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816.e2 Potpourri Toxicosis

Potpourri Toxicosis Client Education
Sheet
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• Cationic detergents include quaternary
BASIC INFORMATION
specific enzymes (uncommon) and acid-base
ammonium compounds (benzalkonium produce increased serum levels of liver-
Definition and benzethonium chlorides), pyridinium or electrolyte abnormalities.
Liquid potpourri is a combination of essential compounds (cetylpyridinium, cetrimonium),
oils and cationic detergents. Acute toxicosis and quinolinium compounds (dequalinium Advanced or Confirmatory Testing
occurs (mostly in cats) from accidental dermal chloride). • Gas chromatography and mass spectrometry
and/or oral exposure and is characterized by • Cationic detergents (depending on con- on urine can identify essential oils and
gastrointestinal (GI) signs from corrosive centration) can be irritating or corrosive metabolites (this can confirm exposure if
oral burns, acute dermatitis at areas of to mucous membranes. They can cause history of exposure not available).
contact, hyperthermia, muscle weakness, and local and systemic effects. Usually, a < 1% • Necropsy: no specific lesions
ataxia. concentration causes irritation to mucous • If indicated by clinical findings, laryn-
membranes, and > 7.5% is corrosive to most goscopy to delineate extent of damage/
Epidemiology mammals. Cats can develop severe corrosive obstruction
SPECIES, AGE, SEX injury with lower concentrations. • If indicated by clinical findings, endoscopic
• All pets of all ages and both sexes are Mechanism of toxicosis: exam of esophagus and stomach may be
susceptible. • Current belief is that cationic detergents have considered within 12-24 hours to rule out
• Cats are more sensitive to essential oils, and a ganglionic blocking effect and a curare-like perforation of GI tract.
grooming behavior can increase toxicosis action, with paralysis of the neuromuscular
from dermal exposures. junction of striated muscle. TREATMENT
• Essential oils can cause mucous membrane
RISK FACTORS irritation and have central nervous system Treatment Overview
Pre-existing liver disease can increase risk and (CNS) depressant effects. Metabolism of Immediate treatment consists of topical
severity of essential oil toxicoses. terpenes occurs in the liver. The terpenes decontamination of affected areas of the
and their metabolites are mainly conjugated body (mouth, skin, and/or eyes). Subsequent
Clinical Presentation through glucuronidation before excretion treatment is supportive in response to specific
HISTORY, CHIEF COMPLAINT through the kidneys. Cats are deficient in lesions, if any. Induction of vomiting is strictly
• Dermal and/or oral contact with liquid their glucuronidation ability and therefore contraindicated (caustic).
potpourri more sensitive to essential oil toxicosis.
• Clinical signs occur in minutes up to 8 hours • Toxicosis is acute, with signs occurring in Acute General Treatment
after exposure. minutes to a few hours after exposure. • Oral: dilution with oral administration of
• Lethargy, drooling, vomiting, diarrhea, • Cats that have dermal exposure may lick milk or water (dogs: 1 2 cup [125 mL] per
vocalizing, dysphagia, anorexia, and tongue the substance off their fur, leading to oral 15 kg; cats: 1-2 tbsp [15-30 mL] per cat;
protrusion are commonly reported by exposure and corrosion. most effective if performed early)
owners. • Dermal exposure: immediate bathing of the
DIAGNOSIS pet, using mild liquid hand dishwashing
PHYSICAL EXAM FINDINGS detergent; monitoring for erythema, swelling,
• Liquid potpourri may be felt (oily texture Diagnostic Overview pain, or pruritus.
on haircoat) or smelled on the coat and/or Diagnosis rests on history and physical exam; • Adjunctive treatment may include admin-
breath. observed or suspected exposure may be istering analgesics, antiinflammatories,
• Signs from oral exposure: hypersalivation, described, but evidence of exposure (smell and antibiotics, because lesions may be
dysphagia, visible corrosive burns of the oral of oily substance on skin) is highly specific. painful and portals of entry for bacterial
or pharyngeal mucosa (ulceration can take Compatible clinical signs are supportive infection.
several hours to appear) (hypersalivation, oral ulcers, anorexia, lethargy, • Ocular: ocular flushing for 20-30 minutes
• Hyperthermia protrusion of tongue) when seen in minutes to with tepid tap water or physiologic saline;
• Signs from dermal exposure: alopecia (focal), hours after the exposure. Specific confirmation fluorescein stain of the cornea to assess for
erythema/dermatitis, cutaneous edema, pain, is possible but not clinically practical. corneal ulceration (p. 209)
ulceration • NOTE: induction of vomiting, gastric lavage,
• Signs from ocular exposure: mild irritation Differential Diagnosis and activated charcoal administration are
to severe corneal ulceration • Corrosives (acids, alkali) toxicoses contraindicated because liquid potpourri is
• Respiratory signs caused by aspiration • Household products (detergents, bleaches, a caustic agent.
pneumonia, pulmonary edema, or airway pine oils) toxicoses • Protecting GI mucosa (p. 312)
obstruction from swelling at pharynx/larynx: • Acetylcholinesterase (AChE) inhibitor pesticides ○ Sucralfate slurry (dog: 0.25-1 g PO q
dyspnea, wheezing, abnormal respiratory (organophosphates, carbamates) toxicoses 8-12h; cat: 0.25-0.5 g PO q 8-12h)
sounds • Upper respiratory tract infection (e.g., ○ Gastric acid reduction:
• Muscular weakness, ataxia, rarely hypotension calicivirus) ■ Proton pump inhibitor: omeprazole
• Uremic ulcers (renal failure) 0.5-1 mg/kg PO q 12h, or
Etiology and Pathophysiology • Food indiscretion, garbage toxicosis ■ H2-antagonist: famotidine (dogs/cats)
Source: • Foreign body 0.5 mg/kg PO, SQ, IM, IV q 12-24h
• Liquid potpourri is a mixture of essential • Pain control: buprenorphine (dogs/cats)
oils and cationic detergents. Initial Database 0.005-0.03 mg/kg IV, IM, SQ q 6-12h, or
• Essential oils are volatile oils or a mixture of • CBC: inflammatory leukogram tramadol (dogs) 1-4 mg/kg PO q 8-12h,
terpenes (complex hydrocarbons) obtained • Serum chemistry profile ± blood gas analysis: cats: 12.5 mg/CAT or 4 mg/kg PO q 12h,
from plants through a distillation process. essential oils causing hepatic damage may or fentanyl patch.

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