Page 1159 - Cote clinical veterinary advisor dogs and cats 4th

Leishmaniasis 579

too small to be seen (e.g., paint dust) or ○ Activated charcoal does not adsorb well PROGNOSIS & OUTCOME
to lead.
may have already passed through the GI ○ Magnesium sulfate 125-250 mg/kg PO • Animals with mild to moderate signs have
VetBooks.ir ○ Lead lines, dense radiograph opaci- may bind to lead in GI tract and cause • BLL may rebound (increase) within 2 weeks Diseases and Disorders
tract.
a good prognosis with treatment.
catharsis.
ties at the long bone metaphysis, are
uncommonly identified in chronic lead
poisoning. • Chelation of stopping chelation due to redistribution
○ Most lead chelators are nephrotoxic.
of tissue stores. If clinical signs are seen,
Monitor renal parameters, and maintain re-dose with chelator; if no signs are seen,
Advanced or Confirmatory Testing adequate hydration. continue to monitor BLL q 14 days.
Blood lead level (BLL) done using whole blood ○ Succimer (meso-2,3-dimercaptosuccinic
in EDTA (purple-top) or heparin (green-top) acid [DMSA]): chelator of choice, least PEARLS & CONSIDERATIONS
tubes nephrotoxic, least likely to bind essential
• BLLs > 0.6 ppm are diagnostic of lead minerals; can be used if lead is still in GI Comments
toxicosis. tract; dogs: 10 mg/kg PO or PR q 8h for • Do not use sodium EDTA to chelate; it can
• BLLs > 0.3-0.4 ppm suggest lead toxicosis 10 days result in hypocalcemia.
and are considered diagnostic with appropri- ○ Calcium disodium ethylenediaminetet- • The only chelator that should be used if lead
ate clinical signs. raacetic acid (CaEDTA): nephrotoxic, still in GI tract is succimer.
• BLLs of 0.1-0.3 ppm suggest significant useful if vomiting is severe; dogs: 25 mg/ • Lead embedded in soft tissue is not a sig-
exposure to lead. kg SQ q 6h diluted in 5% dextrose for nificant source of lead toxicosis, but lead in
• Normal background level is < 1 ppm. 2-5 days; cats: 27.5 mg/kg in 15 mL 5% joint spaces or areas of active inflammation
• BLL is not always reflective of the total body dextrose q 6h for 5 days; rest for 5 days, can be absorbed.
burden of lead and may not correlate with repeat if needed • Although oral exposure is most important,
clinical sign severity. In chronic exposures, ○ Dimercaprol (British anti-Lewisite inhalation of small particles/dust can also
BLL may be relatively low due to distribution [BAL]): nephrotoxic, painful injections, prove toxic.
of lead into bone. contraindicated with hepatic disease; dogs • Lead is stored in bone and may be mobilized
3-6 mg/kg IM q 6-8h for 2 days during time of increased bone resorption
TREATMENT ○ Penicillamine: nephrotoxic, binds essential (lactation, fractures), resulting in delayed
elements (zinc, iron, copper), vomiting is toxicosis.
Treatment Overview common adverse effect; dogs: 8-35 mg/ • If chelation is not effective, ensure the patient
Treatment goals are to stabilize patient and kg PO q 6-8h for 1-2 weeks; cats: is not having continued exposure to lead
manage any severe signs (seizures or anemia). 125 mg/CAT PO q 12h for 5 days source.
Next priority is to remove lead objects from ○ Monitor chelation by monitoring BLL;
GI tract and start chelation therapy to bring decline in BLL should start at about 5 Prevention
BLL into normal range. days after chelation. If signs persist and Remove lead objects and lead-based paint from
BLL not improving, need to make sure environment.
Acute General Treatment re-exposure is not occurring
• Manage seizures Technician Tips
○ Diazepam 0.5-2 mg/kg IV to effect or Chronic Treatment If patient is vomiting, note if foreign mate-
midazolam 0.1-0.5 mg/kg IV Prevent re-exposure in home environment. rial is seen. All lead must be removed from
○ If benzodiazepines are ineffective, pheno- Manage CNS signs (e.g., seizures) if they persist. GI tract before starting chelation (except for
barbital 2-10 mg/kg IV to effect succimer). Make sure patient is well hydrated
○ Other options for intractable seizures: Nutrition/Diet during chelation.
pentobarbital 3-15 mg/kg IV to effect, A bland diet may be used after vomiting is
propofol 0.1-0.6 mg/kg/min, or gas controlled. Client Education
anesthesia (p. 903) Warn clients of risk in older homes if remodel-
• Correct any fluid and electrolyte abnormalities. Behavior/Exercise ing is to be done.
• Control vomiting (p. 1040). Aberrant behavior is possible with lead
• Remove lead from GI tract. exposure. SUGGESTED READING
○ Remove lead before chelation; chelators Wismer T: Lead. In Peterson ME, et al, editors: Small
(except for succimer) enhance absorption Possible Complications animal toxicology, ed 3, St. Louis, 2013, Saunders,
of lead from the GI tract. Neurologic injury can be permanent. pp 609-615.
○ Emesis (p. 1188), endoscopy, gastrostomy,
cathartics, enemas, and whole-bowel Recommended Monitoring AUTHOR: Valentina Merola, DVM, MS, DABVT, DABT
EDITOR: Tina Wismer, DVM, MS, DABVT, DABT
irrigation may be useful. CBC, hematocrit, hydration, renal values, BLL

Leishmaniasis

Epidemiology
BASIC INFORMATION countries worldwide). It has been reported in
dogs in the United States. SPECIES, AGE, SEX
Definition Dogs, cats, foxes, jackals, humans
Leishmaniasis is a vector-borne, zoonotic, Synonyms
protozoal disease that is endemic in the Leishmaniosis, kala-azar GENETICS, BREED PREDISPOSITION
Mediterranean region and South America (>80 Boxers; most dogs with leishmaniasis in the
United States have been foxhounds.
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