Toxicology Emergency? These Questions Will Help Ensure Accurate, Usable History

It can be very stressful when a possible toxin exposure presents to your clinic, especially if the patient is showing life-threatening signs.

There are key questions that will help guide your treatment efforts – and no matter what signs the patient is showing, you can always start with general stabilization: IV fluids, an antiemetic if vomiting, active cooling measures if hyperthermic, anticonvulsants if seizing, oxygen support, checking blood glucose and potentially giving dextrose if the patient is recumbent.

(If you call the ASPCA Animal Poison Control Center at 888.426.4435 for support, this triage sheet will be helpful.)

Once the patient is stabilized, then it is time to ask crucial questions.

Start With The Basics

• If there is potential for an exposure, what type of product(s) could have been involved?
• If there is only a small possibility that there was an exposure, what makes the owners think the pet got into something?
• What is the time frame that it could have occurred?
  • If the owners just got home and discovered the patient symptomatic, what time did they leave the house and what time did they arrive home?
• Does the patient have any underlying health problems or take any medications or supplements?
• If the patient was symptomatic when the owners arrived home, what signs were they seeing?
  • Was there any vomit or diarrhea in the house? If so was there anything unusual in the vomitus?
• Was any at-home treatment performed?
  • Was emesis induced? If so, with what and how much?

Questions About Medications

• Can the owners provide a worst-case scenario for how much could have been involved?
  • If not, was it a 10-20 count bottle? Or closer to a 500-1000 count bottle?
• Can they count the remaining pills?
• If it is the owner’s prescription, can they look at when the script was filled and count back how many pills they have taken based on the script instructions?
• Were multiple medications involved?
  • Was it in a pill minder? If so, how many of each pill are taken on each day and how many days’ worth of medication was ingested?
• Could the pet have ingested any plastic from the pill bottle itself?
• Was it a chewable/gummy that could have xylitol in it?

Questions About Rodenticides

• Does the owner still have the packaging with the EPA reg number, brand name, active ingredient, and/or size?
  • If not, an online identification should not be trusted.
• Was it pellets or blocks and what color was it?
• If blocks, what are the dimensions?
• Was it placed by a pest control officer?
  • Does the receipt have an active ingredient or any product information in it?
  • Can the company be asked what and how much was placed?
• If any blocks are remaining, can they bring one in to have it weighed?
• Worst-case scenario, how many blocks could have been involved?
• Is it possible that the patient could have ingested an additional block before the owners caught them?
• Is today the first possible exposure?

Questions About Gum

• What is the brand and flavor of the gum?
• What does the packaging look like?
• What do the pieces look like?
• How many pieces could have been involved?
• Where the pieces already chewed or where they new?
• Did the patient eat the packaging as well?