NAVLE Canine Toxicology
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Questions and Answers

What clinical signs are associated with Sago palm ingestion in dogs?

Hepatic encephalopathy, seizures, hemorrhagic gastroenteritis

What are typical clinical signs of marijuana ingestion in dogs?

  • Hypotension (correct)
  • Prolonged sedation (correct)
  • Hyper Excitability (correct)
  • Bradycardia (correct)

    • Zinc toxicity in dogs can result from ingesting a penny minted after 1983.

    True

    Dalmatians cannot convert urate to ____. So they excrete most at a rate.

    <p>allantoin</p> Signup and view all the answers

    Match the following clinical signs with the correct plant toxin: Sago palm, Marijuana, Oleander

    <p>Hepatic encephalopathy, seizures, hemorrhagic gastroenteritis = Sago palm Prolonged sedation, hypotension, bradycardia = Marijuana Cardiac arrhythmias, lethargy, GI upset = Oleander</p> Signup and view all the answers

    Which type of bladder neoplasia is the most common in dogs?

    <p>Transitional cell carcinoma</p> Signup and view all the answers

    Chronic bladder infections and inflammation do not increase the risk of bladder neoplasia. (True/False)

    <p>False</p> Signup and view all the answers

    What are the predisposed breeds for bladder neoplasia in dogs?

    <p>West Highland White Terrier, Beagles, Jack Russell Terriers, Scottish Terriers</p> Signup and view all the answers

    Chronic Kidney Disease (CKD) is defined as renal damage that has persisted for ___ months.

    <p>3</p> Signup and view all the answers

    Match the following urinary tract conditions with their descriptions:

    <p>Pyelonephritis = Presents with systematic signs like fever, anorexia, depression, and vomiting Urethral strictures = May form secondary to trauma or lodged calculi Balanoposthitis = An inflammation affecting the glans penis and prepuce Polycystic kidney disease = Chronically increased drinking and urination, decreased appetite, and lethargy</p> Signup and view all the answers

    What is the primary cause of polydipsia in dogs according to the provided content?

    <p>Psychogenic polydipsia</p> Signup and view all the answers

    Which of the following is NOT listed as one of the most common causes of Polyuria/Polydipsia in dogs?

    <p>Leptospirosis</p> Signup and view all the answers

    What are the typical clinical signs associated with Feline Lower Urinary Tract Disease (FLUTD)?

    <p>hematuria, strangiuria, pollakiuria, dysuria</p> Signup and view all the answers

    Leptospirosis primarily affects dogs and has no impact on cats.

    <p>False</p> Signup and view all the answers

    Struvite uroliths are associated with bacterial infection and __________ urine.

    <p>alkaline</p> Signup and view all the answers

    Which management choices are available for treating Struvite urolithiasis?

    <p>All of the above</p> Signup and view all the answers

    Calcium oxalate stones in cats can be dissolved through dietary changes.

    <p>False</p> Signup and view all the answers

    Match the possible management options with struvite urolithiasis:

    <p>Medical dissolution = Encouraging dissolution with nutritional therapy Surgical removal = When stones are large or obstructive Lithotripsy = Treatment when stones are small and not obstructive</p> Signup and view all the answers

    The primary treatment for managing Urethral obstruction includes administration of ______, _______, _______, and _______.

    <p>Dextrose, insulin, sodium bicarbonate, calcium gluconate</p> Signup and view all the answers

    What is the most common type of neoplasia in dogs according to the provided content?

    <p>Lymphoma</p> Signup and view all the answers

    Match the following diseases with their characteristic clinical feature:

    <p>Protein-losing nephropathy (PLN) = Hypoalbuminemia, proteinuria Hyperthyroidism = Ravenously hungry Exocrine pancreatic insufficiency = Decreasing appetite Diabetes mellitus = Normal to increased appetites Renal failure = Pu/pd, weight loss</p> Signup and view all the answers

    What medical management is recommended for dogs prone to forming urate stones?

    <p>Feeding a low purine diet to neutralize or alkalinize the urine pH and administration of allopurinol, a xanthine oxidase inhibitor</p> Signup and view all the answers

    What is a treatment used for cystine stones in dogs?

    <p>Cuprimine</p> Signup and view all the answers

    Owner compliance is essential for the successful treatment of urinary stones in dogs.

    <p>True</p> Signup and view all the answers

    During dissolution therapy, monitor serial abdominal radiographs to assess stone size and urinalysis to assess for persistent ___.

    <p>UTI</p> Signup and view all the answers

    Study Notes

    Toxicity

    • Sago palm ingestion causes acute hepatic necrosis and is highly lethal, with clinical signs including hepatic encephalopathy, seizures, and hemorrhagic gastroenteritis.
    • Marijuana causes prolonged sedation, hypotension, bradycardia, hypothermia, and mydriasis, with rare lethality.
    • Foxglove and oleander are cardiac glycosides, causing cardiac arrhythmias, lethargy, GI upset, and hyperkalemia, with high lethality.
    • Yew may cause vomiting, diarrhea, hypotension, bradycardia, tremors, and seizures, with potential lethality.

    Zinc Toxicity

    • Zinc toxicity can occur from ingesting U.S. pennies minted after 1982, which are 97.5% zinc by weight.
    • Other sources of zinc include batteries, car parts, paint, zinc-oxide sunscreen creams, zippers, and board-game pieces.
    • Zinc toxicity results in hemolytic anemia.

    Urate Crystals

    • Urate crystalluria is commonly associated with congenital portosystemic vascular anomalies (PSVA) and breed-associated in Dalmatians and some other breeds.
    • Urate crystals are composed of uric acid and its salts, usually ammonium urate.
    • Dalmatians cannot convert urate to allantoin, increasing the risk of stone formation.

    Protein-Losing Nephropathy (PLN)

    • PLN is most commonly due to glomerulonephritis (GN).
    • Look for hypoalbuminemia with proteinuria, hypercholesterolemia, and third-spacing of fluid.
    • GN is often idiopathic, but can be secondary to other diseases, such as vector-borne diseases, Lyme disease, and systemic disease.
    • Treat PLN with angiotensin-converting enzyme inhibitors, renal-specific diet, and other medications.

    Urolithiasis

    • Expect bacteriuria with an active sediment in dogs with urolithiasis.
    • Struvite stones are most common in dogs, forming in the presence of urease-producing bacterial urinary tract infections.
    • Struvite stones can be dissolved with strict dietary management and antibiotic therapy.
    • Calcium oxalate stones are becoming more common in dogs, especially in older castrated males.

    Renal Azotemia

    • In renal azotemia, look for isosthenuria, increased BUN and creatinine, and an increased risk of chronic kidney disease.
    • Post-renal azotemia occurs due to lower urinary tract obstruction, while pre-renal azotemia occurs due to dehydration, hypovolemia, or hypotension.

    Proteinuria Testing

    • Perform a urine culture and sensitivity prior to a urine protein:creatinine ratio (UPC) to rule out occult infection.
    • Consider renal biopsy to diagnose the etiology of the underlying glomerular disease.

    Chronic Kidney Disease

    • Dietary considerations for dogs with CRF include restricting protein and phosphorus.
    • Feeding a prescription renal diet is the most important factor for improving quality and quantity of life for pets with chronic kidney disease.

    Polydipsia and Polyuria

    • Polydipsia is defined as water intake >100 mL/kg/24 hours.
    • Polyuria is often associated with polydipsia, and the two are usually defined together.
    • Common causes of polydipsia and polyuria include diabetes mellitus, chronic kidney disease, pyometra, hyperadrenocorticism, and hypercalcemia.

    Leptospirosis

    • Leptospirosis is an important zoonotic disease, causing acute kidney injury and infectious abortion.
    • Urine is the main source of infectious spirochetes, and exposure to blood should be avoided.
    • Diagnosis is via microscopic agglutination test (MAT), and treatment includes doxycycline and supportive care.

    Struvite Urolithiasis

    • Struvite uroliths are radiopaque and associated with bacterial infection and alkaline urine.
    • Management options include medical dissolution, surgical removal, and lithotripsy.

    Transitional Cell Carcinoma

    • Transitional cell carcinoma is a common diagnosis in older dogs, especially Scottish terriers.
    • Clinical signs include pollakiuria, stranguria, dysuria, and hematuria.
    • Diagnosis is via the BRAF urine antigen test.### Tumors
    • Mandibular salivary gland aspiration shows numerous erythrocytes in a proteinaceous background, with cells "windrowing" in eosinophilic, globular to granular mucinous material, typical of glandular secretory product.
    • To perform lymph node aspiration, first identify and firmly fix the node with the non-dominant hand.
    • Fine needle aspiration and cytology can be diagnostic for lymphoma, which is the most common systemic neoplasia in dogs.

    Urinary Tract

    • Transitional cell carcinoma (TCC) is the most common bladder neoplasia in dogs.
    • Types of bladder neoplasia: TCC, squamous cell carcinoma (SCC), adenocarcinoma, hemangiosarcoma, fibrosarcoma, leiomyosarcoma, and benign tumors.
    • Bladder neoplasia is linked to being overweight and exposure to certain insecticides.
    • Predisposed breeds: West Highland White Terrier, Beagles, Jack Russell Terriers, and Scottish Terriers.
    • Clinical signs: hematuria, dysuria, difficulty urinating, and frequent urination.
    • Diagnosis: abdominal radiographs, thoracic radiographs (metastasis), abdominal ultrasound, traumatic catheterization, BRAF, cystoscopy, and biopsy.
    • Staging is important before planning and starting treatment due to the possibility of metastasis.

    Canine Urinary Tract

    • Bladder neoplasia treatment depends on the type of tumor and degree of local invasion and metastasis.
    • Medical treatment: NSAIDs (e.g., piroxicam, meloxicam, or firocoxib) with or without chemotherapy and radiation.
    • Surgery is not usually an option, except if the tumor is in another area of the bladder.

    Chronic Kidney Disease (CKD)

    • Kidney disease is a morphological or functional lesion of the kidney(s).
    • Kidney failure is a decline in kidney function resulting in azotemia.
    • Azotemia: prerenal (decreased renal blood flow, dehydration, hypotension), renal (nephron loss), and postrenal (urinary tract outflow obstruction, uroabdomen).
    • Uremia is a clinical syndrome that occurs secondary to severe azotemia, accompanied by anorexia, nausea, vomiting, diarrhea, melena, hematochezia, oral ulcers, and halitosis.
    • Renal dysfunction: 40% nephron function loss (non-azotemic, normal USG, increased SDMA), 66% nephron function loss (mild azotemia), and 75% nephron function loss (moderate azotemia).
    • CKD is renal damage that has persisted >3 months, with an underlying cause often not identified, leading to irreversible nephron damage and progressive disease.

    Diagnostic Approach to CKD

    • CBC: nonregenerative anemia (decreased EPO production).
    • Chemistry panel: obtain prior to fluid therapy, check for azotemia (BUN and creatinine).
    • SDMA: increased when 40% of nephron function is lost.
    • Urinalysis: prior to fluid therapy, cystocentesis preferred, USG, color, turbidity, dipstick (pH, glucose, ketones, bilirubin, protein, hemoglobin), and sediment.
    • Urine culture: by cystocentesis, to help evaluate for pyelonephritis.
    • Urine protein:creatinine ratio: used to quantify persistent proteinuria.
    • Blood pressure: assess for concurrent hypertension.
    • +/- T4: assess for concurrent hyperthyroidism.
    • Abdominal imaging: radiographs (size, assess for uroliths) and ultrasound (size and architecture, echogenicity, renal pelvic dilation, ureteral dilation, uroliths, perirenal changes).

    IRIS Staging

    • Stage 1: no azotemia.
    • Stage 2: mild azotemia.
    • Stage 3: moderate azotemia.
    • Stage 4: severe azotemia.
    • IRIS substaging: based on UPC and systolic blood pressure.

    Management Goals

    • Slow progression of chronic kidney disease.
    • Optimize quality of life.
    • Avoid potentially nephrotoxic drugs.
    • Treat urinary tract or other systemic disorders.

    Treatment

    • Maintain hydration: feed canned food diet, access to fresh water, SQ fluids (case by case basis), and IV fluids if patient becomes acutely dehydrated.
    • Feed renal diet: reduced protein, highly digestible protein, reduced phosphorus, reduced sodium, increased B vitamins, high caloric density, and neutral effect on acid-base.
    • Control serum phosphorus (<4.0 mmol/l).
    • Manage hypertension: target systolic BP 120-160 mmHg.
    • Correct anemia: therapy considered when PCV <40%.

    Nephrolithiasis

    • Allopurinol may reduce the formation of urate stones.
    • Prevention includes feeding a diet low in purine precursors and promoting formation of less acidic urine that is not highly concentrated.
    • Nephrolithiasis is not associated with an increase in the rate of progression of kidney injury and is generally managed without surgery.

    Balanoposthitis

    • An inflammation affecting the glans penis and prepuce, commonly seen in many sexually mature dogs, usually of little clinical significance.

    • Mild cases usually resolve without treatment.

    • Further diagnosis: complete exam of penis and prepuce to the level of the fornix, cytology, and culture.

    • Rule out: trauma/laceration, snake bite, neoplasia, foreign bodies, urinary tract infection, urolithiasis, or phimosis.

    • Treatment: correct any identified predisposing factors, clip hair away from preputial orifice, lavage preputial cavity with sterile saline solution or a mild antiseptic.### Feline Lower Urinary Tract Disease (FLUTD)

    • Psychological stressors and environmental factors play a significant role in the pathophysiology of FLUTD.

    • Cystic calculi may be a cause of FLUTD, but they are not a direct result of the disease.

    • Surgical treatment for animals that obstruct repeatedly involves a urethrostomy.

    Nephrotic Syndrome

    • Characterized by hypoalbuminemia, proteinuria, hypercholesterolemia, and edema.
    • A complication of glomerular disease (protein-losing nephropathy).
    • Patients may exhibit signs related to renal failure, systemic hypertension, fluid retention, and/or thromboembolic disease, or may not be overtly clinical.
    • Treatment involves using angiotensin-converting enzyme inhibitors (ACE), anti-thrombotics, anti-hypertensive medications, and management of fluid retention and uremia.

    Diuretics

    • Mannitol: an osmotic diuretic that is filtered at the glomerulus and osmotically pulls water into the tubules.
    • Furosemide: a loop diuretic that acts at the loop of Henle.
    • Enalapril: an angiotensin-converting enzyme (ACE) inhibitor.
    • Spironolactone: an aldosterone antagonist.
    • Acetazolamide: a carbonic anhydrase inhibitor.

    Feline Idiopathic Hypercalcemia (FIH)

    • Cats with untreated FIH may develop calcium oxalate urolithiasis and chronic kidney disease.
    • Cats with FIH have modest hypercalcemia and may display no clinical signs.
    • Tissue mineralization is seldom an issue, but can sometimes cause signs related to calcium oxalate urolithiasis or concurrent chronic kidney disease.
    • Treatment involves feeding a wet-only diet that avoids acidifying the urine, and considering glucocorticosteroids or bisphosphonates if ionized hypercalcemia persists.

    Urethral Obstruction

    • Clinical signs include lethargy, vomiting, vocalizing, progressing to recumbency, heart rate of 100 bpm, poor pulse, obtunded mentation, and a large firm bladder on abdominal palpation.
    • Ureteral obstruction is most commonly unilateral, but bilateral obstruction can cause acute renal failure.
    • In some cases, ureteral obstruction can cause permanent renal damage and scarring, leading to "big kidney, little kidney" syndrome.
    • Treatment involves using dextrose, insulin, sodium bicarbonate, and calcium gluconate to treat life-threatening hyperkalemia.

    Struvite Urolithiasis

    • Struvite uroliths are large, radiopaque, and associated with bacterial infection and alkaline urine.
    • Management involves medical dissolution, surgical removal, or lithotripsy.
    • Nutritional therapy may encourage dissolution of small, non-obstructive stones.
    • Obstruction or large stones require surgical removal or other interventions.
    • Struvite crystalluria in cats is typically sterile, but in dogs, it is often associated with bacterial urinary tract infections.

    Calcium Oxalate Stones

    • More common in dogs, especially miniature schnauzers and older castrated males.
    • These uroliths are small, radiopaque, and associated with acidic urine in the absence of UTI.
    • Prevention involves feeding canned food (ideally a urinary-specific prescription diet) to decrease urine specific gravity and reduce calcium oxalate formation.
    • Increased urinary excretion of calcium and oxalate increases the risk of Caox formation.

    Other Urolithiasis

    • Urate uroliths: more common in Dalmatians, associated with a metabolic defect, and can cause urinary tract obstructions.
    • Cystine stones: more common in Newfoundland, dachshunds, and bulldogs, and are associated with metabolic defects.
    • Sabulous urolithiasis: more common in horses, and is caused by calcium carbonate accumulation.

    General Treatment and Management

    • Prevention of infection is key in managing urolithiasis.
    • Dietary therapy involves feeding a specific diet to reduce the risk of stone formation or recurrence.
    • Monitoring and evaluation involve serial abdominal radiographs and urinalysis to assess stone size and detect persistent UTI.
    • Owner compliance is essential for successful dietary treatment.
    • Vaginourethrograms are used to evaluate for structural problems with the genitourinary tract, such as ectopic ureters, strictures, or masses.

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    Description

    This quiz covers toxic substances affecting canines, including Sago palm, Marijuana, Foxglove, and Oleander, and their clinical signs and symptoms.

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