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176.e2 Citrus Oil Extract Toxicosis

Citrus Oil Extract Toxicosis
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used as a solvent, degreaser, flavoring agent,
BASIC INFORMATION
the risk of hypothermia, which can
fragrance, feed additive, and in many house- ○ Dry the patient thoroughly to minimize
Definition hold cleaning products. potentiate tremor.
Adverse effects seen after excessive dermal ○ Concentration of D-limonene and linalool ○ Keeping the patient warm and monitor-
exposure to D-limonene, a major constituent in most flea sprays is < 1%. Shampoos ing the body temperature frequently
in several citrus oil extracts (orange, lemon, usually contain D-limonene 5%. Some are essential to minimize hypothermia
lime). Typical signs of intoxication are hyper- dips contain 78.2% of D-limonene and while not overcompensating and causing
salivation, weakness, ataxia, hypothermia, must be diluted before use on animals. hyperthermia.
muscle tremors, and erythema. Clinical signs Cleaning products for the home can range ○ Avoid overcompensation (risk of iatrogenic
are usually temporary, and an affected animal from 0.5% to 100% D-limonene. hyperthermia). Active rewarming of the
recovers fully within a few hours to a couple • Linalool is found in nature as a monoterpene patient should be terminated and switched
of days. Toxicosis occurs when concentrated in volatile oils, various herbs, leaves, flowers, to passive warmth retention with ongoing
flea products are used on animals without wood, and citrus products. It is used for monitoring after the body temperature >
diluting properly. Oral ingestion can cause fragrance in soaps, detergents, and perfumes 98°F (36.7°C).
gastrointestinal upset. and as a flavoring agent in beverages, chewing Supportive care:
gum, and candy. • Intravenous fluids if necessary (e.g., dehydra-
Epidemiology • The exact toxic mechanism of action is tion, hypotension, electrolyte deficits)
SPECIES, AGE, SEX not clear. Linalool is not a cholinesterase • Oral ingestion: dilute with milk or
• Dogs and cats of all ages, breeds, and both inhibitor. water; consider antiemetics (maropitant
sexes are vulnerable; young and debilitated ○ It has been suggested that these products 1 mg/kg PO) and gastroprotectants
animals are likely to show more severe may cause centrally and peripherally acting (omeprazole 0.5-1 mg/kg PO q 12-24h) if
effects. vasodilation, resulting in hypotension, indicated
• Cats are more sensitive than dogs. hypothermia, and muscle weakness.
PROGNOSIS & OUTCOME
RISK FACTORS DIAGNOSIS
• Inappropriate dilution or excessive use (i.e., • Usually good to excellent; recovery within
more than 5 to 10 times the manufacturer’s Diagnostic Overview hours to a couple of days
recommended use) Suspect toxicosis based on history/evidence of • Deaths have been reported in cats treated
• Risk of D-limonene or linalool toxicity exposure, presence of citrus-like smell on the with inappropriately diluted concentrated
increases when formulated with other skin, and any combination of hypersalivation, flea dips containing D-limonene.
solvents, essential oils, or piperonyl butoxide. erythema, hypothermia, hypotension, and
weakness. The diagnosis is established based PEARLS & CONSIDERATIONS
GEOGRAPHY AND SEASONALITY on history and physical exam alone. Additional
Toxicosis more prevalent in summer months diagnostic testing may be used for ruling Comments
during flea season out other disorders with similar presenting • Animals treated with citrus oil extracts have
signs. a distinct citrus smell.
Clinical Presentation • Hypersalivation in cats is seen quickly in
HISTORY, CHIEF COMPLAINT Differential Diagnosis D-limonene toxicosis, probably due to
• History of exposure (use of spray, shampoo, • Intracranial disease grooming; it may last 15 minutes to 1 hour.
or dip containing citrus oil extracts) • Pyrethrins/pyrethroids toxicosis Severely affected cats also show hypothermia,
• Hypersalivation, hypothermia, muscle weak- • Other causes of tremor (p. 1288) muscle weakness, and tremors.
ness, erythema • Linalool exposure produces signs that
• Ataxia and tremors Initial Database are more severe and longer lasting than
• CBC, serum biochemistry profile, urinalysis: D-limonene.
PHYSICAL EXAM FINDINGS unremarkable • D-Limonene and linalool are well absorbed
Signs as above plus • Blood pressure (p. 1065): hypotension orally; parent compound and metabolites
• A distinct citrus smell may be present on are eliminated primarily through the urine
the animal and is an important diagnostic TREATMENT within 24 hours.
finding. • D-Limonene or other concentrated citrus
• Irritation of eyes and skin; cutaneous ery- Treatment Overview extract–containing flea products are now
thema, especially in the scrotal and perineal Treatment consists of providing supportive rarely found on the market, but orange
areas care (intravenous fluids, maintaining body cleaning products are still popular.
temperature and blood pressure within the • When dips are used in higher concentra-
Etiology and Pathophysiology normal range) and dermal decontamina- tion than recommended, limonene may be
• Crude citrus oil extracts, including tion. Hospitalization may be necessary for absorbed in significant quantities dermally,
D-limonene and linalool, have some insec- severe cases (muscle tremors, weakness, and causing systemic effects.
ticidal properties and are used in shampoos, hypothermia), especially in cats.
sprays, or dips for control of fleas on dogs Prevention
and cats. Acute General Treatment Follow manufacturer’s instructions for dilutions.
• Limonene (occurs in D or L form; L form Dermal decontamination:
has main insecticidal properties) is a mono- • Bathe the patient with a dishwashing liquid Technician Tips
terpene that occurs naturally in some fruits detergent or soap and warm water. Use Warm isotonic intravenous fluids for animal
(citrus), trees, and bushes. It is commonly multiple bathings if needed. with hypothermia.

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