GP world, Brendan?

SPEAKER_02 1:56

Because I'm obviously a bit more used to ECC land, so I feel like I see them all the time, but not many, actually, because weirdly, like every hour of our shift you'll have a chocolate almost, won't you? But they're few and far between in in general practice for some reason. Maybe a couple a year, three a year, I don't know. And then uh obviously grapes and raisins, weirdly, you'd think there'd be just as many, wouldn't you? Yeah, there's not infrequent, hardly ever. I think the commonest inquiries about rodenticide, which is there's a lot to say about that too. So that's that's a really cool one we're gonna come to later.

SPEAKER_01 2:29

Yeah, and I I think to be honest, the reason why I see such a lot out of hours is that normally they're the first consults I'll see every night because most of the time it's when people have got home and they thought, bugger, I left that out, where's that gone? And it's so they won't notice until they've got home from work, which is often when the GP vets are already shutting. So I think that's probably why we see so many out of hours, because it's just timing when people finish work. But the thing that we need to understand about them is one, how to work out if it is a toxicity, and two, how to treat it if it is, because when you do get one, especially one of the more serious ones, you want to know what you're doing. The first thing that we need to do is obviously if you've got a very unstable patient, similar principles to as we've spoken about before, you know, stability and stabilization of your patient is one of the first things. But generally speaking about these cases, history taking is the biggest thing that you can do because it's going to give you so many clues as to what's going on. Are the people that that dog lived with, are they on any medications? Are there any other dogs in the household with medications? Do they have any plants in the house that that dog could have got hold of? Have they gone on walks near public footpaths where you know that people often smoke marijuana? Is there, you know, there's so many different things that you can ask? And I would be as specific as you can because people sometimes don't even think about that it could be toxic to dogs. History is one of the biggest things in these cases, trying to work out could they have eaten something and if they could have done, where are they likely to have picked it up and what is it likely to be?

SPEAKER_02 3:51

Yeah, I probably don't ask as much as I should do for um about um history of ingestion of toxins and things. But I think the cases where I really do pick up pick up my questioning is when I've got a tremoring or a seizure in a patient, if I've got a collapsed patient with low sugar, um mental state that that's you know, i.e. a cannabis or or you know something similar.

SPEAKER_01 4:11

Yeah, exactly.

SPEAKER_02 4:12

But so if they're the ones that I'm really thinking about it, that's probably my contribution there.

SPEAKER_01 4:17

Yeah, definitely. I think that those ones it's always going to be higher on your list because we have those big hitters that we're thinking about all the time, which we will go into. Um, I think for me it's like the cancer diagnosis, like neoplasia is always going to be on your differentials, no matter how low it down, low down it is. And for me, toxicity is always like that as well. Just depends how high I'll put it on my list as to what they're presenting like. So, but anyway, okay, so you've potentially got loads of different ways that these patients could come into you. And I guess the biggest thing to say first is that if they come in and they are unstable, we need to think about stabilizing them first before even thinking, okay, what is it that's caused it and how do we fix it? We need to think how do we get them out of the emergency state first. So you could be talking anything from oxygen, placing IV catheters, intravenous fluid therapy in terms of your shock boluses that we've spoken about before, if you think they're in hypovolemic shock. But I guess the two things that are more specific to toxins is if you've got a tremogenic toxin, no matter what sort of tremogenic toxin it is, or if you've got a toxic toxin that can cause seizures, they're the ones that we need to know how to manage from the get-go, even without knowing what's caused it. So if you've got something that tre that's tremoring when it comes into the practice, and tremoring is different to seizuring because they are still a little alert, they're not completely unconscious, but they are just shaking like crazy. And it's more than your shivering. If you've never seen a tremogenic patient before, look it up on YouTube because it's very obviously different to just someone that's uh to a patient that's shivering. But it's like uh how would you describe it? It's almost like smaller, smaller seizure type activity, but they're with it, isn't it? That's I guess that's how I'd describe it.

SPEAKER_02 5:54

It's like Yeah. If you're thinking of the tremogenic mycotoxins, they're also a little bit um hyper-reactive, aren't they? I think.

SPEAKER_01 6:02

Yeah, they can be.

SPEAKER_02 6:03

I don't know if that goes together with the tremor tremor kind of thing. Yeah.

SPEAKER_01 6:06

Yeah, they can be. And I think from the get-go, in terms of I know normally we get onto medications a bit later in these deep dives, but obviously, if we're thinking about stabilization of these patients from the get-go, if you have a patient that's tremoring, one of the best things that you can do for them is give them something called methocarbamol. I don't think a lot of GP practices have it or use it or know too much about it. I don't know if it's more of an ECC drug, because tremogenic mycotoxins you might not see in GP land that often, but methocarbamol is fantastic in terms of anti-tremogenic, in terms that's what it does, that's its nature. So, in terms of dosage, you want to give between 20 to 45 meg per cig. Generally, I give between about 35 to 45 mig per gig, and you can either give it orally if they're quite alert, or I crush it, mix it with some water and give it as a recto enema, and then it will absorb quite quickly that way. And you can repeat that every eight hours. So that's something to get on board quite quickly if you do have these tremogenic cases. But similarly, we will do another, another pod that focuses on seizure management in general, but then you go into your sort of anti-seizure, anti-apileptic medications as well. If you need something to chill them out, then you'd be reaching for your benzodiazepines like your diazepam or your midazolam. You might be reaching for phenobarbital in your in your really seizuring cases, you might be reaching for propofol CRIs. So there's lots and lots of options in terms of meds to stop them seizuring, and we'll go into those in more detail in a seizure episode that we're going to do. But it's just to say from the get-go, these patients, if they've induced a toxin that will affect their nervous system, they can become tremogenic, they can seizure. So it's dealing with the emergency situation first and then going from there. But in terms of more general toxin management, obviously, when we think about toxicity, one of the big things that we're going to see all the time is vomiting. So if something's eaten something that really disagrees with them, it's it's going to make them sick a lot of the time. So if a patient has started vomiting, in a way that's kind of good because they're they're sort of hopefully if there's anything still in their stomach, they've got rid of some of the stuff that's still left. But at the same time, once you know that they're out of that point and they're just feeling so nauseous and they're bringing up horrible watery bile, or you're worried about aspiration pneumonia, for example, in your brachies, then sort of stopping that vomiting can be really important. So again, that's where things like your Muropetum, metacopromide, and dancitron can come into play. So again, I sort of take that as initial stabilizations because sometimes they are feeling so sick that until you can calm down the sickness, you can't really make them feel much better.

SPEAKER_02 8:35

Yeah, and then never forget that when they vomit, it's your really good clue as to what if they've ingested a toxin, because they might, the owner might not think about it, but you you can ask them a little bit about it. And if they said, Oh yeah, there's some really funny thing in there, or you've obviously got things obvious things which you'd hope the owner would volunteer you, like medicine kind of packaging, things like that, and you go, Oh, yeah, there we are, there we've got our clue. But they might not have um looked at the vomit as well, it might be at home sitting there, and they that was just an incidental part of it. So, yeah, checking what's in the vomit because sometimes they will say, Oh, I think the dog might have eaten XYZ, but if then I point out that the first vomit was actually just food from four hours ago, you go, Well, maybe there's less idea, so yeah, it's a it's a clue.

SPEAKER_01 9:14

Yeah, 100%. One of the big things that I see, I don't know if you've ever had this, but I feel like it happens really often. So I see marijuana toxicities all the time. I don't know why, but I see them all the time. I've seen so many. And I think a lot of people that that smoke it or eat it in brownies or whatever, they'll get quite stoned and then go and go to the toilet, shall we say, outside in public somewhere. So on like some random public footpath. And dogs think it's really, really, really tasty. So I've had a lot of owners come in with a dog that I'm already expecting has marijuana toxicity for various reasons, and I'll but we'll go into those later. But when I've asked the owners if it's vomited, they went, yeah, and it stinks, it looked like poo. And I'm like, bingo, I know what it is. Because I think I find a lot of dogs, people have smoked it, eaten it, whatever. Part of the marijuana has obviously made its way through their system. They've left a little deposit somewhere. The dog's gone and found it, gone, that smells amazing, eating it, and then that's what's come back up in their vomit. So if you ever have someone that says, I think my dog vomited up poo, and it starts to have like a reduced mentation and is weighing everywhere, marijuana is always really high on my list. But there we go. So have you never had that?

SPEAKER_02 10:27

Never. No, but I've I've seen a thing in my history, but I haven't connected it with marijuana. So okay, I'm gonna look out for it now. Yeah, like it.

SPEAKER_01 10:35

But similarly, you might see chocolate wrappers in their vomit, you might see raisins, you could see, I don't know, like you say, medicine packaging, etc. There's loads of different things that you could see that would give you a bit of an idea as to what could have they could have eaten. A bit of plant matter if you think they've eaten a bit of a lily. So there's loads of stuff.

SPEAKER_02 10:51

Could I circle a little bit back to the the unstable thing? Because I think one of the things that's really tempting is if a patient's got altered mental state and they're wobbling around all over the place, it's really tempting to think they're really ill. But they they might not be. Just like, you know, I've got an altered mental state after six pints of beer, but I'm not unstable in the if I am physically unstable, if I'm not critically unstable. And it's a really important, I think it's really easy to kind of go, wow, can't they can barely put two feet in front of each other? Clearly, they need hospitalization and they're really poorly. But then actually, you do their vitals and their blood pressure and their colour and their temperature. And if everything's normal, depending on how ardently you want to do this, you might want to check a glucose. I don't know, you might want to do a 20-second ECG lead too, you know.

SPEAKER_01 11:40

But if everything on the physical parameters is good, I think of that as you can say unstable neurologically, but in terms of cardiovascular and respiratory symptoms, you can call them stable, yeah. I mean it you have to look at the dog as a whole or the cat as a whole picture, don't you? Um, and for example, like if you had both pupils are incredibly dilated, I'm gonna be like, it's probably the drugs. Whereas if you had one that was meiotic and one that was dilated, I'd be thinking maybe this isn't a toxin, maybe there's something else weird going on. So there's lots of different ways that you need to look at it. But yeah, it's a good point. R remember to look at the animal as a whole picture, because yes, the history might tell you something, but make sure you're checking for everything that you could be worried about, you know, check them over in terms of general vitals as well as the biggest thing that they're presenting with. Okay, cool. So we've got our general general stabilization done. Now we need to think about decontamination. It's the mainstay of most of your toxicity cases. It's eaten something toxic or it's come into contact with something toxic. You need to try and reduce that toxic load as much as you possibly can or try and collate that toxin as much as you possibly can. So there's lots of different ways that we can do that, but obviously the most common one for us to think of is emesis. So inducing vomiting. Now, obviously, in dogs it's a hell of a lot easier than in cats. So most of us will have some form of apomorphine in practice, whether that's emadog or what's the other one that's in the multidrug vials? The multidrug bottle. Yes, it's a kind of a trade now. Yeah, so there's there's like the multi-dose drug drug bottle that you can get, or there's the vials. I'm used to emadog, it's just what I'm used to using. But I think generally the biggest thing that I would say with apomorphine is remember it is in that opioid class, so you are gonna get some sedation from it. So warn people of that. And remember as well that if if there's any chance that they're not protecting their airway, then aspiration pneumonia is always something that you need to mention to owners, especially in things like your brachies. Um, one little tip I would give, I don't know if you do the same, but I never give a full dose of apomorphine, unless they're not always give a full dose.

SPEAKER_02 13:40

So you've got two different sides to it. Yeah, I know I remember you working with you once about that. Well, because I I'm giving it for a reason. I'm giving it because I'm suspicious that there might be things in the stomach. I don't I want to hold back amesis. And also, yeah. I don't tell me if I'm wrong, I haven't read this for 10, whatever years, but they on the apomorphine, um, on the Emma dog instructions, it says that you can't just give the extra because it starts antagonizing itself or something. So you could it's not something you could just top up willy-nilly.

SPEAKER_01 14:07

See, I've always I've always found so so generally in the data sheet it says give one mil per 10 kilo of dog, but I give half that. So if I have a 10 kilo dog, I give half a mil. And I say to the owners, because of the sedation effect, because that's what I worry about. I've seen so many get so sedated on it, and I don't want to have to reverse it. So I say I'm gonna start off with half a mil. If in 10 to 15 minutes it's still not vomited, then I'll top it up and give it the remainder. And I warn them it's not the full dose to start off with. But touch wood, I don't remember the last one that wasn't sick, but on that dose, and it means that they wake up a lot faster. I feel like I've got much lower risk of things like aspiration, pneumonia, and true sedation. So I just feel like it's safer. But obviously, if it was something like uh they've been rushed down and they've eaten loads of compost, I'm not gonna fanny around, I'm gonna get all of it out. So it depends how much of a worry you are. Whereas if they're like, Oh yeah, it's eating like three raisins, I'd say they give it half the dose. And if it's not sick, then I'll top it up. So um yeah, it depends, but it's an option for you.

SPEAKER_02 15:05

So I don't mind this. I think all animals should be sedated. I love it. I love a sedated animal, quieter, easier to do stuff to sedate them. Yeah, I've never had anything I've worried about, but then I don't know. It's that it's that specific warning that you're not meant to be able to kind of top it up afterwards. Yeah, I mean I've never had a lot of it.

SPEAKER_01 15:24

No, I top it up if I've ever if they've not vomited and it always seems to work for me. On that note as well, have you heard of these new clever eye drops? Have you heard or used them before?

SPEAKER_02 15:33

I've I have used it, I have used it now, yeah. Um I had my first case, I think, last week, and um it was a Cavalier King Charles or no Cavalier Spaniel. Do you know? I mean, they've got the ever so slightly um bulgy eyes, haven't they? So I gave the standard dose and it uh it was the she was sick once and that was it in 15, 20 minutes. So then I gave another drop drop into both eyes because Vivette Oswith pointed out that maybe a little bit of a a runoff. And then she did a few more vomits.

SPEAKER_01 16:08

Yeah, so I quite I quite like them. Like for anybody that's not heard of them or used them before, they're they are literally an eye drop that you again you can only use them in dogs, but they're not apomorphine, they're a different drug. I can't remember what it's called, that's bad. Yeah. But basically, you give them a number of drops depending on the size of the dog, so it's got like a drop per kilo body weight. But the really lovely thing is is that one, if you give them the set amount of drops and they're not sick, you can repeat it to make sure that they are sick. But also the really lovely thing is you can use it alongside apomorphine. So say you've given something emadog, you know those cases where you're like, you really need to be sick. This is gonna make you so, so ill if you don't vomit this up, and they're not sick on the full dose of emadog, then usually they should vomit because then they've then got both on board. So that's something that's worth bearing in mind. And in terms of when you're making these animals vomit, Brendan, how long do you wait? How long are you waiting after potential toxin ingestion before you're making them sick? Or do you have a time as to how long you would make them sick up to?

SPEAKER_02 17:08

I see. Well, I know in a previous episode you've told me that, you know, it'd go longer than because normally I'm probably thinking four hours might be after that. I might be weighing it up depending on, you know, the significance of what they might have eaten. Um, but I think you've told me that you you've gone as late as six hours and still had stuff up.

SPEAKER_01 17:25

So Yeah, yeah. I mean, I I routinely will do between four and six hours up to for raisins and grapes. I tend to do a bit longer because there's some evidence out there that says that they slow gut transit time, in which case you potentially can get them up even hours after that. So for raisins and grapes. That's that, yeah, isn't it? Yeah, I think potentially if I was really worried about a toxicity, then potentially I'd I'd do it up to 12 hours, but just warn the owners that obviously the longer it's been in there, the less likely it is to come up because you cover your ass then. But even if you can halve the toxic load by getting half of it out, then you're doing an amazing job. So it's better than nothing. Um so yeah, it's just worth bearing in mind.

SPEAKER_02 18:05

Yes, the clever eye drops are going to become the fave because you don't have to stab them. Well, it's usually quite easy to get an eye. Well, it's not always, is it, but it's nice to have the extra option, isn't it, for the eye drops. Actually, I forg I I've I used it. I can't recall. Once you use a is it a single use dropper and then you chuck it away? I've I've forgotten what I used, like a little vial.

SPEAKER_01 18:25

I think so. Yeah, I think they they they're like a little minim, aren't they? I think like your proxy net and things like that. So then you use it for that patient and then you throw it away. So but yeah, they're pretty good. And I think off the top of my head, they're a bit cheaper than your apomorphine as well. I think.

SPEAKER_02 18:38

So Yeah, I thought so as well.

SPEAKER_01 18:40

Which is quite nice. Yeah. Okay, so that's making dogs vomit. What about cats? So say you know a cat has eaten a really long bit of string or something like that that you know it's just eaten, and you think, or maybe I want to try and get it up, or you think it's eating lilies, or whatever, for whatever reason you think I want what's in its stomach to come back up. What do you do? What do you give? So it's one of these horrible things that you feel like nothing you give it is gonna work. Now, loads of papers will talk about xylosine, metatomidine, dexmedatomidine, but what do you use in GP World, Brendan, if you're trying to make a cat vomit?

SPEAKER_02 19:16

Well, you don't normally have xylosine or rhompen as the trade name used to be. Um but the odd clinic has it, don't they? If they don't have it, then I'll just use regular metatomidine. And I I just go low dose, like obviously, because if you give them too much, they fall asleep. So you give them a low dose. And I I tend to give it subcut because I want to kind of slow. I think the nausea, there's this there's a bit where they're nauseous and they might be sick, and then eventually they'll go into sedation. And if I want to increase the time between feeling nauseous and being asleep, I I want to slow the absorption. So I'll go subcut, low dose, and then keep them in the you keep them in the carrier and do a bit of spinning at the right. As soon as they're looking a bit nauseous, you can give them a little bit of spin if you need to on a on a wheelie spin chair in their cat carrier. Yeah.

SPEAKER_01 19:59

Well, see, this is this is something that I wanted to bring up because I had a case a couple of months ago where there was a cat travelling to the clinic who'd eaten loads of lilies, like quite a lot of lily, and they only didn't have any money. Like they told us that before they came to the clinic, and I was working out of hours at that point, and I thought, oh my god, like this cat is gonna get so ill, she knows it's eaten loads of it. And I was like, Well, they're not gonna have the money to be able to hospitalize it and do bloods and all that sort of stuff. So the biggest thing for me is one, decontaminate the fur and everything, but also make it sick. And I was like, I desperately need to make sure that this cat is sick. And I've had quite a few where I've given them an injection and it's just not done anything, it's just sedated them. So for me in that case, I was like, I hate doing it, but I will probably spin that cat because I want it to be sick, because the the risk of it not being sick in that case for me outweighed the sort of welfare issue of spinning them. But I think there's now a massive movement to say, never do it, it's wrong, don't ever do it. But I think it's case-by-case basis, isn't it? Like it's it's I know it's not gonna be nice for the cat. I know it's not high welfare, but equally, if that cat could die by not removing the toxin that it's eaten, then how is spinning it low welfare? Do you see what I mean? It's I think you've I take it into that there's probably gonna be a lot of nurse nurses that are screaming at us now on the podcast, thinking, no, don't ever do it. But um, yeah, I mean, uh so it sounds like you do it still every now and again, do you?

SPEAKER_02 21:27

Yeah, well, any kind of amesis is horrible, isn't it? Because you literally make them feel sick and be sick. And I'm I had the other thing is they're starting to feel nauseous, you get something really smelly like some mackerel or tinned fish or whatever. But I'm putting us let me make them smell it and stuff like that to try and help them just be extra sick. Yeah, yeah, yeah. So I mean I to be honest, how often does it happen? Not not massively. No, not often. So, you know, I'm not thinking of a huge number of cases, but uh yeah, but when when you do need to do it, it's saving you a huge amount of stress having to then deal with the not having to deal with the toxicity in quite the same way. So yeah I think it's a good it's a good thing.

SPEAKER_01 22:02

Yeah. So if anybody does have any very strong opinions on it though and feels completely opposite to us, then you know it's it's worth discussing because I think there are a lot of people that would go, no, I would never do it, it's an awful thing to do. So yeah, but I think you know, sometimes for me the risk outweighs the the worry about it. So in terms of doses for medication in terms of making cats sick, um, xylosine, so Merc VAT manual generally suggests about 0.4 to 0.5 MIG per kig of xylosine. If you're thinking dexmedatomidine, then you might be thinking six to eighteen micrograms per kilo. If you're thinking metatomidine, which is what most of us are gonna have in practice, then it's suggested between 10 to 40 micrograms per kilo. But they say that potentially 20 is the most effective. But again, you know, every everyone's different. I think do whatever you're comfortable with, warn the owners that there's going to be some sedation that comes with it. And just go with what you're comfortable with. You can always top it off potentially if you feel like you want to. And remember, you can always reverse it. So to be honest, I may be a little bit different to you, Brendan, in that I might go a slightly higher dose to start off with, but then I just reverse it quicker. But it depends. It depends how worried I am and how much I want to make it sick.

SPEAKER_02 23:10

So yeah, I go five to ten uh mics per kilo for my metatomidine doses. But uh I say a handful of cases, so but yeah, I think I might said in the euthanasia um topic we did actually, I used to use um low dose of metatomidine for my euthanasias, but I used to be sick a lot and my cats. And then I noticed that the vet I worked with, she used to use the chart dose, which is silly high, 40 or whatever mics, I don't know what it is. Chart dose is super high. And she said because she said to me really casually, oh no, I never get that. And then I realised she uses the chart dose, which was a higher dose. Yeah, so that's why I switched to the higher dose for euthanasias, and this is where I am, where I am for inducing amesis, I suppose. Whatever works in your hands, yeah.

SPEAKER_01 23:53

Yeah, exactly. Okay, so we've spoken about the ones that you would really want to make vomit, but remember there are always going to be those ones that you desperately do not want to make them vomit. If you are suspicious that they've eaten something caustic and you think it's gonna cause more esophagia or oral injury by trying to bring it back up, do not make them sick again. If there are animals that cannot maintain their airway, so they're struggling to breathe, they're actively seizuring, they're collapsed. Do not make those ones sick, because you're gonna get yourself into a whole nother world of trouble if you do. So don't make those. If you think they've ingested something sharp, don't make them sick. So, you know, use a bit of common sense. So don't just think, oh, we could have been something toxic.

SPEAKER_02 24:36

That's yeah, just be within it. Don't make them sick up a chicken carcass.

unknown 24:40

Yeah.

SPEAKER_02 24:40

What's the other one? Um, what about I think what um washing uh washing capsules? What's called the washing machine, washing capsules. Yeah, they're another one which could aspirate and foam, so you don't want to create vomiting, is that right?

SPEAKER_01 24:53

Yeah, exactly. Yeah, and to be honest, it's it's a caustic substance anyway, isn't it? I think in high doses like that, it's an alkali, so you don't want to use it. So I think um, but yeah, just just be very, very careful. So just remember to think, okay, what could they have eaten? Is it going to cause more damage coming back up than it would stay in the stomach? In which case, if your answer is yes, don't make them sick. So just be super careful. Um, when we talk about decontamination, obviously uh emesis is the top of our list, but when we've sort of crossed off emesis or we've stopped making them sick if they've already been vomiting, we then need to think about the animal, it's the whole animal. So it if you're talking about decontamination, always remember the coat and the mouth. So one of the really classic things we see is either the dog that's eating rodenticide and it's got rat bait all in its mouth. Have you ever seen it where they've got like the the blue stuff? So I've had loads of them where they've got loads of it all stuck in their teeth where they've just eaten it. Because it's like a yeah, it's like a pasty thing, but yeah, but remember it's uh it's nearly always bright blue or bright red. So if you see like a red or blue pasty thing in their mouth, like wash that mouth out like crazy. Obviously, be careful, you don't drown them, but just yeah, wash that mouth out. And I guess the other one is if you've got a cat that's uh come into contact with lilies, if they have pollen all over them, clip and wash that cat. Like, I don't care if it's bald, get the pollen off. So, yeah, because obviously otherwise they're just gonna groom themselves and keep intoxicating themselves, so just be super careful. So remember the whole body.

SPEAKER_02 26:20

Well, do you know what the lilies that always stains them, doesn't it? So you always get a bit of a stain. I don't know. You do you clip away that stained fur? Sometimes they're white cats, yeah. Sometimes I'll get to the point where I think, well, I think I've got it off, it's just stained now. But um, you can you clip it off as well.

SPEAKER_01 26:35

Yeah, normally I'll I'll clip all the fur so that I get everything that could look like it's got any pollen on it, clip it all, and then I normally wash it for good measure afterwards. They hate it because they're cats and they hate water. But yes, so I normally wash them anyway just in case. Um yeah, I do not want that pollen to go back into them. Yeah.

SPEAKER_02 26:53

I would say that um there's toxicities that don't worry me as much, but Lily's does because I think we used to always have them in two, three days on IV fluids in general practice where I used to work, and I'd before and after creastinine test them, and they'd they'd so often go up 20-30 on their creastinine. They might still be in the normal range, but they'd go up. Maybe that's because I wasn't clipping their stained or fur off their face, I don't know. But um, it's one I take seriously because it's it's a small amount, isn't it? But I think it warrants it warrants attention. Yeah.

SPEAKER_01 27:23

Yeah. Okay, and uh we spoke about in terms of decontamination, we spoke about those dogs that you might not want to induce emesis because most of the time because they're you know they're seizuring or they're trembling or and you know that they can't control their airway. But there is something else that you can do in those ones where you think this toxin is severe, like it's either going to kill this dog or make it really, really sick if we don't get it out, you can consider gastric lavage. Now, I've only ever done it once and I did not enjoy it at all because it's actually way more difficult, I think, than it sounds to us in to do properly and to get all the stuff out. But so if for example, you've got I did it for a dog that's suspected to be vegan slug bait, so the owner saw it eat slug bait in the garden and I wanted to get it up before it caused a proper metaldehyde problem. So basically I anaesthetized it because it it wasn't being sick properly on apomorphine. I just couldn't make it sick. I don't know why this dog was like so anxious, it was whatever I gave it, it was like, nope, thank you. So I ended up going doing gastric devage to get it all out. The other reasons they say that you could do it is if a dog is eaten something that you think is concreted in its stomach. So for example, if it's made like a really solid mass of something, or if you've got like a bezoa, you know, you know, like if a dog is eating a load of chewing gum, yeah, bezoa, that's it. If your dog is eating a load of chewing gum and it's all clumped together and you're worried about it causing a foreign body or continuing to release lilatil, etc., then at those points, yes, you can consider gastric lavage, but it's not very easy.

SPEAKER_02 28:51

It's like but yeah, you're not gonna get anything wider than the tube up, are you?

SPEAKER_01 28:56

No, but I think the principle is that it potentially tries to break down whatever's in the stomach to try and get it up in small pieces, potentially. So you'd sort of you'd anaesthetise them, put the ET tube in, cuff the ET tube. Sometimes they even pack out the back of the mouth as well to reduce the risk of aspiration, and then pop a tube down or an orogastric tube down, as if you were stomach tubing for a GDV or something. And then you sort of, so sometimes you can elevate the head. Um, you have it's normally a two-person job at least, and then you have one hand on the end of the tube, one hand on like a funnel with a uh jug of water, and you pour in warm water, don't use cold, warm water, sluice them around a little bit, and then you try and get it back out again. But the difficulties is sometimes it just doesn't want to come back, so you end up doing that horrible thing, you know, like when we're all in equine EMS, where you have to like try and suck it, which is disgusting. And if it's a toxin, please don't do that. But it's that's what I find really difficult, is getting it back out again can be really tricky. But for those ones where you're you know it's gonna get really sick, it's worth remembering that you could do it. Um again, the ones where you've got something sharp, something caustic, or it's not stable enough to have a GA, you can't consider it anyway. But it's worth bearing in mind.

SPEAKER_02 30:09

I know a lot of clinics in America have a little pump that you can put on to do that. But I really I had a yeah, I asked a few people in this country and no one seemed to to know how you that that was a something you could buy here. So if someone does know about it, then message us. But it's definitely available.

SPEAKER_01 30:25

I have wondered if you could get like a connection for a suction. You know, like the suction machines we use in surgery. I wonder if there's like a connection you can get to be able to pump it back out again, or whether it had put too much pressure on the esophagus or the stomach. I don't know, but it's worth bearing in mind.

SPEAKER_02 30:39

Yeah, did you sometimes get someone squeezing the stomach as well to help?

SPEAKER_01 30:42

Yeah, so normally I'll like and I roll them side to side all like belot their abdomen to try and move everything around, you know.

SPEAKER_02 30:49

Because once it starts, then it will just come, won't it?

SPEAKER_01 30:51

Yeah.

SPEAKER_02 30:52

Then then you're on the colour.

SPEAKER_01 30:52

Yeah, usually on. Perfect. And then so we've spoken about sort of trying to get rid of the toxin in itself, but in those cases where you can't get rid of it, there's other ways that you can think about decontamination. So we all know about activator charcoal, it's something that's that's very prevalent in practice. We use it all the time, and most of the time, most people have carbidote, which is I guess the the version that a lot of people have on the shelf. So you can get either that liquid version or you have the syringe ones now to sort of prime and repeat. I think the liquid they suggest five mil per kilo as the dose. Now, what I would say is that I never remember there's so many toxins, and I never remember which one you use charcoal for and which one you don't, but there's a little handy thing on their website. So I think it's is it Domes Pharma, the people that make carbidote? I think it is. Basically, if you go onto their website, there's a vet section and it's got like a handy guidelines or how-to or infographics or something, I can't remember what it's called, but if you click on it, there's a carbidote section and there is literally a poster that says, use it for these, repeat dose it in these because that toxin's got enterohepatic circulation. Don't bother using it in these, it's really good. So if you're ever unsure, click on that um graphic. I'll try and find it and see if I can. I don't know, are we allowed to put it in the pocket?

SPEAKER_02 32:07

I've downloaded it on well, I've downloaded it onto my phone, so it's pretty available, isn't it?

SPEAKER_01 32:14

Yeah, it's publicly available. So I'll see if I can put a link to it in the show notes because it would be really useful.

SPEAKER_02 32:19

Am I right in saying, you know, when they brought out the activated charcoal with the prime, uh I know it's all everyone's a bit controversial because it's more expensive, but that was one of the first times we actually had a proprietary cathartic as well, wasn't it? Because the prime's got the cathartic, which kind of rushes things through the other way better, um, which makes a lot of sense for certain toxicities.

SPEAKER_01 32:42

Yeah, definitely.

SPEAKER_02 32:43

Whereas the but obviously you wouldn't want to do it too much and then get a patient with extra fluid loss looks up, especially if if that was an causing additional risk to them.

SPEAKER_01 32:52

Yeah, exactly. And I I think the big thing that puts me off using those syringes in big dogs is the cost because you have to use like multiple prime and multiple repeat syringes and it gets really expensive. Whereas just using high doses of the liquid is much cheaper. So I don't know, use whatever you've got. Like if you some practices will probably only have one or the other, in which case just use whatever you've got. Okay, so we've gone through emesis and clipping the fur and everything and activated charcoal in terms of decontamination. But there's one more type of decontamination which we have in our arsenal that I think a lot of I get the impression that a lot of general practice vets are actually a bit scared to use, intralipid. So I I never used it until I went into emergency work, but now I use it really quite often, and for some cases it's a lifesaver. Like it honestly, it's amazing. When you when you really need it in a really sick toxicity case, it does wonders. But for those of you that have either never used it before or don't know what it is, intra-lipid is literally like liquid fat that you put IV pretty much. It looks like propofol, but it's in a fluid bag, and it works by providing a lipid sink for lipophilic toxins. So for fat-loving toxins, it it works. It's it sort of like collates that toxin if you like. It works as a lipid sink. Um, apparently, it's also meant to help promote cardiac performance as well by providing myocytes with an energy substrate, apparently, and it's supposed to increase the intracellular calcium concentration, apparently, which is supposed to make myocardial contractility a bit better, potentially. But the main thing is to say that it's a lipid sink. So for any toxins that are lipophilic, and again, I Google it every time because I always forget which ones are lipophilic. But if you have a toxin that is making an animal really, really sick, and you know that it loves fat, so it's a lipophilic toxin, intralipid is something you can use. So that's worth bearing in mind.

SPEAKER_02 34:47

Yeah, what what are the toxicities? Because I know people tend to like it for tremorogenic mycotoxin, I believe.

SPEAKER_01 34:53

Mm-hmm. Yeah.

SPEAKER_02 34:54

Which I'm I think they're really hard to decide if it's helped because they do get better as well.

SPEAKER_01 34:59

Yeah.

SPEAKER_02 35:00

So you know, there's times where I've not ended up doing it, and the nurses thought I did do it because the owner kind of said, Oh no, the extra cost. And then the nurse has gone, they're looking so much better. And you're like, No, didn't have it in the end.

SPEAKER_01 35:10

Yeah.

SPEAKER_02 35:11

So it's quite hard to know when it helps, but yeah.

SPEAKER_01 35:14

Yeah. So for me, I d I generally use it for marijuana. Um, if if they're sick. Like sometimes you get a little bit and you're like, Oh, you've had it, you're a bit stoned, but you're fine. Whereas I've had some that have been really quite sick that I've hospitalized. So marijuana sometimes I do. Um, and my tremogenic ones, I nearly always do. Um, but to be honest, most of the tremogenic ones that I see are really, really sick. So yeah, it's it's not benign, like it can cause a lot of problems. You can cause fat embolism, you can cause pancreatitis. So in a schnauzer, I'd be really, really worried about using it, so be careful. In it can cause corneal clouding, potentially cause coagulopathy. So it is not benign. But ultimately, if you've got a dog that is dying of a toxicity and you know it's it's likely had a lipophilic toxin, sometimes I'm just like the the benefits outweigh the risks for me. But that's worth mentioning is it will bind any drug that is lipophilic. So loads of the drugs you've already given to try and make that dog feel better or that cat feel better. If they are lipophilic, it will also bind them. And that includes moropitin, metaclopromide, apomorphine, benzodiazepines, propofol, all of those drugs that you're going to use to stop it being sick, to stop it seizuring. All of those kind of drugs that are lipophilic potentially could get bound by your by your intralipid as well. So be super, super careful because sometimes you might be thinking that you're giving intralipid to try and bind the toxin and make them feel better. But ultimately, if it's not a lipophilic toxin and you've got it wrong and you just bind up all your seizure drugs and it starts seizuring again, you're a little bit buggered. So just be careful. So have you found that, or has it generally always been in cases where you've got known toxicity that you've used it in?

SPEAKER_02 36:56

It's gone without worry for me. Uh the other thing to mention is we give it through a peripheral vein often, is that I think, is that what you're doing as well?

SPEAKER_01 37:04

Yeah, yeah, yeah.

SPEAKER_02 37:05

So Yeah, it's not not needing a central line.

SPEAKER_01 37:07

No, no, no, no. So generally I just give it through a normal IV. Um, if I was, if I had the time to think about it and really would, then I'd probably have a separate IV for other stuff and for normal fluids and a separate IV for your intralipid. But generally, how I make it up is if you've got usually they're a 20% solution. Um, and how you'd usually do use it is you give 1.5 millilitres per kilo, so one and a half mil per kilo over five to 15 minutes initially. So sort of a fairly big amount quite quickly over about 15 minutes, and then you change it to a CRI. So you change it to 0.25, so a quarter of a millilitre per kilo per minute for up to about 30 to 60 minutes. Um, in theory, the manual says that you can use it for up to 24 hours, but I'd never use it for that long because I think the risk is so massive. And to be honest, for me, whenever I've used it in a case that is a lipophilic toxin, you start to notice an improvement fairly quickly. So I think you would know whether your intralipid is going to work and whether it's worth continuing with. But every now and again I've used it, they've got a bit better, and then the patient's declined again four hours later or so. So I might give another bolus or I might restart the CRI for another 30 to 60 minutes or something like that. Um, but yeah, so you so use it, but just use it with care is what I'd say.

SPEAKER_02 38:27

Yeah, I you know, just to add, I just I do remember someone telling me how they their tremogenic mycotoxin cases, they would often this sounds terrible now. Um, but they they used to euthanise them if the owners couldn't afford hospitalisation and intralipid and etc. And I think, but it's really important to say that even without intralipid, those cases on my hands will get better. Now, some the worst ones will take three days to get better, but um a lot of them will be better within 12 hours or better enough within 12 hours, and a calm, chilled-out environment, because I do think they're quite hyper-reactive, is really part of it too. Um, so just don't get too kind of um, you know, into that mindset that this is the treatment. If we can't give the treatment, well, that's it, they're a goner, because um it might speed the resolution, but it it's not massively, yeah. It can you can see some really big changes actually, don't get me wrong. But um, but yeah, it's not essential if yeah, if the patient's otherwise got good physical parameters.

SPEAKER_01 39:25

Yeah, yeah. I mean, I think you must have you must have nicer mycotoxin cases than I do because my tremogenic ones are always awful, but I think it's because they get left.

SPEAKER_02 39:34

Awful in what regard? As in their like Do they get really hypothermic? Or are they going on to the edge of seizures and all of this stuff?

SPEAKER_01 39:42

Yeah, edge of seizures, edge of SERS, like loads of different stuff that happens because I think they're just left way too long, or they've eaten such a massive amount of it that they're really, really, really sick. So we've talked about general stabilization and decontamination, but other things that you always want to consider with any toxicity case is if you're looking at an ulcerating or a caustic agent, then such as like NSAID overdoses, then you might want to consider antacid, camerazole, that sort of stuff potentially. If you're looking at toxins that are going to affect the liver, you might want to consider hepatoprotectants, depending on the type of toxin. So, like your SAME, silibelin, uh sideoxicolic acid, etc., you can always think about those. Think about are there any reversal agents that you can give? So, if, for example, we've given a massive overdose of edatomidine, then obviously it's reversible. So great. If you've given an overdose of opioids, you can use an aloxone. So just think about those possible reversal agents we can use. And also think about if there's any specific antidotes. So it's few and far between the antidotes that we've got for specific toxins. But the big one that springs to mind for me is if you've got an ethylene glycol, we know alcohol works, so or ethanol works in terms of the colour.

SPEAKER_02 40:52

It's not an is it strictly an antidote? I don't know.

SPEAKER_01 40:55

Well, it's like a collating agent, isn't it? But in theory, it's the thing that's going to fix it. Um, the other thing to mention here as well, who I don't know about you, but I use all the time. So if someone calls up and they says, My dog or cat has eaten this, is it toxic? If you're like, no, it is. Get them to call the Animal Poison Line. So there is a company called the Animal Poison Line. It's like a branch of VPIS. And they are on 24 hours a day and they are for custom like clients. They're for dog owners and cat owners. And I think it costs about 40 quid or something, between 35 and 45 quid, something like that. The owners could call them and say, my dog or cat has eaten this much of this within this time. Do I need to go and see a vet? And if they do, then what you can then do is when they get to you, you call the VPIS and they will give you the veterinary rundown of what you should do. You know, how much have they had, how toxic is it, what side effects are you likely to see, what clinical signs should you expect, what medications do they want you to give? What's their prognosis like? They will they're amazing. They will give you so much information, but it is a paid service, but a lot of corporates will they pay into like the membership, don't they? So you can then call them. So yeah, have a little look. But remember, VPIS and animal poison line can be like your lifesaver sometimes, so it's worth bearing in mind. Okie dokie, so we've gone through basics of toxin management, and I know it's a bit broad because you never quite know how they're gonna present. You know, some of them walk in waggy tails and they're like, I've got a belly full of chocolate, and other times they're seizuring and nearly dying because they've eaten something horrendous. So, but because we've got lovely Easter coming up, and you've probably got some really nice time off, haven't you? But I'm working every day. So it's for those of you that are in the same boat as me and going to be seeing the craziness of Easter Bank holiday, um, we thought we'd go over some of the really common things that you might see. So your big hitters are going to obviously be chocolate, grapes, raisins, sultanas, your hot crossbuns things this time of year, daffodils, and we'll touch on lilies as well, just because people tend to get flowers this time of year. So um, okay, so chocolate. If you've got a naughty dog that's eaten loads of chocolate, obviously theobromine is the thing that we're really worried about. Generally, it's dose dependent. So if they eat a bit of it, then you can get mild toxicity, as in gastrointestinal effects, vomiting, diarrhea. If it becomes a much higher dose, then you can get lead to hyperexcitability, tachycardia, arrhythmias, agitation, and eventually to neuroscience, ataxia, tremors, seizures, possibly death, but they'd have to eat a fair amount to be able to get to that point. Um, usually it will take something like six, six hours onwards is when you expect to start seeing symptoms, isn't it? I think.

SPEAKER_02 43:36

Well, so well, the really bad cases will vomit the chocolate up, won't they, within an hour when they've had a really high ingestion. Do you find that? And it's kind of like it's kind of fixing itself. I I find it's very um linear as well, because I think when I first started, I thought, oh my god, a arrhythmias and neurological signs and seizures. But it it's quite linear in that they start off with a bit of vomiting and diarrhea, and if the dose is higher. It will they'll get the vomiting diarrhea plus the tachycardia. And then if if the dose is higher than that, then they might get arrhythmias and then they might get seizures. It's like a linear scale. So you don't have to worry if you've not got the vomiting diarrhea, it's not likely that they're going to go straight to seizures and arrhythmia.

SPEAKER_01 44:15

No, no, no. Exactly.

SPEAKER_02 44:16

So yeah, same, same experience for you.

SPEAKER_01 44:18

Yeah, definitely. And it remember it's all about the three of the bromine content as well. So your white chocolate, you don't really have to worry. Milk chocolate, we're a bit more worried about. Dark chocolate, we're really worried about. So it it depends how much and how big. Yeah. Yeah, it depends how big the dog is and how much they've eaten. Another top tip as well is like your VPIS. Uh Brendan and I have both worked for VetsNow in the past, and there's that handy Vets Now chocolate calculator that you can use and it's accessible to anyone online. So just type in Vets Now chocolate calculator and you can literally type in size of dog, how much chocolate they've eaten, and it will give you green, like, no, it's fine, they don't need to see a vet. Moderate, they might need to see a vet. And red is in, yes, definitely needs to see a vet. Generally, I'll do that while the owner's on the phone and say, you know, if it's orange, I would recommend that you come in and we make them sick. If it's red, you definitely need to come in and we make them sick. So you've got that as your option as well. Yes. So is that what you do?

SPEAKER_02 45:11

It's yeah, a little bit. And sometimes it's contextual in that. But let's say, I don't know, the owner wants to have a nice night's sleep and they've eaten what isn't a terrible dose of chocolate, but it might just be a bit of peace of mind, make the dog sick, and less late to get an up to it tummy at three in the morning. And if they can come in at a time that suits them, have the amesis, that might work better for them. So yeah, sometimes a little bit of a chat as well.

SPEAKER_01 45:35

Yeah, exactly. And then if you do get them in to make them sick, obviously induce amesis, try and get as much up as you can. It undergoes that enterohepatic circulation, so you want to continue to give activated charcoal one repeats. So I think they suggest a dose every six hours for a full 24 hours, ideally. If you have a case that's already hit hyperexcitability, tachycardia, tremors, etc., then obviously you're probably going to want to hospitalise those patients. To be honest, I'd still induce amesis unless they're extremely neurological because you still want to get the toxin out of their system. You don't want it to get worse. But if they're extremely neurological and you're worried about airway, then obviously be careful. And if you are going to put them on fluids, remember you don't need to flush their kidneys through, just support their body with fluid therapy. But the one thing I would say about chocolate is apparently that it says in the BSVA ECC book that the methylxanthines, I struggle to say that word, um, they're reabsorbed back through through the bladder from the urine. So basically, if you are hospitalizing them, try and get them gone out at least every couple of hours for a wee because basically every time they urinate, they're going to get rid of some of that toxin again. You don't want it to keep getting reabsorbed through the bladder. So that's something else to bear in mind. But I think I don't see that many of them that get that sick, to be fair.

SPEAKER_02 46:50

I've heard that about the caffeine. I didn't know that about the methylxanthin, so that's good to know. But oh yeah, I agree. I've seen so many, but yeah, and most of them have have got to the tachycardia vomiting diarrhea, but not further than that. Is that your typical ratio?

SPEAKER_01 47:05

Yeah. I think the only d reason that I could see that it would happen is if they've eaten loads of it overnight and it's been like, I don't know, eight, nine hours because the person's been in bed and then has woken up and they're really, really unwell the next morning. So, but I don't think it happens very often. They'd have to eat a lot. Heeps and raisins and sultanas. I mean, we had a bit of a rant about this before, didn't we? But in our, I think it was our first episode actually, wasn't it, that we spoke about it. Uh wow. Basically, big thing to remember with these guys is that we think it's tartaric acid that's the thing that causes issues. The majority of the time it's obviously acute kidney injury that we're worried about. And it's only really an issue with dogs. We don't really see it in cats that much. They don't tend to get symptoms until about 24 to 72 hours after ingestion. And to be honest, if they are going to get symptoms, usually it's vomiting first and then they'd start to develop PEPD. When you look in VPIS's guidance, it will say make them sick, even if they're completely well, take blood and put them on high rates of fluids for two to three days. I think all we would say is just think about why you're doing it. If you can't give a solid reason as to why you think that's helpful, flushing through the kidneys is not a good answer because it doesn't work. There's basically there's no evidence to say that high rates of fluids in these cases will prevent them from getting an AKI. And actually, it might even make things worse because you're causing, you could cause renal edema in these patients. If they are not normovolemic, then yes, fluids are something that you can consider. And if they do develop an AKI, then yes, absolutely, fluid therapy is the thing you need to be thinking about. But to be honest, in patients that are well and I've made them vomit and I've got the majority of raisins or grapes up, I will always offer it to owners, but say, to be honest, if I were you, I'm not sure that it's something that I would say you desperately have to do, but it's up to you. I can't guarantee that it's not going to help. And then generally, if you want to be really good, then take blood sample on day one just to get your baseline. And then ideally, if the owners are keen every 24 to 48 hours, then repeat those bloods to check your urea and creatinine and obviously come back sooner if they start to develop clinical signs. Um and I I send them home with charcoal, but I think again there's that question as to whether they need to be sent home with charcoal or not, because we don't quite know what the toxin is. Um is that is that kind of what you do?

SPEAKER_02 49:24

Yeah, same kind of thing, exactly. I might let off off the cuff kind of go, well, if you're really worried, you can come back in for a blood test, you know, due 24, 48 hours. And if there's any progression in the, you know, we do a baseline now if you like, but most people don't even do that. Uh but normally if I feel like I've made the dog sick, it's sicked up what the owner perceived to be the amount that the dog's eaten. And sometimes they come up almost whole, don't they?

SPEAKER_01 49:48

Yeah.

SPEAKER_02 49:48

Yeah. I suppose it depends on the situation. If it's, I don't know, if uh you can envisage a very small dog with existing kidney disease that with an unknown amount of uh ingestion, you might maybe you're gonna be more careful.

SPEAKER_01 50:01

Yeah.

SPEAKER_02 50:01

But yeah, for the health that very healthy dog where you think you've got it all up in the amesis. Yeah, I wouldn't be encouraging them. Uh, it's a good example of when not to get a VPIS report, probably, because then you've Because to be fair to people, if you've got that VPIS report telling you that, it's gonna be really hard to go against it, isn't it?

SPEAKER_01 50:17

Yeah, it's and to be honest, when I do to have the discussion with clients, I actually tell them the Veterinary Poisons Information Service still tells us to do this, but there is no evidence that says that that is still the right thing to do. It's just there's no evidence that says otherwise. Does that make sense? I just think that realistically the thinking now is moving towards it doesn't make enough of a difference to warrant it. And that's it.

SPEAKER_02 50:38

And it can be harmful remembering because giving a patient more fluid, the renal edema, that capsule around the kidney is really tight. So if you get any edema there, that's pressure is really going to collapse the renal tubules. And there's really good evidence, I think we touched on it in episode one, where that you're then you're then got higher mortality and higher AKI risk when you're just giving even quite quite relatively low amounts of IV fluids will lead to renal edema and an aggravate kidney injury.

SPEAKER_01 51:08

Yeah.

SPEAKER_02 51:08

So yeah, it's a big deal.

SPEAKER_01 51:10

Yeah, and plus you're going to obliterate their gly glycocalyx in the meantime as well and all their vessels, so it's not benign. So I think everyone thinks of fluids as something you just give and it's fine, but I think we need to move away from that thinking it's quite a benign thing because it's not. So just be careful. Um, the other thing that's worth thinking about as well is sometimes I know it's controversial, but sometimes they don't even make them sick, but it depends how much they've eaten. So there is now a lowest reported dose that's ever been reported to cause AKI in dogs. So for grapes, it's one gram per kilo, um, and for raisins, it's 2.8 grams per kilo. Now, say for example, I have a labrador that's eaten one grape, I will have the conversation with that owner and say, if you are convinced it's only had one grape, we are still well under the lowest reported dose to have ever caused AKI. I I will always say, I cannot tell you categorically that your dog is not going to get an AKI because it's not a hard and fast rule. But it is very unlikely that it probably will, in which case, if you desperately don't want to make it sick, I won't shout at you. But it just gives them that option. And for the ones that don't want to induce amesis, I offer them activated charcoal just in case.

SPEAKER_02 52:24

Yeah, charcoal's controversial, I know, because I know when I chat to the Americans, they are hostile to charcoal in these cases. Because if, for example, it triggers a, I guess, osmotic diet uh diarrhea or anyway, a diarrhea that's leading to fluid loss, then that might increase the risk of hypovolemia and then increase AKI. So it's not without issue, especially if you're doing you know the quite the because a lot of us vets don't quite do the dose that we're meant to on the activated charcoal. And if you do, then you are more late to run into diarrhea. So it's not an unreasonable issue. So and this is just it's really stressful for vets here, isn't it, when you're getting different different guidelines telling you different things.

SPEAKER_01 53:02

Okay, so we've spoken about the controversies of fluids in grapes and raisins, and we'll go on to daffodils in just a second, but just before we touch on it, lily toxicity is something we see all the time in cats. Just remember the entire plant, including the pollen, is extremely toxic in cats. I mean extremely. So I was reading up on the VPIS statistics for this podcast, and they said they've had cases of cats dying from having contact with a box that contained lilies that was like a letterbox-delivered box, just because they came into contact with the pollen that was stuck on the box. So it is extremely toxic. Do not think that it's not. Just I think certain varieties or species of lilies aren't that toxic, but the majority of your standard ones will be. So if you have a cat that's suspected to have eaten lilies, like we said earlier, clip the buggery out of it, clean it, make sure it's got no evidence of pollen all over its body and on its fur, its pores, etc. Try and induce a mesis if you can. And to be honest, for these guys, I probably would put them on fluids because I would be so worried about their kidneys, but I wouldn't be flushing them. I'd be doing it at like a one, one and a half times maintenance, depending on what their kidney values are like on admission and also whether they're normovolemic or not. Because, and I think part of the reason why I'm hospitalising them isn't necessarily even for the fluid therapy to start off with, it's to monitor them because that AKI can happen quite quickly, in which case I want to keep an eye on its urea and creatinine and make sure it's continuing to produce urine.

SPEAKER_02 54:38

So I'm I'm 100% behind everything you just said then. Um it's really important because I've had few people admitting cats that have eaten lilies from the garden. This is the cut flower lilies that come in bouquets. Uh it's not lilies that grow in your garden in the UK. So I think that's a really important because they are a completely different family. Is that what you've heard as well?

SPEAKER_01 54:58

Yeah, to be honest, if I'm ever unsure, I always check. So I get the owner, if I'm ever unsure, I try and get them to take a picture of it. Or sometimes, if they're keen gardeners, they'll know the species anyway, in which case either call VPIS or get the owner to call Animal Poisons Line, or just Google the species of lily because some of them aren't that toxic. Okay, and then moving on from lilies to something that's obviously very seasonal. So your daffodils, so this time of year around Easter, we're gonna get a lot of people having daffodils in their house. And for me, it's typically always puppies because they're like sniffing around and grabbing whatever they can and pulling them out of the garden and stuff like that. So, um, similar to lilies, all parts of the daffodil plant are toxic, particularly the bulbs. So if you've got dogs that have been digging them up and you can't find the bulbs, I'd be more worried. But the flower stems, leaves, and the bulbs are all technically toxic. It's an alkaloid within the daffodil that causes the toxin, and you can get intense vomiting, you can get calcium oxidate crystals that irritate the mouth and the throat. Ingestion can lead to really severe GI upset, and sometimes you can get more serious systemic issues like heart arrhythmias or seizures. But to be honest, I think they'd have to eat a fair bit to cause that sort of thing. The majority of the time it's going to be mild to moderate, so you might get a bit of vomiting, a bit of diarrhea, abdominal pain, excessive drooling, etc. So um, but I can't say I've ever had a severe daffodil toxicity. Can you? I don't think I've ever seen one. No, I don't think they're that common.

SPEAKER_02 56:25

Oh, yeah, I've had transient transient diarrhea and uh a bit of drooling. Um I think it's yeah, that's it. Be aware of it, I suppose.

SPEAKER_01 56:35

I think generally, first principles induce amesis, give charcoal. Maybe they talk about a single dose in daffodils. I'm not sure you need to repeat a dose them. If they're unwell and you're hospitalizing them, then IVFT for rehydration if they've got diarrhea but not for flushing. So um, yeah, it's just something to bear in mind this time of year, but I don't think it's something that's really severe that we need to worry about. Moving on from seasonal ones to common ones, which I see, and I think you probably see all the time. We've mentioned it quite a lot earlier in the episode, but I see absolutely stoned dogs all the time. I see dogs that have eaten marijuana. I probably see one a month at least. I see it all the time. So maybe it's where I live. I mean, generally, your typical presentation is they have a reduced mentation because they're stoned, they look really lethargic, they can be quite ataxic, or they look a bit collapsed because they just can't get up. And the classical thing that you will see is they will be urinary incontinent. They will be leaking urine everywhere. So, like the owner will be saying, Oh, they're just weeing all over the house, or they're laying in their own wee, or they stink of wee, like they stink of urine when they get to you. As soon as I have a collapsed dog that looks stove and it could have potentially eaten marijuana, I'm like, this is marijuana until proven otherwise. So, because they look quite classic when you see them. Often they can smell a bit like vomit when you go near their mouth because sometimes they have already been sick. But with these cases, generally, what you want to do is if they're not completely collapse or have a really severe mentation and reduced mentation, then ideally, again, emesis, activator charcoal, give repeated doses to these guys. They need that repeated dose. Ivy fluid therapy, supportive method. And to be honest, these guys I do give intralipids to, unless it's only mild. But the ones that are sort of sitting up and look over themselves, but they just look a bit stoned. I just say we just need to wait it out and just support them through it. But the ones that are really sick, then yeah, I will give intralipid too.

SPEAKER_02 58:30

Yeah, I I find do you find their vitals are pretty much often normal? I I do, I find their temperature, heart rate is is good, circulation good.

SPEAKER_01 58:38

Yeah, the only thing that I sometimes find is that they can be fairly bradycardic, but I think it's normally in the fit healthy dogs that have just got a low resting heart rate anyway, and it's just because they're so chilled out because nothing's bothered them. They're like woo in their own little fairyland. So I I quite often see like a heart rate of I don't know, 60 to 70 boots per minute, something like that in some of these dogs. And I don't think it's because it's causing a bradycardia. I think it's just chilled them out so much that their heart rate goes to its normal resting bradycardia rate when they're not stressed. But yeah, that they're quite funny when you see them, as long as they're not super sick.

SPEAKER_02 59:11

So yeah, rightly or wrongly I'd send most of mine home. But um, it's because I used to admit them all the time for the first two, three years, and then um I actually got a little bit like, well, they're fine, you know, after the end of the shift, they'll be looking so much better, I'd send them home. The owner would be like, oh, wonderful. Um, but sometimes, and now I talk them, I talk the owner through it because I think I don't know if I'm always giving them the attention they need. Uh whereas an attentive owner that's going to be really on it and keeping an eye, as long as there's a general progression in the right direction over two, four, six hours, and then I just say to them, look, if the dog's getting worse, come back. And I will give them that option too. And a lot of owners, once they know it's expected marijuana, they they will they're they're kind of a bit more relaxed. They're kind of go, oh yeah, great. I can see that now because they initially think, oh my god, what's happened? And then they're like, Oh yeah, and I think they feel more relaxed about having the dog at home.

SPEAKER_01 59:59

Yeah.

SPEAKER_02 1:00:00

I probably haven't seen the severity of cases you've seen, but yeah, the ones I've done, yeah, it's not a bad option.

SPEAKER_01 1:00:06

I've never done um so yeah, I think the ones the ones that are like staggering in and just look a bit drunk and can still hold their heads up and can still eat and stuff, because they all have the munchies as well, which I find hilarious. So those ones, yeah, absolutely. I normally give activated chalk or two and send them home because I'm not going to do anything different in the hospital. Whereas if they're collapsed, then I would keep them in. Um so yeah, it just depends. Depends on the severity. There's such a spectrum of them aren't there. So okay, so that's your that's your marijuana toxicities, which I think we see quite often. Um, probably the next most common one that we see, and I think everyone's kind of terrified of in general practice, is your anticoagulant toxicity, so your rodenticide stuff. Um, I know that it can be really scary thinking about it. Um, so it's something that we wanted to cover. Obviously, it's different to your normal toxicities in that you're not really gonna get vomiting, diarrhoea, etc. They just bleed. But the ones that we are worried about is if you have a dog or cat that's eaten rodenticide, it has to contain that anticoagulant stuff. So the stuff that's gonna bind up your vitamin K. If it if it doesn't bind up your vitamin K, then you'd be less worried. But there are a couple of other rodenticide type drugs, like your, I think it's called bremethylene, I've got in my notes, and colas, I can't say it, colasacalciferol, I can't say it. Um, one of them causes one of them causes neurological signs, um, and one of them can cause AKI. Basically, what I would do is if you've got an owner that thinks that their dog has eaten rat bait, try and work out what type of rat bait it is or get them to bring in the packaging because then you can work out exactly what it is and how worried you need to be. But to be honest, if you know that they've eaten it, make them sick and get it out, is what I would suggest.

SPEAKER_02 1:01:46

Do you do you find the code calcifer one? I I don't really see that. I'm always on the lookout to see, oh, is it the vitamin D type ones? And I in the UK at least I find they're nearly always the vitamin K. Uh the bromethylene ones, isn't that I still I thought that was still a vitamin K antagonist. Is that right? It might be. I'm not sure. Same kind of treatment.

SPEAKER_01 1:02:05

Yeah. I think ultimately, if it's anything that looks like it could be an anticoagulant type one, then it needs to come out because you do not want it to have the effects that it's going to have. So would ultimately, if it's eaten a poison, like no matter what it's going to do, I'd want to get it out. So, but it's just so you could warn owners how much you need to be worried. Um, interestingly, when I was looking stuff up for this, um, they said that one, cats are more resistant to it than dogs are, weirdly. And also, it's really rare for a cat or a dog to ingest a toxic amount through eating the rats that have eaten the rat bait, which I found really interesting because I thought, well, if it's enough to kill the rat, then it might not be enough to kill the cat or the dog. But I thought it would be enough to at least cause some bleeding signs. But apparently it's quite rare. So there we go. If you ever have an owner that's really worried about that, then you can sort of reassure them a little bit with that. Generally, we won't go into the details because it's boring in terms of coag factors and stuff, but basically it depletes your vitamin K, which means it then means you can't make your coagulation factors, which means that your clotting is then blocked in effect. So it means that these dogs would or cats will just bleed. So clinical signs will usually be between three and five days post-ingestion. They don't happen immediately. This is not something that happens two hours after they've eaten it. And to be honest, you get two populations of these guys, you either get the ones where the owners have seen or suspected them to have eaten it and you're making them sick, or they come in and they're bleeding and you've got no idea why, and you have to figure it out. So, yeah, if if you've seen them eat it, or if the owners seen them eat it, generally decontamination, decontamination, decontamination. So make them sick, wash out the mouth, give them repeated doses of charcoal. And what I would generally suggest to owners at this point is especially if they definitely have eaten it, I'd potentially check their coags at day one just to check that they are normal and baseline anyway. And then for the really dedicated owners, I'd recheck them every 24 hours for five days. And if at five days they've got no clinical signs of bleeding and their coags are normal, then I say great, they don't need any further treatment. If their coags start to slow, so you want to look at your um PT and APTT. If you do start to see those times being prolonged, so you're suspecting a coagulation problem, at that point you start vitamin K and you treat for 21 days or so. But otherwise, before then, you probably don't want to start too early.

SPEAKER_02 1:04:17

But you treat for as long as well, depends what the generation of vitamin K is, don't you? So you look up your vitamin K. It's it is it in the formulary? I feel like it's somewhere really accessible. Um the it's somewhere, but yeah, the the newer generation ones you need to treat for longer, don't you? But um a lot of people don't want to do the blood test every day for five days, do they? No. So, and if I've got a bunch I've got a load of vitamin K in the practice, I will talk to them about just treating. Um I think the easiest way to remember about the three to five day kind of delay, though I think it blocks the production of vitamin K, doesn't it? So we've all got vitamin K already, it stops the production of it. So it's only once your vitamin K has been exhausted, which does take a few days, that the symptoms of bleeding can occur. And that's how I kind of helped me remember that there's that delay from eating it to symptoms.

SPEAKER_01 1:05:05

Yeah. I think the only thing I would say as well with prophylactically starting vitamin K is I think they don't actually recommend it now. And I think part of that is because that they well, basically, if you started something and you're not sure there's going to be a problem, then you have to continue it for 21 days. At least you still don't know if they're having a problem. So you could be giving them medication for 21 days that you've got no idea that they actually need. So it seems a bit silly. But then if, like you say, if people were absolutely against doing the blood and you don't want them to start bleeding, then maybe you could do. It just depends, doesn't it? And obviously, if you do have a patient that presents to you as bleeding, if it's got Petique A, if it's got a hemoabdomen, then obviously you want to pocus it, like we've spoken about before in dysnea lectures and stuff, to to think about has it got free fluid in its chest, so in its plural space, in its lungs or in its abdomen, is it bleeding externally? Is autotransfusion an option for you to get those red blood cells back into it if it's bleeding? Super, super fast. So if it's got a massive hemoabdomen, can you get that blood back into the dog's body or the cat's body again? Do you have fresh frozen plasma that you can use to get those c the clotting factors back into it? You need to start that vitamin K at this point. You know, there's lots of things that you can do, but basically it's controlling the bleeding. They're not very nice cases. But um, we we at some point will do a lecture on bleeding issues and we'll touch on transfusions and stuff. So if you guys are like, what are they talking about with auto-transfusions and stuff? We will cover that at some point. So um, but yeah, does that make sense?

SPEAKER_02 1:06:33

Yeah, that's good. That's good. They can I've had the odd awful case. Yeah, I had a a plural bleed it blew bleeding into the plural space case, which was in a little Yorkshire area, and it was yeah, that was hard.

unknown 1:06:44

Yeah.

SPEAKER_01 1:06:44

So something else that we do see all the time is NZ toxicity, dogs and cats. And that can be from ingesting human ones like neproxen, ibuprofen, aspirin, or it can just be typical overdoses in our own species, someone giving their cat dog metacam, or you know, us even overdosing patients in practice, giving a, I don't know, I've heard of 10 times overdoses and stuff before that have been given IV and all that sort of stuff. So it really can happen. Remember that they're your competitive inhibitors of COX enzymes, so your overdoses will cause GI side effects mainly. Um, but that can include gastric ulceration and can lead to AKI. So they're your big ones that we are worried about. But it's again, it's dose dependent. So obviously AKI you'd see in those much higher doses.

SPEAKER_02 1:07:29

I think one of the classics is where they get GI signs, but they're not presented, so then they're getting hypovolemic, and because they've got COX inhibition, they don't maintain the renal perfusion and then they get metotemic, and then they get worse GI signs. So I've had that type of presentation in dogs, and I've had cats where they've had an onsteroid or as part of their treatment, and they've had AKI suspected NCED-related.

SPEAKER_01 1:07:52

It doesn't feel like I see them quite as much as I was expecting to, um, but they do definitely happen. So just keep an eye out for them. Um, in terms of what you're looking for, make sure you're running blood. So you want to check for things like hypoproteinemia, anemia, elevated BUN for things like your ulcers, especially if we're thinking about they could be perforated. Keep an eye on your POCUS, make sure that there's no free abdominal fluid, checking your bloods for your urea and creatinine, making sure they're not developing those AKIs. And then in terms of meds, i.e. fluids in terms of supportive, not flushing, you want to consider anti-emetics, ameprosol, sacral fate, those kind of drugs to help support the gastric lining. But do you ever use mesoprostol in these cases?

SPEAKER_02 1:08:31

I've used it. I'm not sure how much it's doing, and I've definitely heard of it. I think it's not people don't push it, do they? I don't think it's like all it's cracked up to be.

SPEAKER_01 1:08:41

No.

SPEAKER_02 1:08:41

Yeah, what's the latest on that?

SPEAKER_01 1:08:44

Well, I think I've sort of heard that it used to be something that was given to every case, and now it's a bit like, uh, so and to be honest, I think a lot of places don't have it either. So I wouldn't be panicking about it. I don't think it's like a you know, it's not going to be a magic solution for these cases. So I think supportive care and your acid suppressants, etc. Um, and generally they say in these cases that the prognosis is good unless they develop aneuria, oligouria, or severe azotemia, in which case the the prognosis can be more poor. But most of the time these cases do pretty okay, don't they? So it just depends.

SPEAKER_02 1:09:17

Have you have you ever had like the Yorkshire Terry that eats the whole tub of palatable rimadil or something like that? And I've had I've had a couple where they've eaten the whole tub, and weirdly they've been okay. So a little bit like what you say, yeah. It's like you can't always predict what's gonna be a bad outcome.

SPEAKER_01 1:09:34

No, exactly. So okay, and I think one other thing we wanted to cover is tremogenic mycotoxins. So we see these all the blooming time. Now, mycotoxin means that you have a toxin from any sort of mycotic thing, so moldy food, fungus, mushrooms, um, depending on which type of mushroom it is, obviously. Generally, the majority of these cases are ones that have raided a compost bin in the garden or raided like the food waste bin and it's all mouldy and horrible, or there's like moldy food that's been in the fridge that's gone in the in the bin and the dog has then eaten it. So if anything is eaten mould, then this should be very, very high on your list. To be honest, the ones that I've seen, the clinical signs happen really quite fast. So sort of within 30 minutes to a couple of hours, you'll start noticing some signs, and that can start off with vomiting, a bit of ataxia, leading to proper whole body tremors, and it is violent when they do. It can be really quite dramatic. Um, they become really hyper aesthetic, like you were saying, Brendan. They're sort of really super sensitive to light and sound. They can eventually go into seizures, they will be rapidly heavily panting generally. It's really nasty, they're not very nice cases to see, and the pay the owners are often really panicking because they think they're seizuring when they come into you. So they can be really dramatic.

SPEAKER_02 1:10:52

Yeah, they're really dramatic until you kind of piece it together. It's usually uh mouldy dairy is a really common culture culprit, I think.

SPEAKER_01 1:10:59

Yeah.

SPEAKER_02 1:11:00

And um, I I guess moldy bread, I think, is a possible too. I do think they do get worse with the increased stimulation. So as soon as you get them somewhere dark and quiet, they they can settle quite nicely too.

SPEAKER_01 1:11:12

Yeah, yeah. I mean, I've had very big spectrums of them. I've had some that have come in and they're tremoring a bit, and I'd treat them and they're better 24 hours later. I've had some that have come in a bit tremoring and have got worse and worse and worse, and seizured and died. So, like, there's some that can be really, really nasty. So, what I would say is that even if you don't think they've eaten a lot of it, assume that they have and treat them as if they are really sick because if they continue to get worse, they can do so quite quickly. And it's quite difficult to keep on top of. Like, I remember one dog, he was really sad. I had a Daxi who came in, it was quite young, um, and it was tremoring when it got to me, but it was still standing. It was just tremoring. And but I deemed it at the time to be tremoring a bit too much for me to say that it was safe enough to induce a mesis because I wasn't, it wasn't properly standing, it was like wobbling all over the place. And I thought, are you going to be able to control your airway, etc.? So I spoke to the owners and talked to them about options, but I actually opted not to adduce a mesis and I admitted it to bloods, etc. Um, and actually I just wish I'd made it sick because it kept getting worse and worse and worse to the point where I was like, I know it's because your body's still getting more and more toxin that's building up because I've not got it out. So um I was doing everything else by the book, but I think it unless you are absolutely certain that they're not going to be able to control that airway, if they are even remotely standing, I would make them sick. But obviously it's case-by-case basis. But I think from my experience now, if in doubt, make it sick, because what you don't want to do is wait too long and then wish that you had.

SPEAKER_02 1:12:42

So yeah, um, it's methacarbamol is one thing. Keep an eye on temperature, possibly, low steam environment maintenance fluids, I guess, or treat any losses, fluids.

SPEAKER_01 1:12:54

Yeah. Is that the kind of thing?

SPEAKER_02 1:12:55

And then it's seizure management. I've had cases which have purportedly vets have said to me, Oh, that's seizuring. Sometimes it's really hard to tell the difference between like, is it just having like full-on tremor? Yeah. That's took, you know, that's gone. If there's a gradient in this, I think in these cases, between is that I don't know what your experience has been. It's not like a classic seizure from the ones I've had yet.

SPEAKER_01 1:13:16

Yeah, I mean, for me, I check their eyes. If they've got a menace and a normal PLR and they're looking at you and they can follow you around the room, that's not a seizure for me because they're alert they may not look alert, but they obviously are because they're responsive. So for me, that's not yes, it could have a focal seizure, but if it's whole body tremoring, it's not going to be a philanthropic chronic seizure if they're still responsive to you. So yeah, just keep an eye. Uh and I guess that the only other one that's worth bearing in mind here is that if you've had a dog that's recently had puppies or is about to have puppies, remember that you can get these tremors because of hypocalcemia as well. So sometimes it's not always a toxin, so bear that in mind as well. But and it they're going to present quite differently generally, but they are still tremoring. But yeah, so methacarbamol, seizure management, if you need to try and induce a mesif when it's safe. If it's not safe enough to induce emesis, but you think they're stable enough for GA, gastric lavage, if you think they've eaten enough, definitely definitely activated charcoal on repeated doses. For my sick ones, I definitely use intralipid. It seems to really, really help. Um, but for these guys, aspiration pneumonia is a big thing that we have to worry about as well because obviously they're tremoring, they're potentially seizuring, they're not controlling their airways well enough. So just be careful. But yeah, so I think that's pretty much it. They can be quite scary, but just stick to the basics, do what you can and go from there. Sometimes they just need time, and views are just hold your nerve. So I've not seen it in a cat. Have you? No, I don't think I have, to be fair. But then I think cats don't it, we eat such weird things as dogs, they're a bit more clever. They sort of they go and sniff something and they're like, oh no, that's moldy, I'm not gonna eat that. Whereas dogs are like, mm, tasty. And they just eat all this crap that they shouldn't. So okay, so we tried to cover some of the really common toxins that you might see in practice, but obviously there are tons out there that we could cover. What we're gonna do is we've actually, if you haven't seen already, we've just released a new blog. So on our website, so not on our socials, but on our website, so it's www.chattyvets.com. Um, we actually have a blog section on our website. So if you pop onto that, anything that we don't cover in the podcast that we didn't have time to cover because we're too often gabbing and don't have time to say everything we want to say, or if we wanted to give you more information, so stuff in more detail, things that we didn't have time to cover, then have a look on that blog because it's often on there. So there were things that we wanted to cover that didn't have time to. So for example, paracetamol toxicity, salbutamol toxicity, which we see quite often now, ethylene glycol, blue-green algae, slug bait, etc. There's quite a few big ones out there. Xylitol, yeah. So there's quite a few big ones out there that we've not actually touched on today that you really should have in the back of your mind when thinking about toxicity cases. So we're going to do a blog post for that, which hopefully will be up and running by the time this podcast goes live. So keep an eye out for that. Do you have a little look and comment on there, or you can use it as a discussion forum with us as well if you have any questions.

SPEAKER_02 1:16:06

Yeah, go and look at it. Love it.

SPEAKER_01 1:16:08

Okay, so roundup time. We've covered loads today. Again, from our general approach to toxins and stabilization, when to use apomorphine and charcoal, when to consider intralipid therapy, and generally what to do if we have a specific toxicity that we know about in our patients.

SPEAKER_02 1:16:24

We hope as ever you've enjoyed listening. And remember to get in touch if you have any comments or suggestions to help us improve these pods for you. Any topics you particularly want us to cover.

SPEAKER_01 1:16:35

Yeah, absolutely. And remember, you can use that blog post to get in touch with us too. But for now, thank you very much for listening. We're having a well-deserved rest next Sunday. Well, I say rest, I'll actually be working most of the bank holiday and making loads of dogs vomit. But we look forward to seeing you again in a couple of weeks, anyway, for our first two-week date down episode in April.

SPEAKER_02 1:16:56

Yes, we'll see you in a couple of weeks where we'll be covering loads of interesting topics from how to deal with difficult clients and all compliance, IVDE in Dashans, and how to approach the issue of costs with our clients and highometras in pitches.

SPEAKER_01 1:17:11

Yeah, we're looking forward to it already. Have a lovely Easter. And until then, it's bye from me.

SPEAKER_02 1:17:16

And buy from me. Take care.

SPEAKER_03 1:17:32

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