Albuterol Toxicity : Why Inhalers Help You, but Harm Lucky

Written by:  Sara Shypkoski

For many of the 22 million people in the United States with asthma a simple device known as an inhaler can offer almost immediate relief during an attack.

Inhalers are composed of a small pressurized canister that contains a solution of asthma medicine fitted into a plastic actuator that releases a fixed dose of the solution in an aerosol or inhalant form.  An Inhaler can either be used in emergencies to manage acute symptoms or on a daily basis to control chronic symptoms.  The majority of rescue inhalers contain albuterol, a drug used to stimulate the bronchial muscles in the lungs to relax and allow the air passages to open.  When used properly, an   inhaler is the safest, quickest, and most effective way to manage an asthma attack.

Unfortunately, to dogs the colorful plastic, small size and odd smell is something they won’t just pass by if they find it lying around. When his sharp teeth puncture the pressurized canister, the entire contents are released instantly. In a 60-lb dog, a full inhaler contains approximately 10 times the therapeutic dose of albuterol. In an overdose, these drugs affect both the bronchial muscles as well as the cardiac muscles. The results are immediate, severe, and include the following:

•    Increased heart rate (up to 200 beats a minute!)
•    Abnormal heart rhythms (arrhythmias)
•    Increased respiratory rate or panting
•    Abnormal behavior (Tremors, shaking, restlessness, hiding, agitation, lethargy, weakness)
•    Low or high blood pressure
•    Electrolyte abnormalities, most commonly low potassium
•    Nausea and/or vomiting

If you see your pet bite into or ingest an inhaler, or if your pet is experiencing symptoms of albuterol toxicity, take him to your nearest emergency clinic for immediate care. Bring the inhaler, and if available, the original packaging as well as any medications that your pet is currently taking. Do NOT induce vomiting at home or give your pet any over-the-counter medication.

Lucky will typically need to be hospitalized on IV fluids for 12 to 48 hours while his body metabolizes or gets rid of the albuterol.   An electrocardiogram or ECG machine will provide continuous visualization of his heart rate and rhythm, and his blood pressure will be regularly monitored. Blood tests will be used to check his electrolytes and regular doses of a beta antagonist (aka beta blocker) may be used to counteract the effects of the albuterol, an agonist. Other drugs may be given for muscle tremors, seizures, arrhythmias, vomiting, or diarrhea.

If treated promptly albuterol toxicity is rarely fatal, though pre-existing heart conditions or pets on other medications are at greater risk for complications. The best thing you can do for your pet is to keep those inhalers out of their reach. Avoid disposing of used canisters in trash cans that are accessible to pets as even used inhalers can be dangerous. Central Veterinary Emergency Services is available night, weekends, and holidays so that, if Lucky does take a bite out of your inhaler, you can breathe easier knowing that he’s in the best of hands and hearts.

Hit By A Car

It's scary when it happens.  Your pet darts into the road at the wrong time and gets tangled with an oncoming car.  But what do you do next?  How should the pet be handled? Should you take him directly to the vet?  What if he has an open wound? Or, what if he doesn't look hurt at all?

These are all great questions, but the main one I want to answer is the last one, what if he doesn't look hurt?  Maybe your pet came out of the incident with a small cut or a slight limp and you are debating whether a trip to the veterinarian's office is required.  On the one hand "Lucky" has lived up to his name and it's great that the external injuries are minimal.  However, the potential internal injuries that can't be seen are actually still life threatening.

When a client brings an animal to the vet that has been hit by a car obviously the external injuries are easier to see and treat.  Any lacerations, penetrating injuries, or fractures need to be assessed and treated appropriately.  But the Veterinarian is also observing and evaluating the animal for appropriate gum color, breathing difficulties, bleeding from the mouth, nose, or rectum, blood in the urine, indication of pain when touched, uneven pupil dilation, staggering, or inability to stand.  All of these are indications of potential head injury or internal organ damage that, if left untreated, can be critical or even fatal.

The Veterinarian will likely recommend x-rays to view the size and shape of internal organs, silhouette of the lungs, and whether there looks like free fluid in the abdomen.  Additional diagnostics may include a blood test that might indicate internal bleeding, and an ultrasound to get a better view at the internal organs if there is suspicion of injury.

Your pet may also need treatment for shock which would include intravenous fluids and hospitalization to stabilize before heading home.

Of course, we hope for the best possible outcome; that the pet truly has sustained no more than a couple scrapes and all is well.  We also believe that it is in your pet's best interest to get checked out at the Veterinarian's office should such an unfortunate event occur.

Gorilla Glue: Apparently To Pets It's Rather Tasty

Video Courtesy of KSL.com

Resting comfortably in his cage is a one year old boxer named Wiley who had an up close and personal experience with Gorilla Glue. Fortunately he didn't eat much, but what remained in his stomach had to be surgically removed.  He'll be feeling much better in a couple days.

CVES sees about 3 to 4 cases a year of Gorilla glue ingestion and so far most of those cases have had a positive outcome.  The problem with gorilla glue is that it can actually adhere to the stomach lining and, depending on the amount of time it remains in the stomach, may require removal of some of the stomach with the gorilla glue to get it out.

This is an example of the type of mass the glue can grow into.  This was not the actual glue removed from Wiley.  You can see that about three quarters of the bottle was consumed and it grew into a size significantly larger.

On the Gorilla Glue website you'll find this statement:  Gorilla Glue is a polyurethane glue. All polyurethane glues foam when they come in contact with moisture and may cause gastro-intestinal blockage if swallowed. This is not unique to Gorilla Glue, but true of all polyurethane glues. If you think there has been a case of ingesting the glue, seek medical or veterinary advice immediately.

The primary signs of a problem after gorilla glue ingestion are vomiting, diarrhea, and poor appetite.  If you suspect your pet has ingested gorilla glue get him or her to a veterinary hospital right away.  Gorilla Glue has its place, but do your best to make sure that place in not in your pet's stomach.

Hypothermia in Pets

Winter finally hit in Colorado.  With temperatures in the teens and 20s and overnight lows dropping below zero it is important to take some extra precautions to keep you pets warm.  Some dogs are more sensitive to the cold than others. Small breeds, short haired dogs, puppies and geriatric dogs, dogs that are normally "indoor" pets, and those with heart or other medical conditions are all more sensitive to colder temperatures. A dog's normal body temperature is between 99.5 and 102.5. When a dog fitting one of the above descriptions is exposed to colder temperatures he or she often has a difficult time keeping his/her core body temperature within the normal range. When the temperature dips below the normal range hypothermia sets in. Hypothermia means that your dog is loosing body heat faster than it can be replaced.

Signs of hypothermia:
- shivering
- lethargy
- stiff muscles
- pale or gray gums
- stumbling or lack of coordination
- fixed and dilated pupils
- low heart and breathing rates
- collapse
- or even coma

With mild hypothermia your dog is likely to be shivering and appear lethargic. As the hypothermia increases in severity the other symptoms become evident.  Your dog becomes increasingly unresponsive as his body goes into heat conservation mode. At this time your dog's focus will be on keeping his vital organs working by restricting the blood flow from all other parts of the body. If it's not treated, hypothermia can be fatal.

Prevention is Key
Dogs sensitive to cold should be kept inside with quick potty breaks outside. The small dogs and short haired breeds benefit from a doggy jacket that helps to keep their core warm. Booties may also be a good idea as lots of heat escapes through a dogs foot pads.

Treatment
Mild hypothermia can be reversed by getting back in a warm environment and wrapping your dog with a blanket until the shivering stops. Hypothermia that has dropped the dogs temperature to the 90-94 degree range will require rewarming methods. Water bottles filled with warm water placed around your dog deliver a safe warm heat source. Stay away from heating pads as it is easy to burn your dog's skin. It is recommended that you take your animal to your family veterinarian or veterinary emergency service for observation and/or treatment if you need to treat for hypothermia. Severe hypothermia requires immediate veterinary intervention. Unfortunately, it may be difficult to reverse the damage at this level of hypothermia, but we can hope for the best.

Cuddle up with your four-legged friends and stay warm!

Skiing and Your Dog

Winter in Colorado is a funny thing.  Storms can dump feet of snow in the mountains and not a flake will reach the valley and plains.  Such is the case this winter.  The great part is that the feet of snow in the mountains makes for great skiing, on the slopes or back-country, whichever you choose. But if you choose to bring your dog into the woods with you, consider his safety.

A very energentic 11 month old Visla was having fun in the woods with his owners, who were on snowshoes, when a back country skier collided with their dog.  Unfortunately, the dog sustained a severe laceration to his right front leg that needed immediate medical care.  The edge of the ski sliced through the muscle and a nerve, cutting down to the bone.  The owners were able to get him to Central Veterinary Emergency Services where the ER Veterinarian sutured the wound.  This sweet dog lost a lot of blood, but he recovered well and was sent home that evening.  It will be 2 - 3 months before the Veterinarian and his owners will be able to determine the full extent of his injuries and whether he suffered any long term effects from the accident.

Fortunately there is a positive ending to this story, but had his owners been in the back country when this happened he might not have faired so well.

Outside magazine has a great article that describes the steps to train your four footed friend to behave safely around you as you're skiing, but it really depends on the dog. Cross-country skiing is less dangerous, but, as some commentors pointed out at the end of the article, is still best done with a well trained dog.

The moral of the story... enjoy the great outdoors, but consider how well your dog can obey commands before bringing him along.

Toxic Compost Pile

Composting has become a rather common practice as  more people look for ways to "go green" or to simply decrease their food bill.  The booth at the farmers market was busy all summer long describing the various systems of composting and how to get started.  If you are considering starting your own compost pile and have a dog, consider the method that is best for keeping your four legged scavenger out of the pile.

Unfortunately, a largely unknown danger may be lurking in your compost pile.  A substance identified as a tremorgenic mycotoxin could be growing in your pile and if ingested by your dog, could cause a serious or even deadly reaction.  Tremorgenic = shaking, tremors, seizures and mycotoxin = poisonous fungus.  Penitrem A is a type of tremorgenic mycotoxin associated with the Penecillium fungi that can be found in compost piles and spoiled food.

If you see your animal get into the spoiled garbage or catch him eating from the compost pile it is best to get him to a Veterinarian who can induce vomiting, especially if symptoms of poisoning are present.  Symptoms of toxicity include increased heart rate, panting, tremors, very excited or anxious, vomiting, hyperthermia or fever, and if enough has been ingested, or if left untreated, can develop into seizures or even death.

Treatment will include making the dog vomit followed by a dose of activated charcoal (also known as Toxiban) that helps to absorb any remaining mycotoxin left in the stomach.  Then medication will be administered to stop the tremors which will help decrease the body temperature.  Additionally IV fluids and other supportive measures will help flush the poison from the body and make the dog more comfortable. 

Tremorgenic Mycotoxin is not a common household name, but if your dog is caught munching in the compost pile it's one that you know warrants immediate action with a trip to the Veterinarian.  Tell "Lucky" to leave the compost for the garden - he has plenty of delicious food in his dog dish!

My Pet Is Having A Seizure - What Do I Do?

It's been a busy holiday weekend for Central Veterinary Emergency Services.  When I asked one of the Technicians the most common condition among the cases her response was that we had seen all kinds of conditions without any common theme.  Then just an hour later we had three dogs come in for seizures all in a row. 

This sweet Rottweiler may look like she's ready or Christmas, but the bells are actually to alert us if she starts having more seizures. 

Seizures are an indication of something else going on in the body.  The cause can originate from a toxic exposure, epilepsy, too much calcium after having puppies, a tumor, a head injury, or multiple other disease conditions.  Your veterinarian can take a full history and do some diagnostic testing to rule out possible causes and narrow down the reason for the seizures.

Watching your cat or dog have a seizure can be frightening.  His body may tense up. He may have a far away look on his face along with body twitching or feet paddling. His whole body may shake and convulse. He may start drooling and seem unaware of your presence.  He may even stop breathing or urinate or defecate on himself.

The best thing you can do for your pet during a seizure is to keep both of you safe. Protect him from rolling off a bed or couch, or falling down stairs. Keep your hands and face away from his mouth so he doesn't unknowingly bite you. Place pillows or blankets under his head and between his body and sharp corners or furniture.  Remove other pets from the area.  Dim the lights and turn off load noises like TVs or radios to provide a quiet environment. Time and record the length and intensity of each seizure.  Call your veterinarian right away to determine if an immediate visit is advisable. Be sure to inform your veterinarian of any possible exposure to a poisonous substance.

Give your pet some time to recover.  He may be groggy or "out of it" for a while.  Once he has returned to normal (within about 10 to 20 minutes) he can resume regular activities.  Allow him to go outside for a potty break if he is stable on his feet and seems aware of his surroundings.  It may be advisable to keep him in close proximity for a while to see if another seizure develops.

A seizure can be an isolated incident or they can become recurrent.  Medications can be prescribed by your veterinarian to control seizure activity.  As always you know your pet the best ,so be an advocate for him to be sure he gets care if you are concerned or feel like something isn't right.