IV. With few exceptions, it is more important to treat the animal than worry about the diagnosis (i.e., the diagnosis is important, but saving the animal’s life is more important).

V. Do not let the client or anything else make the diagnosis for you.

VI. Important toxicants in veterinary clinical practice:

A. Rodenticides

B. Insecticides

C. Organic compounds, such as antifreeze, halogenated hydrocarbon

D. Inorganics: metals

E. Plants

Management and Treatment of Toxicoses

When the task at hand is treatment of intoxications, the primary emphasis should be on prevention, not treatment. Therefore client education is at the top of the list, whether the client is a producer or an individual animal owner. Client education should emphasize proper handling as well as storage techniques.

Primary Goals of Therapy

I. Emergency intervention and prevention of further exposure

A. Removal of the animal from the toxicant, or the toxicant from the animal; washing the animal

B. Maintenance of normal respiratory and cardiac function

II. Establishment of a tentative diagnosis on which to base rational therapeutic measures

III. Delaying of further absorption

IV. Application of specific antidotes and remedial measures

V. Hastening the elimination of the absorbed toxicant

VI. Supportive therapy

VII. Determination of the source of the toxicant

VIII. Client education

Telephone Instructions

The owner should do the following until the animal is taken to the veterinarian or until the veterinarian sees the animal(s).

I. Do not waste time.

II. Protect the animal from injuring itself, and protect the people and other animals in the vicinity. It is important that the animal owner protect himself or herself if externally applied chemicals (pesticides) are involved.

III. Bring suspect material, with original container, if possible along with any vomitus. Clean glass containers are best. This is especially important if medical/legal aspects are involved.

IV. If there will be a time delay, and if the owner is insistent about treating the animal with some “medication” and if the animal is not sedated or unconscious, then the owner can be advised to do the following:

A. Administer milk.

B. Administer activated charcoal if available.

C. Administer water.

D. The owner may be advised to wash dermally exposed animals with soap and water, but the owner should use proper precautions.

E. 5 mL of hydrogen peroxide (1 tsp) on base of tongue or 1⁄2 to 1 tsp of syrup of ipecac; clinician must explain precautions about vomition as well as toxicity of syrup of ipecac.

Treatment After The Animal is seen

Emergency Intervention: Keep the Animal Alive

I. Establish patent airway.

II. Assess and maintain myocardial activity.

Delay Absorption

I. Remove external contaminants

II. Induce emesis

A. Of little value after 2 to 4 hours of ingestion

B. Syrup of ipecac

1. 1 to 2 mL/kg, maximum of 15 mL for largest dog

2. Only 50% effective in dogs, may repeat after 20 minutes. If emesis does not occur after second dosage, the syrup of ipecac must be removed by gastric lavage.

3. Syrup of ipecac must not be used when activated charcoal will be used in the treatment regimen.

C. Copper sulfate —dangerous

D. Table salt —dangerous

E. Hydrogen peroxide —5mL on base of tongue

F. Apomorphine —Lilly

1. Most reliable

2. Most effective

3. 0.04 mg/kg intravenously or

4. 0.08 mg/kg intramuscularly

5. Disadvantages

a) Protracted emesis

b) May deepen respiratory depression, but if respiration is depressed, then central nervous system depression is also present; therefore induction of emesis would be contraindicated.

c) May be effectively controlled by appropriate narcotic antagonists administered intravenously

(a) Narcan —0.04 mg/kg

(b) Lorfan —0.02 mg/kg

d) It is a Schedule II drug that is no longer manufactured. It may be rereleased at some unspecified time in the future. Even though it is no longer being marketed, it is still found in many clinics.

III. Contraindications for Induction of Emesis

A. Unconsciousness or central nervous system depression (respiratory depression)

B. Intoxication of petroleum distillates?

C. Use of tranquilizers or antiemetics

D. If > 2 to 4 hours since ingestion

E. Ingestion of acids or alkalis: weakened stomach wall, retching may rupture, also reinjure esophagus and oral cavity.

IV. Activated charcoal may be used with emetics to increase the efficiency of both techniques.

V. Vomitus should be saved.

Gastric Lavage

I. Animal is unconscious: light anesthesia, with endotracheal tube (cuffed) extended beyond teeth.

II. Lower head and thorax.

III. Measure oral–gastric tube from muzzle to xiphoid cartilage and mark.

IV. Use same size oral–gastric tube as endotracheal tube 1 mm = 3 French; use as large a tube as possible.

V. Use 5 to 10 mL/kg of lavage solution for infusion.

VI. Aspirate solution from stomach using a large aspirator bulb or 50-mL syringe.

VII. Repeat cycle 10 to 15 times; activated charcoal will increase efficiency.

VIII. Precautions:

A. Use low pressures; do not force fluid.

B. Reduce volume in obviously weakened stomachs.

C. Do not rupture esophageal or gastric walls.

Adsorbents

I. Activated charcoal

A. Vegetable or petroleum origin, not animal origin

B. Activated by increasing surface area and heating

C. Sources:

1. SUPERCHAR —Gulf Biosystems, Dallas (This is currently off the market (as of early 1991). A Japanese company has purchased it and is considering rereleasing it in the future.

2. TOXIBAN —Vetamix, Shenandoah, Iowa

3. Use a bathtub or another easily cleaned area

4. Make a slurry with water, 1 gm/5-10 mL water

5. Dosage = 2 to 8 g/kg BW

6. Administer by oral–gastric tube using funnel or large syringe

7. Administer a saline cathartic 30 minutes after charcoal.

8. For best results, activated charcoal should be re-administered qid for several days after an intoxication.

D. Remember: Do not use with syrup of ipecac

E. Universal Antidote — not effective

1. Activated charcoal —2 parts

2. Magnesium oxide —1 part

3. Tannic acid —1 part

4. “Burnt” toast —not effective

Cathartics

I. Saline cathartic —best

A. Sodium sulfate —1 g/kg best

B. Magnesium sulfate

II. Mineral oil and/or vegetable oil may be contraindicated; always follow with a saline cathartic.

Colonic Lavage or High Enema

I. Sources of activated charcoal —see Table 1

II. Locally acting antidotes —see Table 2

III. Systemic antidotes —see Table 3

Table 1 Some Available Activated Charcoal Products

Table 2 Locally Acting Antidotes Against Unabsorbed Poisons and Principles of Treatment

Toxicant	Antidote and Dose or Concentration
Acids, corrosives	Weak alkali-magnesium oxide solution (1:25 warm water) internally. Never give sodium bicarbonate! Milk of magnesia—1 to 15 mL. Flush externally with water. Apply paste of sodium bicarbonate.
Alkali, caustic	Weak acid—vinegar (diluted 1:4), 1% acetic acid, or lemon juice given orally. Dilute albumin (4 to 6 egg whites to 1 qt warm water) or give whole milk followed by activated charcoal and then a cathartic because some compounds are soluble in excess albumin. Local—flush with copious amounts of water and apply vinegar.
Alkaloids	Potassium permanganate (1:5000 to 1:10,000) for lavage or oral administration. Tannic acid or strong tea (200 to 500 mg in 30 to 60 mL of water) except in cases of poisoning by cocaine, nicotine, physostigmine, atropine, and morphine. Emetic or purgative should be used for prompt removal of tannates.
Arsenic	Sodium thiosulfate—10% solution given orally (0.5 to 3 g for small animals), followed by lavage or emesis. Protein—evaporated milk, egg whites. Tannic acid or strong tea (see specific antidote in Table 3).
Barium salts Bismuth salts Carbon tetrachloride	Sodium sulfate and magnesium sulfate (20% solution given orally) Dosage: 2 to 25 gm. Acacia or gum arabic as mucilage. Empty stomach, give high-protein and carbohydrate diet; maintain fluid and electrolyte balance. Hemodialysis is indicated in anuria. Epinephrine is contraindicated (ventricular fibrillation).
Copper	Albumin (see Alkali, above). Sodium ferrocyanide in water (0.3 to 3.5 g for small animals). (See specific antidote in Table 3.) Magnesium oxide (see Acids, above).
Detergents, anionic (Na, K, NH₄⁺salts)	Milk or water followed by demulcent (oils, acacia, gelatin, starch, egg white)
Detergents, cationic (chlorides, iodides)	Soap (castile) dissolved in 4 times its bulk of hot water. Albumin (see Alkali, above).
Fluoride	Calcium (milk, lime water, or powdered chalk mixed with water) given orally.
Formaldehyde	Ammonia water (0.2% orally) or ammonium acetate (1% for lavage). Starch—1 part to 15 parts hot water, added gradually. Gelatin soaked in water for 30 min. Albumin (see Alkali, above). Sodium thiosulfate (see Arsenic, above).
Iron	Sodium bicarbonate—1% for lavage. (See specific antidote in Table 3.)
Lead	Sodium or magnesium sulfate given orally. Sodium ferrocyanide (see Copper, above). See specific antidote. Albumin (see Alkali, above).
Mercury	Protein—milk, egg whites (see Alkali, above). Magnesium oxide (see Acids, above). Sodium formaldehyde sulfoxylate—5% solution for lavage. Starch (see Formaldehyde, above). Activated charcoal—5 to 50 g. (See specific antidote in Table 3.)
Oxalic acid	Calcium—calcium hydroxide as 0.15% solution. Other alkalis are contraindicated because their salts are more soluble. Chalk or other calcium salts. Magnesium sulfate as cathartic. Maintain diuresis to prevent calcium oxalate deposition in kidney.
Petroleum distillates (aliphatic hydrocarbons)	Olive oil, other vegetable oils, or mineral oil given orally. After 30 min, sodium sulfate as cathartic. Emesis and lavage are contraindicated for ingested volatile solvents, but petroleum distillates are used as carrier agents for more toxic agents.
Phenol and cresols	Soap and water or alcohol lavage of skin. Sodium bicarbonate (0.5%) dressings. Activated charcoal and/or mineral oil given orally.
Phosphorous	Copper sulfate (0.2 to 0.4% solution) or potassium permanganate (1:5000 solution) for lavage. Turpentine (preferably old oxidized) in gelatin capsules or floated on hot water. Give 2 mL 4 times at 15-minute intervals. Activated charcoal. Do not give vegetable oil cathartic. Remove all fat from diet.
Silver nitrate	Normal saline for lavage. Albumin (see Alkali, above).
Unknown (e.g., toxic plants or other materials)	Activated charcoal (replaces universal antidote). For small animals: through stomach tube, as a slurry in water. Follow with emetic or cathartic and repeat procedure.

Table 3 Specific Systemic Antidotes and Dosages

Toxic Agent	Systemic Antidote	Dosage and Method for Treatment
Acetaminophen	B-acetylcysteine (Mucomyst, Mead Johnson)	150 mg/kg loading dose, PO or IV, then 50 mg/kg every 4 hours for 17-20 additional doses.
	Cimetidine	5 mg/kg, orally, every 6-8 hours for 2-3 days. To prevent biotransformation of acetaminophen.
Amphetamines	Chlorpromazine	1 mg/kg IM, IP, IV; administer only half dose if barbiturates have been given: blocks excitation. Higher doses (10-18 mg/kg IV) may be beneficial if large volumes are consumed. Treatment of increased intracranial pressure may be indicated (mannitol, furosemide)
	Urinary alkalinization: Ammonium chloride	100 to 200 mg/kg per day divided every 8 to 12 hours (contraindicated with myoglobinuria, renal failure of acidosis).
Amitraz	Atipamezole	50 g/kg IM. Signs should reverse in 10 minutes. Repeat every 3-4 hours as needed. Can follow with 0.1 mg/kg yohimbine IM every 6 hours.
	Yohimbine	Dogs 0.11 mg/kg IV slowly Cats 0.5 mg/kg IV slowly
Antitussives	Naloxone	If narcotic (e.g., hydrocodone, codeine)
Arsenic, mercury and other heavy metals except cadmium, lead silver, selenium, and thallium	Dimercaprol (BAL, Hynson, Wescott & Dunning)	10% solution in oil; give small animals 2.5 to 5 mg/kg IM every 4 hours for 2 days, bid for the next 10 days or until recovery. Note: In severe acute poisoning, 5 mg/kg dosage should be given only for the first day.
	D-Penicillamine (Cuprimine, Merck & Co.)	Developed for chronic mercury poisoning, now seems most promising drug; no reports on dosage in animals. Dosage for humans is 250 mg orally, every 6 hours for 10 days (3 to 4 mg/kg).
Aspirin	No specific antidote (see also, nonsteroidal antiinflammatory drugs)	Acute toxicosis: urinary alkalinization, other supportive therapy; doses of 50 mg/kg per day (dog) and 25 mg/kg/day (cat); 7 mL/kg per day of bismuth subsalicylate (dogs and cats) may be toxic.
Atropine, Belladonna alkaloids	Physostigmine salicylate	0.1 to 0.6 mg/kg (do not use neostigmine).
Barbiturates	Doxapram (Dopram)	2% solution: Give small animals 3 to 5 mg/kg IV only (0.14 to 0.25 mL/kg) repeated as necessary.
Barium, bismuth salts	Sodium sulfate/magnesium sulfate	20% solution given orally, 2 to 25 g.
Bleach	Treat as alkali	Use of emetics is controversial; treat as an alkali poisoning. Therapies have included milk or water (large volumes), milk of magnesia (2-3 mg/kg), egg whites, or powdered milk slurry. Sodium bicarbonate is not recommended.
Borates (roach killers, fleas products, fertilizers, herbicides, antiseptics, disinfectants, contact lens solutions)	No specific antidote	Supportive therapy includes emetics and gastric lavage, fluid therapy and diuresis, treatment of seizures and hyperthermia as indicated.
Botulism	Antitoxin	Use is controversial. Supportive care may be sufficient. Supportive therapy may include penicillin, physostigmine or neostigmine, and atropine.
Bromethalin	No specific antidote	Supportive care may include treatment of cerebral edema.
Bromides	Chlorides (sodium or ammonium salts)	0.5 to 1 g daily for several days; hasten excretion.
Caffeine/chocolate	No specific antidote	General treatment, diazepam (2 to 5 mg/kg) for tremors, treat arrhythmias as indicated.
Carbon monoxide	Oxygen	Pure oxygen at normal or high pressure; artificial respiration; blood transfusion.
Cholinergic agents	Atropine sulfate	0.02 to 0.04 mg/kg, as needed.
Cholinesterase inhibitors	Atropine sulfate	Dosage is 0.2 - 0.4 mg/kg, repeated as needed for atropinization. Treat cyanosis (if present) first. Blocks only muscarinic effects. Atropine in oil may be injected for prolonged effect during the night. Avoid atropine intoxication!
	Pralidoxime chloride (2-PAM) (organophosphates, some carbamates; but not carbaryl, dimethan, or carbam piloxime)	5% solution; five 20 to 50 mg/kg IM or by slow IV (0.2 to 1.0 mg/kg) injection (maximum dose is 500 mg/min), repeat as needed. 2-PAM alleviates nicotinic effect and regenerates cholinesterase. Morphine, succinylcholine, and phenothiazine tranquilizers are contraindicated.
	Diphenhydramine	1-4 mg/kg IM, PO every 8 hours to block nicotinic effects.
Cocaine	No specific antidote	Chlorpromazine (up to 15 mg/kg; may lower seizure threshold, use cautiously); butylcholinesterase may convert cocaine to inactive metabolites (currently under investigation); fluids metoprolol or isopropanolol to treat cardiac arrhythmias (see methylxanthines); phentolamine or sodium nitroprusside if beta blockers cause hypertension; lidocaine (instead of beta blockers) to control cardiac arrhythmias; see methylxanthines.
Crayons (aniline dyes)	Ascorbic acid	20-30 mg/kg PO or 20 mg/kg IV slowly
	Methylene blue (if ascorbic acid fails)	Dogs: 3-4 mg/kg IV Cats: 1.5 mg/kg.(Methylene blue may cause Heinz body formation in the absence of methemoglobinemia, and sometimes in the presence of methemoglobinemia.)
Copper	D-Penicillamine (Cuprimine)	52 mg/kg for 6 days (also see Arsenic)
	Ammonium molybdate Sodium thiosulfate	50 to 500 mg, PO, once a day 300 to 1000 mg, PO, once a day
	Ammonium tetrathiomolybdate	100 to 500 mg, PO on alternate days for 3 treatments
Coumarin-derivative anticoagulants	Vitamin K₁ (Aqua-MEPHYTON, 5 mg caps, Merck & Co.) (Vita K₁, Eschar, 25 mg caps) Whole blood or plasma	Give 3-5 mg/kg/day with canned food. Treat 7 days for warfarin-type, treat 21 to 30 days for second-generation anticoagulant rodenticides. Oral therapy is more efficacious than IV. Blood transfusion, 25 mL/kg.
Curare	Neostigmine methylsulfate	Solution: 1:5000 for 1:2000. (1 mL = 0.2 or 0.5 mg/mL). Dose is 0.005 mg/5 kg, SC. Follow with IV injection of atropine (0.04 mg/kg).
	Edrophonium chloride (Tensilon, Roche) Artificial respiration	1% solution; give 0.05 to 1.0 mg/kg IV.
Cyanide	Methemoglobin (sodium nitrite is used to form methemoglobin) Sodium thiosulfate	1% solution of sodium nitrite, dosage is 16 mg/kg IV (1.6 mL/kg). Follow with sodium thiosulfate 20% solution at dosage of 30 to 40 mg/kg (0.15 to 0.2 mL/kg) IV. If treatment is repeated, use only sodium thiosulfate. Note: The above may be given simultaneously as follows: 0.5 mL/kg of combination consisting of 10 g sodium nitrite, 15 g sodium thiosulfate, distilled water quantity sufficient 250 mL. Dosage may be repeated once. If further treatment is required, give only 20% solution of sodium thiosulfate at level of 0.2 mL/kg.
Decongestants	No specific antidote	Treat symptomatically.
Detergents: anionic (Na, K, NH₄⁺)		Milk or water followed by demulcent (oils, acacia, gelatin, starch, egg white.)
Detergents: cationic (chlorides, iodides		Castile soap dissolved in 4 times bulk of hot water. Albumin, see Alkali above.
Diatomaceous earth		No treatment indicated unless pulmonary, then supportive.
Digitalis glycosides, oleander, and *Bufo* toads	Potassium chloride	Dog: 0.5 to 2.0 g, orally in divided doses, or in serious cases as diluted solution given IV by slow drip (ECG control is essential).
	Diphenylhydantoin Propranolol (ß -blocker)	25 mg/minute IV control is established. 0.5-1.0 mg/kg IV or IM as needed to control cardiac arrhythmias (ECG control is essential).
	Atropine sulfate	0.02 to 0.04 mg/kg as needed for cholinergic control.
		2 to 5 mg/kg, control convulsions
	Diazepam (Valium, Roche)	(2 to 5 mg/kg) in the case of Bufo toads, must treat convulsions first.
Ethylene glycol	Ethanol	See methanol and ethylene glycol. Minimal lethal dose of ethylene glycol is 4.2 to 6.6 mL/kg (4.5 ounces in 20-lb dog) and 1.5 mL for cats. Give IV, 1.1 g/kg (4.4 mL/kg) of 25% solution. Give 0.5 gm/kg (2.0 mL/kg) every 4 hours for 4 days. To prevent or correct acidosis, use sodium bicarbonate IV, 0.4 g/kg. Activated charcoal: 5 g/kg orally if within 4 hours of ingestion.
	4-Methylpyrazole	20 mg/kg, 15 mg/kg at 12 and 24 hours, 5 mg/kg at 36 hours
	Sodium bicarbonate 5%	8 mL/kg (dog) or 6 mg/kg (cat) IP every 4 hours for five treatments, then every 6 hours for four more treatments.
Fertilizer	No specific antidote	Supportive therapy may include treatment for electrolyte disorders, vomiting, H₂ receptor blockers for gastritis, (sucralfate and analgesics as needed)
Fluoride	Calcium borogluconate	3 to 10 mL of 5% to 10% solution.
Fluoracetate (Compound 1080®, Sigma)	Glyceryl monoacetin	0.1 to 0.5 mg/kg IM hourly for several hours (total 2 to 4 mg/kg); or diluted (0.5 to 1%) IV (danger of hemolysis). Monoacetin is available only from chemical supply houses.
	Acetamide	Animal may be protected if acetamide is given before or simultaneously with Compound 1080 (experimental).
	Pentobarbital Note: All treatments are generally unrewarding.	May protect against lethal dose (experimental).
Formaldehyde		Ammonia water (0.2% orally) or ammonium acetate (1% for lavage). Starch—1 part to 15 parts hot water, added gradually. Gelatin soaked in water for 30 minutes. Albumin (see Alkali, above). Sodium thiosulfate (see Arsenic, above).
Garbage	No specific therapy.	Supportive therapy may include antiemetics (metoclopramide or phenothiazines) and treatment of endotoxemia.
Hallucinogens (LSD, phencyclidine[PCP])	Diazepam (Valium, Roche)	As needed—avoid respiratory depression (2 to 5 mg/kg).
Heparin	Protamine sulfate	1% solution; give 1 to 1.5 mg to antagonize each 1 mg of heparin; slow IV injection. Reduce dose as time increases between heparin injection and start of treatment (after 30 minutes give only 0.5 mg).
Iron salts	Deferoxamine (Desferal, Ciba)	Dose for animals not yet established. Dose for humans is 5 g of 5% solution given orally, then 20 mg/kg IM every 4 to 6 hours. In case of shock, dose is 40 mg/kg by IV drip over 4-hour period; may be repeated in 6 hours, then 15 mg/kg by drip every 8 hours.
Ivermectin	Physostigmine	0.06 mg/kg IV very slowly; actions should last 30 to 90 minutes.
	Picrotoxin (GABA antagonist)	Use is controversial. May cause severe seizures. Other treatment may include epinephrine and, if the product causing toxicosis is Eqvalan, an antihistamine to counteract polysorbate 80 (releases histamine in dogs), and atropine.
Lead	Calcium disodium edetate (CaNa₂EDTA)	Dosage: Maximum safe dose is 75 mg/kg/24 hours (only for severe case). EDTA is available in 20% solution; for IV drip, dilute in 5% glucose to 0.5%; for IM, add procaine to 20% solution to give 0.5% concentration of procaine.
Lead (cont.)	EDTA and BAL	BAL is given as 10% solution in oil. Treatment: 1. In severe case (CNS involvement w/> 100 ug Pb/100 gm whole blood) give 4 mg/kg. BAL only as initial dose; follow after 4 hours, and every 4 hours for 3 to 4 days, with BAL and EDTA (12.5 mg/kg) at separate IM sites; skip 2 or 3 days, and then treat again for 3 to 4 days. 2. In subacute case w/< 100 ug Pb/100 g whole blood, give only 50 mg EDTA/kg/24 hours for 3 to 5 days.
	Penicillamine (Cuprimine, Merck & Co.)	3. May use after treatments either 1 or 2 with 100 mg/kg/day orally for 1 to 4 weeks.
	Thiamine HCl	Experimental for nervous signs; 5 mg/kg, IV, bid, for 1 to 2 weeks; give slowly and watch for untoward reactions
	Succimer (Chemet)	Oral human dose = 10 mg/kg every 8 hours for 5 days, then 10 mg/kg bid for 2 weeks (total of 19 days of therapy) Animal dosages have not been established. (Used if blood lead levels > 45 ppm.)
Local anesthetics	See treatment for methemoglobinemia	Particularly cats.
Marijuana	No effective antidotes	Protein—milk, egg whites (see alkali, above). Magnesium oxide (see acids, above). Sodium formaldehyde sulfoxylate—5% solution for lavage. Starch (see Formaldehyde, table 2) Activated charcoal—5-50 g.
Metaldehyde	Diazepam (Valium, Roche)	2 to 5 mg/kg IV to control tremors.
	Triflupromazine	0.2 to 2 mg/kg IV.
	Pentobarbital	To effect.
	Note: Should monitor liver function and treat accordingly
Methanol and ethylene glycol	Ethanol 4 - Methyl Pyrazole	Give IV, 1.1 g/kg (4.4 mL/kg) of 25% solution. Give 0.5 g/kg (2 mL/kg) every 4 hours for 4 days. To prevent or correct acidosis, use sodium bicarbonate IV, 0.4 g/kg. Activated charcoal: 5 g/kg orally if within 4 hours of ingestion. 20 mg/kg, 15 mg/kg at 12 and 24 hours, 5 mg/kg at 36 hours
Methemoglobinemia-producing agents (nitrites, chlorates)	Methylene blue	1% solution (maximum concentration), give by slow IV injection, 8.8 mg/kg; (0.9 mL/kg); repeat if needed. To prevent fall in blood pressure in case of nitrite poisoning, use a sympathomimetic drug (ephedrine or epinephrine). (Not recommended for cats.)
	Ascorbic acid	20 to 30 mg/kg PO or 20 mg/kg IV slowly; methylene blue; dog 3-4 mg/kg IV slowly if ascorbic acid not effective; cats 1.5 mg/kg.
Morphine and related drugs	Naloxone chloride (Narcan, Endo)	0.1 mg/kg IV. Do not repeat if respiration is not satisfactory.
	Levallorphan tartrate (Lorfan, Roche)	Give IV, 0.1 to 0.5 mL of solution containing 1 mg/mL. Note: Use either of the above antidotes only in acute poisoning. Artificial respiration may be indicated. Activated charcoal is also indicated.
Mothballs (naphthalene, paradichlorobenzene)	No specific antidote	Supportive care includes fluid therapy and maintenance of renal and hepatic function.
Narcotics	Naloxone	Emesis—indicated only if patient is sufficiently alert. Dog: 0.02 to 0.04 mg/kg IV; repeat as needed. Cat: 0.05 to 0.1 mg/kg IV; repeat as needed. Supportive therapy may include anticonvulsants (especially for meperidine), fluid therapy.
Nicotine	No specific antidote	Emesis—indicated only within 60 minutes and in absence of clinical signs. Atropine indicated to control parasympathetic signs.
Nonsteroidal antiinflammatory drugs	Sucralfate	500-100 mg PO every 8 hours.
	Misoprostol	3 to 5 μg/kg every 8 to 12 hours
	Omeprazole	0.7 mg/kg every 24 hours (dog); alternative, ranitidine or famotidine (dog and cat)
Oxalates	Calcium	Treatment: 23% solution of calcium gluconate IV. Give 3 to 20 mL (to control hypocalcemia). Or Ca hydroxide as 0.15% solution or chalk or other calcium salts. Magnesium sulfate as cathartic. Other alkalines are contraindicated because their salts are more soluble. Maintain diuresis to prevent calcium oxalate deposition in kidney.
Onion/garlic	No specific antidote	Supportive therapy should address methemoglobinemia and hemoglobinuria. Avoid acidic urine.
Organic solvents: acetone, benzene, benzol, methanol, methylene chloride, naphtha, trichloroethane, acetonitrile, chloroform, trichloroethylene, tuolulene, xylene, xylol	No specific antidote	Emesis contraindicated. Supportive therapy includes treatment of cardiac arrhythmias, methemoglobinemia, renal failure, chemical pneumonia.
Petroleum distillates (aliphatic hydrocarbons)		Olive oil, other vegetable oils, or mineral oil given orally. After 30 minutes, sodium sulfate as cathartic. Emesis and lavage are contraindicated for ingested volatile solvents, but petroleum distillates are used as carrier agents for more toxic agents.
Phenols and cresols		Soap and water or alcohol lavage of skin. Sodium bicarbonate (0.5%) dressings. Activated charcoal and/or mineral oil given orally.
Phenothiazine	Methylamphetamine (Desoxyn, Abbott)	0.1 to 0.2 mg/kg IV; also transfusion. Only available in tablet form.
	Diphenhydramine HCl	For CNS depression, 2 to 5 mg/kg IV for extrapyramidal signs.
Phytotoxins and botulin	Antitoxins not available commercially except with botulism.	As indicated for specific antitoxins. Examples of phytotoxins: ricin, abrin, robin, crotin.
Plants		Treat signs as necessary.
Red squill	Atropine sulfate, propranolol, potassium chloride	As for digitalis and oleander
Scorpion sting	Ativenin (may not be recommended)	Supportive therapy includes analgesia to control pain (morphine and meperidine but not butorphanol are contraindicated because of potential synergy with scorpion venom); methocarbamol (if muscle spasms evident) and fluid therapy.
Smoke inhalation	Supportive therapy	Supportive therapy should target the respiratory system and treatment of carbon monoxide intoxication. Oxygen therapy; intermittent positive pressure ventilation with positive end-expiratory pressure with positive inotropic support, bronchodilators, treatment for cyanide poisoning if indicated, and treatment for cerebral edema.
Snake bite Rattlesnake Copperhead Water moccasin	Antivenin (Wyeth) (Trivalent Crotalidae)(Fort Dodge)	Caution: equine origin. Administer 1 to 2 vials, IV, slowly, diluted in 250 to 500 mL of saline or lactated Ringer’s. Also administer antihistamines. Corticosteroids are contraindicated.
Coral snake	(Wyeth)	Caution: equine origin. May be used as with pit viper antivenin.
Spider bite Black widow	Antivenin (Merck & Co.)	Caution: equine origin. Administer IV undiluted. Supportive therapy should include muscle relaxants (dantrolene or methocarbamol) analgesics, calcium gluconate for severe muscle cramping.
	Dantrolene sodium (Dantrium, Norwich-Eaton)	1 mg/kg IV. Followed by 1 mg/kg PO every 4 hours.
Brown Recluse	Dapsone	1 mg/kg, bid for 10 days
Strontium	Calcium salts	Usual dose of calcium borogluconate.
	Ammonium chloride	0.2 to 0.5 g orally 3 to 4 times daily.
	Potassium chloride	Give simultaneously with thiocarbazone or Prussian blue, 2 to 6 g orally daily in divided doses.
Strychnine and brucine	Pentobarbital	Give IV to effect; higher dose is usually required than that required for anesthesia. Place animal in warm, quiet room.
	Amobarbital	Give by slow IV infusion; inject to effect. Duration of sedation is usually 4 to 6 hours.
	Methocarbamol (Robaxin, Robins)	10% solution; average first dose is 149 mg/kg IV (range: 40 to 300 mg). Repeat half dose as needed.
	Glyceryl guaiacolate (Guaiafenison, Summit Hill Labs)	110 mg/kg IV, 5% solution. Repeat as necessary.
	Diazepam (Valium, Roche)	2 to 5 mg/kg, control convulsions, induce emesis, then use other agents.
Thallium	Prussian blue	0.2 gm/kg orally in 3 divided doses daily.
	Potassium chloride	Give simultaneously with Prussian blue, 2 to 6 gm orally daily in divided doses.
Theobromine	See caffeine/chocolate poisoning
Toad poisoning (Bufo alvarius, Bufo marinus)	Propranolol (Bufo poisoning only)	1.5-5 mg/kg IV; repeat in 20 minutes if ECG does not normalize; supportive therapy includes fluid therapy.
	Atropine	0.04 mg/kg IV to control hypersalivation or asystole.
	Lidocaine	Dogs: 1-2 mg/kg IV followed by continuous infusion of 25 to 75 μg/kg/min; cats: 0.25 to 1 mg/kg IV bolus followed by 5 to 40 μg/kg/min continuous IV infusion.
	Diazepam (Valium, Roche)	(2 to 5 mg/kg) in the case of Bufo toads, must treat convulsions first.
Tricyclic antidepressants	No specific antidote	Supportive therapy should target seizures (diazepam, phenobarbital, or general anesthesia with pentobarbital or short-acting thiobarbiturates; or, if unsuccessful, neuromuscular blockade with pancuronium (0.03 to 0.06 mg/kg IV) or vercuronium (10 to 20 μg/kg IV in dogs or 20 to 40 μg/kg in cats]); cardiotoxicity (see toad poisoning): propanolol, lidocaine (quinidine, procainamide and disopyramide are contraindicated); sodium bicarbonate (1-3 meq/kg).
Unknown (e.g., toxic plants or other materials)	No specific antidote	Activated charcoal 2-5 gm/kg (replaces universal antidote). For small animals: through stomach tube, as a slurry in water. Follow with emetic or cathartic, and repeat procedure.
Vitamin D₃ rodenticides	Treatment of hypercalcemia	Supportive therapy should target treatment of hypercalcemia (0.9% saline solution); control of seizures and treatment of hyperthermia. Calciuria can be promoted with furosemide (1 to 5 mg/kg every 6 to 12 hours for 2 to 4 weeks); prednisolone; calcitonin (4 to 6 IU/kg every 6 to 12 hours if calcium > 18 mg/dl; sodium bicarbonate if severe metabolic acidosis.
	Amphogel, Basagel	As phosphate binders (aluminum hydroxide 30 to 90 mg/kg PO every 8 to 24 hours for 2 weeks).
Xylitol		Hypoglycemia: 1-2 mL of 25% dextrose followed by 2.5%-5% dextrose infusion as needed to maintain normoglycemia. Add potassium to fluids to maintain serum potassium (treat for 12 to 24 hours). Hepatic necrosis: 140 to 280 mg/kg N-acetylcysteine IV followed by 70 mg/kg qid IV or PO; S-adenosylmethionine 17-20 mg/kg/day PO, silymarin 20 to 50 mg/kg/day PO.
Zinc	Chelation therapy (see lead)	CaEDTA, Succimer. Other supportive therapy includes fluid therapy and antisecretory drugs such as ranitidine, famotidine, or omeprazole to decrease oral absorption of zinc.

PO, By mouth; IV, intravenous; IM, intramuscular; IP, intraperitoneal; SC, subcutaneous; ECG, electrocardiogram; CNS, central nervous system.

Elimination of Absorbed Toxicants

General

I. Kidneys—easiest to manipulate

II. Bile, feces

III. Lungs

Renal Elimination

I. Requires adequate renal function: minimum of 0.1 mL/kg/min of urine production

II. May require hydration: fluid therapy

III. Diuretics

A. Furosemide —Lasix - 5 mg/kg, every 6-8 hours

B. Mannitol —2 gm/kg/hr

C. Manipulation of pH

1. For an acid, pH = pKa + log I

2. For a base, pH = pKa + log U

3. Many chemicals are weak acids or bases.

4. Degree of ionization depends on pH of medium and pKa of compound.

IV. Facts about pKas of compounds

A. Acid with low pKa = strong acid

B. Acid with high pKa = weak acid

C. Base with low pKa = weak base

D. Base with high pKa = strong base

E. At pHs above pKa

1. Acids = ionized

2. Bases = un-ionized

F. At pHs below pKa

1. Acids = un-ionized

2. Bases = ionized

G. Compounds that are un-ionized at physiologic pHs could be expected to traverse membranes if the compound is lipid soluble.

H. The gastrointestinal tract and the kidney are the organs where clinicians can take advantage of the pH differences. “ION TRAPPING”

1. Drugs are readily absorbed from the gastrointestinal tract if the non-ionized form is lipid soluble and if:

a) an acid with pKa > 2

b) a base with pKa < 11

I. Exceptions:

1. 2-PAM —completely ionized, absorbed from stomach but will not readily cross blood–brain barrier

J. Examples of “ION TRAPPING”

1. Acid—Acetylsalicylic acid (aspirin) and some barbiturates remain more ionized in alkalinized urine.

2. Bases—amphetamines and other basic compounds remain more ionized in acidic urine.

K. Urinary acidifying agents

1. Ammonium chloride — 200 mg/kg per day in divided doses

2. Ethylenediamine dihydrochloride, Chlorethamine —1-2 tabs, tid

3. Physiological saline (PSS) intravenously

L. Urinary alkalinizing agents

1. Sodium bicarbonate —5 meq/kg/hr

Peritoneal Dialysis

I. For use when kidneys do not function

II. Time consuming

III. Infusion of dialyzing fluids into peritoneal cavity, allowing the fluid to stay there for 30 to 60 minutes before removal

IV. May insert dialysis catheter, or just use 18-gauge needle

V. May alter pH of dialyzing fluids if type of offending agent is known (e.g., acid or base, pKa)

Supportive Measures in Therapy of Intoxications

I. Body temperature control

II. Respiratory support measures

A. Analeptics

1. Doxapram (Dopram): 3 to 5 mg/kg

2. Short acting

3. May induce convulsions

B. Respirate: “GRAB THE CHEST”

1. Patent airway—cuffed endotracheal tube

2. Tracheotomy

3. Respirator

III. Cardiovascular support

A. Requirements

1. Adequate circulating volume

2. Adequate cardiac function

3. Adequate tissue perfusion

4. Adequate acid–base balance

B. Immediate concern - blood volume and cardiac activity

1. Hypovolemia: give whole blood if there loss of cells and volume

2. Hypovolemia: fluid loss—lactated Ringer’s, plasma expanders

3. Cardiac activity - massage, pharmaceutical agents

IV. Acid–base balance

V. Pain

VI. Central nervous system disorders

A. Depression: see respiratory depression

B. Hyperactivity: managed by central nervous system depressants

1. Pentobarbital sodium —agent of choice for convulsions and hyperactivity (precautions)

2. Inhalant anesthetics: disadvantages and advantages

3. Skeletal muscle relaxants

a) Glyceryl guaiacolate, Guaiafenison

b) Methocarbamol, Robaxin

c) Diazepam, Valium: 0.5-1.5 mg/kg, intravenously or intramuscularly

4. Place in quiet, dark room to cut visual and auditory stimuli.

Rodenticides

Strychnine

I. Spinal convulsant

A. Competes with glycine

B. Reduces inhibitory postsynaptic potential

II. Signs occur 10 minutes to 2 hours after ingestion.

III. Apprehension, nervousness, tenseness, stiffness, tetanic convulsions with intermittent relaxation.

IV. Animal may die after 1 convulsion or may convulse for 1 to 2 hours before death occurs.

V. Affected animals almost never vomit. (i.e., full stomach at necropsy).

VI. Treatment:

A. After ingestion, before convulsions, with some signs:

1. Diazepam 2-5 mg/kg intravenously

a) Apomorphine intravenously, 0.04 mg/kg

b) Pentobarbital as needed

2. After onset of convulsions

a) Pentobarbital to effect

b) Gastric lavage

c) Place in quiet room

d) Animal should be observed for several days after apparent recovery.

Sodium Fluoroacetate (Compound 1080)

I. Biotransformed to fluorocitrate, blocks aconitase

II. Convulsant toxicant, not induced by external stimuli

III. Attempts to vomit, micturate, and defecate after onset of early nervous signs

IV. Convulsions can be controlled by pentobarbital, but it is extremely difficult to prevent death.

Anticoagulant Rodenticides

I. Competes with vitamin K, causes deficiencies in clotting factors II, VII,IX, X

II. Signs: hypovolemic shock, bleeding from body orifices, subcutaneous hemorrhages, pale mucous membranes, blood in body cavities

III. Treatment

A. Handle animals carefully.

B. Blood transfusion: whole blood or plasma blood transfusion, 25 mL/kg.

C. Use small needles.

D. Vitamin K₁ (Aqua-MEPHYTON, 5-mg caps, Merck & Co.)(Vita K₁, Eschar, 25-mg caps). Give 3-5 mg/kg/day with canned food. Treat 7 days for warfarin-type, treat 21 to 30 days for second-generation anticoagulant rodenticides. Oral therapy is more efficacious than intravenous therapy.

Cholecalciferol (Vitamin D₃) Quintox^R, True Grit Rampage^R, Ortho Rat-B-Gone^R

I. Active ingredient: cholecalciferol, 0.075% baits

II. Mechanism of action: mobilizes calcium from bones into the blood, causing a “calcium-like” toxicity to the heart. Lower dosages over a long time can cause an actual vitamin D toxicoses.

III. Toxicity: mice = 84 mg/kg (lethal dose); rats = 50 mg/kg (lethal dose); dogs = >100 g/kg.

IV. Clinical signs: cessation of eating, lethargy, nausea, vomiting, diarrhea, polyuria, profuse sweating, polydipsia, and neurologic disturbances. Vasoconstriction and hypertension may be seen along with a shortened QT interval and prolonged PR interval. Serum calcium >11.5 mg/dL with increased BUN, creatine, and phosphorus.

V. Lesions: Acute = heart stops in systole; chronic = calcium deposits in soft tissues, aorta, tendons, muscle

VI. Reported by pest control personnel as safe around pets.

VII. No good antidotes; potassium chloride can be used if ECG monitoring is undertaken. No antidote for calcification

VIII. Treatment: Induce vomiting, and administer activated chrcoal. A saline cathartic should be used in cases of recent (within 3 hours) exposure. Moniter the serum calcium after 24 hours to determine if further therapy is necessary. Fluid therapy should include normal saline (intravenous) and furosemide as a diuretic. Thiazide diuretics are contraindicated. Corticosteroids have several beneficial effects and should be used. Also, calcitonin can be administered in microgram quantities (4-6 IU/kg) subcutaneously every 2 to 3 hours initially. Treatment with diuretics and cortisone should continue until serum calcium level remains normal. Check the serum calcium level 24 hours after treatment is stopped. Long-term therapy, for 2 weeks or more, may be required.

Insecticides

Chlorinated Hydrocarbon Insecticides

I. Not as common, but still in use

II. Signs:

A. Abnormal posture

B. Fine tremors to gross convulsions

C. Salivation

III. Treatment

A. General treatment

B. Control convulsions: pentobarbital, might try diazepam (intravenous) first

Rotenone

I. Botanical insecticide: Derris spp.

II. Low toxicity: 1 to 3 grams/kg

III. Signs: vomiting caused by gastric irritation

A. Incoordination

B. Muscle tremors

C. Clonic convulsions

D. Respiratory failure

IV. Treatment: General treatment

Pyrethrum and Synthetic Pyrethroids

I. Names: allethrin, cyfluthrin, cypermethrin, deltamethrin, decamethrin, fenpropathrin, fenvalerate, flumethrin, kadethrin, permethrin, resmethrin, terallethrin, tetramethrin (-rin suffix)

II. Low toxicity, except in fish and some tropical birds

III. Increased sensitivity to external stimuli: fine tremors to gross tremors to prostration

IV. Pawing, burrowing, salivation to writhing, convulsions

V. Treatment = diazepam

Diethyltoluamide (DEET)

I. History: DEET was synthesized in 1954 and used as an insect repellent. It is effective against mosquitoes, biting flies, gnats, chiggers, ticks, and fleas. The content of DEET in various products has ranged from 5% to 100%. The Hartz Company used DEET in dog and cat flea collars in their Blockade product line. Hartz withdrew its Blockade products from the market primarily because of consumer pressure and negative publicity. Some pets were reported to have died after exposure to Blockade.

II. Clinical signs and symptoms: In animals and humans, DEET is absorbed through the skin. It has been known to produce blisters, skin necrosis, erythema, central nervous system disturbances, and death in animals. In humans it also produces blisters, skin necrosis, a burning sensation, erythema, ulcerations, slurred speech, confusion, convulsions, and (without treatment) even death. It seems to be more toxic to female humans than male humans. This may be an occupational phenomenon of female association with dipping and spraying animals.

III. Although neurologic signs in animals and humans may resolve, the parent compound and its metabolites are detectable for up to 2 weeks after an episode.

Organophosphates and Carbamates

I. Signs: overstimulation of parasympathetic nervous system (cholinergic, nicotinic, central nervous system)

A. Salivation, lacrimation, sweating

B. Muscular involvement

C. Constricted pupils

D. Respiratory involvement

E. Gastrointestinal involvement

F. Urinary incontinence

G. Central nervous system signs

II. Treatment organophosphates = Atropine + 2-PAM

A. Atropine: 0.2-0.4 mg/kg (1⁄4 intravenously, remainder subcutaneously)

B. 2-PAM: 20-50 mg/kg intramuscularly (of no value after enzyme has “aged”.

C. Neither atropine nor 2-PAM will control all of the signs: do not overtreat

III. Treatment of carbamates: atropine only; some carbamates are just as toxic as organophosphates; extensive treatment not required, as with organophosphates

IV. Diazepam may be used to control some of the central nervous system signs.

Organic Compounds

Ethylene Glycol (Antifreeze)

I. Biotransformed---> glycolic acid ---> oxalic acid ----> calcium oxalate (alcohol dehydrogenase)

II. Antifreeze = 95% ethylene glycol

III. Toxic dose = 2 to 10 mL/kg

IV. Early signs = depression, central nervous system signs, nausea, vomiting, polydipsia, polyuria, dehydration

V. May return to normal within 12 hours

VI. Signs return within 24 hours, with more severe, metabolic acidosis. Animals surviving 24 hours will have renal problems: signs of uremia, progressive increase in BUN, hyperkalemia, and acidosis; urine sediment may have birefringent crystals.

VII. Lesions: hemorrhages in gastrointestinal mucosa, swollen and congested kidneys, hyperemia and edema of lungs

VIII. Treatment:

A. Activated charcoal (if within 8 hours)

B. 20% ethanol, 5 mL/kg intravenously every 5-8 hours for 48-72 hours (causes central nervous system depression)

C. 5% sodium bicarbonate, 8 mL/kg, every 8 hours as needed > 48 hours.

D. 4-Methylpyrazole (5% solution) may be used instead of ethanol. It is better than ethanol because it does not induce central nervous system depression. As with ethanol, best results are obtained if treatment is initiated within 4 to 6 hours. Do not use in cats.

1. Initial dosage 20 mg/kg

2. 15 mg/kg 12 and 24 hours after ingestion

3. 5 mg/kg 36 hours after ingestion.

Polyhalogenated compounds

I. Polyhalogenated biphenyls

A. Induce enzymes

B. “Multiple Diseases”

1. Chick edema disease, reduced hatchability embryotoxic

2. Acneiform dermatitis

3. Interferes with poryphrin metabolism

4. “Cola-colored” babies in Japan, “Yusho”

5. Tolerances in food for human consumption

II. Dioxins

A. Common contaminant in chlorinated hydrocarbons

B. Extremely toxic in laboratory animals, not as toxic in humans

C. Diseases

1. Liver

2. Rapidly proliferating tissues

3. Spermatogenesis

4. Gastrointestinal mucosa

5. Cancer

6. Teratogenesis: animals, humans

D. Episodes

1. Seveso, Italy

2. Missouri (several episodes)

3. Oregon

4. Michigan

Inorganics

Lead

I. Most common heavy metal toxicant in the world

II. Animals affected: cattle, young dogs, exotic birds

III. Age: Nursing animals are more susceptible

A. Dogs: 2 to 8 months usually

B. Bovine: any age

C. Birds: any

IV. Signs:

A. Gastrointestinal disturbances: vomiting, abdominal pain, anorexia

B. Neurologic signs: 3 to 4 days after lead colic in dogs, abnormal behavior, pica, hysteria convulsions; cattle and birds: neurologic signs.

C. Laboratory

1. Hematopoietic: late in syndrome nucleated red cells, other red blood cell abnormalities

2. Radiographic

a) Gastrointestinal tract

b) Lead line in Bones

3. Blood lead > 0.6 ppm, 0.05-0.25 = normal

V. Treatment:

A. Remove lead from gastrointestinal tract

B. Calcium disodium EDTA: 75-100 mg/kg per day, intravenously or intramuscularly

C. Penicillamine 100 mg/kg per day if owner refuses to hospitalize

D. Bronchoalveolar lavage 4 mg/kg qid with EDTA w/severe nervous signs

E. Thiamine HCl: 5 mg/kg, intravenously bid for 1 to 2 weeks

Mercury (Possible Problem in Grains or Dog Food)

I. Inorganic and organic forms

A. Inorganic absorbed through gastrointestinal tract, lungs

B. Organic: also through skin

C. Aryl and methoxyethyl forms produce signs similar to inorganic

D. Alkyl = typical signs + neurologic signs

II. “Typical” signs

A. Gastrointestinal, abdominal pain, weakness, anorexia, central nervous system depression, renal signs

B. Proteinuria = common

III. Alkyl mercurial signs

A. Sudden onset, ataxia, stumbling, hyperesthesia, convulsions, prostration

B. Young born with neurologic deficits

C. Focal central malacia, cord not affected.

IV. Treatment:

A. Acute, “typical”—bronchoalveolar lavage

B. Chronic—penicillamine

C. No treatment for alkyl mercurial intoxications

Arsenical Intoxication

I. Inorganic and organic forms

II. Extremely important in some areas of United States, equal to lead in some cases

III. Many sources: herbicides (old and new), insecticides, tonics, heartworm treatment, growth promotants

IV. Clinical signs: gastrointestinal, abdominal pain, depression, diarrhea; chronic: rough hair coat, unthrifty, cattle may have enlarged joints

V. Clinical signs (phenylarsonic): central nervous system, paresis, incoordination (drunk pig syndrome), alert and will continue to eat, blindness (not constant); signs are reversible unless nerve damage has developed; just remove from source

VI. Treatment: “typical”

A. Early = general treatment, sodium thiosulfate, orally

B. Late = bronchoalveolar lavage 2.5 to 5 mg/kg, 2 to 4 times per day for 10 days or until recovery

C. No treatment for phenylarsonic compounds.

Copper and Molybdenum

I. A “toxicity” of one means a deficiency of the other.

II. Copper toxicoses occurs primarily in sheep, although Bedlington Terriers have a congenital problem with copper accumulation.

III. Molybdenum toxicoses (molybdenosis) occurs primarily in cattle but may cause a problem in young lambs.

IV. Ideal ratio is Cu:Mo = 6:1 in the diet, total intake if the ratio is outside 2:1 to 10:1, problems can be expected.

V. Copper toxicoses

A. An acute disease can occur; typical heavy metal along with intravascular hemolysis

B. Usual disease = chronic accumulation in liver with a subsequent massive release of copper, > 150 ppm Cu, wet weight = potential problems

C. Usual sign = a sudden hemolytic crisis leading to anemia and jaundice (not always)

D. Course of disease = 24 to 48 hours

VI. Molybdenum toxicoses

A. Usually a chronic disease: “poor doers,” chronic diarrhea, appear hypoproteinemic, achromotrichia, poor reproductive performance, anemia, joint problems

B. Sheep may develop wool problems, produce lambs with incoordination (“swayback”)

VII. Treatment:

A. Copper toxicoses = penicillamine –chelating agent, ammonium tetrathiomolybdate, change diet

B. Molybdenosis = copper glycinate, change diet

Introduction