Page 2269 - Cote clinical veterinary advisor dogs and cats 4th

Lipid Emulsion for Intoxication 1127

• Intubate the animal. ○ Nasal blastomycosis can cause • Examine the ventral surface of the tongue.
nasopharyngitis.
○ Arytenoid cartilages should be flexible ○ Nasopharyngeal masses in cats include ○ Sublingual and mandibular salivary ducts
VetBooks.ir sized tube. Cartilages may not be easily inflammatory polyps, tumors (e.g., ○ Cats have lingual molar salivary glands in
enough to accommodate an appropriately
open at sublingual caruncle (a mucosal
fold).
oncocytoma).
pushed aside if they are calcified, their
connections fibrosed, or a mass is present.
melanoma, lymphoma, mast cell tumor,
first molar.
○ If a nasopharyngeal mass blocks the ○ Nasopharyngeal masses in dogs include a fold of tissue medial to the mandibular
laryngeal ostium, elevate the mass with polyp, transmissible venereal tumor. ○ Ranula are saliva-filled outpouchings from
an instrument or cotton-tipped swab, • Examine the space dorsal to soft palate and leakage of sublingual/mandibular salivary
and insert about 4 inches of a long palatine bone with retroflexed endoscope or ducts. If ruptured, excess mucosal folds
(e.g., 18-24 inch) polypropylene urinary dental mirror. and blood may be seen.
catheter between the laryngeal cartilages ○ The oval-shaped choanae are the openings ○ Sublingual masses include neoplasia,
into the trachea. While holding catheter of the two nasopharyngeal meatuses, and traumatic proliferation, ectopic thyroid
tip end steady near the larynx, slide the caudal to them is the intrapharyngeal cysts.
endotracheal tube over the catheter. ostium. There should be no visible • Examine the mandible, maxilla, buccal
Remove the catheter after the tube is in. turbinates in these spaces. pouches, mucous membranes, lips for Procedures and Techniques
• Retract the soft palate rostrally with a spay ■ Nasopharyngeal turbinates have been trauma; neoplasia; petechiae; erosions;
hook, stay suture, or Babcock forceps to reported as a contributing factor to vesiculobullous (autoimmune), ulcerative,
examine the nasopharynx. inspiratory dyspnea in brachycephalic or proliferative lesions.
○ In a heavily sedated, nonanesthetized breeds. ○ Parotid and zygomatic ducts open at level
dog, retraction may not be possible due ○ Choanal atresia and nasopharyngeal of maxillary fourth premolars.
to gag reflex. In that case, palpate soft stenosis: the choanae and intrapharyngeal • Proceed to dental examination (p. 1140).
palate for bulges or masses, and press it ostium are not visible because of partial
dorsally. During dorsal depression, the soft or complete membranous or osseous Postprocedure
palate should sink (indent) toward the obstruction. • Monitor for dyspnea postoperatively.
skull into the three-sided trough created ○ Nasopharyngeal dysgenesis (reported in • Cats with mouths held open fully by spring-
by the caudal nasal spine of palatine bone dachshunds) results in a slitlike intra- loaded gags can develop cortical blindness
rostrally and bony ridges of palatine and pharyngeal ostium. and neurologic deficits.
pterygoid bones laterally. If this space is • Return palate to its normal position, and
not palpable, there may be a mass or tissue evaluate tonsils. Palatine tonsils are usually Alternatives and Their
thickening. partially to completely hidden from view Relative Merits
• With the palate retracted, examine tissues because of their positions in tonsillar fossae. Other diagnostic modalities include laryngeal
along dorsal and caudolateral aspects of Tonsillar enlargement may be caused by ultrasound for diagnosis of laryngeal paralysis
nasopharynx and oropharynx for swelling, inflammation, neoplasia, or negative pressure (cats especially) and MRI or contrast CT for
discharge, and discoloration. from inspiratory dyspnea. determining extent of lesions.
○ Foreign bodies (e.g., sticks, needles) may • Examine hard palate for oronasal fistulae,
penetrate these areas and embed or migrate ulcerations, trauma, and masses. SUGGESTED READING
caudally. ○ The incisive papilla is a normal mass of Kressin D: Oral examination of cats and dogs.
○ Pharyngeal mucoceles cause swelling dorsal tissue on midline caudal to the maxillary Compend Contin Educ 31:72-85, 2009.
to larynx that may obstruct the airway. incisors. On either side are openings of the
Temporary treatment with a stab incision incisive ducts, which lead to the vomer AUTHOR: Karen M. Tobias, DVM, MS, DACVS
EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
and suctioning of entrapped saliva or nasal organ. Thompson, DVM, DABVP
permanent treatment with sialadenectomy ○ Hard palate mucosa normally has trans-
may be necessary for anesthetic recovery. verse ridges.

Lipid Emulsion for Intoxication

Difficulty level: ♦ is created in the aqueous portion of the blood. efficacy, including charge at physiologic pH,
The lipid phase transiently sequesters the toxin, protein binding, and volume of distribution.
Synonyms decreasing free (active) drug and then accelerates • Toxins with positive outcomes (reported and
Intralipid therapy, intravenous lipid emulsion its movement from drug-susceptible organs to anecdotal): marijuana, baclofen, calcium
(ILE) therapy organs that can store (muscle, fat), detoxify channel blockers, avermectins, local anesthet-
(liver), or excrete (kidney, bladder) the toxin. ics, serotonergic medications
Overview and Goal
The goal of ILE is to use lipids supplied by Indications Contraindications
fat emulsions (often used as part of parenteral • Intoxications that do not have a good • Allergies to egg, soy, fish, safflower, or
nutrition) to reduce the severity of toxicoses outcome using traditional therapies coconut: anaphylaxis
and/or the length of treatment required for • Severe or potentially severe clinical signs • Limited fat metabolism/elimination
intoxication. The exact mechanism of action is • Lipophilic toxins (toxins that have a high • Coagulopathy
unknown, but the lipid shuttle theory is the most log P value) more likely to benefit from this • Hypokalemia (p. 516)
accepted. With the infusion of ILE, a lipid phase therapy. Other toxin properties can also affect • Hypophosphatemia

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