Page 1376 - Cote clinical veterinary advisor dogs and cats 4th

Nicotine Toxicosis 693.e3

• If no response, reassess the diagnosis. If the PEARLS & CONSIDERATIONS associated with idiopathic neutropenia in dogs: 11
diagnosis is unchanged, consider human IV Comments cases (1990-2002). J Am Vet Med Assoc 229:87-91,
2006.
VetBooks.ir a second dose may be administered after • Sepsis is rare if the neutrophil count is ADDITIONAL SUGGESTED Diseases and Disorders
immunoglobulin 0.5 g/kg slow IV once, and
24-48 hours if necessary (risk of anaphylaxis
> 1000/mcL.
at either time) or cyclosporine (e.g., Atopica
2-5 mg/kg PO q 12h); monitoring of • The median age of onset of immune-mediated READINGS
neutropenia may be younger than for other
Brown MR, et al: Neutropenia in dogs and cats:
serum cyclosporine levels is recommended immune-mediated hematologic disorders. a retrospective study of 261 cases. J Am Animal
(target: 200-500 ng/mL). Initially, avoid • The combination of fever and neutropenia Hosp Assoc 37:131-139, 2001.
administering myelosuppressive drugs such as is a life-threatening emergency that warrants Schnelle AN, et al: Neutropenia in dogs and cats:
azathioprine or cyclophosphamide, although obtaining specimens for culture and starting causes and consequences. Vet Clin North Am Small
Anim Pract 42(1):111-122, 2012.
they may be indicated in some refractory IV antibiotics immediately. Schultze AE: Interpretation of canine leukocyte
cases. • Cats tolerate neutropenia better than dogs. responses. In Weiss DJ, et al, editors: Schalm’s
veterinary hematology, ed 6, Ames, IA, 2010,
Possible Complications Technician Tips Wiley-Blackwell, pp 321-334.
Sepsis Pay special attention to aseptic technique when Weiss DJ: Evaluation of antineutrophil IgG antibodies
placing catheters or performing any invasive in persistently neutropenic dogs. J Vet Intern Med
Recommended Monitoring techniques in neutropenic patients. Wear gloves 21:440-444, 2007.
Frequent assessment of body temperature and while handling.
periodic re-evaluation of neutrophil count RELATED CLIENT EDUCATION
Client Education SHEET
PROGNOSIS & OUTCOME Monitor temperature at home, and contact your
veterinarian immediately for further tests and Consent to Perform Bone Marrow Biopsy
Most dogs affected with primary immune- treatment if fever develops.
mediated neutropenia that are < 4 years of age AUTHOR: Susan M. Cotter, DVM, DACVIM
EDITOR: Jonathan E. Fogle, DVM, PhD, DACVIM
recover. Older dogs or those with pancytopenia SUGGESTED READING
are more likely to develop complications, and Brown CD, et al: Evaluation of clinicopathologic
their prognosis is guarded. features, response to treatment, and risk factors

Nicotine Toxicosis Client Education
Sheet

BASIC INFORMATION PHYSICAL EXAM FINDINGS some nicotine. Indian tobacco (Lobelia
• Hypersalivation inflata) contains mostly lobeline (curare-like
Definition • Nausea paralytic) and some nicotine.
Intoxication of pets due to ingestion of tobacco • Tenesmus Mechanism of toxicosis:
or related products manifests with acute onset • Tachycardia; may be followed by bradycardia • Nicotine mimics acetylcholine at sympathetic
of gastrointestinal (GI) signs followed by (sinus) and parasympathetic ganglia, neuromuscular
potentially severe neurologic dysfunction. • Hypertension; may be followed by junctions of skeletal muscle, and some
hypotension synapses in the CNS. Low dosages cause
Epidemiology • Shallow, slow respirations, leading to depolarization and stimulation of receptors
SPECIES, AGE, SEX cyanosis, respiratory paralysis similar to acetylcholine. Higher dosages
All animals of all ages and both sexes are • Neuromuscular weakness, tremors, collapse cause stimulation followed by blockade
susceptible. Dogs are more likely to be involved of autonomic ganglia and neuromuscular
than cats. Etiology and Pathophysiology junctions of skeletal muscle.
Source: • Stimulation of sympathetic cardiovascular
RISK FACTORS • Sources consist of cigarettes (including ganglia and adrenal medulla can lead to
• Availability of nicotine-containing products electronic/mechanical), cigars, chewing release of catecholamines.
in pet’s environment tobacco, bidi cigarettes, flavored hookah • GI effects: parasympathetic stimulation can
• Dogs may be particularly attracted to chewing tobacco, nicotine gum, nicotine skin patches lead to increased tone and motility.
tobacco or liquid nicotine containing flavor- (Nicorette, Nicotrol), inhalers, nasal sprays, • Death can result from respiratory paralysis.
ing agents such as honey, molasses, licorice, and nicotinic insecticides (nicotine sulfate,
syrups, or sugars. an insecticide available at a concentra- DIAGNOSIS
tion of 0.05%-4% as dust or spray and
Clinical Presentation a concentrated 40% solution [Black Leaf Diagnostic Overview
HISTORY, CHIEF COMPLAINT 40]; banned in the United States since A tentative diagnosis is made based on sus-
• Direct observation or indirect evidence of 2001). picion/evidence of exposure to nicotine and
exposure to nicotine-containing products • Nicotine is a water-soluble alkaloid found appropriate clinical signs.
• Rapid onset of clinical signs; spontaneous primarily in cultivated tobacco (Nicotiana
vomiting, salivation, and diarrhea tabacum) but also in wild tobacco ( Nicotiana Differential Diagnosis
• Initial central nervous system (CNS) excita- attenuata and Nicotiana trigonophylla). Tree • Other intoxications: strychnine, methylx-
tion and tachypnea followed by lethargy/ tobacco ( Nicotiana glauca) contains mostly anthines, tremorgenic mycotoxins/garbage
weakness anabasine (a teratogen) but does contain toxicosis, organophosphates/carbamates

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