Difference between revisions of "Chocolate Poisoning-Dog"
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==Introduction== | ==Introduction== | ||
| − | Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate <ref name=" | + | 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>. The concentration of methylxanthines differs between products. For example the average methylxanthine content of milk chocolate is 2mg/g, while that of baking chocolate is 16mg/g. <ref name=multiples> Tilley, Smith'''The 5-Minute Veterinary Consult Canine and Feline''' (Second Edition), ''Lippencott, Williams and Wilkins''</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 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 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=" | + | 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== | ==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 | + | 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== | ==Diagnosis== | ||
===Clinical Signs=== | ===Clinical Signs=== | ||
| − | Chocolate poisoning results in CNS, gastrointestinal, cardiovascular | + | Chocolate poisoning results in CNS, gastrointestinal, cardiovascular 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>. These signs are observed quite quickly after ingestion of toxic amount of chocolate.<ref name="multiple"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Second Edition,2007 </ref> | ||
| − | *'''CNS:''' hyperactivity | + | *'''CNS:''' hyperexcitability, hyperactivity, ataxia initially can evolve into 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> |
| − | + | *'''Gastrointestinal:''' diarrhoea, emesis, haematemesis, colic.<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> | |
| − | *'''Gastrointestinal:''' diarrhoea, emesis, haematemesis | + | *'''Cardiorespiratory:''' arrhythmias,infrequently bradycardia but usually tachycardia.<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> |
| − | *''' | + | *'''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> |
| − | |||
| − | *'''Urological:''' polydypsia and polyuria may also be present <ref name="multiples"> | ||
===Laboratory Tests=== | ===Laboratory Tests=== | ||
| − | Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion | + | Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion. The following laboratory tests are possible but not commonly used; |
| − | + | * 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 consequence of 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>. |
| − | * Blood Glucose: Hypoglycaemia as a | + | * 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>. |
| − | * Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning | ||
===Other=== | ===Other=== | ||
| − | *ECG: rate and rhythm abnormalities | + | *ECG: rate and rhythm abnormalities |
===Pathology=== | ===Pathology=== | ||
| − | + | The methylxanthines yield their effects through | |
| − | + | *'''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>. | |
| − | *'''Antagonism of Adenosine Receptors:'''<ref name=" | + | *'''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>. |
| − | *'''Inhibition of Cyclic Nucleotide Phosphodiesterase:'''<ref name="multiple"> | + | 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> |
| − | *'''Modulation of Intracellular Calcium Concentrations:''' <ref name= | ||
| − | 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== | ==Treatment== | ||
| − | '''Of dogs presenting with clinical signs''' | + | *'''Of dogs presenting with clinical signs''' |
| − | *'''Inital stabilisation of Cardiorespiratory System:''' | + | **'''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=" | + | ***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: | + | ***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"> | + | ***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> |
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| + | **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== | ==Prognosis== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
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Revision as of 20:52, 9 January 2011
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This article is still under construction. |
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Introduction
Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate [1]. The concentration of methylxanthines differs between products. For example the average methylxanthine content of milk chocolate is 2mg/g, while that of baking chocolate is 16mg/g. [1]. Concentrations ranging from of 100-250mg/kg of theobromine and 110-200mg/kg of caffeine have been reported to cause fatalities [1]. The consumption of more than 20mg/kg of total methylxanthines is considered the cut-off point in deciding whether or not to treat [1]. 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 [1]. Methylxanthines are also present in beverages and foods other than chocolates [1].
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 [1].
Diagnosis
Clinical Signs
Chocolate poisoning results in CNS, gastrointestinal, cardiovascular and urological signs.[1], [2]. These signs are observed quite quickly after ingestion of toxic amount of chocolate.[2]
- CNS: hyperexcitability, hyperactivity, ataxia initially can evolve into muscle tremors, clonic seizures and hyperthermia.[1], [2]
- Gastrointestinal: diarrhoea, emesis, haematemesis, colic.[1], [2]
- Cardiorespiratory: arrhythmias,infrequently bradycardia but usually tachycardia.[1], [2]
- Urological: polydypsia and polyuria may also be present [1]
Laboratory Tests
Diagnosis is usually on the basis of clinical signs and a known history of chocolate ingestion. The following laboratory tests are possible but not commonly used;
- Detection of methylxanthines in bodily fluids such as plasma, urine and stomach contents [1].
- Blood Glucose: Hypoglycaemia as a consequence of hyperactivity. not seen consistently with chocolate poisoning [1].
- Urinalysis: Proteinuria, low specific gravity; not seen consistently with chocolate poisoning [1].
Other
- ECG: rate and rhythm abnormalities
Pathology
The methylxanthines yield their effects through
- Antagonism of Adenosine Receptors:[1] this antagonism results in stimulation of the central nervous system, vasoconstriction and increase in heart rate [1] and also diureses [1]
- Inhibition of Cyclic Nucleotide Phosphodiesterase:[2] consequently there is an increase in cyclic AMP, which in turn leads to greater catecholamine release and their effects [1].
- 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. [1].
Ventricular fibrillation, and other cardiac dysrhythmias are most frequently the ultimate cause of death.[3], [4]
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 [1].
- 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 [1]
- Bradycardia: Atropine at a dose of 0.01mg to 0.02mg per kg [1]
- Inital stabilisation of Cardiorespiratory System:
- 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
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 BSAVA Manual of Canine and Feline Emergency and Critical CareChapter 19, Second Edition,2007 Cite error: Invalid
<ref>tag; name "multiples" defined multiple times with different content Cite error: Invalid<ref>tag; name "multiples" defined multiple times with different content Cite error: Invalid<ref>tag; name "multiples" defined multiple times with different content Cite error: Invalid<ref>tag; name "multiples" defined multiple times with different content Cite error: Invalid<ref>tag; name "multiples" defined multiple times with different content Cite error: Invalid<ref>tag; name "multiples" defined multiple times with different content Cite error: Invalid<ref>tag; name "multiples" defined multiple times with different content Cite error: Invalid<ref>tag; name "multiples" defined multiple times with different content Cite error: Invalid<ref>tag; name "multiples" defined multiple times with different content Cite error: Invalid<ref>tag; name "multiples" defined multiple times with different content Cite error: Invalid<ref>tag; name "multiples" defined multiple times with different content Cite error: Invalid<ref>tag; name "multiples" defined multiple times with different content Cite error: Invalid<ref>tag; name "multiples" defined multiple times with different content Cite error: Invalid<ref>tag; name "multiples" defined multiple times with different content Cite error: Invalid<ref>tag; name "multiples" defined multiple times with different content Cite error: Invalid<ref>tag; name "multiples" defined multiple times with different content Cite error: Invalid<ref>tag; name "multiples" defined multiple times with different content Cite error: Invalid<ref>tag; name "multiples" defined multiple times with different content Cite error: Invalid<ref>tag; name "multiples" defined multiple times with different content Cite error: Invalid<ref>tag; name "multiples" defined multiple times with different content Cite error: Invalid<ref>tag; name "multiples" defined multiple times with different content Cite error: Invalid<ref>tag; name "multiples" defined multiple times with different content - ↑ 2.0 2.1 2.2 2.3 2.4 2.5 http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/211104.htm. Cite error: Invalid
<ref>tag; name "multiple" defined multiple times with different content Cite error: Invalid<ref>tag; name "multiple" defined multiple times with different content Cite error: Invalid<ref>tag; name "multiple" defined multiple times with different content Cite error: Invalid<ref>tag; name "multiple" defined multiple times with different content Cite error: Invalid<ref>tag; name "multiple" defined multiple times with different content - ↑ 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
- ↑ 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