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Brunfelsia Toxicosis 138.e7

• Tremor disorders (e.g., generalized tremor
disorder, shaker syndrome) (p. 1288)
VetBooks.ir Initial Database Diseases and Disorders
CBC, serum biochemistry profile, urinalysis:
expected to stay within reference ranges. Useful
for ruling out other possible causes
TREATMENT

Treatment Overview
Treatment is aimed at early decontamination
of the patient (inducing emesis, administration
of activated charcoal), controlling tremors and
seizures, and supportive care. Decontaminate Brunfelsia Toxicosis Brunfelsia calycina plant.
cautiously to avoid complications from these
procedures (p. 1087).
○ Animals should be kept in a dark, quiet • The signs can be mistaken for strychnine
Acute General Treatment environment; stimulation may worsen the toxicity. However, strychnine’s signs rarely
• Decontamination techniques. Note: induce signs. continue for longer than 48 hours.
vomiting only in asymptomatic patients • Ancillary care • Dogs are attracted to berries and seeds.
because inducing emesis can trigger seizures. ○ Fluid diuresis to maintain intravascular
○ Hydrogen peroxide 3% (dogs only): 2 mL/ volume and to lessen risk of pigment Prevention
kg to maximum of 45 mL. Repeat once nephropathy from possible rhabdomyolysis Remove the plant from pet’s environment.
in 15 minutes if no emesis. associated with tremors and seizures
○ Apomorphine (dogs): 0.03-0.04 mg/kg ○ Monitor and treat hyperthermia secondary Technician Tips
IV, IM. The tablet can also be crushed to seizures and tremors. Dogs, particularly large-breed ones, should have
and mixed with water and instilled in the ○ Control vomiting with maropitant 1 mg/ well-padded bedding to avoid pressure sores
conjunctival sac. Rinse eye after vomiting kg SQ q 24h (up to 5 days) if needed. due to prolonged immobility.
occurs. ○ Respiratory support (intubation and
○ Gastric lavage or enterogastric lavage may ventilation) may be needed in severe Client Education
be helpful in symptomatic animals to cases. Make clients aware of Brunfelsia toxicity
remove berries/seed pods. potential and how to avoid having their dogs
○ Activated charcoal 1-2 g/kg PO +/− a Recommended Monitoring come in contact with the plant.
cathartic such as sorbitol. Activated Serum biochemistry profile, urinalysis if
charcoal can be given without first induc- rhabdomyolysis is suspected SUGGESTED READING
ing emesis in patients showing clinical Khan SA: Brunfelsia species: beautiful but deadly.
signs and can be instilled after gastric or PROGNOSIS & OUTCOME Vet Med 103:138-143, 2008.
enterogastric lavage. Monitor serum
sodium to avoid or manage activated • Good prognosis if presented early ADDITIONAL SUGGESTED
charcoal–associated hypernatremia. • Guarded if seizures are difficult to control READINGS
• Control muscle tremors and seizures. during the initial presentation Burrows GE, et al: Toxic plants of North America,
○ Diazepam 1-2 mg/kg IV may control • Tremors may continue for several days. ed 2, Ames, IA, 2013, Wiley-Blackwell, pp
seizures but generally does not control 1134-1136.
tremors. PEARLS & CONSIDERATIONS Knight AP: A guide to poisonous house and garden,
○ Methocarbamol 100-200 mg/kg slow IV Jackson, WY, 2006, Teton New Media, pp
to effect and repeated as needed for Comments 51-52.
tremors. Do not exceed 330 mg/kg/day. • All species of Brunfelsia are considered toxic.
○ If tremors and seizures are not controlled • The flowers on the plant change from dark RELATED CLIENT EDUCATION
with the above agents, pentobarbital purple to lavender to white over a few days, SHEET
3-15 mg/kg slow IV to effect, propofol and all three colors may exist on the same
4-6 mg/kg IV followed by a CRI, or gas plant at the same time. This change is the How to Induce Vomiting
anesthesia may be needed to avoid muscle reason for the common names yesterday-
contraction–associated hyperthermia, today-tomorrow, morning-noon-and-night, AUTHOR: Eric Dunayer, VMD, MS, DABT, DABVT
which can become severe. and kiss-me-quick. EDITOR: Tina Wismer, DVM, MS, DABVT, DABT

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