Page 205 - Cote clinical veterinary advisor dogs and cats 4th

Aspirin Toxicosis 83.e3

Aspirin Toxicosis Client Education
Sheet
VetBooks.ir Chronic Treatment Diseases and Disorders

DIAGNOSIS
BASIC INFORMATION
May need long-term therapy for hepatic insuf-
Definition Diagnostic Overview ficiency (p. 174)
Toxicosis secondary to an acute overdose or In most cases, exposure is known, and the
chronic administration of an aspirin compound. history and clinical signs may be sufficient to Nutrition/Diet
Vomiting and gastric irritation/ulceration is make a diagnosis. Without a known history, May need liver supportive diet
common. Liver effects, acidosis, and seizures clinical signs, clinical pathology, and endoscopic
can occur at higher doses. testing may be needed. Drug Interactions
Glucocorticoids increase risk of nonsteroidal
Synonym Differential Diagnosis antiinflammatory drug (NSAID)–associated
Salicylate toxicosis • Toxins: ethylene glycol, ethanol, anticoagu- GI ulcers; avoid combination
lants
Epidemiology • Any cause of GI ulcers, thrombocytopathy, Possible Complications
SPECIES, AGE, SEX acute hepatopathy, or metabolic acidosis • Perforation of gastric ulcers
All breeds and sexes are susceptible. Cats are • Hepatopathy
more sensitive than dogs because they are Initial Database
deficient in metabolic enzymes needed for • CBC: anemia from GI hemorrhage (regenera- Recommended Monitoring
detoxification. tive), leukocytosis (peritonitis) possible If perforated ulcers are suspected, abdominal
• Serum chemistry: elevated liver enzymes and radiographs (free air), ultrasound, or diagnostic
Clinical Presentation bilirubin, hypoproteinemia from bleeding peritoneal lavage may aid in diagnosis.
DISEASE FORMS/SUBTYPES • Blood gases: metabolic acidosis
Acute toxicosis and chronic toxicosis are both • Urinalysis: glycosuria PROGNOSIS & OUTCOME
characterized by vomiting. • Radiographs: free air in peritoneal cavity
suggests GI perforation Most cases have a good prognosis, decreases to
HISTORY, CHIEF COMPLAINT guarded with GI perforation
History of exposure (acute or chronic) to Advanced or Confirmatory Testing
aspirin. Signs can begin within a few hours • Salicylic acid concentration in serum or urine PEARLS & CONSIDERATIONS
after an acute exposure. Vomiting (with or (long turnaround time makes this clinically
without blood) is the most common clinical irrelevant) Comments
sign. Lethargy, anorexia, tachypnea, muscular • Endoscopic exam of GI tract looking for Even therapeutic doses of aspirin can cause
weakness, ataxia, coma, and seizures are ulcers vomiting in some animals.
rarer. • Other tests to rule out other differential
diagnoses, as indicated Prevention
PHYSICAL EXAM FINDINGS Impress upon owners not to give medications
Can vary from minor gastrointestinal (GI) upset TREATMENT without speaking to a veterinarian first.
and abdominal pain, to dehydration, pale
mucous membranes, bruising, icterus, ataxia, Treatment Overview Technician Tips
and seizures with severe toxicosis Goals are decontamination (if possible) and Monitor for changes in attitude, which may
preventing/managing GI, liver, and CNS effects. reflect perforation of the GI tract.
Etiology and Pathophysiology
• Aspirin inhibits cyclooxygenase, resulting in Acute General Treatment Client Education
reduced prostaglandin and thromboxane • Decontamination: emesis if asymptomatic Discuss common adverse effects of aspirin with
synthesis. and recent ingestion (p. 1087), activated owners. If using low-dose aspirin as a platelet
• Reduction of prostaglandins reduces pain, charcoal (1-3 g/kg PO) if above potential inhibitor, be sure owners understand the correct,
but prostaglandins are also important for seizure dose very low dose.
normal physiologic function (protective GI • Prevent or manage GI effects: misoprostol
mucous layer, renal medullary blood flow). (1-3 mcg/kg PO q 8h), omeprazole (0.5-1 g/ SUGGESTED READING
This can lead to GI ulcers and secondary kg PO q 12-24h), sucralfate (0.25-1 g PO Talcott PA, et al: Nonsteroidal antiinflammatories.
perforation. q 8-12h); see Ulcers (p. 380) In Peterson ME, et al, editors: Small animal toxicol-
• At high doses, salicylates uncouple mito- • Prevent or manage liver effects: fluid diuresis, ogy, ed 3, St. Louis, 2014, Elsevier.
chondrial oxidative phosphorylation and SAMe (20 mg/kg PO q 24h); see Hepatic
inhibit Krebs cycle dehydrogenases, leading Injury, Acute (p. 442) RELATED CLIENT EDUCATION
to hyperthermia and metabolic acidosis. • Correct acid-base imbalance: sodium SHEET
• Aspirin permanently inhibits platelet func- bicarbonate in fluids
tion, potentially exacerbating bleeding. • Supportive care: control vomiting with Human Medications Dangerous for Pets
• It is thought that central nervous system maropitant (1 mg/kg SQ q 24h), control
(CNS) effects (ataxia, coma, seizure) are seizures with diazepam (1-2 mg/kg IV), AUTHOR & EDITOR: Tina Wismer, DVM, MS, DABVT,
secondary to decreased brain glucose concen- blood transfusions as needed, surgery if DABT
trations (despite peripheral normoglycemia). perforation suspected

www.ExpertConsult.com