The dangers that lurk in our homes

The dangers that lurk in our homes

April 10, 2014

From the desk of Dr. Voorheis

 

Some of you may be familiar with the term “baby proof your home”. But have you ever heard of “pet proofing” your home? Same concept really, it’s all about providing a safe environment for those that cannot protect themselves. Children and pets often get into many of the same “things” around the house and suffer from similar consequences. But sometimes, pets offer up a completely unique set of challenges. So guess what we’re talking about his week…..the dangers that lurk in our homes! Some of this you may already know, but I guarantee there will be some new and valuable information as well.

By definition, this cannot be an all inclusive list or discussion of things that can harm your pets. The number of things that dogs and cats get into never ceases to amaze me. We can attempt to get a handle on it by dividing things into categories. But let’s understand something. There are 114 chapters in my latest Small Animal Emergency and Critical Care text book. Of those, 26 chapters would be included in the topic of Household Poisons and Emergencies. I’m not even going to attempt to be “all inclusive” this week.  As usual, I will attempt to discuss the things that I see and the things that interest me and hopefully interest you. A word up front: if you don’t know whether or not something will harm your pet, Google it or better yet, ask your veterinarian. Better safe than sorry.

So what are the main culprits in our homes that negatively affect our pets? Things we see most often at WBAH are adverse reactions to:

 •      Common household and yard plants that can cause illness

 •      Drugs – prescription, over-the-counter, and otherwise

 •      Insecticides and insect control products

 •      Chemical bait products – rat, mice bait

 •      Household cleaners

 •      Food and food like products

Let’s break this down. I will go in the order of the most frequently seen here at the hospital. I’m including photos so you know what to watch for in your yards and when out on walks, hikes or on vacation.

 

Household and Yard Plants

Sago Palm – It’s often found in your back or front yard. They are beautiful, commonly sold at Lowes, Home Depot or your local nursery.  All parts of the Sago Palm are poisonous but especially the seeds or “nuts” which contain the largest amount of the toxin. The ingestion of just one or two seeds can cause serious effects including vomiting, diarrhea, depression, seizures and acute hepatitis culminating in liver failure. As a clinician you don’t forget these cases. I think these plants should be equipped with a warning label prior to purchase. They are heartbreaking cases to treat. Even if you don’t have them at your house, watch your dogs closely when you’re out on walks as your neighbors may have one accessible in their front yard.

  sago1           sago2                                 

Lillies – the Easter Lilly in particular, but all lillies belonging to genus Lillium are highly toxic to cats (Easter Lilly, Tiger Lily, Rubrum Lily, Japanese Show Lily and certain species of daylily).

Ingestion of small amounts of the plant can cause kidney failure and ultimately death.

     lilles2   lilles3   lillies1       

Marijuana – the incidence of marijuana intoxication is on the rise. For whatever reason, we used to see a few cases a year. We now see- more than one case a month.  It is the number one plant/drug toxicity seen at WBAH. The signs vary from depression of the Central Nervous System and lack of coordination to vomiting, diarrhea, drooling, increased heart rate, seizures and coma.

The signs are dose related. In other words, the more of the drug consumed, the more severe the signs. In addition, the form that the drug is ingested in seems to make a difference in the symptoms. Most deaths related to marijuana in dogs are due to the ingestion of cannabis butter. Apparently the drug is more highly concentrated in butter.  Now- a word about your veterinarians and staff at WBAH. We are not the police. We are here to help you and your pets. It is far more helpful to your pet that you are honest about the possibility of marijuana ingestion. Withholding that information does not allow us to do our job properly and save lives.

 mj1 mj2 mj3                              

Oleander – I was raised by my mom to be scared to death of this plant yet we had a backyard full of it at one point – hmmmm. All parts of the plant are toxic and contain cardiac glycosides that have the potential to cause serious side effects such as gastrointestinal irritation, abnormal heart function, hypothermia and death.

  ole1 ole2 ole3             

Tulip/Narcissus bulbs – The bulb portion of Tulipa/Narcissus spp. contain toxins that can cause intense gastrointestinal irritation, drooling, loss of appetite, depression of the central nervous system, convulsions and cardiac abnormalities.

tup1 tup2                    

Azalea/RhododendronMembers of the Rhododendrum spp. contain substances known as grayantoxins which can produce vomiting, drooling, diarrhea and weakness and depression of the central nervous system in animals. Severe azalea poisoning could ultimately lead to coma and death from cardiovascular collapse.

 aza1 aza2 aza3   

Castor Bean – The poisonous principle in Ricinus communis is ricin which is a highly toxic protein that can produce severe abdominal pain, drooling, vomiting, diarrhea, excessive thirst, weakness and loss of appetite. Severe cases of poisoning can result in dehydration, muscle twitching, tremors, seizures, coma and death.

bean1                    bean2                                

Cyclamen – Cyclamen species contain cyclamine and the highest concentration of this toxic component is typically located in the root portion of the plant. If consumed, cyclamen can produce significant gastrointestinal irritation, including intense vomiting. Fatalities have been reported.

cyc1 cyc2 cyc3                

Yew – Taxus spp. contains a toxic component known as taxine which causes central nervous system effects such as trembling, lack of coordination and difficulty breathing. It can also cause significant gastronintestinal irritation and cardiac failure which can result in death.

 yew1 yew2 yew3          

Kalanchoe This plant contains components that can produce gastrointestinal irritation as well as those that are toxic to the heart and can seriously affect cardiac rhythm and rate.

 pot1 pot2 pot3        

Pothos – Pothos belongs to the Araceae family. If chewed or ingested, this popular household plant can cause significant mechanical irritation and swelling of the oral tissues and other parts of the gastrointestinal tract.

green1 green2 green3       

 

Holiday Plants

Poinsettias – generally overrated in toxicity. If ingested, poinsettias can be mildly irritating to mouth and stomach and may cause mild vomiting and/or nausea. “But wait Doc, I’ve always heard they are deadly”.  This information is out there on the internet and even some veterinarians claim it’s true but it’s just not so. It is felt to have come from plants of the same family as poinsettia being labeled as poinsettia.

                    

pont1 pont2 pont3 

 

Mistletoe – usually causes gastrointestinal upset if ingested. If enough is ingested, it can cause cardiac arrhythmias. If you pet eats Mistletoe it should be seen by a veterinarian immediately.

 toe1 toe2

                       

Holly – ingestion can cause vomiting, nausea, diarrhea and lethargy.

 holly1 holly2                                      

Christmas trees & decorations And while I’m on the subject of holiday hazards. Put water in the Christmas tree bowl – don’t add the packet of “fertilizer”. Some of these packets contain fertilizer that if ingested are toxic. Just better and easier to avoid adding packets of unknown composition to the water the tree is sitting in. Cats love to drink this water. So let’s make it safe, ok?

Electric light cords – hide them and protect them because your dogs and cats like to chew on them. Electrical shock injury ranges in severity from burns to lips and tongue to pulmonary (lung) edema and death.

Ribbons and tinsel – the presents under the tree at my house- long ago stopped having ribbon on them. One of our cats is crazy about ribbons. Both ribbons and tinsel have HIGH potential to cause the worst type of foreign body injury. It’s called linear foreign body and it is often fatal. A linear foreign body occurs when some part of something linear like a cloth, ribbon or string gets stuck in the stomach or base of tongue. The rest of the linear foreign body tries to pass or move along. The result is a bunching up of the gut. Think of trying to pass an elastic waistband through sweat pants, or elastic through the tops of curtains. Hmmmm, not sure what that’s called but you have to bunch up the material to get it to pass, right? The foreign body that is stuck remains as an anchor and the stuff that tries to pass literally saws through the intestine. The result may be as many as 30 or 40 holes in the intestinal tract. These pets die. It’s much easier to stop wrapping with ribbons and stop using tinsel if you have pets, especially cats!

 decor1 decor2 decor3

               

Medications – prescription and over-the-counter

Keep medications (yours and your pets) out of the reach of your animals. Dogs and cats both can be very clever about getting into medication. Keep the medications that you take and that you give to your dog or cat in a closed cabinet, preferably with a child/pet safe lock on the door. It can be more of a pain to keep them hidden that way but it is so much safer for the pets.  Things even happen at my house.  Many of you have heard me talk fondly of my Labrador, Milo. That dog has gotten himself in more trouble than almost any client’s dog I have ever worked with. Several years ago, he ingested more than 100, 75 mg non flavored Rimadyl tablets. They were kept on top of the refrigerator. One of my cats jumped on the counter and then on to the top of the refrigerator, knocking down the bottle. Milo ate every single pill. It happened in the wee hours of the morning.  I remember hearing a sound in the kitchen which I ignored and went back to sleep.  At 6 am, I found the empty bottle and rushed him in to work. Massive over dosages of non-steroidal anti-inflammatory drugs could have and maybe should have put him into renal failure, caused gastric ulceration or caused severe liver damage. He spent a few days in the hospital but never developed the failure that was expected. He did get sick but the point is he should have died and he didn’t. I never expected that my animals would tag-team to get into trouble but it happens. It happens more than you think.  All pet and human medications should be kept safe and out of reach in a cabinet.  Pain killers, cold medicines, anti-cancer drugs, anti-depressants, diet pills, are all examples of human medications that can be potentially lethal to pets.

There are two common medications that deserve special mention. The first is Acetaminophen better known as Tylenol. This drug is found in over 200 different over the counter and prescription medications. This medication can be fatal to cats, even in small doses. Cats lack glucuronyl transferase which decreases their ability to metabolize the drug. A toxic metabolite build up causes severe damage to red blood cells by causing the oxidation of hemoglobin from hemoglobin to methemoglobin, a compound which DOES NOT carry oxygen. Do not give your cat Tylenol or acetaminophen in any form.  Dogs, especially small dogs, can get sick from Tylenol. There are appropriate dosages for using Tylenol in dogs, especially in combination with a narcotic for pain relief, but it is my belief that we have plenty of other and much safer drug combinations to reach for than to risk the misuse of Tylenol in dogs.  Best not to go there.

The second special mention drug is Ibuprofen.  Ibuprofen belongs to a class of drugs called non steroidal anti-inflammatory drugs (NSAIDS). These drugs inhibit an enzyme called cyclooxygenase. This enzyme is involved in the production of inflammatory chemicals called prostaglandins. When the inflammatory cascade is active, cells use their cyclooxygenase enzymes to begin to convert fats from their cell membranes into prostaglandins. NSAIDs put a stop to this.  There are several types of cyclooxygenase. Some types are involved in producing inflammatory prostaglandins and others involved in producing prostaglandins needed for normal body functions. Ibuprofen is what is called a non-selective cyclooxygenase inhibitor which means it inhibits all types of cyclooxygenase, not just the ones that produce inflammatory mediators. Ibuprofen inhibits prostaglandins involved in the blood supply to the stomach as well as blood supply to the kidneys. In humans, these effects are minor enough that they do not preclude approval for over-the-counter use but in dogs and cats, these issues are life threatening. It turns out that dogs and cats are more sensitive to these issues. Prescription NSAIDs in the dog are more sparing of COX-1 effects on the stomach and kidneys. Ibuprofen is too toxic for safe use in dogs or cats at any dose. If a pet is lucky, exposure will not have reached toxic dose but it may not take much given that the typical non-prescription pill contains 200 mg. The first level of toxicity involves ulceration of the stomach which leads to vomiting with or without blood, appetite loss, and/or stools that are black from digested blood. The worst case is rupture of the stomach leading to death. Repeated use of ibuprofen will increase the risk of toxicity even at doses that are not toxic in single exposures. Ibuprofen inhibits production of prostaglandins needed for normal blood circulation to the stomach. Without normal blood flow, the stomach cannot produce a proper protective layer of mucous to protect its tissues from the harsh digestive acid it contains. That is the cause of the stomach ulceration. Treatment involves IV fluids and medications to heal the ulcer or ulcers. At higher doses, we see kidney failure. Toxins that the kidneys normally filter out are not filtered. Depending on the dosage administered or ingested and the amount of time between ingestion and presentation at the vet’s office, that damage may or may not be permanent. Treatment involves IV fluids, medications to try to open up kidney blood flow, and other supportive measures. High doses of Ibuprofen can cause coma and death.

 It’s time to add to a statement I make often which is “Remember, cats are not small dogs”. By that I mean that cats are a completely different species with different metabolic requirement and different ways of metabolizing medications, etc. To this I will now add “Dogs and cats are not small people”. Don’t use your medications on them without consulting a veterinarian first. Never ever. 

Insecticides and Insect Control Products

Organophosphates – these are insecticides. Not as commonly used around the house as they once were. Some of you may know them by the names malathion, parathion, diazinon, fenthion, dichlorvos, chlorpyrifos, ethion. Exposure in our type of practice is rare. They inhibit or inactivate an enzyme which causes excessive amounts of a neurotransmitter to accumulate resulting in muscle over stimulation. I still remember the mnemonic we used in veterinary medical school to remember the signs… SLUDGE (salivation, lacrimation (tearing), urination, defecation, gastrointestinal-movement, emesis).

We don’t see this much in an acute type of ingestion or exposure. Chronic low level exposure is beyond the scope of this blog as we don’t live in an agricultural area where low level exposure might take place. Diagnoses of this type would require testing for level of acetylcholine esterase activity in the blood.  Treatment is atropine which works for the majority of signs of high level exposure. Less is known about its efficacy with low level exposure.

Pyrethrins and Permethrin – pyrethrins are a pair of natural compounds produced by the Chrysanthemum cinerariifolium that have potent insecticide activity. They are often combined with piperonyl butoxide which is a synergist and prevents the insect’s detoxification of the pyrethrin. These are used in products such as Ovitrol or Adams flea spray. These are safe for use in dogs and cats. They rapidly breakdown in sunlight and air. So they don’t last a long time, with applications needing to repeat usually daily.

Permethrin is different. This is a synthetic product which can be used as flea and tick control ONLY FOR DOGS. Every year we see cat’s that are poisoned because someone applied a topical flea product for DOGS onto their cat. If the flea product that you are about to put on your cat says DOGS, please don’t use it. 

Here are some over the counter dog products that are potentially fatal to your cat:

1. Happy Jack DuraSpot

2. Liberty 50

3. Omnitrol

4. K9 Advantix

5. K9 Advantix II

6. Pronyl OTC Max

7. FiproGuard Max

8. SpectraSure Plus

9. Vectra 3D

10. Zodiac Spot On Groomer’s Pack

There are two labeled for cats that I personally would stay away from:

1. Biospot Defense

2. Vet-Kem Ovitrol X-tend

Both have the synthetic pyrethroid “etofenprox + methoprene” in them. They appear to be safe for cats. However, etofenprox is a synthetic pyrethroid that is metabolized by liver and cats lack that liver enzyme system. Remember the acetaminophen we talked about earlier? I would not use these products on a cat because there are safer products available such as Revolution and Comfortis.  

Bait products

Rat and Mouse bait products can be a problem. In our suburban environment, we have loads of rats and mice. There are two main types of rat and mouse bait.  Those that cause brain swelling and hyperkalemia and those that inhibit vitamin K and therefore the synthesis of clotting factors. These are factors involved in forming a blood clot and what keeps the blood inside vessels and not leaking into tissues.  Those that inhibit Vitamin K such as Warfarin, Diphacinone, Brodifacoum and Bromadiolone are actually easier to treat.  But don’t get me wrong, both types can be fatal. But at least there is an antidote to the vitamin K inhibitors.

Here is the important take home point. Most of these cases that are presented to us are presented days after ingestion of the rat bait. Often the owners were aware that the dog ate the product but because no signs developed right away, they thought they were “in the clear”. Then the dogs begin to bleed out. If your dog eats any kind of poison, especially the rat and mouse baits, bring the dog and the bait or its box to the hospital right away. Do not delay. Treatment for rat bait toxicity depends on how quickly we get to the dog. We may induce vomiting and inject with Vitamin K and send home with oral vitamin K. Or we may have to hospitalize, give blood or plasma transfusions, and other supportive measures.

Snail bait

What about those pesky snails? They are often controlled with molluscicide (Antimilice, Ariotox, Blitzem, Deadline, Halizan, Limatox, Limeol, and Slugit).  The active ingredient is Metaldehyde. Metaldehyde was popular in the 70’s when it was sold as slug bait that was “non-toxic” to dogs. We would see dog after dog, seizuring after exposure. This stuff is still being sold. Even the water runoff from an area that has been treated can be toxic. If ingested, signs follow quickly such as drooling, muscle tremors and restlessness progressing to seizures. The seizures will not stop until treated or until death happens. It also is hepatotoxic. Treatment is to stop the seizuring, control hyperthermia and provide lots of IV fluid support. Survival is possible if we get to them in time.

Household/Garage products

Ethylene Glycol – This is the greenish-yellow fluid that you put in your car’s radiator otherwise known as Anti-freeze. It is a sweet tasting fluid and it will kill your cat or dog. The absolute best way to avoid the problems associated with ethylene glycol toxicity is to address any radiator leak immediately and professionally. Do not allow dogs or cats assess to radiator fluid or under cars with a radiator leak. It is rapidly absorbed from the gastrointestinal tract and rapidly transformed in the liver by alcohol dehydrogenase to glycoaldehyde, glyoxalic acid and oxalic acid. This leads to severe metabolic acidosis and renal (kidney) damage.  A lethal dose is only 1.4 ml/kg in cats which is one teaspoon for average sized cat. A lethal dose in dogs is 6.6 ml/kg.  Two organ systems are affected. One is the nervous system where it appears as though they are drunk. The other is the kidneys. Rapid kidney failure occurs. Ethylene glycol has the highest fatality rate of all poisons. Animals present depressed, vomiting and initially increased thirst progressing to kidney shut down. Neurologic signs progress from lethargy, coma, seizures and then death. Kidneys are often swollen and painful, especially in cats. If we get the case within 5 hours and confirm ethylene glycol poisoning, it is treatable. If we get to the patient more than 5 hours post ingestion, we treat with a drug called fomepizole. Still worth trying if diagnosis is within 12 to 24 hours. Peritoneal dialysis may be beneficial. Kidney transplantation has been performed at University referral centers for cats with this problem. If fomepizole is not available, ethanol can be used.  I don’t however want to write about this poison as if it is highly treatable. We always try because that’s who we are and that’s what we do. But most cats and dogs die from ethylene glycol toxicity. It’s sad but true.

Foods

Before I talk about individual problem foods, a particular food category should be addressed and that would be fatty foods. Things like bacon and/or bacon drippings.  fat from your steak, chicken or turkey skin and butter. High fat foods contribute to gastrointestinal signs and especially a condition called pancreatitis. Pancreatitis is going to be a subject of a different upcoming blog because it is a rather complicated discussion. One of the risk factors for pancreatitis is high fat diets. We certainly do our dogs and cats no favors by feeding high fat table scraps. They are not small people and cannot handle the level of fat in the diet that people can.

 Now let’s talk about some individual foods and food ingredients that may act as toxins that many people may not be aware of.

 Macadamia nuts – ingestion of this item causes a syndrome of tremors, weakness, agitation, vomiting, diarrhea and paralysis in dogs.  Clinical signs develop when 2.4 to 62.4 gram/kg of macadamia nuts have been ingested. The symptoms can develop within 12 hours of ingestion. Mechanism of toxicity is unknown. The neurologic signs include tremors, ataxia (drunken gaits), weakness and ascending paralysis primarily of the rear limbs. Treatment is symptomatic. If we get to the animals within 3 hours of ingestion we will induce vomiting. Recovery generally happens within 48 hours.

 Chocolate toxicity ingestion of chocolate (methylxanthine alkaloids) in sufficient quantity can cause gastrointestinal, neurologic and cardiac abnormalities. Methylxanthine alkaloids = theobromine and caffeine from the cocoa bean.

 

Type Theobromine (mg/oz) Type Theobromine(mg/oz)
Cocoa Shell Mulch 400-857 Semi Sweet Chocolate 150-257
Cocoa Beans 314-1228 Milk Chocolate 44-63
Cocoa Powder 150-742 Hot Chocolate Powder 11-14
Baker’s Chocolate 390-457 White Chocolate 0.26-1.4
Range of theobromine per ounce of chocolate      
MilkChocolate44mg/oz 5 kg 10 kg 20 kg 30 kg 50 kg 70 kg
1 oz 9 mg/kg 4.5 mg/kg 2.2 mg/kg 1.5 mg/kg < 1mg/kg < 1mg/kg
8 oz (1 c) 71 mg/kg 35 mg/kg 18 mg/kg 12 mg/kg 7 mg/kg 5 mg/kg
16 oz (2 c) 141 mg/kg 70 mg/kg 35 mg/kg 23 mg/kg 14 mg/kg 10 mg/kg
32 oz (4 c) 282 mg/kg 141 mg/kg 71 mg/kg 47 mg/kg 28 mg/kg 20 mg/kg
Semi SweetChocolate(150 mg/oz) 5 kg 10 kg 20 kg 30 kg 50 kg 70 kg
1 oz 30 mg/kg 15 mg/kg 8 mg/kg 5 mg/kg 3 mg/kg 2 mg/kg
8 oz (1 c) 240 mg/kg 120 mg/kg 60 mg/kg 40 mg/kg 24 mg/kg 17 mg/kg
16 oz (2 c) 480 mg/kg 240 mg/kg 120 mg/kg 80 mg/kg 48 mg/kg 34 mg/kg
32 oz (4 c) 960 mg/kg 480 mg/kg 240 mg/kg 160 mg/kg 96 mg/kg 69 mg/kg
Bakers Chocolate 390mg/oz 5 kg 10 kg 20 kg 30 kg 50 kg 70 kg
1 oz 78 mg/kg 39 mg/kg 20 mg/kg 13 mg/kg 8 mg/kg 6 mg/kg
8 oz(1 c) 624 mg/kg 312 mg/kg 156 mg/kg 104 mg/kg 62 mg/kg 45 mg/kg
16 oz (2 c) 1248 mg/kg 624 mg/kg 312 mg/kg 208 mg/kg 125mg/kg 89 mg/kg
32 oz (4 c) 2496 mg/kg 1248 mg/kg 624 mg/kg 416 mg/kg 250 mg/kg 178 mg/kg
Chocolate dose based on weight (kg) of the patient and type of chocolate  
Red numbers indicate a dose greater than or near 100 mg/kg    
               

 Systems affected by ingestion of chocolate products are gastrointestinal (vomiting and diarrhea), urologic , nervous system (hyperactivity), CNS stimulation, seizures. Musculoskeletal (tremors, increased reflexes) and cardiovascular (tachycardia). Treatment involves inducing vomiting if they have recently ingested the chocolate. Otherwise it will be fluid support, activated charcoal to try to block absorption, placement of a urinary catheter because the active ingredient is absorbed back into circulation through the bladder wall. Seizures are controlled and drugs to slow the heart rate down. Expect two to three days of treatment.

 Grapes and Raisins –

This topic is poorly understood. Symptoms are vomiting, diarrhea and Acute Renal Failure secondary to the ingestion of raisins or grapes. Ingestion also causes acute tubular necrosis of the kidney tubules and little urine to no urine is produced. Signs start within 24 hours of ingestion of raisins or grapes. Vomiting and diarrhea come first and renal signs follow. Treatment includes induction of vomiting followed by administration of activated charcoal and lots of IV fluids. Damage to kidneys may be permanent.

 There are many food and beverage items that cause problems for dogs and cats and far too many to list here. To name just a few of the common offenders we have coffee, alcohol, artificial sweeteners in food items, onions, garlic, avocados, walnuts, yeast dough, any pit fruit like cherries/apricots/peaches etc. With pit fruits, the actual pit is the problem.  For a longer list of food and chemicals/drugs that are poisonous to pets, please visit:

 

http://www.petpoisonhelpline.com/    or      http://www.aspca.org/pet-care/animal-poison-control

 

Another tool to get familiar with is CPR for pets. There is a handy guide below.

 Well, I think that’s enough doom and gloom for today. Pet proof your home and yard and keep your critters out of harm’s way.  Give it the old college try!

Until next week,

 

Dr. Voorheis

 

 

cpr

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