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Adder Bites

2011-01-23T17:51:46Z

Eanugent: /* Introduction */

{{unfinished}}

==Introduction==
The adder, also known as the viper, is native to many parts of the UK, where it is the only poisonous snake living in the wild <ref name="multiples"> '''http://www.nhs.uk/conditions/Bites-snake/Pages/Introduction.aspx'''accessed on 10.11.2010 </ref>. Adder bites are most frequent between february and october. The habitat of the common european adder (Vipera Berus) extends throughout England, Wales, Scotland and some islands off the coast of Scotland, and the isle of Wight <ref> '''Treatment of bites by adders and exotic venomous snake''',Warrell DA,''BMJ'' 2005;331:1244 doi:10.1136/bmj.331.7527.1244(Published 12 november 2005) </ref>. <ref name="multiples"> '''http://www.nhs.uk/conditions/Bites-snake/Pages/Introduction.aspx'''accessed on 10.11.2010 </ref>. Adder bites can be accommpanied by the injection of venom <ref name="multiples"> '''http://www.nhs.uk/conditions/Bites-snake/Pages/Introduction.aspx'''accessed on 10.11.2010 </ref>, through one of the most sophisticated mechanisms seen in the animal kingdom <ref> '''http://www.forestry.gov.uk/forestry/adder''', accessed on 10.11.2010 </ref>, or they can be venom-less in which case the damaged caused to the victim is limited to the puncture wounds <ref name="multiples"> '''http://www.nhs.uk/conditions/Bites-snake/Pages/Introduction.aspx'''accessed on 10.11.2010 </ref>. The mortality rate in dogs that have received venomous bites is thought to be 3.5% to 4% <ref name="multiples"> '''Clinical and biochemical changes in 53 Swedish dogs bitten by the European adder - ''Viper berus'' ''', Lervik et al, Acta Vet Scand. 2010; 52(1):26, accessed at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2873270/?tool=pubmed#B1 on 08.12.10 </ref>. In dogs the most common site of the bite is the head, followed by the forelimb <ref name="multiples"> '''Clinical and biochemical changes in 53 Swedish dogs bitten by the European adder - ''Viper berus'' ''', Lervik et al, Acta Vet Scand. 2010; 52(1):26, accessed at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2873270/?tool=pubmed#B1 on 08.12.10 </ref>.

==Signalment==

Adder bites have been reported in dogs, cats and horses <ref> '''http://www.fabcats.org/owners/poisons/Cats%20and%20poisons.html''', accessed on 10.11.2010 </ref>.

==Diagnosis==
===Clinical Signs===
*Swelling at puncture site
*Altered Mentation
*Cardiac Abnormalities <ref name="multiples"> '''Clinical and biochemical changes in 53 Swedish dogs bitten by the European adder - ''Viper berus'' ''', Lervik et al, Acta Vet Scand. 2010; 52(1):26, accessed at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2873270/?tool=pubmed#B1 on 08.12.10 </ref>
*Initial Pyrexia <ref name="multiples"> '''Clinical and biochemical changes in 53 Swedish dogs bitten by the European adder - ''Viper berus'' ''', Lervik et al, Acta Vet Scand. 2010; 52(1):26, accessed at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2873270/?tool=pubmed#B1 on 08.12.10 </ref>

===Laboratory Tests===
*'''Biochemistry:''' Transient elevations in one or more of the following parameters may be seen; Alanine Aminotransferase, Alkaline Phosphatase, Bile Acids, Glutamate Dehydrogenase and Creatinine Kinase <ref name="multiples"> '''Clinical and biochemical changes in 53 Swedish dogs bitten by the European adder - ''Viper berus'' ''', Lervik et al, Acta Vet Scand. 2010; 52(1):26, accessed at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2873270/?tool=pubmed#B1 on 08.12.10 </ref>.

===Pathology===
==Treatment==
*'''Antiserum:'''
*'''Supportive Treatment''''
**'''Fluid Therapy:'''
**'''Analgesia'''
**'''Anti-inflammatories'''
**'''Anti-biotics'''
==Prognosis==
==References==
<references/>

Chocolate Poisoning-Dog

2011-01-23T10:11:12Z

Eanugent: /* Clinical Signs */

{{unfinished}}
"[[File:Chocolate.jpg|thumb|Chocolate]]"
==Introduction==
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. The consumption of more than 20mg/kg of total methylxanthines, the dose at which mild signs such as vomiting, diarrhoea and polyuria are induced <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>, is considered the cut-off point in deciding whether or not to treat <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>. The concentration of methylxanthines differs between products <ref name="multiples"> Tilley, LP, Smith, FWK'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref> and therefore the number of grammes required to reach this threshold vary according to the product; in a 10kg dog 5000g of white chocolate provides the equivalent 20mg/kg dose of methylxanthines that 12-40g of plain chocolate, 83-117g of milk chocolate or 7-25g of cocoa powder does <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA''</ref>
Methylxanthines are also present in beverages and foods other than chocolates <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

==Signalment==
Dog that live indoors are more likely to have access to chocolate. Also puppies and dogs that scavenge are at a greater risk of eating food that is not intended for their consumption. Small breeds of dogs may reach the toxic level of methylxanthine concentration per body weight more easily <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>.

==Diagnosis==
===Clinical Signs===
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular, respiratory and urological signs <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>, <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref> which are evident soon after ingestion of a toxic amount of chocolate <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''CNS:''' hyperactivity, behavioural changes, ataxia, muscle tremors, clonic seizures and hyperthermia <ref name="multiple"> Tilley, LP, Smith, FWK '''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>, <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>, <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Gastrointestinal:''' diarrhoea, emesis, haematemesis <ref name="multiples"> Tilley, LP, Smith, FWK'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>, <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>.
*'''Cardiovascular:''' arrhythmias,tachycardia, bradycardia sometimes, hypotension <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>, <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>.
*'''Respiratory:''' tachypnoea <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.
*'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.

===Laboratory Tests===
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>. The following laboratory tests are possible but not commonly used;

* Assays for detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>.
* Blood Glucose: Hypoglycaemia as a sequela to hyperactivity. not seen consistently with chocolate poisoning <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>.
* Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>.

===Other===
*ECG: rate and rhythm abnormalities <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>.

===Pathology===
Following absorption from the gastrointestinal tract caffeine and theobromine are metabolised in the liver <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>. Caffeine has a half life of 4.5 hours in dogs while theobromine has a half life of 17.5 hours <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>. In humans the half life of theobromine ranges from 6 to 10 hours, significantly shorter than that in dogs which may explain the susceptibility of dogs to chocolate poisoning REF.
Methylxanthines have the following modes of action.

*'''Antagonism of Adenosine Receptors:'''<ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> this antagonism results in stimulation of the central nervous system and an increase in heart rate <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref> and also diureses <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>
*'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>.
*'''Modulation of Intracellular Calcium Concentrations:''' <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.<ref> Carson TL (2006) Methylxanthines. In: ''Small Animal Toxicology'', ed. ME Peterson, PA Talcott, pp.845-852. Elsevier Saunders, St. Louis in '''BSAVA Manual of Canine and Feline Emergency Care''' Chapter 19, Second Edition,2007 </ref>, <ref> Holmgren P, Norden-Petterson L and Ahlner J (2004)Caffeine fatalaties: four case reports. ''Forensic Science International'' '''139''', 71-73 '''BSAVA Manual of Canine and Feline Emergency Care''' Second Edition,2007 </ref>.

==Treatment==
'''Of dogs presenting with clinical signs'''
*'''Inital stabilisation of Cardiorespiratory System:'''
**Tachycardia: beta-blockers, eg orally administered metoprolol at a dose of 0.5mg to 1mg per kg every 8 hours <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Premature Ventricluar Contractions: lidocaine; iv bolus of 2mg to 6mg per kg administered slowly, after which a constant rate infusion of 20ug to 70ug per kg per minute should be given <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.

*'''Treatment of seizures and hyperactivity'''
**IV Diazepam at a dose of 0.5 to 2 mg/kg <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Alternative to diazepam is barbiturates <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Treating the seizures and hyperactivity should help restore normal body temperature. If animal still hyperthermic then this should be treated directly <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Correction of acid/base and electrolyte inbalances''' <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>,

*'''Insertion of urinary catheter'''
**Helps prevent further absorption of theobromine and caffeine across bladder wall <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

'''Of dogs with a known history of recent chocolate ingestion but who have not yet developed clinical signs'''
*Administration of apomorphine (0.03mg/kg IV) or hydrogen peroxide (1-5 ml/kg PO) ref 5 min vet consult in order to induce emesis and/or of activated charcoal in order to minimise further absorption of methylxanthines re 5 min vet consult

==Prognosis==
If treated correctly and early enough ref 5min consult the prognosis is good and a complete recovery can be expected <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>. For animals presenting with seizures and arrhythmias the prognosis is more cautious.

==References==
<references/>

Chocolate Poisoning-Dog

2011-01-23T10:10:29Z

Eanugent: /* Introduction */

{{unfinished}}
"[[File:Chocolate.jpg|thumb|Chocolate]]"
==Introduction==
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. The consumption of more than 20mg/kg of total methylxanthines, the dose at which mild signs such as vomiting, diarrhoea and polyuria are induced <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>, is considered the cut-off point in deciding whether or not to treat <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>. The concentration of methylxanthines differs between products <ref name="multiples"> Tilley, LP, Smith, FWK'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref> and therefore the number of grammes required to reach this threshold vary according to the product; in a 10kg dog 5000g of white chocolate provides the equivalent 20mg/kg dose of methylxanthines that 12-40g of plain chocolate, 83-117g of milk chocolate or 7-25g of cocoa powder does <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA''</ref>
Methylxanthines are also present in beverages and foods other than chocolates <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

==Signalment==
Dog that live indoors are more likely to have access to chocolate. Also puppies and dogs that scavenge are at a greater risk of eating food that is not intended for their consumption. Small breeds of dogs may reach the toxic level of methylxanthine concentration per body weight more easily <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>.

==Diagnosis==
===Clinical Signs===
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular, respiratory and urological signs <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>, <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref> which are evident soon after ingestion of a toxic amount of chocolate <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''CNS:''' hyperactivity, behavioural changes, ataxia, muscle tremors, clonic seizures and hyperthermia <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>, <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>, <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Gastrointestinal:''' diarrhoea, emesis, haematemesis <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>, <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>.
*'''Cardiovascular:''' arrhythmias,tachycardia, bradycardia sometimes, hypotension <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>, <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>.
*'''Respiratory:''' tachypnoea <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.
*'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.

===Laboratory Tests===
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>. The following laboratory tests are possible but not commonly used;

* Assays for detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>.
* Blood Glucose: Hypoglycaemia as a sequela to hyperactivity. not seen consistently with chocolate poisoning <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>.
* Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>.

===Other===
*ECG: rate and rhythm abnormalities <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>.

===Pathology===
Following absorption from the gastrointestinal tract caffeine and theobromine are metabolised in the liver <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>. Caffeine has a half life of 4.5 hours in dogs while theobromine has a half life of 17.5 hours <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>. In humans the half life of theobromine ranges from 6 to 10 hours, significantly shorter than that in dogs which may explain the susceptibility of dogs to chocolate poisoning REF.
Methylxanthines have the following modes of action.

*'''Antagonism of Adenosine Receptors:'''<ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> this antagonism results in stimulation of the central nervous system and an increase in heart rate <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref> and also diureses <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>
*'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>.
*'''Modulation of Intracellular Calcium Concentrations:''' <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.<ref> Carson TL (2006) Methylxanthines. In: ''Small Animal Toxicology'', ed. ME Peterson, PA Talcott, pp.845-852. Elsevier Saunders, St. Louis in '''BSAVA Manual of Canine and Feline Emergency Care''' Chapter 19, Second Edition,2007 </ref>, <ref> Holmgren P, Norden-Petterson L and Ahlner J (2004)Caffeine fatalaties: four case reports. ''Forensic Science International'' '''139''', 71-73 '''BSAVA Manual of Canine and Feline Emergency Care''' Second Edition,2007 </ref>.

==Treatment==
'''Of dogs presenting with clinical signs'''
*'''Inital stabilisation of Cardiorespiratory System:'''
**Tachycardia: beta-blockers, eg orally administered metoprolol at a dose of 0.5mg to 1mg per kg every 8 hours <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Premature Ventricluar Contractions: lidocaine; iv bolus of 2mg to 6mg per kg administered slowly, after which a constant rate infusion of 20ug to 70ug per kg per minute should be given <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.

*'''Treatment of seizures and hyperactivity'''
**IV Diazepam at a dose of 0.5 to 2 mg/kg <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Alternative to diazepam is barbiturates <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Treating the seizures and hyperactivity should help restore normal body temperature. If animal still hyperthermic then this should be treated directly <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Correction of acid/base and electrolyte inbalances''' <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>,

*'''Insertion of urinary catheter'''
**Helps prevent further absorption of theobromine and caffeine across bladder wall <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

'''Of dogs with a known history of recent chocolate ingestion but who have not yet developed clinical signs'''
*Administration of apomorphine (0.03mg/kg IV) or hydrogen peroxide (1-5 ml/kg PO) ref 5 min vet consult in order to induce emesis and/or of activated charcoal in order to minimise further absorption of methylxanthines re 5 min vet consult

==Prognosis==
If treated correctly and early enough ref 5min consult the prognosis is good and a complete recovery can be expected <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>. For animals presenting with seizures and arrhythmias the prognosis is more cautious.

==References==
<references/>

Chocolate Poisoning-Dog

2011-01-23T10:10:06Z

Eanugent: /* Introduction */

{{unfinished}}
"[[File:Chocolate.jpg|thumb|Chocolate]]"
==Introduction==
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. The consumption of more than 20mg/kg of total methylxanthines, the dose at which mild signs such as vomiting, diarrhoea and polyuria are induced <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>, is considered the cut-off point in deciding whether or not to treat <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>. The concentration of methylxanthines differs between products <ref name="multiples"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref> and therefore the number of grammes required to reach this threshold vary according to the product; in a 10kg dog 5000g of white chocolate provides the equivalent 20mg/kg dose of methylxanthines that 12-40g of plain chocolate, 83-117g of milk chocolate or 7-25g of cocoa powder does <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA''</ref>
Methylxanthines are also present in beverages and foods other than chocolates <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

==Signalment==
Dog that live indoors are more likely to have access to chocolate. Also puppies and dogs that scavenge are at a greater risk of eating food that is not intended for their consumption. Small breeds of dogs may reach the toxic level of methylxanthine concentration per body weight more easily <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>.

==Diagnosis==
===Clinical Signs===
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular, respiratory and urological signs <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>, <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref> which are evident soon after ingestion of a toxic amount of chocolate <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''CNS:''' hyperactivity, behavioural changes, ataxia, muscle tremors, clonic seizures and hyperthermia <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>, <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>, <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Gastrointestinal:''' diarrhoea, emesis, haematemesis <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>, <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>.
*'''Cardiovascular:''' arrhythmias,tachycardia, bradycardia sometimes, hypotension <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>, <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>.
*'''Respiratory:''' tachypnoea <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.
*'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.

===Laboratory Tests===
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>. The following laboratory tests are possible but not commonly used;

* Assays for detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>.
* Blood Glucose: Hypoglycaemia as a sequela to hyperactivity. not seen consistently with chocolate poisoning <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>.
* Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>.

===Other===
*ECG: rate and rhythm abnormalities <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>.

===Pathology===
Following absorption from the gastrointestinal tract caffeine and theobromine are metabolised in the liver <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>. Caffeine has a half life of 4.5 hours in dogs while theobromine has a half life of 17.5 hours <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>. In humans the half life of theobromine ranges from 6 to 10 hours, significantly shorter than that in dogs which may explain the susceptibility of dogs to chocolate poisoning REF.
Methylxanthines have the following modes of action.

*'''Antagonism of Adenosine Receptors:'''<ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> this antagonism results in stimulation of the central nervous system and an increase in heart rate <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref> and also diureses <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>
*'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>.
*'''Modulation of Intracellular Calcium Concentrations:''' <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.<ref> Carson TL (2006) Methylxanthines. In: ''Small Animal Toxicology'', ed. ME Peterson, PA Talcott, pp.845-852. Elsevier Saunders, St. Louis in '''BSAVA Manual of Canine and Feline Emergency Care''' Chapter 19, Second Edition,2007 </ref>, <ref> Holmgren P, Norden-Petterson L and Ahlner J (2004)Caffeine fatalaties: four case reports. ''Forensic Science International'' '''139''', 71-73 '''BSAVA Manual of Canine and Feline Emergency Care''' Second Edition,2007 </ref>.

==Treatment==
'''Of dogs presenting with clinical signs'''
*'''Inital stabilisation of Cardiorespiratory System:'''
**Tachycardia: beta-blockers, eg orally administered metoprolol at a dose of 0.5mg to 1mg per kg every 8 hours <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Premature Ventricluar Contractions: lidocaine; iv bolus of 2mg to 6mg per kg administered slowly, after which a constant rate infusion of 20ug to 70ug per kg per minute should be given <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.

*'''Treatment of seizures and hyperactivity'''
**IV Diazepam at a dose of 0.5 to 2 mg/kg <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Alternative to diazepam is barbiturates <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Treating the seizures and hyperactivity should help restore normal body temperature. If animal still hyperthermic then this should be treated directly <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Correction of acid/base and electrolyte inbalances''' <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>,

*'''Insertion of urinary catheter'''
**Helps prevent further absorption of theobromine and caffeine across bladder wall <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

'''Of dogs with a known history of recent chocolate ingestion but who have not yet developed clinical signs'''
*Administration of apomorphine (0.03mg/kg IV) or hydrogen peroxide (1-5 ml/kg PO) ref 5 min vet consult in order to induce emesis and/or of activated charcoal in order to minimise further absorption of methylxanthines re 5 min vet consult

==Prognosis==
If treated correctly and early enough ref 5min consult the prognosis is good and a complete recovery can be expected <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>. For animals presenting with seizures and arrhythmias the prognosis is more cautious.

==References==
<references/>

Chocolate Poisoning-Dog

2011-01-23T10:09:01Z

Eanugent:

{{unfinished}}
"[[File:Chocolate.jpg|thumb|Chocolate]]"
==Introduction==
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. The consumption of more than 20mg/kg of total methylxanthines, the dose at which mild signs such as vomiting, diarrhoea and polyuria are induced <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>, is considered the cut-off point in deciding whether or not to treat <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>. The concentration of methylxanthines differs between products <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref> and therefore the number of grammes required to reach this threshold vary according to the product; in a 10kg dog 5000g of white chocolate provides the equivalent 20mg/kg dose of methylxanthines that 12-40g of plain chocolate, 83-117g of milk chocolate or 7-25g of cocoa powder does <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA''</ref>
Methylxanthines are also present in beverages and foods other than chocolates <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

==Signalment==
Dog that live indoors are more likely to have access to chocolate. Also puppies and dogs that scavenge are at a greater risk of eating food that is not intended for their consumption. Small breeds of dogs may reach the toxic level of methylxanthine concentration per body weight more easily <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>.

==Diagnosis==
===Clinical Signs===
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular, respiratory and urological signs <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>, <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref> which are evident soon after ingestion of a toxic amount of chocolate <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''CNS:''' hyperactivity, behavioural changes, ataxia, muscle tremors, clonic seizures and hyperthermia <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>, <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>, <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Gastrointestinal:''' diarrhoea, emesis, haematemesis <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>, <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>.
*'''Cardiovascular:''' arrhythmias,tachycardia, bradycardia sometimes, hypotension <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>, <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>.
*'''Respiratory:''' tachypnoea <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.
*'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.

===Laboratory Tests===
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>. The following laboratory tests are possible but not commonly used;

* Assays for detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>.
* Blood Glucose: Hypoglycaemia as a sequela to hyperactivity. not seen consistently with chocolate poisoning <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>.
* Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>.

===Other===
*ECG: rate and rhythm abnormalities <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>.

===Pathology===
Following absorption from the gastrointestinal tract caffeine and theobromine are metabolised in the liver <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>. Caffeine has a half life of 4.5 hours in dogs while theobromine has a half life of 17.5 hours <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>. In humans the half life of theobromine ranges from 6 to 10 hours, significantly shorter than that in dogs which may explain the susceptibility of dogs to chocolate poisoning REF.
Methylxanthines have the following modes of action.

*'''Antagonism of Adenosine Receptors:'''<ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> this antagonism results in stimulation of the central nervous system and an increase in heart rate <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref> and also diureses <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>
*'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects <ref name="multiple"> Tilley, LP, Smith, FWK ()'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref>.
*'''Modulation of Intracellular Calcium Concentrations:''' <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.<ref> Carson TL (2006) Methylxanthines. In: ''Small Animal Toxicology'', ed. ME Peterson, PA Talcott, pp.845-852. Elsevier Saunders, St. Louis in '''BSAVA Manual of Canine and Feline Emergency Care''' Chapter 19, Second Edition,2007 </ref>, <ref> Holmgren P, Norden-Petterson L and Ahlner J (2004)Caffeine fatalaties: four case reports. ''Forensic Science International'' '''139''', 71-73 '''BSAVA Manual of Canine and Feline Emergency Care''' Second Edition,2007 </ref>.

==Treatment==
'''Of dogs presenting with clinical signs'''
*'''Inital stabilisation of Cardiorespiratory System:'''
**Tachycardia: beta-blockers, eg orally administered metoprolol at a dose of 0.5mg to 1mg per kg every 8 hours <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Premature Ventricluar Contractions: lidocaine; iv bolus of 2mg to 6mg per kg administered slowly, after which a constant rate infusion of 20ug to 70ug per kg per minute should be given <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.

*'''Treatment of seizures and hyperactivity'''
**IV Diazepam at a dose of 0.5 to 2 mg/kg <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Alternative to diazepam is barbiturates <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Treating the seizures and hyperactivity should help restore normal body temperature. If animal still hyperthermic then this should be treated directly <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Correction of acid/base and electrolyte inbalances''' <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>,

*'''Insertion of urinary catheter'''
**Helps prevent further absorption of theobromine and caffeine across bladder wall <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

'''Of dogs with a known history of recent chocolate ingestion but who have not yet developed clinical signs'''
*Administration of apomorphine (0.03mg/kg IV) or hydrogen peroxide (1-5 ml/kg PO) ref 5 min vet consult in order to induce emesis and/or of activated charcoal in order to minimise further absorption of methylxanthines re 5 min vet consult

==Prognosis==
If treated correctly and early enough ref 5min consult the prognosis is good and a complete recovery can be expected <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>. For animals presenting with seizures and arrhythmias the prognosis is more cautious.

==References==
<references/>

Chocolate Poisoning-Dog

2011-01-23T09:53:50Z

Eanugent:

{{unfinished}}
"[[File:Chocolate.jpg|thumb|Chocolate]]"
==Introduction==
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. The consumption of more than 20mg/kg of total methylxanthines, the dose at which mild signs such as vomiting, diarrhoea and polyuria are induced <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>, is considered the cut-off point in deciding whether or not to treat <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>. The concentration of methylxanthines differs between products <ref name=multiples> Tilley, Smith'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref> and therefore the number of grammes required to reach this threshold vary according to the product; in a 10kg dog 5000g of white chocolate provides the equivalent 20mg/kg dose of methylxanthines that 12-40g of plain chocolate, 83-117g of milk chocolate or 7-25g of cocoa powder does <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA''</ref>
Methylxanthines are also present in beverages and foods other than chocolates <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

==Signalment==
Dog that live indoors are more likely to have access to chocolate. Also puppies and dogs that scavenge are at a greater risk of eating food that is not intended for their consumption. Small breeds of dogs may reach the toxic level of methylxanthine concentration per body weight more easily <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>.

==Diagnosis==
===Clinical Signs===
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular, respiratory and urological signs.<ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref> which are evident soon after ingestion of a toxic amount of chocolate <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''CNS:''' hyperactivity, behavioural changes, ataxia, muscle tremors, clonic seizures and hyperthermia <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>, <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Gastrointestinal:''' diarrhoea, emesis, haematemesis <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>.
*'''Cardiovascular:''' arrhythmias,tachycardia, bradycardia sometimes, hypotension <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>.
*'''Respiratory:''' tachypnoea <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.
*'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.

===Laboratory Tests===
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>. The following laboratory tests are possible but not commonly used;

* Assays for detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Blood Glucose: Hypoglycaemia as a sequela to hyperactivity. not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.

===Other===
*ECG: rate and rhythm abnormalities <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.

===Pathology===
Following absorption from the gastrointestinal tract caffeine and theobromine are metabolised in the liver <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>. Caffeine has a half life of 4.5 hours in dogs while theobromine has a half life of 17.5 hours <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>. In humans the half life of theobromine ranges from 6 to 10 hours, significantly shorter than that in dogs which may explain the susceptibility of dogs to chocolate poisoning REF.
Methylxanthines have the following modes of action.

*'''Antagonism of Adenosine Receptors:'''<ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> this antagonism results in stimulation of the central nervous system and an increase in heart rate <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref> and also diureses <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>
*'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.
*'''Modulation of Intracellular Calcium Concentrations:''' <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.<ref> Carson TL (2006) Methylxanthines. In: ''Small Animal Toxicology'', ed. ME Peterson, PA Talcott, pp.845-852. Elsevier Saunders, St. Louis in '''BSAVA Manual of Canine and Feline Emergency Care''' Chapter 19, Second Edition,2007 </ref>, <ref> Holmgren P, Norden-Petterson L and Ahlner J (2004)Caffeine fatalaties: four case reports. ''Forensic Science International'' '''139''', 71-73 '''BSAVA Manual of Canine and Feline Emergency Care''' Second Edition,2007 </ref>.

==Treatment==
'''Of dogs presenting with clinical signs'''
*'''Inital stabilisation of Cardiorespiratory System:'''
**Tachycardia: beta-blockers, eg orally administered metoprolol at a dose of 0.5mg to 1mg per kg every 8 hours <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Premature Ventricluar Contractions: lidocaine; iv bolus of 2mg to 6mg per kg administered slowly, after which a constant rate infusion of 20ug to 70ug per kg per minute should be given <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.

*'''Treatment of seizures and hyperactivity'''
**IV Diazepam at a dose of 0.5 to 2 mg/kg <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Alternative to diazepam is barbiturates <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Treating the seizures and hyperactivity should help restore normal body temperature. If animal still hyperthermic then this should be treated directly <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Correction of acid/base and electrolyte inbalances''' <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>,

*'''Insertion of urinary catheter'''
**Helps prevent further absorption of theobromine and caffeine across bladder wall <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

'''Of dogs with a known history of recent chocolate ingestion but who have not yet developed clinical signs'''
*Administration of apomorphine (0.03mg/kg IV) or hydrogen peroxide (1-5 ml/kg PO) ref 5 min vet consult in order to induce emesis and/or of activated charcoal in order to minimise further absorption of methylxanthines re 5 min vet consult

==Prognosis==
If treated correctly and early enough ref 5min consult the prognosis is good and a complete recovery can be expected <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>. For animals presenting with seizures and arrhythmias the prognosis is more cautious.

==References==
<references/>

Chocolate Poisoning-Dog

2011-01-23T09:50:12Z

Eanugent:

{{unfinished}}
"[[File:Chocolate.jpg|thumb|Chocolate]]"
==Introduction==
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. The consumption of more than 20mg/kg of total methylxanthines, the dose at which mild signs such as vomiting, diarrhoea and polyuria are induced <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>, is considered the cut-off point in deciding whether or not to treat <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>. The concentration of methylxanthines differs between products <ref name=multiples> Tilley, Smith'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref> and therefore the number of grammes required to reach this threshold vary according to the product; in a 10kg dog 5000g of white chocolate provides the equivalent 20mg/kg dose of methylxanthines that 12-40g of plain chocolate, 83-117g of milk chocolate or 7-25g of cocoa powder does <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA''</ref>
Methylxanthines are also present in beverages and foods other than chocolates <ref name="multiple"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

==Signalment==
Dog that live indoors are more likely to have access to chocolate. Also puppies and dogs that scavenge are at a greater risk of eating food that is not intended for their consumption. Small breeds of dogs may reach the toxic level of methylxanthine concentration per body weight more easily <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>.

==Diagnosis==
===Clinical Signs===
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular, respiratory and urological signs.<ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref> which are evident soon after ingestion of a toxic amount of chocolate <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''CNS:''' hyperactivity, behavioural changes, ataxia, muscle tremors, clonic seizures and hyperthermia <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>, <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Gastrointestinal:''' diarrhoea, emesis, haematemesis <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>.
*'''Cardiovascular:''' arrhythmias,tachycardia, bradycardia sometimes, hypotension <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>.
*'''Respiratory:''' tachypnoea <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.
*'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.

===Laboratory Tests===
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>. The following laboratory tests are possible but not commonly used;

* Assays for detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Blood Glucose: Hypoglycaemia as a sequela to hyperactivity. not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.

===Other===
*ECG: rate and rhythm abnormalities <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.

===Pathology===
Following absorption from the gastrointestinal tract caffeine and theobromine are metabolised in the liver <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>. Caffeine has a half life of 4.5 hours in dogs while theobromine has a half life of 17.5 hours <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>. In humans the half life of theobromine ranges from 6 to 10 hours, significantly shorter than that in dogs which may explain the susceptibility of dogs to chocolate poisoning REF.
Methylxanthines have the following modes of action.

*'''Antagonism of Adenosine Receptors:'''<ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> this antagonism results in stimulation of the central nervous system and an increase in heart rate <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref> and also diureses <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>
*'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.
*'''Modulation of Intracellular Calcium Concentrations:''' <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.<ref> Carson TL (2006) Methylxanthines. In: ''Small Animal Toxicology'', ed. ME Peterson, PA Talcott, pp.845-852. Elsevier Saunders, St. Louis in '''BSAVA Manual of Canine and Feline Emergency Care''' Chapter 19, Second Edition,2007 </ref>, <ref> Holmgren P, Norden-Petterson L and Ahlner J (2004)Caffeine fatalaties: four case reports. ''Forensic Science International'' '''139''', 71-73 '''BSAVA Manual of Canine and Feline Emergency Care''' Second Edition,2007 </ref>.

==Treatment==
'''Of dogs presenting with clinical signs'''
*'''Inital stabilisation of Cardiorespiratory System:'''
**Tachycardia: beta-blockers, eg orally administered metoprolol at a dose of 0.5mg to 1mg per kg every 8 hours <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Premature Ventricluar Contractions: lidocaine; iv bolus of 2mg to 6mg per kg administered slowly, after which a constant rate infusion of 20ug to 70ug per kg per minute should be given <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.

*'''Treatment of seizures and hyperactivity'''
**IV Diazepam at a dose of 0.5 to 2 mg/kg <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Alternative to diazepam is barbiturates <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Treating the seizures and hyperactivity should help restore normal body temperature. If animal still hyperthermic then this should be treated directly <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Correction of acid/base and electrolyte inbalances''' <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>,

*'''Insertion of urinary catheter'''
**Helps prevent further absorption of theobromine and caffeine across bladder wall <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

'''Of dogs with a known history of recent chocolate ingestion but who have not yet developed clinical signs'''
*Administration of apomorphine (0.03mg/kg IV) or hydrogen peroxide (1-5 ml/kg PO) ref 5 min vet consult in order to induce emesis and/or of activated charcoal in order to minimise further absorption of methylxanthines re 5 min vet consult

==Prognosis==
If treated correctly and early enough ref 5min consult the prognosis is good and a complete recovery can be expected <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>. For animals presenting with seizures and arrhythmias the prognosis is more cautious.

==References==
<references/>

Chocolate Poisoning-Dog

2011-01-23T09:42:08Z

Eanugent: /* Clinical Signs */

{{unfinished}}
"[[File:Chocolate.jpg|thumb|Chocolate]]"
==Introduction==
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. The consumption of more than 20mg/kg of total methylxanthines, the dose at which mild signs such as vomiting, diarrhoea and polyuria are induced <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>, is considered the cut-off point in deciding whether or not to treat <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>. The concentration of methylxanthines differs between products <ref name=multiples> Tilley, Smith'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref> and therefore the number of grammes required to reach this threshold vary according to the product; in a 10kg dog 5000g of white chocolate provides the equivalent 20mg/kg dose of methylxanthines that 12-40g of plain chocolate, 83-117g of milk chocolate or 7-25g of cocoa powder does <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA''</ref>
Methylxanthines are also present in beverages and foods other than chocolates <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

==Signalment==
Dog that live indoors are more likely to have access to chocolate. Also puppies and dogs that scavenge are at a greater risk of eating food that is not intended for their consumption. Small breeds of dogs may reach the toxic level of methylxanthine concentration per body weight more easily <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>.

==Diagnosis==
===Clinical Signs===
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular, respiratory and urological signs.<ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref> which are evident soon after ingestion of a toxic amount of chocolate <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''CNS:''' hyperactivity, behavioural changes, ataxia, muscle tremors, clonic seizures and hyperthermia <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>, <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Gastrointestinal:''' diarrhoea, emesis, haematemesis <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>.
*'''Cardiovascular:''' arrhythmias,tachycardia, bradycardia sometimes, hypotension <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>.
*'''Respiratory:''' tachypnoea <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.
*'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.

===Laboratory Tests===
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>. The following laboratory tests are possible but not commonly used;

* Assays for detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Blood Glucose: Hypoglycaemia as a sequela to hyperactivity. not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.

===Other===
*ECG: rate and rhythm abnormalities <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.

===Pathology===
Following absorption from the gastrointestinal tract caffeine and theobromine are metabolised in the liver <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>. Caffeine has a half life of 4.5 hours in dogs while theobromine has a half life of 17.5 hours <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>. In humans the half life of theobromine ranges from 6 to 10 hours, significantly shorter than that in dogs which may explain the susceptibility of dogs to chocolate poisoning REF.
Methylxanthines have the following modes of action.

*'''Antagonism of Adenosine Receptors:'''<ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> this antagonism results in stimulation of the central nervous system and an increase in heart rate <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref> and also diureses <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>
*'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.
*'''Modulation of Intracellular Calcium Concentrations:''' <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.<ref> Carson TL (2006) Methylxanthines. In: ''Small Animal Toxicology'', ed. ME Peterson, PA Talcott, pp.845-852. Elsevier Saunders, St. Louis in '''BSAVA Manual of Canine and Feline Emergency Care''' Chapter 19, Second Edition,2007 </ref>, <ref> Holmgren P, Norden-Petterson L and Ahlner J (2004)Caffeine fatalaties: four case reports. ''Forensic Science International'' '''139''', 71-73 '''BSAVA Manual of Canine and Feline Emergency Care''' Second Edition,2007 </ref>.

==Treatment==
'''Of dogs presenting with clinical signs'''
*'''Inital stabilisation of Cardiorespiratory System:'''
**Tachycardia: beta-blockers, eg orally administered metoprolol at a dose of 0.5mg to 1mg per kg every 8 hours <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Premature Ventricluar Contractions: lidocaine; iv bolus of 2mg to 6mg per kg administered slowly, after which a constant rate infusion of 20ug to 70ug per kg per minute should be given <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.

*'''Treatment of seizures and hyperactivity'''
**IV Diazepam at a dose of 0.5 to 2 mg/kg <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Alternative to diazepam is barbiturates <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Treating the seizures and hyperactivity should help restore normal body temperature. If animal still hyperthermic then this should be treated directly <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Correction of acid/base and electrolyte inbalances''' <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>,

*'''Insertion of urinary catheter'''
**Helps prevent further absorption of theobromine and caffeine across bladder wall <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

'''Of dogs with a known history of recent chocolate ingestion but who have not yet developed clinical signs'''
*Administration of apomorphine (0.03mg/kg IV) or hydrogen peroxide (1-5 ml/kg PO) ref 5 min vet consult in order to induce emesis and/or of activated charcoal in order to minimise further absorption of methylxanthines re 5 min vet consult

==Prognosis==
If treated correctly and early enough ref 5min consult the prognosis is good and a complete recovery can be expected <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>. For animals presenting with seizures and arrhythmias the prognosis is more cautious.

==References==
<references/>

Chocolate Poisoning-Dog

2011-01-23T09:40:00Z

Eanugent:

{{unfinished}}
"[[File:Chocolate.jpg|thumb|Chocolate]]"
==Introduction==
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. The consumption of more than 20mg/kg of total methylxanthines, the dose at which mild signs such as vomiting, diarrhoea and polyuria are induced <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>, is considered the cut-off point in deciding whether or not to treat <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>. The concentration of methylxanthines differs between products <ref name=multiples> Tilley, Smith'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref> and therefore the number of grammes required to reach this threshold vary according to the product; in a 10kg dog 5000g of white chocolate provides the equivalent 20mg/kg dose of methylxanthines that 12-40g of plain chocolate, 83-117g of milk chocolate or 7-25g of cocoa powder does <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA''</ref>
Methylxanthines are also present in beverages and foods other than chocolates <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

==Signalment==
Dog that live indoors are more likely to have access to chocolate. Also puppies and dogs that scavenge are at a greater risk of eating food that is not intended for their consumption. Small breeds of dogs may reach the toxic level of methylxanthine concentration per body weight more easily <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>.

==Diagnosis==
===Clinical Signs===
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular, respiratory and urological signs.<ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref> which are evident soon after ingestion of a toxic amount of chocolate <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''CNS:''' hyperactivity, behavioural changes, ataxia, muscle tremors, clonic seizures and hyperthermia <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>, <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Gastrointestinal:''' diarrhoea, emesis, haematemesis <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">BSAVA Congress 2007 Scientific Proceedings p253-254</ref>
*'''Cardiovascular:''' arrhythmias,tachycardia, bradycardia sometimes, hypotension <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>.
*'''Respiratory:''' tachypnoea <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.
*'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.

===Laboratory Tests===
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>. The following laboratory tests are possible but not commonly used;

* Assays for detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Blood Glucose: Hypoglycaemia as a sequela to hyperactivity. not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.

===Other===
*ECG: rate and rhythm abnormalities <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.

===Pathology===
Following absorption from the gastrointestinal tract caffeine and theobromine are metabolised in the liver <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>. Caffeine has a half life of 4.5 hours in dogs while theobromine has a half life of 17.5 hours <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>. In humans the half life of theobromine ranges from 6 to 10 hours, significantly shorter than that in dogs which may explain the susceptibility of dogs to chocolate poisoning REF.
Methylxanthines have the following modes of action.

*'''Antagonism of Adenosine Receptors:'''<ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> this antagonism results in stimulation of the central nervous system and an increase in heart rate <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref> and also diureses <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>
*'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.
*'''Modulation of Intracellular Calcium Concentrations:''' <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.<ref> Carson TL (2006) Methylxanthines. In: ''Small Animal Toxicology'', ed. ME Peterson, PA Talcott, pp.845-852. Elsevier Saunders, St. Louis in '''BSAVA Manual of Canine and Feline Emergency Care''' Chapter 19, Second Edition,2007 </ref>, <ref> Holmgren P, Norden-Petterson L and Ahlner J (2004)Caffeine fatalaties: four case reports. ''Forensic Science International'' '''139''', 71-73 '''BSAVA Manual of Canine and Feline Emergency Care''' Second Edition,2007 </ref>.

==Treatment==
'''Of dogs presenting with clinical signs'''
*'''Inital stabilisation of Cardiorespiratory System:'''
**Tachycardia: beta-blockers, eg orally administered metoprolol at a dose of 0.5mg to 1mg per kg every 8 hours <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Premature Ventricluar Contractions: lidocaine; iv bolus of 2mg to 6mg per kg administered slowly, after which a constant rate infusion of 20ug to 70ug per kg per minute should be given <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.

*'''Treatment of seizures and hyperactivity'''
**IV Diazepam at a dose of 0.5 to 2 mg/kg <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Alternative to diazepam is barbiturates <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Treating the seizures and hyperactivity should help restore normal body temperature. If animal still hyperthermic then this should be treated directly <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Correction of acid/base and electrolyte inbalances''' <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>,

*'''Insertion of urinary catheter'''
**Helps prevent further absorption of theobromine and caffeine across bladder wall <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

'''Of dogs with a known history of recent chocolate ingestion but who have not yet developed clinical signs'''
*Administration of apomorphine (0.03mg/kg IV) or hydrogen peroxide (1-5 ml/kg PO) ref 5 min vet consult in order to induce emesis and/or of activated charcoal in order to minimise further absorption of methylxanthines re 5 min vet consult

==Prognosis==
If treated correctly and early enough ref 5min consult the prognosis is good and a complete recovery can be expected <ref name="multiples"> Warman, SM (2007)Dietary intoxications'''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme''' ''BSAVA'' </ref>. For animals presenting with seizures and arrhythmias the prognosis is more cautious.

==References==
<references/>

Chocolate Poisoning-Dog

2011-01-22T22:24:18Z

Eanugent:

{{unfinished}}
"[[File:Chocolate.jpg|thumb|Chocolate]]"
==Introduction==
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. The consumption of more than 20mg/kg of total methylxanthines, the dose at which mild signs such as vomiting, diarrhoea and polyuria are induced <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>, is considered the cut-off point in deciding whether or not to treat <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>. The concentration of methylxanthines differs between products <ref name=multiples> Tilley, Smith'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref> and therefore the number of grammes required to reach this threshold vary according to the product; in a 10kg dog 5000g of white chocolate provides the equivalent 20mg/kg dose of methylxanthines that 12-40g of plain chocolate, 83-117g of milk chocolate or 7-25g of cocoa powder does <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>.
Methylxanthines are also present in beverages and foods other than chocolates <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

==Signalment==
Dog that live indoors are more likely to have access to chocolate. Also puppies and dogs that scavenge are at a greater risk of eating food that is not intended for their consumption. Small breeds of dogs may reach the toxic level of methylxanthine concentration per body weight more easily <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>.

==Diagnosis==
===Clinical Signs===
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular, respiratory and urological signs.<ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref> which are evident soon after ingestion of a toxic amount of chocolate <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''CNS:''' hyperactivity, behavioural changes, ataxia, muscle tremors, clonic seizures and hyperthermia <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>, <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Gastrointestinal:''' diarrhoea, emesis, haematemesis <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">BSAVA Congress 2007 Scientific Proceedings p253-254</ref>
*'''Cardiovascular:''' arrhythmias,tachycardia, bradycardia sometimes, hypotension <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>
*'''Respiratory:''' tachypnoea <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.
*'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.

===Laboratory Tests===
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>. The following laboratory tests are possible but not commonly used;

* Assays for detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Blood Glucose: Hypoglycaemia as a sequela to hyperactivity. not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.

===Other===
*ECG: rate and rhythm abnormalities <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.

===Pathology===
Following absorption from the gastrointestinal tract caffeine and theobromine are metabolised in the liver <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>. Caffeine has a half life of 4.5 hours in dogs while theobromine has a half life of 17.5 hours <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>. In humans the half life of theobromine ranges from 6 to 10 hours, significantly shorter than that in dogs which may explain the susceptibility of dogs to chocolate poisoning REF.
Methylxanthines have the following modes of action.

*'''Antagonism of Adenosine Receptors:'''<ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> this antagonism results in stimulation of the central nervous system and an increase in heart rate <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref> and also diureses <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>
*'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.
*'''Modulation of Intracellular Calcium Concentrations:''' <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.<ref> Carson TL (2006) Methylxanthines. In: ''Small Animal Toxicology'', ed. ME Peterson, PA Talcott, pp.845-852. Elsevier Saunders, St. Louis in '''BSAVA Manual of Canine and Feline Emergency Care''' Chapter 19, Second Edition,2007 </ref>, <ref> Holmgren P, Norden-Petterson L and Ahlner J (2004)Caffeine fatalaties: four case reports. ''Forensic Science International'' '''139''', 71-73 '''BSAVA Manual of Canine and Feline Emergency Care''' Second Edition,2007 </ref>.

==Treatment==
'''Of dogs presenting with clinical signs'''
*'''Inital stabilisation of Cardiorespiratory System:'''
**Tachycardia: beta-blockers, eg orally administered metoprolol at a dose of 0.5mg to 1mg per kg every 8 hours <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Premature Ventricluar Contractions: lidocaine; iv bolus of 2mg to 6mg per kg administered slowly, after which a constant rate infusion of 20ug to 70ug per kg per minute should be given <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.

*'''Treatment of seizures and hyperactivity'''
**IV Diazepam at a dose of 0.5 to 2 mg/kg <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Alternative to diazepam is barbiturates <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Treating the seizures and hyperactivity should help restore normal body temperature. If animal still hyperthermic then this should be treated directly <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Correction of acid/base and electrolyte inbalances''' <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>,

*'''Insertion of urinary catheter'''
**Helps prevent further absorption of theobromine and caffeine across bladder wall <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

'''Of dogs with a known history of recent chocolate ingestion but who have not yet developed clinical signs'''
*Administration of apomorphine (0.03mg/kg IV) or hydrogen peroxide (1-5 ml/kg PO) ref 5 min vet consult in order to induce emesis and/or of activated charcoal in order to minimise further absorption of methylxanthines re 5 min vet consult

==Prognosis==
If treated correctly and early enough ref 5min consult the prognosis is good and a complete recovery can be expected ref bsava proceedings. For animals presenting with seizures and arrhythmias the prognosis is more cautious.

==References==
<references/>

Chocolate Poisoning-Dog

2011-01-22T22:20:54Z

Eanugent: /* Laboratory Tests */

{{unfinished}}
"[[File:Chocolate.jpg|thumb|Chocolate]]"
==Introduction==
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. The consumption of more than 20mg/kg of total methylxanthines, the dose at which mild signs such as vomiting, diarrhoea and polyuria are induced <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>, is considered the cut-off point in deciding whether or not to treat <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>. The concentration of methylxanthines differs between products <ref name=multiples> Tilley, Smith'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref> and therefore the number of grammes required to reach this threshold vary according to the product; in a 10kg dog 5000g of white chocolate provides the equivalent 20mg/kg dose of methylxanthines that 12-40g of plain chocolate, 83-117g of milk chocolate or 7-25g of cocoa powder does <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>.
Methylxanthines are also present in beverages and foods other than chocolates <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

==Signalment==
Dog that live indoors are more likely to have access to chocolate. Also puppies and dogs that scavenge are at a greater risk of eating food that is not intended for their consumption. Small breeds of dogs may reach the toxic level of methylxanthine concentration per body weight more easily <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>.

==Diagnosis==
===Clinical Signs===
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular, respiratory and urological signs.<ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref> which are evident soon after ingestion of a toxic amount of chocolate <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''CNS:''' hyperactivity, behavioural changes, ataxia, muscle tremors, clonic seizures and hyperthermia <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>, <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Gastrointestinal:''' diarrhoea, emesis, haematemesis <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">BSAVA Congress 2007 Scientific Proceedings p253-254</ref>
*'''Cardiovascular:''' arrhythmias,tachycardia, bradycardia sometimes, hypotension <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>
*'''Respiratory:''' tachypnoea <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm'''. </ref>.
*'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 02.10.2010 </ref>

===Laboratory Tests===
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>. The following laboratory tests are possible but not commonly used;

* Assays for detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Blood Glucose: Hypoglycaemia as a sequela to hyperactivity. not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.

===Other===
*ECG: rate and rhythm abnormalities <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.

===Pathology===
Following absorption from the gastrointestinal tract caffeine and theobromine are metabolised in the liver <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>. Caffeine has a half life of 4.5 hours in dogs while theobromine has a half life of 17.5 hours <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>. In humans the half life of theobromine ranges from 6 to 10 hours, significantly shorter than that in dogs which may explain the susceptibility of dogs to chocolate poisoning REF.
Methylxanthines have the following modes of action.

*'''Antagonism of Adenosine Receptors:'''<ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> this antagonism results in stimulation of the central nervous system and an increase in heart rate <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref> and also diureses <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>
*'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.
*'''Modulation of Intracellular Calcium Concentrations:''' <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.<ref> Carson TL (2006) Methylxanthines. In: ''Small Animal Toxicology'', ed. ME Peterson, PA Talcott, pp.845-852. Elsevier Saunders, St. Louis in '''BSAVA Manual of Canine and Feline Emergency Care''' Chapter 19, Second Edition,2007 </ref>, <ref> Holmgren P, Norden-Petterson L and Ahlner J (2004)Caffeine fatalaties: four case reports. ''Forensic Science International'' '''139''', 71-73 '''BSAVA Manual of Canine and Feline Emergency Care''' Second Edition,2007 </ref>.

==Treatment==
'''Of dogs presenting with clinical signs'''
*'''Inital stabilisation of Cardiorespiratory System:'''
**Tachycardia: beta-blockers, eg orally administered metoprolol at a dose of 0.5mg to 1mg per kg every 8 hours <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Premature Ventricluar Contractions: lidocaine; iv bolus of 2mg to 6mg per kg administered slowly, after which a constant rate infusion of 20ug to 70ug per kg per minute should be given <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.

*'''Treatment of seizures and hyperactivity'''
**IV Diazepam at a dose of 0.5 to 2 mg/kg <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Alternative to diazepam is barbiturates <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Treating the seizures and hyperactivity should help restore normal body temperature. If animal still hyperthermic then this should be treated directly <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Correction of acid/base and electrolyte inbalances''' <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>,

*'''Insertion of urinary catheter'''
**Helps prevent further absorption of theobromine and caffeine across bladder wall <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

'''Of dogs with a known history of recent chocolate ingestion but who have not yet developed clinical signs'''
*Administration of apomorphine (0.03mg/kg IV) or hydrogen peroxide (1-5 ml/kg PO) ref 5 min vet consult in order to induce emesis and/or of activated charcoal in order to minimise further absorption of methylxanthines re 5 min vet consult

==Prognosis==
If treated correctly and early enough ref 5min consult the prognosis is good and a complete recovery can be expected ref bsava proceedings. For animals presenting with seizures and arrhythmias the prognosis is more cautious.

==References==
<references/>

Chocolate Poisoning-Dog

2011-01-22T22:19:22Z

Eanugent:

{{unfinished}}
"[[File:Chocolate.jpg|thumb|Chocolate]]"
==Introduction==
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. The consumption of more than 20mg/kg of total methylxanthines, the dose at which mild signs such as vomiting, diarrhoea and polyuria are induced <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>, is considered the cut-off point in deciding whether or not to treat <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>. The concentration of methylxanthines differs between products <ref name=multiples> Tilley, Smith'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref> and therefore the number of grammes required to reach this threshold vary according to the product; in a 10kg dog 5000g of white chocolate provides the equivalent 20mg/kg dose of methylxanthines that 12-40g of plain chocolate, 83-117g of milk chocolate or 7-25g of cocoa powder does <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>.
Methylxanthines are also present in beverages and foods other than chocolates <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

==Signalment==
Dog that live indoors are more likely to have access to chocolate. Also puppies and dogs that scavenge are at a greater risk of eating food that is not intended for their consumption. Small breeds of dogs may reach the toxic level of methylxanthine concentration per body weight more easily <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>.

==Diagnosis==
===Clinical Signs===
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular, respiratory and urological signs.<ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref> which are evident soon after ingestion of a toxic amount of chocolate <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''CNS:''' hyperactivity, behavioural changes, ataxia, muscle tremors, clonic seizures and hyperthermia <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>, <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Gastrointestinal:''' diarrhoea, emesis, haematemesis <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">BSAVA Congress 2007 Scientific Proceedings p253-254</ref>
*'''Cardiovascular:''' arrhythmias,tachycardia, bradycardia sometimes, hypotension <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>
*'''Respiratory:''' tachypnoea <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm'''. </ref>.
*'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 02.10.2010 </ref>

===Laboratory Tests===
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion <ref name>="multiples" http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm </ref>. The following laboratory tests are possible but not commonly used;

* Assays for detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Blood Glucose: Hypoglycaemia as a sequela to hyperactivity. not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.

===Other===
*ECG: rate and rhythm abnormalities <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.

===Pathology===
Following absorption from the gastrointestinal tract caffeine and theobromine are metabolised in the liver <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>. Caffeine has a half life of 4.5 hours in dogs while theobromine has a half life of 17.5 hours <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>. In humans the half life of theobromine ranges from 6 to 10 hours, significantly shorter than that in dogs which may explain the susceptibility of dogs to chocolate poisoning REF.
Methylxanthines have the following modes of action.

*'''Antagonism of Adenosine Receptors:'''<ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> this antagonism results in stimulation of the central nervous system and an increase in heart rate <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref> and also diureses <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>
*'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.
*'''Modulation of Intracellular Calcium Concentrations:''' <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.<ref> Carson TL (2006) Methylxanthines. In: ''Small Animal Toxicology'', ed. ME Peterson, PA Talcott, pp.845-852. Elsevier Saunders, St. Louis in '''BSAVA Manual of Canine and Feline Emergency Care''' Chapter 19, Second Edition,2007 </ref>, <ref> Holmgren P, Norden-Petterson L and Ahlner J (2004)Caffeine fatalaties: four case reports. ''Forensic Science International'' '''139''', 71-73 '''BSAVA Manual of Canine and Feline Emergency Care''' Second Edition,2007 </ref>.

==Treatment==
'''Of dogs presenting with clinical signs'''
*'''Inital stabilisation of Cardiorespiratory System:'''
**Tachycardia: beta-blockers, eg orally administered metoprolol at a dose of 0.5mg to 1mg per kg every 8 hours <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Premature Ventricluar Contractions: lidocaine; iv bolus of 2mg to 6mg per kg administered slowly, after which a constant rate infusion of 20ug to 70ug per kg per minute should be given <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>.

*'''Treatment of seizures and hyperactivity'''
**IV Diazepam at a dose of 0.5 to 2 mg/kg <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Alternative to diazepam is barbiturates <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Treating the seizures and hyperactivity should help restore normal body temperature. If animal still hyperthermic then this should be treated directly <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Correction of acid/base and electrolyte inbalances''' <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>,

*'''Insertion of urinary catheter'''
**Helps prevent further absorption of theobromine and caffeine across bladder wall <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

'''Of dogs with a known history of recent chocolate ingestion but who have not yet developed clinical signs'''
*Administration of apomorphine (0.03mg/kg IV) or hydrogen peroxide (1-5 ml/kg PO) ref 5 min vet consult in order to induce emesis and/or of activated charcoal in order to minimise further absorption of methylxanthines re 5 min vet consult

==Prognosis==
If treated correctly and early enough ref 5min consult the prognosis is good and a complete recovery can be expected ref bsava proceedings. For animals presenting with seizures and arrhythmias the prognosis is more cautious.

==References==
<references/>

Chocolate Poisoning-Dog

2011-01-22T22:15:59Z

Eanugent:

{{unfinished}}
"[[File:Chocolate.jpg|thumb|Chocolate]]"
==Introduction==
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. The consumption of more than 20mg/kg of total methylxanthines, the dose at which mild signs such as vomiting, diarrhoea and polyuria are induced <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref>, is considered the cut-off point in deciding whether or not to treat <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>. The concentration of methylxanthines differs between products <ref name=multiples> Tilley, Smith'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref> and therefore the number of grammes required to reach this threshold vary according to the product; in a 10kg dog 5000g of white chocolate provides the equivalent 20mg/kg dose of methylxanthines that 12-40g of plain chocolate, 83-117g of milk chocolate or 7-25g of cocoa powder does <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>.
Methylxanthines are also present in beverages and foods other than chocolates <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

==Signalment==
Dog that live indoors are more likely to have access to chocolate. Also puppies and dogs that scavenge are at a greater risk of eating food that is not intended for their consumption. Small breeds of dogs may reach the toxic level of methylxanthine concentration per body weight more easily <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>.

==Diagnosis==
===Clinical Signs===
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular, respiratory and urological signs.<ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiples">Merck & Co (2008) The Merck Veterinary Manual (Eight Edition), Merial found at http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm&word=chocolate%2cpoisoning accessed January 2011</ref> which are evident soon after ingestion of a toxic amount of chocolate <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''CNS:''' hyperactivity, behavioural changes, ataxia, muscle tremors, clonic seizures and hyperthermia <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>, <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Gastrointestinal:''' diarrhoea, emesis, haematemesis <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">BSAVA Congress 2007 Scientific Proceedings p253-254</ref>
*'''Cardiovascular:''' arrhythmias,tachycardia, bradycardia sometimes, hypotension <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>
*'''Respiratory:''' tachypnoea <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm'''. </ref>.
*'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 02.10.2010 </ref>

===Laboratory Tests===
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion <ref name>="multiples" http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm </ref>. The following laboratory tests are possible but not commonly used;

* Assays for detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Blood Glucose: Hypoglycaemia as a sequela to hyperactivity. not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.

===Other===
*ECG: rate and rhythm abnormalities <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.

===Pathology===
Following absorption from the gastrointestinal tract caffeine and theobromine are metabolised in the liver <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>. Caffeine has a half life of 4.5 hours in dogs while theobromine has a half life of 17.5 hours <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>. In humans the half life of theobromine ranges from 6 to 10 hours, significantly shorter than that in dogs which may explain the susceptibility of dogs to chocolate poisoning REF.
Methylxanthines have the following modes of action.

*'''Antagonism of Adenosine Receptors:'''<ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> this antagonism results in stimulation of the central nervous system and an increase in heart rate <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref> and also diureses <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>
*'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.
*'''Modulation of Intracellular Calcium Concentrations:''' <ref name=multiples> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>.
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.<ref> Carson TL (2006) Methylxanthines. In: ''Small Animal Toxicology'', ed. ME Peterson, PA Talcott, pp.845-852. Elsevier Saunders, St. Louis in '''BSAVA Manual of Canine and Feline Emergency Care''' Chapter 19, Second Edition,2007 </ref>, <ref> Holmgren P, Norden-Petterson L and Ahlner J (2004)Caffeine fatalaties: four case reports. ''Forensic Science International'' '''139''', 71-73 '''BSAVA Manual of Canine and Feline Emergency Care''' Second Edition,2007 </ref>.

==Treatment==
'''Of dogs presenting with clinical signs'''
*'''Inital stabilisation of Cardiorespiratory System:'''
**Tachycardia: beta-blockers, eg orally administered metoprolol at a dose of 0.5mg to 1mg per kg every 8 hours <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Premature Ventricluar Contractions: lidocaine; iv bolus of 2mg to 6mg per kg administered slowly, after which a constant rate infusion of 20ug to 70ug per kg per minute should be given <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg <ref name="multiples">'''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 07.11.2010 </ref>

*'''Treatment of seizures and hyperactivity'''
**IV Diazepam at a dose of 0.5 to 2 mg/kg <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Alternative to diazepam is barbiturates <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Treating the seizures and hyperactivity should help restore normal body temperature. If animal still hyperthermic then this should be treated directly <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Correction of acid/base and electrolyte inbalances''' ref merck

*'''Insertion of urinary catheter'''
**Helps prevent further absorption of theobromine and caffeine across bladder wall <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

'''Of dogs with a known history of recent chocolate ingestion but who have not yet developed clinical signs'''
*Administration of apomorphine (0.03mg/kg IV) or hydrogen peroxide (1-5 ml/kg PO) ref 5 min vet consult in order to induce emesis and/or of activated charcoal in order to minimise further absorption of methylxanthines re 5 min vet consult

==Prognosis==
If treated correctly and early enough ref 5min consult the prognosis is good and a complete recovery can be expected ref bsava proceedings. For animals presenting with seizures and arrhythmias the prognosis is more cautious.

==References==
<references/>

Chocolate Poisoning-Dog

2011-01-22T22:07:28Z

Eanugent: /* Treatment */

{{unfinished}}
"[[File:Chocolate.jpg|thumb|Chocolate]]"
==Introduction==
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. The consumption of more than 20mg/kg of total methylxanthines, the dose at which mild signs such as vomiting, diarrhoea and polyuria are induced <ref name="multiples"> http://www.merckvetmanual.com/mvm/index </ref>, is considered the cut-off point in deciding whether or not to treat <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>. The concentration of methylxanthines differs between products <ref name=multiples> Tilley, Smith'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref> and therefore the number of grammes required to reach this threshold vary according to the product; in a 10kg dog 5000g of white chocolate provides the equivalent 20mg/kg dose of methylxanthines that 12-40g of plain chocolate, 83-117g of milk chocolate or 7-25g of cocoa powder does <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>.
Methylxanthines are also present in beverages and foods other than chocolates <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

==Signalment==
Dog that live indoors are more likely to have access to chocolate. Also puppies and dogs that scavenge are at a greater risk of eating food that is not intended for their consumption. Small breeds of dogs may reach the toxic level of methylxanthine concentration per body weight more easily <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>.

==Diagnosis==
===Clinical Signs===
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular, respiratory and urological signs.<ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>,
<ref name="multiple"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''' </ref> which are evident soon after ingestion of a toxic amount of chocolate <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''CNS:''' hyperactivity, behavioural changes, ataxia, muscle tremors, clonic seizures and hyperthermia <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>, <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Gastrointestinal:''' diarrhoea, emesis, haematemesis <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">BSAVA Congress 2007 Scientific Proceedings p253-254</ref>
*'''Cardiovascular:''' arrhythmias,tachycardia, bradycardia sometimes, hypotension <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>
*'''Respiratory:''' tachypnoea <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm'''. </ref>.
*'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 02.10.2010 </ref>

===Laboratory Tests===
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion <ref name>="multiples" http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm </ref>. The following laboratory tests are possible but not commonly used;

* Assays for detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Blood Glucose: Hypoglycaemia as a sequela to hyperactivity. not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.

===Other===
*ECG: rate and rhythm abnormalities <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.

===Pathology===
Following absorption from the gastrointestinal tract caffeine and theobromine are metabolised in the liver <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>. Caffeine has a half life of 4.5 hours in dogs while theobromine has a half life of 17.5 hours <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>. In humans the half life of theobromine ranges from 6 to 10 hours, significantly shorter than that in dogs which may explain the susceptibility of dogs to chocolate poisoning REF.
Methylxanthines have the following modes of action.

*'''Antagonism of Adenosine Receptors:'''<ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> this antagonism results in stimulation of the central nervous system and an increase in heart rate <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref> and also diureses <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>
*'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.
*'''Modulation of Intracellular Calcium Concentrations:''' <ref name=multiples> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>.
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.<ref> Carson TL (2006) Methylxanthines. In: ''Small Animal Toxicology'', ed. ME Peterson, PA Talcott, pp.845-852. Elsevier Saunders, St. Louis in '''BSAVA Manual of Canine and Feline Emergency Care''' Chapter 19, Second Edition,2007 </ref>, <ref> Holmgren P, Norden-Petterson L and Ahlner J (2004)Caffeine fatalaties: four case reports. ''Forensic Science International'' '''139''', 71-73 '''BSAVA Manual of Canine and Feline Emergency Care''' Second Edition,2007 </ref>.

==Treatment==
'''Of dogs presenting with clinical signs'''
*'''Inital stabilisation of Cardiorespiratory System:'''
**Tachycardia: beta-blockers, eg orally administered metoprolol at a dose of 0.5mg to 1mg per kg every 8 hours <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Premature Ventricluar Contractions: lidocaine; iv bolus of 2mg to 6mg per kg administered slowly, after which a constant rate infusion of 20ug to 70ug per kg per minute should be given <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg <ref name="multiples">'''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 07.11.2010 </ref>

*'''Treatment of seizures and hyperactivity'''
**IV Diazepam at a dose of 0.5 to 2 mg/kg <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Alternative to diazepam is barbiturates <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Treating the seizures and hyperactivity should help restore normal body temperature. If animal still hyperthermic then this should be treated directly <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Correction of acid/base and electrolyte inbalances''' ref merck

*'''Insertion of urinary catheter'''
**Helps prevent further absorption of theobromine and caffeine across bladder wall <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

'''Of dogs with a known history of recent chocolate ingestion but who have not yet developed clinical signs'''
*Administration of apomorphine (0.03mg/kg IV) or hydrogen peroxide (1-5 ml/kg PO) ref 5 min vet consult in order to induce emesis and/or of activated charcoal in order to minimise further absorption of methylxanthines re 5 min vet consult

==Prognosis==
If treated correctly and early enough ref 5min consult the prognosis is good and a complete recovery can be expected ref bsava proceedings. For animals presenting with seizures and arrhythmias the prognosis is more cautious.

==References==
<references/>

Chocolate Poisoning-Dog

2011-01-22T22:06:30Z

Eanugent: /* Treatment */

{{unfinished}}
"[[File:Chocolate.jpg|thumb|Chocolate]]"
==Introduction==
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. The consumption of more than 20mg/kg of total methylxanthines, the dose at which mild signs such as vomiting, diarrhoea and polyuria are induced <ref name="multiples"> http://www.merckvetmanual.com/mvm/index </ref>, is considered the cut-off point in deciding whether or not to treat <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>. The concentration of methylxanthines differs between products <ref name=multiples> Tilley, Smith'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref> and therefore the number of grammes required to reach this threshold vary according to the product; in a 10kg dog 5000g of white chocolate provides the equivalent 20mg/kg dose of methylxanthines that 12-40g of plain chocolate, 83-117g of milk chocolate or 7-25g of cocoa powder does <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>.
Methylxanthines are also present in beverages and foods other than chocolates <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

==Signalment==
Dog that live indoors are more likely to have access to chocolate. Also puppies and dogs that scavenge are at a greater risk of eating food that is not intended for their consumption. Small breeds of dogs may reach the toxic level of methylxanthine concentration per body weight more easily <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>.

==Diagnosis==
===Clinical Signs===
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular, respiratory and urological signs.<ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>,
<ref name="multiple"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''' </ref> which are evident soon after ingestion of a toxic amount of chocolate <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''CNS:''' hyperactivity, behavioural changes, ataxia, muscle tremors, clonic seizures and hyperthermia <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>, <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Gastrointestinal:''' diarrhoea, emesis, haematemesis <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">BSAVA Congress 2007 Scientific Proceedings p253-254</ref>
*'''Cardiovascular:''' arrhythmias,tachycardia, bradycardia sometimes, hypotension <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>
*'''Respiratory:''' tachypnoea <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm'''. </ref>.
*'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 02.10.2010 </ref>

===Laboratory Tests===
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion <ref name>="multiples" http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm </ref>. The following laboratory tests are possible but not commonly used;

* Assays for detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Blood Glucose: Hypoglycaemia as a sequela to hyperactivity. not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.

===Other===
*ECG: rate and rhythm abnormalities <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.

===Pathology===
Following absorption from the gastrointestinal tract caffeine and theobromine are metabolised in the liver <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>. Caffeine has a half life of 4.5 hours in dogs while theobromine has a half life of 17.5 hours <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>. In humans the half life of theobromine ranges from 6 to 10 hours, significantly shorter than that in dogs which may explain the susceptibility of dogs to chocolate poisoning REF.
Methylxanthines have the following modes of action.

*'''Antagonism of Adenosine Receptors:'''<ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> this antagonism results in stimulation of the central nervous system and an increase in heart rate <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref> and also diureses <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>
*'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.
*'''Modulation of Intracellular Calcium Concentrations:''' <ref name=multiples> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>.
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.<ref> Carson TL (2006) Methylxanthines. In: ''Small Animal Toxicology'', ed. ME Peterson, PA Talcott, pp.845-852. Elsevier Saunders, St. Louis in '''BSAVA Manual of Canine and Feline Emergency Care''' Chapter 19, Second Edition,2007 </ref>, <ref> Holmgren P, Norden-Petterson L and Ahlner J (2004)Caffeine fatalaties: four case reports. ''Forensic Science International'' '''139''', 71-73 '''BSAVA Manual of Canine and Feline Emergency Care''' Second Edition,2007 </ref>.

==Treatment==
'''Of dogs presenting with clinical signs'''
*'''Inital stabilisation of Cardiorespiratory System:'''
**Tachycardia: beta-blockers, eg orally administered metoprolol at a dose of 0.5mg to 1mg per kg every 8 hours <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Premature Ventricluar Contractions: lidocaine; iv bolus of 2mg to 6mg per kg administered slowly, after which a constant rate infusion of 20ug to 70ug per kg per minute should be given <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg <ref name="multiples">'''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 07.11.2010 </ref>

*'''Treatment of seizures and hyperactivity'''
**IV Diazepam at a dose of 0.5 to 2 mg/kg <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Alternative to diazepam is barbiturates <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
**Treating the seizures and hyperactivity should help restore normal body temperature. If animal still hyperthermic then this should be treated directly <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Correction of acid/base and electrolyte inbalances''' ref merck

*'''Insertion of urinary catheter'''
**Helps prevent further absorption of theobromine and caffeine across bladder wall <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

'''Of dogs with a known history of recent chocolate ingestion but who have not yet developed clinical signs'''
*Administration of apomorphine (0.03mg/kg IV) or hydrogen peroxide (1-5 ml/kg PO) ref 5 min vet consult in order to induce emesis and/or of activated charcoal in order to minimise further absorption of methylxanthines re 5 min vet consult

==Prognosis==
If treated correctly and early enough ref 5min consult the prognosis is good and a complete recovery can be expected ref bsava proceedings. For animals presenting with seizures and arrhythmias the prognosis is more cautious.

==References==
<references/>

Chocolate Poisoning-Dog

2011-01-22T22:05:07Z

Eanugent: /* Treatment */

{{unfinished}}
"[[File:Chocolate.jpg|thumb|Chocolate]]"
==Introduction==
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. The consumption of more than 20mg/kg of total methylxanthines, the dose at which mild signs such as vomiting, diarrhoea and polyuria are induced <ref name="multiples"> http://www.merckvetmanual.com/mvm/index </ref>, is considered the cut-off point in deciding whether or not to treat <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>. The concentration of methylxanthines differs between products <ref name=multiples> Tilley, Smith'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref> and therefore the number of grammes required to reach this threshold vary according to the product; in a 10kg dog 5000g of white chocolate provides the equivalent 20mg/kg dose of methylxanthines that 12-40g of plain chocolate, 83-117g of milk chocolate or 7-25g of cocoa powder does <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>.
Methylxanthines are also present in beverages and foods other than chocolates <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

==Signalment==
Dog that live indoors are more likely to have access to chocolate. Also puppies and dogs that scavenge are at a greater risk of eating food that is not intended for their consumption. Small breeds of dogs may reach the toxic level of methylxanthine concentration per body weight more easily <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>.

==Diagnosis==
===Clinical Signs===
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular, respiratory and urological signs.<ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>,
<ref name="multiple"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''' </ref> which are evident soon after ingestion of a toxic amount of chocolate <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''CNS:''' hyperactivity, behavioural changes, ataxia, muscle tremors, clonic seizures and hyperthermia <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>, <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Gastrointestinal:''' diarrhoea, emesis, haematemesis <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">BSAVA Congress 2007 Scientific Proceedings p253-254</ref>
*'''Cardiovascular:''' arrhythmias,tachycardia, bradycardia sometimes, hypotension <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>
*'''Respiratory:''' tachypnoea <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm'''. </ref>.
*'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 02.10.2010 </ref>

===Laboratory Tests===
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion <ref name>="multiples" http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm </ref>. The following laboratory tests are possible but not commonly used;

* Assays for detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Blood Glucose: Hypoglycaemia as a sequela to hyperactivity. not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.

===Other===
*ECG: rate and rhythm abnormalities <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.

===Pathology===
Following absorption from the gastrointestinal tract caffeine and theobromine are metabolised in the liver <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>. Caffeine has a half life of 4.5 hours in dogs while theobromine has a half life of 17.5 hours <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>. In humans the half life of theobromine ranges from 6 to 10 hours, significantly shorter than that in dogs which may explain the susceptibility of dogs to chocolate poisoning REF.
Methylxanthines have the following modes of action.

*'''Antagonism of Adenosine Receptors:'''<ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> this antagonism results in stimulation of the central nervous system and an increase in heart rate <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref> and also diureses <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>
*'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.
*'''Modulation of Intracellular Calcium Concentrations:''' <ref name=multiples> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>.
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.<ref> Carson TL (2006) Methylxanthines. In: ''Small Animal Toxicology'', ed. ME Peterson, PA Talcott, pp.845-852. Elsevier Saunders, St. Louis in '''BSAVA Manual of Canine and Feline Emergency Care''' Chapter 19, Second Edition,2007 </ref>, <ref> Holmgren P, Norden-Petterson L and Ahlner J (2004)Caffeine fatalaties: four case reports. ''Forensic Science International'' '''139''', 71-73 '''BSAVA Manual of Canine and Feline Emergency Care''' Second Edition,2007 </ref>.

==Treatment==
'''Of dogs presenting with clinical signs'''
**'''Inital stabilisation of Cardiorespiratory System:'''
***Tachycardia: beta-blockers, eg orally administered metoprolol at a dose of 0.5mg to 1mg per kg every 8 hours <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
***Premature Ventricluar Contractions: lidocaine; iv bolus of 2mg to 6mg per kg administered slowly, after which a constant rate infusion of 20ug to 70ug per kg per minute should be given <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
***Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg <ref name="multiples">'''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 07.11.2010 </ref>

**'''Treatment of seizures and hyperactivity'''
***IV Diazepam at a dose of 0.5 to 2 mg/kg <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
***Alternative to diazepam is barbiturates <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
***Treating the seizures and hyperactivity should help restore normal body temperature. If animal still hyperthermic then this should be treated directly <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

**'''Correction of acid/base and electrolyte inbalances''' ref merck

**'''Insertion of urinary catheter'''
***Helps prevent further absorption of theobromine and caffeine across bladder wall <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

'''Of dogs with a known history of recent chocolate ingestion but who have not yet developed clinical signs'''
**Administration of apomorphine (0.03mg/kg IV) or hydrogen peroxide (1-5 ml/kg PO) ref 5 min vet consult in order to induce emesis and/or of activated charcoal in order to minimise further absorption of methylxanthines re 5 min vet consult

==Prognosis==
If treated correctly and early enough ref 5min consult the prognosis is good and a complete recovery can be expected ref bsava proceedings. For animals presenting with seizures and arrhythmias the prognosis is more cautious.

==References==
<references/>

Chocolate Poisoning-Dog

2011-01-22T22:02:16Z

Eanugent:

{{unfinished}}
"[[File:Chocolate.jpg|thumb|Chocolate]]"
==Introduction==
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. The consumption of more than 20mg/kg of total methylxanthines, the dose at which mild signs such as vomiting, diarrhoea and polyuria are induced <ref name="multiples"> http://www.merckvetmanual.com/mvm/index </ref>, is considered the cut-off point in deciding whether or not to treat <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>. The concentration of methylxanthines differs between products <ref name=multiples> Tilley, Smith'''The 5-Minute Veterinary Consult Canine and Feline(Second Edition)''' ''Lippencott, Williams and Wilkins''</ref> and therefore the number of grammes required to reach this threshold vary according to the product; in a 10kg dog 5000g of white chocolate provides the equivalent 20mg/kg dose of methylxanthines that 12-40g of plain chocolate, 83-117g of milk chocolate or 7-25g of cocoa powder does <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>.
Methylxanthines are also present in beverages and foods other than chocolates <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

==Signalment==
Dog that live indoors are more likely to have access to chocolate. Also puppies and dogs that scavenge are at a greater risk of eating food that is not intended for their consumption. Small breeds of dogs may reach the toxic level of methylxanthine concentration per body weight more easily <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>.

==Diagnosis==
===Clinical Signs===
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular, respiratory and urological signs.<ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>,
<ref name="multiple"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''' </ref> which are evident soon after ingestion of a toxic amount of chocolate <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''CNS:''' hyperactivity, behavioural changes, ataxia, muscle tremors, clonic seizures and hyperthermia <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>, <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Gastrointestinal:''' diarrhoea, emesis, haematemesis <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">BSAVA Congress 2007 Scientific Proceedings p253-254</ref>
*'''Cardiovascular:''' arrhythmias,tachycardia, bradycardia sometimes, hypotension <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>
*'''Respiratory:''' tachypnoea <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm'''. </ref>.
*'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 02.10.2010 </ref>

===Laboratory Tests===
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion <ref name>="multiples" http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm </ref>. The following laboratory tests are possible but not commonly used;

* Assays for detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Blood Glucose: Hypoglycaemia as a sequela to hyperactivity. not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.

===Other===
*ECG: rate and rhythm abnormalities <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.

===Pathology===
Following absorption from the gastrointestinal tract caffeine and theobromine are metabolised in the liver <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>. Caffeine has a half life of 4.5 hours in dogs while theobromine has a half life of 17.5 hours <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>. In humans the half life of theobromine ranges from 6 to 10 hours, significantly shorter than that in dogs which may explain the susceptibility of dogs to chocolate poisoning REF.
Methylxanthines have the following modes of action.

*'''Antagonism of Adenosine Receptors:'''<ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> this antagonism results in stimulation of the central nervous system and an increase in heart rate <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref> and also diureses <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>
*'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.
*'''Modulation of Intracellular Calcium Concentrations:''' <ref name=multiples> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>.
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.<ref> Carson TL (2006) Methylxanthines. In: ''Small Animal Toxicology'', ed. ME Peterson, PA Talcott, pp.845-852. Elsevier Saunders, St. Louis in '''BSAVA Manual of Canine and Feline Emergency Care''' Chapter 19, Second Edition,2007 </ref>, <ref> Holmgren P, Norden-Petterson L and Ahlner J (2004)Caffeine fatalaties: four case reports. ''Forensic Science International'' '''139''', 71-73 '''BSAVA Manual of Canine and Feline Emergency Care''' Second Edition,2007 </ref>.

==Treatment==
*'''Of dogs presenting with clinical signs'''
**'''Inital stabilisation of Cardiorespiratory System:'''
***Tachycardia: beta-blockers, eg orally administered metoprolol at a dose of 0.5mg to 1mg per kg every 8 hours <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
***Premature Ventricluar Contractions: lidocaine; iv bolus of 2mg to 6mg per kg administered slowly, after which a constant rate infusion of 20ug to 70ug per kg per minute should be given <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
***Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg <ref name="multiples">'''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 07.11.2010 </ref>

**'''Treatment of seizures and hyperactivity'''
***IV Diazepam at a dose of 0.5 to 2 mg/kg <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
***Alternative to diazepam is barbiturates <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
***Treating the seizures and hyperactivity should help restore normal body temperature. If animal still hyperthermic then this should be treated directly <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

**'''Correction of acid/base and electrolyte inbalances''' ref merck

**'''Insertion of urinary catheter'''
***Helps prevent further absorption of theobromine and caffeine across bladder wall <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Of dogs with a known history of recent chocolate ingestion but who have not yet developed clinical signs'''
**Administration of apomorphine (0.03mg/kg IV) or hydrogen peroxide (1-5 ml/kg PO) ref 5 min vet consult in order to induce emesis and/or of activated charcoal in order to minimise further absorption of methylxanthines re 5 min vet consult

==Prognosis==
If treated correctly and early enough ref 5min consult the prognosis is good and a complete recovery can be expected ref bsava proceedings. For animals presenting with seizures and arrhythmias the prognosis is more cautious.

==References==
<references/>

Chocolate Poisoning-Dog

2011-01-22T18:41:47Z

Eanugent:

{{unfinished}}
"[[File:Chocolate.jpg|thumb|Chocolate]]"
==Introduction==
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. The consumption of more than 20mg/kg of total methylxanthines, the dose at which mild signs such as vomiting, diarrhoea and polyuria are induced <ref name="multiples"> http://www.merckvetmanual.com/mvm/index </ref>, is considered the cut-off point in deciding whether or not to treat <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>. The concentration of methylxanthines differs between products <ref name=multiples> Tilley, Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippencott, Williams and Wilkins''</ref> and therefore the number of grammes required to reach this threshold vary according to the product; in a 10kg dog 5000g of white chocolate provides the equivalent 20mg/kg dose of methylxanthines that 12-40g of plain chocolate, 83-117g of milk chocolate or 7-25g of cocoa powder does <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>.
Methylxanthines are also present in beverages and foods other than chocolates <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

==Signalment==
Dog that live indoors are more likely to have access to chocolate. Also puppies and dogs that scavenge are at a greater risk of eating food that is not intended for their consumption. Small breeds of dogs may reach the toxic level of methylxanthine concentration per body weight more easily <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>.

==Diagnosis==
===Clinical Signs===
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular, respiratory and urological signs.<ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>,
<ref name="multiple"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''' </ref> which are evident soon after ingestion of a toxic amount of chocolate <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''CNS:''' hyperactivity, behavioural changes, ataxia, muscle tremors, clonic seizures and hyperthermia <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>, <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Gastrointestinal:''' diarrhoea, emesis, haematemesis <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">BSAVA Congress 2007 Scientific Proceedings p253-254</ref>
*'''Cardiovascular:''' arrhythmias,tachycardia, bradycardia sometimes, hypotension <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>
*'''Respiratory:''' tachypnoea <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm'''. </ref>.
*'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 02.10.2010 </ref>

===Laboratory Tests===
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion <ref name>="multiples" http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm </ref>. The following laboratory tests are possible but not commonly used;

* Assays for detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Blood Glucose: Hypoglycaemia as a sequela to hyperactivity. not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.

===Other===
*ECG: rate and rhythm abnormalities <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.

===Pathology===
Following absorption from the gastrointestinal tract caffeine and theobromine are metabolised in the liver <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>. Caffeine has a half life of 4.5 hours in dogs while theobromine has a half life of 17.5 hours <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>. In humans the half life of theobromine ranges from 6 to 10 hours, significantly shorter than that in dogs which may explain the susceptibility of dogs to chocolate poisoning REF.
Methylxanthines have the following modes of action.

*'''Antagonism of Adenosine Receptors:'''<ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> this antagonism results in stimulation of the central nervous system and an increase in heart rate <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref> and also diureses <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>
*'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref> consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.
*'''Modulation of Intracellular Calcium Concentrations:''' <ref name=multiples> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>.
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.<ref> Carson TL (2006) Methylxanthines. In: ''Small Animal Toxicology'', ed. ME Peterson, PA Talcott, pp.845-852. Elsevier Saunders, St. Louis in '''BSAVA Manual of Canine and Feline Emergency Care''' Chapter 19, Second Edition,2007 </ref>, <ref> Holmgren P, Norden-Petterson L and Ahlner J (2004)Caffeine fatalaties: four case reports. ''Forensic Science International'' '''139''', 71-73 '''BSAVA Manual of Canine and Feline Emergency Care''' Second Edition,2007 </ref>.

==Treatment==
*'''Of dogs presenting with clinical signs'''
**'''Inital stabilisation of Cardiorespiratory System:'''
***Tachycardia: beta-blockers, eg orally administered metoprolol at a dose of 0.5mg to 1mg per kg every 8 hours <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
***Premature Ventricluar Contractions: lidocaine; iv bolus of 2mg to 6mg per kg administered slowly, after which a constant rate infusion of 20ug to 70ug per kg per minute should be given <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
***Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg <ref name="multiples">'''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 07.11.2010 </ref>

**'''Treatment of seizures and hyperactivity'''
***IV Diazepam at a dose of 0.5 to 2 mg/kg <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
***Alternative to diazepam is barbiturates <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.
***Treating the seizures and hyperactivity should help restore normal body temperature. If animal still hyperthermic then this should be treated directly <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

**'''Correction of acid/base and electrolyte inbalances''' ref merck

**'''Insertion of urinary catheter'''
***Helps prevent further absorption of theobromine and caffeine across bladder wall <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

*'''Of dogs with a known history of recent chocolate ingestion but who have not yet developed clinical signs'''
**Administration of apomorphine (0.03mg/kg IV) or hydrogen peroxide (1-5 ml/kg PO) ref 5 min vet consult in order to induce emesis and/or of activated charcoal in order to minimise further absorption of methylxanthines re 5 min vet consult

==Prognosis==
If treated correctly and early enough ref 5min consult the prognosis is good and a complete recovery can be expected ref bsava proceedings. For animals presenting with seizures and arrhythmias the prognosis is more cautious.

==References==
<references/>

Chocolate Poisoning-Dog

2011-01-22T17:53:54Z

Eanugent: /* Introduction */

{{unfinished}}
"[[File:Chocolate.jpg|thumb|Chocolate]]"
==Introduction==
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. The consumption of more than 20mg/kg of total methylxanthines, the dose at which mild signs such as vomiting, diarrhoea and polyuria are induced <ref name="multiples"> http://www.merckvetmanual.com/mvm/index </ref>, is considered the cut-off point in deciding whether or not to treat <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>. The concentration of methylxanthines differs between products <ref name=multiples> Tilley, Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippencott, Williams and Wilkins''</ref> and therefore the number of grammes required to reach this threshold vary according to the product; in a 10kg dog 5000g of white chocolate provides the equivalent 20mg/kg dose of methylxanthines that 12-40g of plain chocolate, 83-117g of milk chocolate or 7-25g of cocoa powder does <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>.
Methylxanthines are also present in beverages and foods other than chocolates <ref name="multiples"> King, LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>.

==Signalment==
Dog that live indoors are more likely to have access to chocolate. Also puppies and dogs that scavenge are at a greater risk of eating food that is not intended for their consumption. Small breeds of dogs may reach the toxic level of methylxanthine concentration per body weight more easily <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>.

==Diagnosis==
===Clinical Signs===
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular, respiratory and urological signs.<ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>,
<ref name="multiple"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''' </ref> which are evident soon after ingestion of a toxic amount of chocolate <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Second Edition,2007 </ref>

*'''CNS:''' hyperactivity, behavioural changes, ataxia, muscle tremors, clonic seizures and hyperthermia <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>, <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Second Edition,2007 </ref>
*'''Gastrointestinal:''' diarrhoea, emesis, haematemesis <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">BSAVA Congress 2007 Scientific Proceedings p253-254</ref>
*'''Cardiovascular:''' arrhythmias,tachycardia, bradycardia sometimes, hypotension <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>
*'''Respiratory:''' tachypnoea <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm'''. </ref>.
*'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 02.10.2010 </ref>

===Laboratory Tests===
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion <ref name>="multiples" http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm </ref>. The following laboratory tests are possible but not commonly used;

* Assays for detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Blood Glucose: Hypoglycaemia as a sequela to hyperactivity. not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.

===Other===
*ECG: rate and rhythm abnormalities <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.

===Pathology===
Following absorption from the gastrointestinal tract caffeine and theobromine are metabolised in the liver <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>. Caffeine has a half life of 4.5 hours in dogs while theobromine has a half life of 17.5 hours <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>. In humans the half life of theobromine ranges from 6 to 10 hours, significantly shorter than that in dogs which may explain the susceptibility of dogs to chocolate poisoning REF.
Methylxanthines have the following modes of action.

*'''Antagonism of Adenosine Receptors:'''<ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care''' Second Edition, 2007</ref> this antagonism results in stimulation of the central nervous system and an increase in heart rate <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref> and also diureses <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>
*'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiple"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care''' Second Edition,2007</ref> consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.
*'''Modulation of Intracellular Calcium Concentrations:''' <ref name=multiples> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>.
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.<ref> Carson TL (2006) Methylxanthines. In: ''Small Animal Toxicology'', ed. ME Peterson, PA Talcott, pp.845-852. Elsevier Saunders, St. Louis in '''BSAVA Manual of Canine and Feline Emergency Care''' Chapter 19, Second Edition,2007 </ref>, <ref> Holmgren P, Norden-Petterson L and Ahlner J (2004)Caffeine fatalaties: four case reports. ''Forensic Science International'' '''139''', 71-73 '''BSAVA Manual of Canine and Feline Emergency Care''' Second Edition,2007 </ref>.

==Treatment==
*'''Of dogs presenting with clinical signs'''
**'''Inital stabilisation of Cardiorespiratory System:'''
***Tachycardia: beta-blockers, eg orally administered metoprolol at a dose of 0.5mg to 1mg per kg every 8 hours <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>.
***Premature Ventricluar Contractions: lidocaine; iv bolus of 2mg to 6mg per kg administered slowly, after which a constant rate infusion of 20ug to 70ug per kg per minute should be given <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>.
***Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg <ref name="multiples">'''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 07.11.2010 </ref>

**'''Treatment of seizures and hyperactivity'''
***IV Diazepam at a dose of 0.5 to 2 mg/kg <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>.
***Alternative to diazepam is barbiturates <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>.
***Treating the seizures and hyperactivity should help restore normal body temperature. If animal still hyperthermic then this should be treated directly <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>

**'''Correction of acid/base and electrolyte inbalances''' ref merck

**'''Insertion of urinary catheter'''
***Helps prevent further absorption of theobromine and caffeine across bladder wall ref bsava

*'''Of dogs with a known history of recent chocolate ingestion but who have not yet developed clinical signs'''
**Administration of apomorphine (0.03mg/kg IV) or hydrogen peroxide (1-5 ml/kg PO) ref 5 min vet consult in order to induce emesis and/or of activated charcoal in order to minimise further absorption of methylxanthines re 5 min vet consult

==Prognosis==
If treated correctly and early enough ref 5min consult the prognosis is good and a complete recovery can be expected ref bsava proceedings. For animals presenting with seizures and arrhythmias the prognosis is mor cautious.

==References==
<references/>

Chocolate Poisoning-Dog

2011-01-22T17:50:34Z

Eanugent: /* Introduction */

{{unfinished}}
"[[File:Chocolate.jpg|thumb|Chocolate]]"
==Introduction==
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name="multiples"> King,LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities <ref name="multiples"> King,LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care(2nd Edition)''' ''BSAVA''</ref>. <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>. The consumption of more than 20mg/kg of total methylxanthines, the dose at which mild signs such as vomiting, diarrhoea and polyuria are induced <ref name="multiples"> http://www.merckvetmanual.com/mvm/index </ref>, is considered the cut-off point in deciding whether or not to treat <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>. The concentration of methylxanthines differs between products <ref name=multiples> Tilley, Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippencott, Williams and Wilkins''</ref> and therefore the number of grammes required to reach this threshold vary according to the product; in a 10kg dog 5000g of white chocolate provides the equivalent 20mg/kg dose of methylxanthines that 12-40g of plain chocolate, 83-117g of milk chocolate or 7-25g of cocoa powder does <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>.
Methylxanthines are also present in beverages and foods other than chocolates <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>.

==Signalment==
Dog that live indoors are more likely to have access to chocolate. Also puppies and dogs that scavenge are at a greater risk of eating food that is not intended for their consumption. Small breeds of dogs may reach the toxic level of methylxanthine concentration per body weight more easily <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>.

==Diagnosis==
===Clinical Signs===
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular, respiratory and urological signs.<ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>,
<ref name="multiple"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''' </ref> which are evident soon after ingestion of a toxic amount of chocolate <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Second Edition,2007 </ref>

*'''CNS:''' hyperactivity, behavioural changes, ataxia, muscle tremors, clonic seizures and hyperthermia <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>, <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Second Edition,2007 </ref>
*'''Gastrointestinal:''' diarrhoea, emesis, haematemesis <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">BSAVA Congress 2007 Scientific Proceedings p253-254</ref>
*'''Cardiovascular:''' arrhythmias,tachycardia, bradycardia sometimes, hypotension <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>
*'''Respiratory:''' tachypnoea <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm'''. </ref>.
*'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 02.10.2010 </ref>

===Laboratory Tests===
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion <ref name>="multiples" http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm </ref>. The following laboratory tests are possible but not commonly used;

* Assays for detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Blood Glucose: Hypoglycaemia as a sequela to hyperactivity. not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.

===Other===
*ECG: rate and rhythm abnormalities <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.

===Pathology===
Following absorption from the gastrointestinal tract caffeine and theobromine are metabolised in the liver <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>. Caffeine has a half life of 4.5 hours in dogs while theobromine has a half life of 17.5 hours <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>. In humans the half life of theobromine ranges from 6 to 10 hours, significantly shorter than that in dogs which may explain the susceptibility of dogs to chocolate poisoning REF.
Methylxanthines have the following modes of action.

*'''Antagonism of Adenosine Receptors:'''<ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care''' Second Edition, 2007</ref> this antagonism results in stimulation of the central nervous system and an increase in heart rate <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref> and also diureses <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>
*'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiple"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care''' Second Edition,2007</ref> consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.
*'''Modulation of Intracellular Calcium Concentrations:''' <ref name=multiples> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>.
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.<ref> Carson TL (2006) Methylxanthines. In: ''Small Animal Toxicology'', ed. ME Peterson, PA Talcott, pp.845-852. Elsevier Saunders, St. Louis in '''BSAVA Manual of Canine and Feline Emergency Care''' Chapter 19, Second Edition,2007 </ref>, <ref> Holmgren P, Norden-Petterson L and Ahlner J (2004)Caffeine fatalaties: four case reports. ''Forensic Science International'' '''139''', 71-73 '''BSAVA Manual of Canine and Feline Emergency Care''' Second Edition,2007 </ref>.

==Treatment==
*'''Of dogs presenting with clinical signs'''
**'''Inital stabilisation of Cardiorespiratory System:'''
***Tachycardia: beta-blockers, eg orally administered metoprolol at a dose of 0.5mg to 1mg per kg every 8 hours <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>.
***Premature Ventricluar Contractions: lidocaine; iv bolus of 2mg to 6mg per kg administered slowly, after which a constant rate infusion of 20ug to 70ug per kg per minute should be given <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>.
***Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg <ref name="multiples">'''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 07.11.2010 </ref>

**'''Treatment of seizures and hyperactivity'''
***IV Diazepam at a dose of 0.5 to 2 mg/kg <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>.
***Alternative to diazepam is barbiturates <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>.
***Treating the seizures and hyperactivity should help restore normal body temperature. If animal still hyperthermic then this should be treated directly <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>

**'''Correction of acid/base and electrolyte inbalances''' ref merck

**'''Insertion of urinary catheter'''
***Helps prevent further absorption of theobromine and caffeine across bladder wall ref bsava

*'''Of dogs with a known history of recent chocolate ingestion but who have not yet developed clinical signs'''
**Administration of apomorphine (0.03mg/kg IV) or hydrogen peroxide (1-5 ml/kg PO) ref 5 min vet consult in order to induce emesis and/or of activated charcoal in order to minimise further absorption of methylxanthines re 5 min vet consult

==Prognosis==
If treated correctly and early enough ref 5min consult the prognosis is good and a complete recovery can be expected ref bsava proceedings. For animals presenting with seizures and arrhythmias the prognosis is mor cautious.

==References==
<references/>

Chocolate Poisoning-Dog

2011-01-22T17:49:16Z

Eanugent:

{{unfinished}}
"[[File:Chocolate.jpg|thumb|Chocolate]]"
==Introduction==
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name="multiples"> King,LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''(2nd Edition) ''BSAVA''</ref>. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities <ref name="multiples"> King,LG, Boag, A (2007) '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''(2nd Edition) ''BSAVA''</ref>. <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>. The consumption of more than 20mg/kg of total methylxanthines, the dose at which mild signs such as vomiting, diarrhoea and polyuria are induced <ref name="multiples"> http://www.merckvetmanual.com/mvm/index </ref>, is considered the cut-off point in deciding whether or not to treat <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>. The concentration of methylxanthines differs between products <ref name=multiples> Tilley, Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippencott, Williams and Wilkins''</ref> and therefore the number of grammes required to reach this threshold vary according to the product; in a 10kg dog 5000g of white chocolate provides the equivalent 20mg/kg dose of methylxanthines that 12-40g of plain chocolate, 83-117g of milk chocolate or 7-25g of cocoa powder does <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>.
Methylxanthines are also present in beverages and foods other than chocolates <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>.

==Signalment==
Dog that live indoors are more likely to have access to chocolate. Also puppies and dogs that scavenge are at a greater risk of eating food that is not intended for their consumption. Small breeds of dogs may reach the toxic level of methylxanthine concentration per body weight more easily <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>.

==Diagnosis==
===Clinical Signs===
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular, respiratory and urological signs.<ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>,
<ref name="multiple"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''' </ref> which are evident soon after ingestion of a toxic amount of chocolate <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Second Edition,2007 </ref>

*'''CNS:''' hyperactivity, behavioural changes, ataxia, muscle tremors, clonic seizures and hyperthermia <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>, <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Second Edition,2007 </ref>
*'''Gastrointestinal:''' diarrhoea, emesis, haematemesis <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">BSAVA Congress 2007 Scientific Proceedings p253-254</ref>
*'''Cardiovascular:''' arrhythmias,tachycardia, bradycardia sometimes, hypotension <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>
*'''Respiratory:''' tachypnoea <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm'''. </ref>.
*'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 02.10.2010 </ref>

===Laboratory Tests===
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion <ref name>="multiples" http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm </ref>. The following laboratory tests are possible but not commonly used;

* Assays for detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Blood Glucose: Hypoglycaemia as a sequela to hyperactivity. not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.

===Other===
*ECG: rate and rhythm abnormalities <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.

===Pathology===
Following absorption from the gastrointestinal tract caffeine and theobromine are metabolised in the liver <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>. Caffeine has a half life of 4.5 hours in dogs while theobromine has a half life of 17.5 hours <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>. In humans the half life of theobromine ranges from 6 to 10 hours, significantly shorter than that in dogs which may explain the susceptibility of dogs to chocolate poisoning REF.
Methylxanthines have the following modes of action.

*'''Antagonism of Adenosine Receptors:'''<ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care''' Second Edition, 2007</ref> this antagonism results in stimulation of the central nervous system and an increase in heart rate <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref> and also diureses <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>
*'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiple"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care''' Second Edition,2007</ref> consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.
*'''Modulation of Intracellular Calcium Concentrations:''' <ref name=multiples> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>.
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.<ref> Carson TL (2006) Methylxanthines. In: ''Small Animal Toxicology'', ed. ME Peterson, PA Talcott, pp.845-852. Elsevier Saunders, St. Louis in '''BSAVA Manual of Canine and Feline Emergency Care''' Chapter 19, Second Edition,2007 </ref>, <ref> Holmgren P, Norden-Petterson L and Ahlner J (2004)Caffeine fatalaties: four case reports. ''Forensic Science International'' '''139''', 71-73 '''BSAVA Manual of Canine and Feline Emergency Care''' Second Edition,2007 </ref>.

==Treatment==
*'''Of dogs presenting with clinical signs'''
**'''Inital stabilisation of Cardiorespiratory System:'''
***Tachycardia: beta-blockers, eg orally administered metoprolol at a dose of 0.5mg to 1mg per kg every 8 hours <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>.
***Premature Ventricluar Contractions: lidocaine; iv bolus of 2mg to 6mg per kg administered slowly, after which a constant rate infusion of 20ug to 70ug per kg per minute should be given <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>.
***Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg <ref name="multiples">'''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 07.11.2010 </ref>

**'''Treatment of seizures and hyperactivity'''
***IV Diazepam at a dose of 0.5 to 2 mg/kg <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>.
***Alternative to diazepam is barbiturates <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>.
***Treating the seizures and hyperactivity should help restore normal body temperature. If animal still hyperthermic then this should be treated directly <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>

**'''Correction of acid/base and electrolyte inbalances''' ref merck

**'''Insertion of urinary catheter'''
***Helps prevent further absorption of theobromine and caffeine across bladder wall ref bsava

*'''Of dogs with a known history of recent chocolate ingestion but who have not yet developed clinical signs'''
**Administration of apomorphine (0.03mg/kg IV) or hydrogen peroxide (1-5 ml/kg PO) ref 5 min vet consult in order to induce emesis and/or of activated charcoal in order to minimise further absorption of methylxanthines re 5 min vet consult

==Prognosis==
If treated correctly and early enough ref 5min consult the prognosis is good and a complete recovery can be expected ref bsava proceedings. For animals presenting with seizures and arrhythmias the prognosis is mor cautious.

==References==
<references/>

Chocolate Poisoning-Dog

2011-01-22T17:32:09Z

Eanugent: /* Prognosis */

{{unfinished}}
"[[File:Chocolate.jpg|thumb|Chocolate]]"
==Introduction==
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>. The consumption of more than 20mg/kg of total methylxanthines, the dose at which mild signs such as vomiting, diarrhoea and polyuria are induced <ref name="multiples"> http://www.merckvetmanual.com/mvm/index </ref>, is considered the cut-off point in deciding whether or not to treat <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>. The concentration of methylxanthines differs between products <ref name=multiples> Tilley, Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippencott, Williams and Wilkins''</ref> and therefore the number of grammes required to reach this threshold vary according to the product; in a 10kg dog 5000g of white chocolate provides the equivalent 20mg/kg dose of methylxanthines that 12-40g of plain chocolate, 83-117g of milk chocolate or 7-25g of cocoa powder does <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>.
Methylxanthines are also present in beverages and foods other than chocolates <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>.

==Signalment==
Dog that live indoors are more likely to have access to chocolate. Also puppies and dogs that scavenge are at a greater risk of eating food that is not intended for their consumption. Small breeds of dogs may reach the toxic level of methylxanthine concentration per body weight more easily <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>.

==Diagnosis==
===Clinical Signs===
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular, respiratory and urological signs.<ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>,
<ref name="multiple"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''' </ref> which are evident soon after ingestion of a toxic amount of chocolate <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Second Edition,2007 </ref>

*'''CNS:''' hyperactivity, behavioural changes, ataxia, muscle tremors, clonic seizures and hyperthermia <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>, <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Second Edition,2007 </ref>
*'''Gastrointestinal:''' diarrhoea, emesis, haematemesis <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">BSAVA Congress 2007 Scientific Proceedings p253-254</ref>
*'''Cardiovascular:''' arrhythmias,tachycardia, bradycardia sometimes, hypotension <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>
*'''Respiratory:''' tachypnoea <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm'''. </ref>.
*'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 02.10.2010 </ref>

===Laboratory Tests===
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion <ref name>="multiples" http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm </ref>. The following laboratory tests are possible but not commonly used;

* Assays for detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Blood Glucose: Hypoglycaemia as a sequela to hyperactivity. not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.

===Other===
*ECG: rate and rhythm abnormalities <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.

===Pathology===
Following absorption from the gastrointestinal tract caffeine and theobromine are metabolised in the liver <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>. Caffeine has a half life of 4.5 hours in dogs while theobromine has a half life of 17.5 hours <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>. In humans the half life of theobromine ranges from 6 to 10 hours, significantly shorter than that in dogs which may explain the susceptibility of dogs to chocolate poisoning REF.
Methylxanthines have the following modes of action.

*'''Antagonism of Adenosine Receptors:'''<ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care''' Second Edition, 2007</ref> this antagonism results in stimulation of the central nervous system and an increase in heart rate <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref> and also diureses <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>
*'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiple"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care''' Second Edition,2007</ref> consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.
*'''Modulation of Intracellular Calcium Concentrations:''' <ref name=multiples> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>.
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.<ref> Carson TL (2006) Methylxanthines. In: ''Small Animal Toxicology'', ed. ME Peterson, PA Talcott, pp.845-852. Elsevier Saunders, St. Louis in '''BSAVA Manual of Canine and Feline Emergency Care''' Chapter 19, Second Edition,2007 </ref>, <ref> Holmgren P, Norden-Petterson L and Ahlner J (2004)Caffeine fatalaties: four case reports. ''Forensic Science International'' '''139''', 71-73 '''BSAVA Manual of Canine and Feline Emergency Care''' Second Edition,2007 </ref>.

==Treatment==
*'''Of dogs presenting with clinical signs'''
**'''Inital stabilisation of Cardiorespiratory System:'''
***Tachycardia: beta-blockers, eg orally administered metoprolol at a dose of 0.5mg to 1mg per kg every 8 hours <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>.
***Premature Ventricluar Contractions: lidocaine; iv bolus of 2mg to 6mg per kg administered slowly, after which a constant rate infusion of 20ug to 70ug per kg per minute should be given <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>.
***Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg <ref name="multiples">'''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 07.11.2010 </ref>

**'''Treatment of seizures and hyperactivity'''
***IV Diazepam at a dose of 0.5 to 2 mg/kg <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>.
***Alternative to diazepam is barbiturates <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>.
***Treating the seizures and hyperactivity should help restore normal body temperature. If animal still hyperthermic then this should be treated directly <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>

**'''Correction of acid/base and electrolyte inbalances''' ref merck

**'''Insertion of urinary catheter'''
***Helps prevent further absorption of theobromine and caffeine across bladder wall ref bsava

*'''Of dogs with a known history of recent chocolate ingestion but who have not yet developed clinical signs'''
**Administration of apomorphine (0.03mg/kg IV) or hydrogen peroxide (1-5 ml/kg PO) ref 5 min vet consult in order to induce emesis and/or of activated charcoal in order to minimise further absorption of methylxanthines re 5 min vet consult

==Prognosis==
If treated correctly and early enough ref 5min consult the prognosis is good and a complete recovery can be expected ref bsava proceedings. For animals presenting with seizures and arrhythmias the prognosis is mor cautious.

==References==
<references/>

Chocolate Poisoning-Dog

2011-01-22T17:22:25Z

Eanugent: /* Treatment */

{{unfinished}}
"[[File:Chocolate.jpg|thumb|Chocolate]]"
==Introduction==
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>. The consumption of more than 20mg/kg of total methylxanthines, the dose at which mild signs such as vomiting, diarrhoea and polyuria are induced <ref name="multiples"> http://www.merckvetmanual.com/mvm/index </ref>, is considered the cut-off point in deciding whether or not to treat <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>. The concentration of methylxanthines differs between products <ref name=multiples> Tilley, Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippencott, Williams and Wilkins''</ref> and therefore the number of grammes required to reach this threshold vary according to the product; in a 10kg dog 5000g of white chocolate provides the equivalent 20mg/kg dose of methylxanthines that 12-40g of plain chocolate, 83-117g of milk chocolate or 7-25g of cocoa powder does <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>.
Methylxanthines are also present in beverages and foods other than chocolates <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>.

==Signalment==
Dog that live indoors are more likely to have access to chocolate. Also puppies and dogs that scavenge are at a greater risk of eating food that is not intended for their consumption. Small breeds of dogs may reach the toxic level of methylxanthine concentration per body weight more easily <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>.

==Diagnosis==
===Clinical Signs===
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular, respiratory and urological signs.<ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>,
<ref name="multiple"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''' </ref> which are evident soon after ingestion of a toxic amount of chocolate <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Second Edition,2007 </ref>

*'''CNS:''' hyperactivity, behavioural changes, ataxia, muscle tremors, clonic seizures and hyperthermia <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>, <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Second Edition,2007 </ref>
*'''Gastrointestinal:''' diarrhoea, emesis, haematemesis <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">BSAVA Congress 2007 Scientific Proceedings p253-254</ref>
*'''Cardiovascular:''' arrhythmias,tachycardia, bradycardia sometimes, hypotension <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>
*'''Respiratory:''' tachypnoea <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm'''. </ref>.
*'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 02.10.2010 </ref>

===Laboratory Tests===
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion <ref name>="multiples" http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm </ref>. The following laboratory tests are possible but not commonly used;

* Assays for detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Blood Glucose: Hypoglycaemia as a sequela to hyperactivity. not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.

===Other===
*ECG: rate and rhythm abnormalities <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.

===Pathology===
Following absorption from the gastrointestinal tract caffeine and theobromine are metabolised in the liver <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>. Caffeine has a half life of 4.5 hours in dogs while theobromine has a half life of 17.5 hours <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>. In humans the half life of theobromine ranges from 6 to 10 hours, significantly shorter than that in dogs which may explain the susceptibility of dogs to chocolate poisoning REF.
Methylxanthines have the following modes of action.

*'''Antagonism of Adenosine Receptors:'''<ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care''' Second Edition, 2007</ref> this antagonism results in stimulation of the central nervous system and an increase in heart rate <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref> and also diureses <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>
*'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiple"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care''' Second Edition,2007</ref> consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.
*'''Modulation of Intracellular Calcium Concentrations:''' <ref name=multiples> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>.
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.<ref> Carson TL (2006) Methylxanthines. In: ''Small Animal Toxicology'', ed. ME Peterson, PA Talcott, pp.845-852. Elsevier Saunders, St. Louis in '''BSAVA Manual of Canine and Feline Emergency Care''' Chapter 19, Second Edition,2007 </ref>, <ref> Holmgren P, Norden-Petterson L and Ahlner J (2004)Caffeine fatalaties: four case reports. ''Forensic Science International'' '''139''', 71-73 '''BSAVA Manual of Canine and Feline Emergency Care''' Second Edition,2007 </ref>.

==Treatment==
*'''Of dogs presenting with clinical signs'''
**'''Inital stabilisation of Cardiorespiratory System:'''
***Tachycardia: beta-blockers, eg orally administered metoprolol at a dose of 0.5mg to 1mg per kg every 8 hours <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>.
***Premature Ventricluar Contractions: lidocaine; iv bolus of 2mg to 6mg per kg administered slowly, after which a constant rate infusion of 20ug to 70ug per kg per minute should be given <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>.
***Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg <ref name="multiples">'''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 07.11.2010 </ref>

**'''Treatment of seizures and hyperactivity'''
***IV Diazepam at a dose of 0.5 to 2 mg/kg <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>.
***Alternative to diazepam is barbiturates <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>.
***Treating the seizures and hyperactivity should help restore normal body temperature. If animal still hyperthermic then this should be treated directly <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>

**'''Correction of acid/base and electrolyte inbalances''' ref merck

**'''Insertion of urinary catheter'''
***Helps prevent further absorption of theobromine and caffeine across bladder wall ref bsava

*'''Of dogs with a known history of recent chocolate ingestion but who have not yet developed clinical signs'''
**Administration of apomorphine (0.03mg/kg IV) or hydrogen peroxide (1-5 ml/kg PO) ref 5 min vet consult in order to induce emesis and/or of activated charcoal in order to minimise further absorption of methylxanthines re 5 min vet consult

==Prognosis==
==References==
<references/>

Chocolate Poisoning-Dog

2011-01-22T17:12:34Z

Eanugent: /* Treatment */

{{unfinished}}
"[[File:Chocolate.jpg|thumb|Chocolate]]"
==Introduction==
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>. The consumption of more than 20mg/kg of total methylxanthines, the dose at which mild signs such as vomiting, diarrhoea and polyuria are induced <ref name="multiples"> http://www.merckvetmanual.com/mvm/index </ref>, is considered the cut-off point in deciding whether or not to treat <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>. The concentration of methylxanthines differs between products <ref name=multiples> Tilley, Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippencott, Williams and Wilkins''</ref> and therefore the number of grammes required to reach this threshold vary according to the product; in a 10kg dog 5000g of white chocolate provides the equivalent 20mg/kg dose of methylxanthines that 12-40g of plain chocolate, 83-117g of milk chocolate or 7-25g of cocoa powder does <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>.
Methylxanthines are also present in beverages and foods other than chocolates <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>.

==Signalment==
Dog that live indoors are more likely to have access to chocolate. Also puppies and dogs that scavenge are at a greater risk of eating food that is not intended for their consumption. Small breeds of dogs may reach the toxic level of methylxanthine concentration per body weight more easily <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>.

==Diagnosis==
===Clinical Signs===
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular, respiratory and urological signs.<ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>,
<ref name="multiple"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''' </ref> which are evident soon after ingestion of a toxic amount of chocolate <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Second Edition,2007 </ref>

*'''CNS:''' hyperactivity, behavioural changes, ataxia, muscle tremors, clonic seizures and hyperthermia <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>, <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Second Edition,2007 </ref>
*'''Gastrointestinal:''' diarrhoea, emesis, haematemesis <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">BSAVA Congress 2007 Scientific Proceedings p253-254</ref>
*'''Cardiovascular:''' arrhythmias,tachycardia, bradycardia sometimes, hypotension <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>
*'''Respiratory:''' tachypnoea <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm'''. </ref>.
*'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 02.10.2010 </ref>

===Laboratory Tests===
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion <ref name>="multiples" http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm </ref>. The following laboratory tests are possible but not commonly used;

* Assays for detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Blood Glucose: Hypoglycaemia as a sequela to hyperactivity. not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.

===Other===
*ECG: rate and rhythm abnormalities <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.

===Pathology===
Following absorption from the gastrointestinal tract caffeine and theobromine are metabolised in the liver <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>. Caffeine has a half life of 4.5 hours in dogs while theobromine has a half life of 17.5 hours <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>. In humans the half life of theobromine ranges from 6 to 10 hours, significantly shorter than that in dogs which may explain the susceptibility of dogs to chocolate poisoning REF.
Methylxanthines have the following modes of action.

*'''Antagonism of Adenosine Receptors:'''<ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care''' Second Edition, 2007</ref> this antagonism results in stimulation of the central nervous system and an increase in heart rate <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref> and also diureses <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>
*'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiple"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care''' Second Edition,2007</ref> consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.
*'''Modulation of Intracellular Calcium Concentrations:''' <ref name=multiples> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>.
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.<ref> Carson TL (2006) Methylxanthines. In: ''Small Animal Toxicology'', ed. ME Peterson, PA Talcott, pp.845-852. Elsevier Saunders, St. Louis in '''BSAVA Manual of Canine and Feline Emergency Care''' Chapter 19, Second Edition,2007 </ref>, <ref> Holmgren P, Norden-Petterson L and Ahlner J (2004)Caffeine fatalaties: four case reports. ''Forensic Science International'' '''139''', 71-73 '''BSAVA Manual of Canine and Feline Emergency Care''' Second Edition,2007 </ref>.

==Treatment==
*'''Of dogs presenting with clinical signs'''
**'''Inital stabilisation of Cardiorespiratory System:'''
***Tachycardia: beta-blockers, eg orally administered metoprolol at a dose of 0.5mg to 1mg per kg every 8 hours <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>.
***Premature Ventricluar Contractions: lidocaine; iv bolus of 2mg to 6mg per kg administered slowly, after which a constant rate infusion of 20ug to 70ug per kg per minute should be given <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>.
***Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg <ref name="multiples">'''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 07.11.2010 </ref>

**'''Treatment of seizures and hyperactivity'''
***IV Diazepam at a dose of 0.5 to 2 mg/kg <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>.
***Alternative to diazepam is barbiturates <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>.
***Treating the seizures and hyperactivity should help restore normal body temperature. If animal still hyperthermic then this should be treated directly <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>

**'''Correction of acid/base and electrolyte inbalances''' ref merck

**'''Insertion of urinary catheter'''
***Helps prevent further absorption of theobromine and caffeine across bladder wall ref bsava

*'''Of dogs with a known history of recent chocolate ingestion but who have not yet developed clinical signs'''
**

==Prognosis==
==References==
<references/>

Chocolate Poisoning-Dog

2011-01-22T17:02:26Z

Eanugent: /* Treatment */

{{unfinished}}
"[[File:Chocolate.jpg|thumb|Chocolate]]"
==Introduction==
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>. The consumption of more than 20mg/kg of total methylxanthines, the dose at which mild signs such as vomiting, diarrhoea and polyuria are induced <ref name="multiples"> http://www.merckvetmanual.com/mvm/index </ref>, is considered the cut-off point in deciding whether or not to treat <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>. The concentration of methylxanthines differs between products <ref name=multiples> Tilley, Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippencott, Williams and Wilkins''</ref> and therefore the number of grammes required to reach this threshold vary according to the product; in a 10kg dog 5000g of white chocolate provides the equivalent 20mg/kg dose of methylxanthines that 12-40g of plain chocolate, 83-117g of milk chocolate or 7-25g of cocoa powder does <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>.
Methylxanthines are also present in beverages and foods other than chocolates <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>.

==Signalment==
Dog that live indoors are more likely to have access to chocolate. Also puppies and dogs that scavenge are at a greater risk of eating food that is not intended for their consumption. Small breeds of dogs may reach the toxic level of methylxanthine concentration per body weight more easily <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>.

==Diagnosis==
===Clinical Signs===
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular, respiratory and urological signs.<ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>,
<ref name="multiple"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''' </ref> which are evident soon after ingestion of a toxic amount of chocolate <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Second Edition,2007 </ref>

*'''CNS:''' hyperactivity, behavioural changes, ataxia, muscle tremors, clonic seizures and hyperthermia <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>, <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Second Edition,2007 </ref>
*'''Gastrointestinal:''' diarrhoea, emesis, haematemesis <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">BSAVA Congress 2007 Scientific Proceedings p253-254</ref>
*'''Cardiovascular:''' arrhythmias,tachycardia, bradycardia sometimes, hypotension <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>
*'''Respiratory:''' tachypnoea <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm'''. </ref>.
*'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 02.10.2010 </ref>

===Laboratory Tests===
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion <ref name>="multiples" http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm </ref>. The following laboratory tests are possible but not commonly used;

* Assays for detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Blood Glucose: Hypoglycaemia as a sequela to hyperactivity. not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.

===Other===
*ECG: rate and rhythm abnormalities <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.

===Pathology===
Following absorption from the gastrointestinal tract caffeine and theobromine are metabolised in the liver <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>. Caffeine has a half life of 4.5 hours in dogs while theobromine has a half life of 17.5 hours <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>. In humans the half life of theobromine ranges from 6 to 10 hours, significantly shorter than that in dogs which may explain the susceptibility of dogs to chocolate poisoning REF.
Methylxanthines have the following modes of action.

*'''Antagonism of Adenosine Receptors:'''<ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care''' Second Edition, 2007</ref> this antagonism results in stimulation of the central nervous system and an increase in heart rate <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref> and also diureses <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>
*'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiple"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care''' Second Edition,2007</ref> consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.
*'''Modulation of Intracellular Calcium Concentrations:''' <ref name=multiples> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>.
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.<ref> Carson TL (2006) Methylxanthines. In: ''Small Animal Toxicology'', ed. ME Peterson, PA Talcott, pp.845-852. Elsevier Saunders, St. Louis in '''BSAVA Manual of Canine and Feline Emergency Care''' Chapter 19, Second Edition,2007 </ref>, <ref> Holmgren P, Norden-Petterson L and Ahlner J (2004)Caffeine fatalaties: four case reports. ''Forensic Science International'' '''139''', 71-73 '''BSAVA Manual of Canine and Feline Emergency Care''' Second Edition,2007 </ref>.

==Treatment==
*'''Of dogs presenting with clinical signs'''
**'''Inital stabilisation of Cardiorespiratory System:'''
***Tachycardia: beta-blockers, eg orally administered metoprolol at a dose of 0.5mg to 1mg per kg every 8 hours <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>.
***Premature Ventricluar Contractions: lidocaine; iv bolus of 2mg to 6mg per kg administered slowly, after which a constant rate infusion of 20ug to 70ug per kg per minute should be given <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>.
***Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg <ref name="multiples">'''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 07.11.2010 </ref>

**'''Seizures and hyperactivity'''
***IV Diazepam at a dose of 0.5 to 2 mg/kg <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>.
***Alternative to diazepam is barbiturates <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>.
***Treating the seizures and hyperactivity should help restore normal body temperature <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>

*'''Of dogs with a known history of recent chocolate ingestion but who have not yet developed clinical signs'''
**

==Prognosis==
==References==
<references/>

Chocolate Poisoning-Dog

2011-01-22T16:44:06Z

Eanugent: /* Pathology */

{{unfinished}}
"[[File:Chocolate.jpg|thumb|Chocolate]]"
==Introduction==
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>. The consumption of more than 20mg/kg of total methylxanthines, the dose at which mild signs such as vomiting, diarrhoea and polyuria are induced <ref name="multiples"> http://www.merckvetmanual.com/mvm/index </ref>, is considered the cut-off point in deciding whether or not to treat <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>. The concentration of methylxanthines differs between products <ref name=multiples> Tilley, Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippencott, Williams and Wilkins''</ref> and therefore the number of grammes required to reach this threshold vary according to the product; in a 10kg dog 5000g of white chocolate provides the equivalent 20mg/kg dose of methylxanthines that 12-40g of plain chocolate, 83-117g of milk chocolate or 7-25g of cocoa powder does <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>.
Methylxanthines are also present in beverages and foods other than chocolates <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>.

==Signalment==
Dog that live indoors are more likely to have access to chocolate. Also puppies and dogs that scavenge are at a greater risk of eating food that is not intended for their consumption. Small breeds of dogs may reach the toxic level of methylxanthine concentration per body weight more easily <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>.

==Diagnosis==
===Clinical Signs===
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular, respiratory and urological signs.<ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>,
<ref name="multiple"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''' </ref> which are evident soon after ingestion of a toxic amount of chocolate <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Second Edition,2007 </ref>

*'''CNS:''' hyperactivity, behavioural changes, ataxia, muscle tremors, clonic seizures and hyperthermia <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>, <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Second Edition,2007 </ref>
*'''Gastrointestinal:''' diarrhoea, emesis, haematemesis <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">BSAVA Congress 2007 Scientific Proceedings p253-254</ref>
*'''Cardiovascular:''' arrhythmias,tachycardia, bradycardia sometimes, hypotension <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>
*'''Respiratory:''' tachypnoea <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm'''. </ref>.
*'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 02.10.2010 </ref>

===Laboratory Tests===
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion <ref name>="multiples" http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm </ref>. The following laboratory tests are possible but not commonly used;

* Assays for detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Blood Glucose: Hypoglycaemia as a sequela to hyperactivity. not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.

===Other===
*ECG: rate and rhythm abnormalities <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.

===Pathology===
Following absorption from the gastrointestinal tract caffeine and theobromine are metabolised in the liver <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>. Caffeine has a half life of 4.5 hours in dogs while theobromine has a half life of 17.5 hours <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>. In humans the half life of theobromine ranges from 6 to 10 hours, significantly shorter than that in dogs which may explain the susceptibility of dogs to chocolate poisoning REF.
Methylxanthines have the following modes of action.

*'''Antagonism of Adenosine Receptors:'''<ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care''' Second Edition, 2007</ref> this antagonism results in stimulation of the central nervous system and an increase in heart rate <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref> and also diureses <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>
*'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiple"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care''' Second Edition,2007</ref> consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.
*'''Modulation of Intracellular Calcium Concentrations:''' <ref name=multiples> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>.
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.<ref> Carson TL (2006) Methylxanthines. In: ''Small Animal Toxicology'', ed. ME Peterson, PA Talcott, pp.845-852. Elsevier Saunders, St. Louis in '''BSAVA Manual of Canine and Feline Emergency Care''' Chapter 19, Second Edition,2007 </ref>, <ref> Holmgren P, Norden-Petterson L and Ahlner J (2004)Caffeine fatalaties: four case reports. ''Forensic Science International'' '''139''', 71-73 '''BSAVA Manual of Canine and Feline Emergency Care''' Second Edition,2007 </ref>.

==Treatment==
*'''Of dogs presenting with clinical signs'''
**'''Inital stabilisation of Cardiorespiratory System:'''
***Tachycardia: beta-blockers, eg orally administered metoprolol at a dose of 0.5mg to 1mg per kg every 8 hours <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>.
***Premature Ventricluar Contractions: slow intravenous bolus of 2mg to 6mg per kg of lidocaine. Following this a constant rate infusion of 20ug to 70ug per kg per minute <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>
***Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg <ref name="multiples">'''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 07.11.2010 </ref>

**Once stable treat as outlined below
*'''Of dogs with a known history of recent chocolate ingestion but who have not yet developed clinical signs'''
**
==Prognosis==
==References==
<references/>

Chocolate Poisoning-Dog

2011-01-09T23:19:26Z

Eanugent: /* Pathology */

{{unfinished}}
"[[File:Chocolate.jpg|thumb|Chocolate]]"
==Introduction==
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>. The consumption of more than 20mg/kg of total methylxanthines, the dose at which mild signs such as vomiting, diarrhoea and polyuria are induced <ref name="multiples"> http://www.merckvetmanual.com/mvm/index </ref>, is considered the cut-off point in deciding whether or not to treat <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>. The concentration of methylxanthines differs between products <ref name=multiples> Tilley, Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippencott, Williams and Wilkins''</ref> and therefore the number of grammes required to reach this threshold vary according to the product; in a 10kg dog 5000g of white chocolate provides the equivalent 20mg/kg dose of methylxanthines that 12-40g of plain chocolate, 83-117g of milk chocolate or 7-25g of cocoa powder does <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>.
Methylxanthines are also present in beverages and foods other than chocolates <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>.

==Signalment==
Dog that live indoors are more likely to have access to chocolate. Also puppies and dogs that scavenge are at a greater risk of eating food that is not intended for their consumption. Small breeds of dogs may reach the toxic level of methylxanthine concentration per body weight more easily <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>.

==Diagnosis==
===Clinical Signs===
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular, respiratory and urological signs.<ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>,
<ref name="multiple"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''' </ref> which are evident soon after ingestion of a toxic amount of chocolate <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Second Edition,2007 </ref>

*'''CNS:''' hyperactivity, behavioural changes, ataxia, muscle tremors, clonic seizures and hyperthermia <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>, <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Second Edition,2007 </ref>
*'''Gastrointestinal:''' diarrhoea, emesis, haematemesis <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">BSAVA Congress 2007 Scientific Proceedings p253-254</ref>
*'''Cardiovascular:''' arrhythmias,tachycardia, bradycardia sometimes, hypotension <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>
*'''Respiratory:''' tachypnoea <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm'''. </ref>.
*'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 02.10.2010 </ref>

===Laboratory Tests===
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion <ref name>="multiples" http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm </ref>. The following laboratory tests are possible but not commonly used;

* Assays for detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Blood Glucose: Hypoglycaemia as a sequela to hyperactivity. not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.

===Other===
*ECG: rate and rhythm abnormalities <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.

===Pathology===
Following absorption from the gastrointestinal tract caffeine and theobromine are metabolised in the liver <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>. Caffeine has a half life of 4.5 hours in dogs while theobromine has a half life of 17.5 hours <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>. In humans the half life of theobromine ranges from 6 to 10 hours, significantly shorter than that in dogs which may explain the susceptibility of dogs to chocolate poisoning REF.
Methylxanthines have the following modes of action.

*'''Antagonism of Adenosine Receptors:'''<ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care''' Second Edition, 2007</ref> this antagonism results in stimulation of the central nervous system and an increase in heart rate <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref> and also diureses <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>
*'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiple"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care''' Second Edition,2007</ref> consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.
*'''Modulation of Intracellular Calcium Concentrations:''' <ref name=multiples> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>.
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.<ref> Carson TL (2006) Methylxanthines. In: ''Small Animal Toxicology'', ed. ME Peterson, PA Talcott, pp.845-852. Elsevier Saunders, St. Louis in '''BSAVA Manual of Canine and Feline Emergency Care''' Chapter 19, Second Edition,2007 </ref>, <ref> Holmgren P, Norden-Petterson L and Ahlner J (2004)Caffeine fatalaties: four case reports. ''Forensic Science International'' '''139''', 71-73 '''BSAVA Manual of Canine and Feline Emergency Care''' Second Edition,2007 </ref>

==Treatment==
*'''Of dogs presenting with clinical signs'''
**'''Inital stabilisation of Cardiorespiratory System:'''
***Tachycardia: beta-blockers, eg orally administered metoprolol at a dose of 0.5mg to 1mg per kg every 8 hours <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>.
***Premature Ventricluar Contractions: slow intravenous bolus of 2mg to 6mg per kg of lidocaine. Following this a constant rate infusion of 20ug to 70ug per kg per minute <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>
***Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg <ref name="multiples">'''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 07.11.2010 </ref>

**Once stable treat as outlined below
*'''Of dogs with a known history of recent chocolate ingestion but who have not yet developed clinical signs'''
**
==Prognosis==
==References==
<references/>

Chocolate Poisoning-Dog

2011-01-09T23:00:46Z

Eanugent: /* Pathology */

{{unfinished}}
"[[File:Chocolate.jpg|thumb|Chocolate]]"
==Introduction==
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>. The consumption of more than 20mg/kg of total methylxanthines, the dose at which mild signs such as vomiting, diarrhoea and polyuria are induced <ref name="multiples"> http://www.merckvetmanual.com/mvm/index </ref>, is considered the cut-off point in deciding whether or not to treat <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>. The concentration of methylxanthines differs between products <ref name=multiples> Tilley, Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippencott, Williams and Wilkins''</ref> and therefore the number of grammes required to reach this threshold vary according to the product; in a 10kg dog 5000g of white chocolate provides the equivalent 20mg/kg dose of methylxanthines that 12-40g of plain chocolate, 83-117g of milk chocolate or 7-25g of cocoa powder does <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>.
Methylxanthines are also present in beverages and foods other than chocolates <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>.

==Signalment==
Dog that live indoors are more likely to have access to chocolate. Also puppies and dogs that scavenge are at a greater risk of eating food that is not intended for their consumption. Small breeds of dogs may reach the toxic level of methylxanthine concentration per body weight more easily <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>.

==Diagnosis==
===Clinical Signs===
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular, respiratory and urological signs.<ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>,
<ref name="multiple"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''' </ref> which are evident soon after ingestion of a toxic amount of chocolate <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Second Edition,2007 </ref>

*'''CNS:''' hyperactivity, behavioural changes, ataxia, muscle tremors, clonic seizures and hyperthermia <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>, <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Second Edition,2007 </ref>
*'''Gastrointestinal:''' diarrhoea, emesis, haematemesis <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">BSAVA Congress 2007 Scientific Proceedings p253-254</ref>
*'''Cardiovascular:''' arrhythmias,tachycardia, bradycardia sometimes, hypotension <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>
*'''Respiratory:''' tachypnoea <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm'''. </ref>.
*'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 02.10.2010 </ref>

===Laboratory Tests===
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion <ref name>="multiples" http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm </ref>. The following laboratory tests are possible but not commonly used;

* Assays for detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Blood Glucose: Hypoglycaemia as a sequela to hyperactivity. not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.

===Other===
*ECG: rate and rhythm abnormalities <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.

===Pathology===
Following absorption from the gastrointestinal tract caffeine and theobromine are metabolised in the liver <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>. Caffeine has a half life of 4.5 hours in dogs while theobromine has a half life of 17.5 hours <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>. In humans the half life of theobromine ranges from 6 to 10 hours, significantly shorter than that in dogs which may explain the susceptibility of dogs to chocolate poisoning REF

*'''Antagonism of Adenosine Receptors:'''<ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care''' Second Edition, 2007</ref> this antagonism results in stimulation of the central nervous system, vasoconstriction and increase in heart rate <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref> and also diureses <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>
*'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiple"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care''' Second Edition,2007</ref> consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.
*'''Modulation of Intracellular Calcium Concentrations:'''Enhanced uptake and decreased sequestration within the cell leads to amplification of intracellular calcium levels in cardiac and skeletal muscle, the net result of which is a positive inotropic effect on these muscles. <ref name=multiples> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>.
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.<ref> Carson TL (2006) Methylxanthines. In: ''Small Animal Toxicology'', ed. ME Peterson, PA Talcott, pp.845-852. Elsevier Saunders, St. Louis in '''BSAVA Manual of Canine and Feline Emergency Care''' Chapter 19, Second Edition,2007 </ref>, <ref> Holmgren P, Norden-Petterson L and Ahlner J (2004)Caffeine fatalaties: four case reports. ''Forensic Science International'' '''139''', 71-73 '''BSAVA Manual of Canine and Feline Emergency Care''' Second Edition,2007 </ref>

==Treatment==
*'''Of dogs presenting with clinical signs'''
**'''Inital stabilisation of Cardiorespiratory System:'''
***Tachycardia: beta-blockers, eg orally administered metoprolol at a dose of 0.5mg to 1mg per kg every 8 hours <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>.
***Premature Ventricluar Contractions: slow intravenous bolus of 2mg to 6mg per kg of lidocaine. Following this a constant rate infusion of 20ug to 70ug per kg per minute <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>
***Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg <ref name="multiples">'''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 07.11.2010 </ref>

**Once stable treat as outlined below
*'''Of dogs with a known history of recent chocolate ingestion but who have not yet developed clinical signs'''
**
==Prognosis==
==References==
<references/>

Chocolate Poisoning-Dog

2011-01-09T22:54:24Z

Eanugent: /* Other */

{{unfinished}}
"[[File:Chocolate.jpg|thumb|Chocolate]]"
==Introduction==
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>. The consumption of more than 20mg/kg of total methylxanthines, the dose at which mild signs such as vomiting, diarrhoea and polyuria are induced <ref name="multiples"> http://www.merckvetmanual.com/mvm/index </ref>, is considered the cut-off point in deciding whether or not to treat <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>. The concentration of methylxanthines differs between products <ref name=multiples> Tilley, Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippencott, Williams and Wilkins''</ref> and therefore the number of grammes required to reach this threshold vary according to the product; in a 10kg dog 5000g of white chocolate provides the equivalent 20mg/kg dose of methylxanthines that 12-40g of plain chocolate, 83-117g of milk chocolate or 7-25g of cocoa powder does <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>.
Methylxanthines are also present in beverages and foods other than chocolates <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>.

==Signalment==
Dog that live indoors are more likely to have access to chocolate. Also puppies and dogs that scavenge are at a greater risk of eating food that is not intended for their consumption. Small breeds of dogs may reach the toxic level of methylxanthine concentration per body weight more easily <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>.

==Diagnosis==
===Clinical Signs===
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular, respiratory and urological signs.<ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>,
<ref name="multiple"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''' </ref> which are evident soon after ingestion of a toxic amount of chocolate <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Second Edition,2007 </ref>

*'''CNS:''' hyperactivity, behavioural changes, ataxia, muscle tremors, clonic seizures and hyperthermia <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>, <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Second Edition,2007 </ref>
*'''Gastrointestinal:''' diarrhoea, emesis, haematemesis <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">BSAVA Congress 2007 Scientific Proceedings p253-254</ref>
*'''Cardiovascular:''' arrhythmias,tachycardia, bradycardia sometimes, hypotension <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>
*'''Respiratory:''' tachypnoea <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm'''. </ref>.
*'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 02.10.2010 </ref>

===Laboratory Tests===
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion <ref name>="multiples" http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm </ref>. The following laboratory tests are possible but not commonly used;

* Assays for detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Blood Glucose: Hypoglycaemia as a sequela to hyperactivity. not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.

===Other===
*ECG: rate and rhythm abnormalities <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.

===Pathology===
Following absorption from the gastrointestinal tract caffeine and theobromine are metabolised in the liver <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>.

*'''Antagonism of Adenosine Receptors:'''<ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care''' Second Edition, 2007</ref> this antagonism results in stimulation of the central nervous system, vasoconstriction and increase in heart rate <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref> and also diureses <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>
*'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiple"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care''' Second Edition,2007</ref> consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.
*'''Modulation of Intracellular Calcium Concentrations:'''Enhanced uptake and decreased sequestration within the cell leads to amplification of intracellular calcium levels in cardiac and skeletal muscle, the net result of which is a positive inotropic effect on these muscles. <ref name=multiples> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>.
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.<ref> Carson TL (2006) Methylxanthines. In: ''Small Animal Toxicology'', ed. ME Peterson, PA Talcott, pp.845-852. Elsevier Saunders, St. Louis in '''BSAVA Manual of Canine and Feline Emergency Care''' Chapter 19, Second Edition,2007 </ref>, <ref> Holmgren P, Norden-Petterson L and Ahlner J (2004)Caffeine fatalaties: four case reports. ''Forensic Science International'' '''139''', 71-73 '''BSAVA Manual of Canine and Feline Emergency Care''' Second Edition,2007 </ref>

==Treatment==
*'''Of dogs presenting with clinical signs'''
**'''Inital stabilisation of Cardiorespiratory System:'''
***Tachycardia: beta-blockers, eg orally administered metoprolol at a dose of 0.5mg to 1mg per kg every 8 hours <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>.
***Premature Ventricluar Contractions: slow intravenous bolus of 2mg to 6mg per kg of lidocaine. Following this a constant rate infusion of 20ug to 70ug per kg per minute <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>
***Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg <ref name="multiples">'''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 07.11.2010 </ref>

**Once stable treat as outlined below
*'''Of dogs with a known history of recent chocolate ingestion but who have not yet developed clinical signs'''
**
==Prognosis==
==References==
<references/>

Chocolate Poisoning-Dog

2011-01-09T22:53:17Z

Eanugent: /* Laboratory Tests */

{{unfinished}}
"[[File:Chocolate.jpg|thumb|Chocolate]]"
==Introduction==
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>. The consumption of more than 20mg/kg of total methylxanthines, the dose at which mild signs such as vomiting, diarrhoea and polyuria are induced <ref name="multiples"> http://www.merckvetmanual.com/mvm/index </ref>, is considered the cut-off point in deciding whether or not to treat <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>. The concentration of methylxanthines differs between products <ref name=multiples> Tilley, Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippencott, Williams and Wilkins''</ref> and therefore the number of grammes required to reach this threshold vary according to the product; in a 10kg dog 5000g of white chocolate provides the equivalent 20mg/kg dose of methylxanthines that 12-40g of plain chocolate, 83-117g of milk chocolate or 7-25g of cocoa powder does <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>.
Methylxanthines are also present in beverages and foods other than chocolates <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>.

==Signalment==
Dog that live indoors are more likely to have access to chocolate. Also puppies and dogs that scavenge are at a greater risk of eating food that is not intended for their consumption. Small breeds of dogs may reach the toxic level of methylxanthine concentration per body weight more easily <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>.

==Diagnosis==
===Clinical Signs===
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular, respiratory and urological signs.<ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>,
<ref name="multiple"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''' </ref> which are evident soon after ingestion of a toxic amount of chocolate <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Second Edition,2007 </ref>

*'''CNS:''' hyperactivity, behavioural changes, ataxia, muscle tremors, clonic seizures and hyperthermia <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>, <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Second Edition,2007 </ref>
*'''Gastrointestinal:''' diarrhoea, emesis, haematemesis <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">BSAVA Congress 2007 Scientific Proceedings p253-254</ref>
*'''Cardiovascular:''' arrhythmias,tachycardia, bradycardia sometimes, hypotension <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>
*'''Respiratory:''' tachypnoea <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm'''. </ref>.
*'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 02.10.2010 </ref>

===Laboratory Tests===
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion <ref name>="multiples" http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm </ref>. The following laboratory tests are possible but not commonly used;

* Assays for detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Blood Glucose: Hypoglycaemia as a sequela to hyperactivity. not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.

===Other===
*ECG: rate and rhythm abnormalities

===Pathology===
Following absorption from the gastrointestinal tract caffeine and theobromine are metabolised in the liver <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>.

*'''Antagonism of Adenosine Receptors:'''<ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care''' Second Edition, 2007</ref> this antagonism results in stimulation of the central nervous system, vasoconstriction and increase in heart rate <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref> and also diureses <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>
*'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiple"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care''' Second Edition,2007</ref> consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.
*'''Modulation of Intracellular Calcium Concentrations:'''Enhanced uptake and decreased sequestration within the cell leads to amplification of intracellular calcium levels in cardiac and skeletal muscle, the net result of which is a positive inotropic effect on these muscles. <ref name=multiples> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>.
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.<ref> Carson TL (2006) Methylxanthines. In: ''Small Animal Toxicology'', ed. ME Peterson, PA Talcott, pp.845-852. Elsevier Saunders, St. Louis in '''BSAVA Manual of Canine and Feline Emergency Care''' Chapter 19, Second Edition,2007 </ref>, <ref> Holmgren P, Norden-Petterson L and Ahlner J (2004)Caffeine fatalaties: four case reports. ''Forensic Science International'' '''139''', 71-73 '''BSAVA Manual of Canine and Feline Emergency Care''' Second Edition,2007 </ref>

==Treatment==
*'''Of dogs presenting with clinical signs'''
**'''Inital stabilisation of Cardiorespiratory System:'''
***Tachycardia: beta-blockers, eg orally administered metoprolol at a dose of 0.5mg to 1mg per kg every 8 hours <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>.
***Premature Ventricluar Contractions: slow intravenous bolus of 2mg to 6mg per kg of lidocaine. Following this a constant rate infusion of 20ug to 70ug per kg per minute <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>
***Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg <ref name="multiples">'''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 07.11.2010 </ref>

**Once stable treat as outlined below
*'''Of dogs with a known history of recent chocolate ingestion but who have not yet developed clinical signs'''
**
==Prognosis==
==References==
<references/>

Chocolate Poisoning-Dog

2011-01-09T22:52:48Z

Eanugent: /* Clinical Signs */

{{unfinished}}
"[[File:Chocolate.jpg|thumb|Chocolate]]"
==Introduction==
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>. The consumption of more than 20mg/kg of total methylxanthines, the dose at which mild signs such as vomiting, diarrhoea and polyuria are induced <ref name="multiples"> http://www.merckvetmanual.com/mvm/index </ref>, is considered the cut-off point in deciding whether or not to treat <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>. The concentration of methylxanthines differs between products <ref name=multiples> Tilley, Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippencott, Williams and Wilkins''</ref> and therefore the number of grammes required to reach this threshold vary according to the product; in a 10kg dog 5000g of white chocolate provides the equivalent 20mg/kg dose of methylxanthines that 12-40g of plain chocolate, 83-117g of milk chocolate or 7-25g of cocoa powder does <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>.
Methylxanthines are also present in beverages and foods other than chocolates <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>.

==Signalment==
Dog that live indoors are more likely to have access to chocolate. Also puppies and dogs that scavenge are at a greater risk of eating food that is not intended for their consumption. Small breeds of dogs may reach the toxic level of methylxanthine concentration per body weight more easily <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>.

==Diagnosis==
===Clinical Signs===
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular, respiratory and urological signs.<ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>,
<ref name="multiple"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''' </ref> which are evident soon after ingestion of a toxic amount of chocolate <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Second Edition,2007 </ref>

*'''CNS:''' hyperactivity, behavioural changes, ataxia, muscle tremors, clonic seizures and hyperthermia <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>, <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Second Edition,2007 </ref>
*'''Gastrointestinal:''' diarrhoea, emesis, haematemesis <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">BSAVA Congress 2007 Scientific Proceedings p253-254</ref>
*'''Cardiovascular:''' arrhythmias,tachycardia, bradycardia sometimes, hypotension <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>
*'''Respiratory:''' tachypnoea <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm'''. </ref>.
*'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 02.10.2010 </ref>

===Laboratory Tests===
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion <ref name="multiples" http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm </ref>. The following laboratory tests are possible but not commonly used;

* Assays for detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Blood Glucose: Hypoglycaemia as a sequela to hyperactivity. not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.

===Other===
*ECG: rate and rhythm abnormalities

===Pathology===
Following absorption from the gastrointestinal tract caffeine and theobromine are metabolised in the liver <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>.

*'''Antagonism of Adenosine Receptors:'''<ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care''' Second Edition, 2007</ref> this antagonism results in stimulation of the central nervous system, vasoconstriction and increase in heart rate <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref> and also diureses <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>
*'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiple"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care''' Second Edition,2007</ref> consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.
*'''Modulation of Intracellular Calcium Concentrations:'''Enhanced uptake and decreased sequestration within the cell leads to amplification of intracellular calcium levels in cardiac and skeletal muscle, the net result of which is a positive inotropic effect on these muscles. <ref name=multiples> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>.
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.<ref> Carson TL (2006) Methylxanthines. In: ''Small Animal Toxicology'', ed. ME Peterson, PA Talcott, pp.845-852. Elsevier Saunders, St. Louis in '''BSAVA Manual of Canine and Feline Emergency Care''' Chapter 19, Second Edition,2007 </ref>, <ref> Holmgren P, Norden-Petterson L and Ahlner J (2004)Caffeine fatalaties: four case reports. ''Forensic Science International'' '''139''', 71-73 '''BSAVA Manual of Canine and Feline Emergency Care''' Second Edition,2007 </ref>

==Treatment==
*'''Of dogs presenting with clinical signs'''
**'''Inital stabilisation of Cardiorespiratory System:'''
***Tachycardia: beta-blockers, eg orally administered metoprolol at a dose of 0.5mg to 1mg per kg every 8 hours <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>.
***Premature Ventricluar Contractions: slow intravenous bolus of 2mg to 6mg per kg of lidocaine. Following this a constant rate infusion of 20ug to 70ug per kg per minute <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>
***Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg <ref name="multiples">'''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 07.11.2010 </ref>

**Once stable treat as outlined below
*'''Of dogs with a known history of recent chocolate ingestion but who have not yet developed clinical signs'''
**
==Prognosis==
==References==
<references/>

Chocolate Poisoning-Dog

2011-01-09T22:51:50Z

Eanugent: /* Introduction */

{{unfinished}}
"[[File:Chocolate.jpg|thumb|Chocolate]]"
==Introduction==
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>. The consumption of more than 20mg/kg of total methylxanthines, the dose at which mild signs such as vomiting, diarrhoea and polyuria are induced <ref name="multiples"> http://www.merckvetmanual.com/mvm/index </ref>, is considered the cut-off point in deciding whether or not to treat <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>. The concentration of methylxanthines differs between products <ref name=multiples> Tilley, Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippencott, Williams and Wilkins''</ref> and therefore the number of grammes required to reach this threshold vary according to the product; in a 10kg dog 5000g of white chocolate provides the equivalent 20mg/kg dose of methylxanthines that 12-40g of plain chocolate, 83-117g of milk chocolate or 7-25g of cocoa powder does <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>.
Methylxanthines are also present in beverages and foods other than chocolates <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>.

==Signalment==
Dog that live indoors are more likely to have access to chocolate. Also puppies and dogs that scavenge are at a greater risk of eating food that is not intended for their consumption. Small breeds of dogs may reach the toxic level of methylxanthine concentration per body weight more easily <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>.

==Diagnosis==
===Clinical Signs===
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular, respiratory and urological signs.<ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>,
<ref name="multiple"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''' </ref> which are evident soon after ingestion of a toxic amount of chocolate <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Second Edition,2007 </ref>

*'''CNS:''' hyperactivity, behavioural changes, ataxia, muscle tremors, clonic seizures and hyperthermia <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>, <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Second Edition,2007 </ref>
*'''Gastrointestinal:''' diarrhoea, emesis, haematemesis <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">BSAVA Congress 2007 Scientific Proceedings p253-254</ref>
*'''Cardiovascular:''' arrhythmias,tachycardia, bradycardia sometimes <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>
*'''Respiratory:''' tachypnoea <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm'''. </ref>.
*'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 02.10.2010 </ref>

===Laboratory Tests===
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion <ref name="multiples" http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm </ref>. The following laboratory tests are possible but not commonly used;

* Assays for detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Blood Glucose: Hypoglycaemia as a sequela to hyperactivity. not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.

===Other===
*ECG: rate and rhythm abnormalities

===Pathology===
Following absorption from the gastrointestinal tract caffeine and theobromine are metabolised in the liver <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>.

*'''Antagonism of Adenosine Receptors:'''<ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care''' Second Edition, 2007</ref> this antagonism results in stimulation of the central nervous system, vasoconstriction and increase in heart rate <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref> and also diureses <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>
*'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiple"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care''' Second Edition,2007</ref> consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.
*'''Modulation of Intracellular Calcium Concentrations:'''Enhanced uptake and decreased sequestration within the cell leads to amplification of intracellular calcium levels in cardiac and skeletal muscle, the net result of which is a positive inotropic effect on these muscles. <ref name=multiples> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>.
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.<ref> Carson TL (2006) Methylxanthines. In: ''Small Animal Toxicology'', ed. ME Peterson, PA Talcott, pp.845-852. Elsevier Saunders, St. Louis in '''BSAVA Manual of Canine and Feline Emergency Care''' Chapter 19, Second Edition,2007 </ref>, <ref> Holmgren P, Norden-Petterson L and Ahlner J (2004)Caffeine fatalaties: four case reports. ''Forensic Science International'' '''139''', 71-73 '''BSAVA Manual of Canine and Feline Emergency Care''' Second Edition,2007 </ref>

==Treatment==
*'''Of dogs presenting with clinical signs'''
**'''Inital stabilisation of Cardiorespiratory System:'''
***Tachycardia: beta-blockers, eg orally administered metoprolol at a dose of 0.5mg to 1mg per kg every 8 hours <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>.
***Premature Ventricluar Contractions: slow intravenous bolus of 2mg to 6mg per kg of lidocaine. Following this a constant rate infusion of 20ug to 70ug per kg per minute <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>
***Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg <ref name="multiples">'''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 07.11.2010 </ref>

**Once stable treat as outlined below
*'''Of dogs with a known history of recent chocolate ingestion but who have not yet developed clinical signs'''
**
==Prognosis==
==References==
<references/>

Chocolate Poisoning-Dog

2011-01-09T22:09:00Z

Eanugent: /* Pathology */

{{unfinished}}
"[[File:Chocolate.jpg|thumb|Chocolate]]"
==Introduction==
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>. The consumption of more than 20mg/kg of total methylxanthines, the dose at which mild signs such as vomiting, diarrhoea and polyuria are induced <ref name="multiples" http://www.merckvetmanual.com/mvm/index </ref>, is considered the cut-off point in deciding whether or not to treat <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>. The concentration of methylxanthines differs between products <ref name=multiples> Tilley, Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippencott, Williams and Wilkins''</ref> and therefore the number of grammes required to reach this threshold vary according to the product; in a 10kg dog 5000g of white chocolate provides the equivalent 20mg/kg dose of methylxanthines that 12-40g of plain chocolate, 83-117g of milk chocolate or 7-25g of cocoa powder does <ref name="multiples"> '''Dietary intoxications, Chocolate (Theobromine and Caffeine)''', Warman SM, p253,''BSAVA Congress 2007 Scientific Proceedings, Veterinary Programme'' </ref>.
Methylxanthines are also present in beverages and foods other than chocolates <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>.

==Signalment==
Dog that live indoors are more likely to have access to chocolate. Also puppies and dogs that scavenge are at a greater risk of eating food that is not intended for their consumption. Small breeds of dogs may reach the toxic level of methylxanthine concentration per body weight more easily <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>.

==Diagnosis==
===Clinical Signs===
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular, respiratory and urological signs.<ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>,
<ref name="multiple"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''' </ref> which are evident soon after ingestion of a toxic amount of chocolate <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Second Edition,2007 </ref>

*'''CNS:''' hyperactivity, behavioural changes, ataxia, muscle tremors, clonic seizures and hyperthermia <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>, <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Second Edition,2007 </ref>
*'''Gastrointestinal:''' diarrhoea, emesis, haematemesis <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">BSAVA Congress 2007 Scientific Proceedings p253-254</ref>
*'''Cardiovascular:''' arrhythmias,tachycardia, bradycardia sometimes <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippincott, Williams and Wilkins''</ref>, <ref name="multiple">'''BSAVA Congress 2007 Scientific Proceedings''', p253-254</ref>
*'''Respiratory:''' tachypnoea <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm'''. </ref>.
*'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 02.10.2010 </ref>

===Laboratory Tests===
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion <ref name="multiples" http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm </ref>. The following laboratory tests are possible but not commonly used;

* Assays for detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Blood Glucose: Hypoglycaemia as a sequela to hyperactivity. not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins''</ref>.
* Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.

===Other===
*ECG: rate and rhythm abnormalities

===Pathology===
Following absorption from the gastrointestinal tract caffeine and theobromine are metabolised in the liver <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>.

*'''Antagonism of Adenosine Receptors:'''<ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care''' Second Edition, 2007</ref> this antagonism results in stimulation of the central nervous system, vasoconstriction and increase in heart rate <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref> and also diureses <ref name="multiples"> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>
*'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiple"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care''' Second Edition,2007</ref> consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects <ref name="multiples">Tilley Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Third Edition), ''Lippincott, Williams and Wilkins'' </ref>.
*'''Modulation of Intracellular Calcium Concentrations:'''Enhanced uptake and decreased sequestration within the cell leads to amplification of intracellular calcium levels in cardiac and skeletal muscle, the net result of which is a positive inotropic effect on these muscles. <ref name=multiples> '''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 04.10.2010 </ref>.
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.<ref> Carson TL (2006) Methylxanthines. In: ''Small Animal Toxicology'', ed. ME Peterson, PA Talcott, pp.845-852. Elsevier Saunders, St. Louis in '''BSAVA Manual of Canine and Feline Emergency Care''' Chapter 19, Second Edition,2007 </ref>, <ref> Holmgren P, Norden-Petterson L and Ahlner J (2004)Caffeine fatalaties: four case reports. ''Forensic Science International'' '''139''', 71-73 '''BSAVA Manual of Canine and Feline Emergency Care''' Second Edition,2007 </ref>

==Treatment==
*'''Of dogs presenting with clinical signs'''
**'''Inital stabilisation of Cardiorespiratory System:'''
***Tachycardia: beta-blockers, eg orally administered metoprolol at a dose of 0.5mg to 1mg per kg every 8 hours <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>.
***Premature Ventricluar Contractions: slow intravenous bolus of 2mg to 6mg per kg of lidocaine. Following this a constant rate infusion of 20ug to 70ug per kg per minute <ref name="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</ref>
***Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg <ref name="multiples">'''http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm''', accessed on 07.11.2010 </ref>

**Once stable treat as outlined below
*'''Of dogs with a known history of recent chocolate ingestion but who have not yet developed clinical signs'''
**
==Prognosis==
==References==
<references/>

Chocolate Poisoning-Dog

2011-01-09T22:01:14Z

Eanugent: /* Clinical Signs */

Chocolate Poisoning-Dog

2011-01-09T21:58:09Z

Eanugent: /* Introduction */

Chocolate Poisoning-Dog

2011-01-09T21:52:34Z

Eanugent: /* Laboratory Tests */

Chocolate Poisoning-Dog

2011-01-09T21:50:57Z

Eanugent: /* Laboratory Tests */

Chocolate Poisoning-Dog

2011-01-09T21:47:30Z

Eanugent: /* Laboratory Tests */

Chocolate Poisoning-Dog

2011-01-09T21:19:24Z

Eanugent: /* Clinical Signs */

Chocolate Poisoning-Dog

2011-01-09T21:11:10Z

Eanugent: /* Clinical Signs */

Chocolate Poisoning-Dog

2011-01-09T21:07:04Z

Eanugent: /* Clinical Signs */

Chocolate Poisoning-Dog

2011-01-09T20:57:29Z

Eanugent: /* Introduction */

Chocolate Poisoning-Dog

2011-01-09T20:55:13Z

Eanugent: /* Introduction */

Chocolate Poisoning-Dog

2011-01-09T20:52:57Z

Eanugent: /* Introduction */

Chocolate Poisoning-Dog

2011-01-09T20:42:29Z

Eanugent: /* Signalment */

Chocolate Poisoning-Dog

2011-01-09T20:41:14Z

Eanugent: /* Introduction */

Chocolate Poisoning-Dog

2011-01-09T20:31:49Z

Eanugent: /* Introduction */

Chocolate Poisoning-Dog

2011-01-09T20:26:47Z

Eanugent: /* Introduction */

Chocolate Poisoning-Dog

2011-01-09T20:14:04Z

Eanugent: /* Signalment */

Chocolate Poisoning-Dog

2011-01-09T20:13:09Z

Eanugent: /* Signalment */