FASAVA Congress 2017

Most aspects of traditional decontamination have lost some favour in human medicine as a first line of defence with intoxications, as other modalities (haemodialysis, plasmaphoresis, mechanical ventilation, etc) & antidotes (fomepizole, digitoxin-specific Abs, 2-PAM) become more mainstream. Yet, the types of intoxications in small animals together with financial & other limitations make the continued use of emesis, gastric lavage and activated charcoal still warranted in veterinary toxicology. Even so, timing is crucial and there are indications and contraindications depending on the status of the patient and the type of intoxicant. Emetics used have a see-sawing history of favour & disfavour and there are toxin-specific scenarios that need to be considered. These factors will be explored to reflect current veterinary judgement.                                                                                                
The newest antidote, ILE (Intra-Lipid Emulsion) has received rave reviews for many intoxications and veterinary use has mirrored the enthusiastic acceptance of this remedy for all forms of poisonings. Time will tell if it truly is the silver bullet; in the meantime, consideration of the intoxicant, ILE’s mode of action (is it the lipid sink theory valid, or is it simply the increased intra-cellular calcium that protects cardiac myocytes?), and the degree and method of intoxication is prudent to help ensure an effective outcome. The current use of ILE will be detailed.                                                                                               
Old common intoxicants like the LAAC’s (Long-acting anticoagulant rodenticides) always make an interesting discussion as newer more potent agents with a sustained effect demand us to be more diligent in our therapies – some simple rules and tips enhance our chances enormously.                                          
Of the newer emerging poisons, Xylitol, deserves special mention because of its rapidly increasing incidence of canine intoxication which isn’t likely to wane anytime soon because of its common use in human foods.