Changes

===Clinical Signs===

===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>,  

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>

<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>

*'''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>

*'''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>

Methylxanthines have the following modes of action.

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>

*'''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="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="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>.

*'''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>.

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>.

*'''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="multiples"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition,2007 </ref>.

***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"> '''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"> 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>

***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'''

**'''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>.

***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"> '''BSAVA Manual of Canine and Feline Emergency and Critical Care'''Chapter 19, Second Edition, 2007</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"> '''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"> 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

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

**'''Insertion of urinary catheter'''

**'''Insertion of urinary catheter'''

***Helps prevent further absorption of theobromine and caffeine across bladder wall ref bsava

***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'''

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

==Prognosis==

==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.

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==

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