Changes

==Introduction==

==Introduction==

Toxicity is due to the presence of methylxanthines such as theobromine and caffeine in chocolate.<ref name="multiple"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Second Edition,2007 </ref>. The concentration of methylxanthines in chocolate 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>.

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 in chocolate 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>.

==Signalment==

==Signalment==

*'''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>.

*'''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>.

*'''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''' 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>

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

***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>

 

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

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

**

**

==Prognosis==

==Prognosis==

==References==

==References==

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