Page 412 - Cote clinical veterinary advisor dogs and cats 4th

Cleaning Products Toxicosis 179

○ Nonionic detergents: hand dishwashing Initial Database • Ondansetron 0.1-0.3 mg/kg IV q 8-12h,
or
detergent, some shampoos, many low- • CBC: leukocytosis (cationic detergents, • Dolasetron mesylate 0.6 mg/kg IV q 24h
VetBooks.ir ate, alkyl phenoxy polyethoxy ethanol, • Serum biochemistry profile: electrolyte Broad-spectrum antibiotics if caustic burns and/ Diseases and Disorders
sudsing laundry products; alkyl ethoxyl-
phenol); methemoglobinemia (phenol)
changes (from severe vomiting or dehydra-
or secondary infection present:
polyethylene glycol stearates
○ Anionic detergents: laundry detergents,
electric dishwashing detergents, some tion; cationic detergents, phenols); hepatic • Ampicillin 22 mg/kg IV q 8h plus enrofloxa-
cin 5 mg/kg IM or diluted 1 : 1 with sterile
or renal failure (phenol)
shampoos, solvent/detergent degreasers; • Urinalysis: unremarkable unless renal saline and given slowly IV q 12h (5 mg/kg
alkyl sodium sulfonates, alkyl sodium failure q 24h in cats), or
sulfates, dioctyl sodium sulfosuccinates, • Fluorescein staining for corneal ulcers • Amoxicillin-clavulanate 12.5 mg/kg PO q
sodium lauryl sulfates, tetrapropylene (cationic detergents, phenol) 12h (dogs); 62.5 mg/CAT PO q 12h (cats)
benzene sulfonate • Abdominal imaging (radiographs, ultra- until signs resolve
○ Cationic detergents (quaternary ammo- sound): to rule out other causes of acute Supportive care:
nium compounds): fabric softeners, liquid severe vomiting • Crystalloid intravenous fluids for rehydration
potpourri, germicides, sanitizers; benze- • Thoracic radiographs if respiratory signs are • Manage pain (caustic burns): opiates (fentanyl
thonium chloride, benzalkonium chloride, present; may show evidence of aspiration patch, buprenorphine 0.01-0.03 mg/kg IM,
alkyl dimethyl 3,4-dichlorobenzene, pneumonia and/or noncardiogenic pulmo- IV, SQ q 6-8h, or butorphanol 0.1-1 mg/
cetylpyridinium chloride nary edema kg IM, IV, or SQ q 6-12h).
○ Zwitterionic detergents: most shampoos, • Rarely, ventilation required for respiratory
bath products, and nonirritant toiletries Advanced or Confirmatory Testing manifestations (p. 1185)
• Disinfectants are chemicals applied on inani- Endoscopic examination of esophagus to rule
mate objects to inhibit or kill microorganisms out perforation within 12-24 hours (cationic Nutrition/Diet
(e.g., quaternary ammonium compounds detergents, phenol) • Watery slurry or soft mashed food while
[cationic detergents], phenols, pine oils, visible mucosal erosions are present
bleaches, alcohols). TREATMENT • Feeding tube (pp. 1106 and 1109) if anorexia
Mechanism of toxicosis: is prolonged
• Depending on dosage and concentration, Treatment Overview
soaps, anionic, nonionic, and zwitterionic • Emesis induction is contraindicated in most Recommended Monitoring
detergents, and chlorine bleaches are mildly types of cleaning liquid intoxications because • CBC, serum chemistry profile: electrolyte
irritating to the mucous membranes. Oral vomiting risks further esophageal injury or changes and other effects of vomiting
or cutaneous burns are rare. Laundry aspiration; also, many patients spontaneously • Monitor oral cavity, perioral skin for caustic
pods have an increased risk of aspiration vomit. burns (cationic detergents, phenol) to
pneumonia. • Dilution by administration of oral liquid, determine when to introduce solid food.
• Homemade soaps/laundry detergents and such as milk or water • Pulse oximetry, thoracic radiography if
alkaline anionic detergents (e.g., electric • Prophylactic protection of gastrointestinal aspiration (pine oils, laundry pods)
dishwashing detergents) can cause more (GI) mucosa
severe oral lesions. • Supportive therapy based on clinical signs PROGNOSIS & OUTCOME
• Inhalation of chlorine fumes can cause
pulmonary irritation, coughing, and if severe, Acute General Treatment • Excellent with soaps, detergents (other than
dyspnea and noncardiogenic pulmonary Decontamination of patient (p. 1087): cationic), and household bleaches
edema. • Oral dilution: milk (preferred) or water. • Good to guarded if pulmonary edema
• Quaternary ammonium compounds are Approximately 0.25-0.5 cup (125-250 mL) develops or if caustic burns are present
structurally similar to decamethonium for a 14-kg (30-lb) dog and 1-2 tablespoons (cationic detergents, phenols in cats)
(neuromuscular blocking agent) and hexa- (5-10 mL) for a 5-kg (11-lb) cat
methonium (ganglionic blocking agent). • Emesis induction (p. 1188) is rarely needed. PEARLS & CONSIDERATIONS
The systemic effects may resemble organo- For use in cases of toxicosis with soaps
phosphate insecticide toxicosis (p. 718). (usually bar soaps) or detergents (other Comments
They also cause corrosive damage to skin than cationic), perform within 2 hours only Soaps, detergents (other than cationic), and
and oral mucosa. if very large amounts have been ingested. household bleaches have a low order of toxicity
• Phenol (1%-5%) can cause oral or dermal Do not induce vomiting for alkaline anionic and can be treated by immediate dilution (oral
burns, respiratory stimulation, and alkalosis detergents, cationic detergents, phenol, or administration of milk or water). Exposure
followed by metabolic acidosis. pine oils. to cationic detergents, phenol, and alkaline
• Pine oil disinfectants are irritating to the • Dermal: wash exposed area (cationic anionic detergents can lead to oral ulcers/
mucous membranes. detergents, phenol) with water for 20-30 burns and systemic effects (ataxia, weakness,
minutes. seizures).
DIAGNOSIS • Ocular: flush eyes with tepid tap water (or
saline) for 20-30 minutes. Fluorescein stain Prevention
Diagnostic Overview to assess for corneal ulcers Keep household cleaning products out of reach
Diagnosis is considered based on suspicion or Protect GI mucosa (for cationic detergents, of pets.
evidence of exposure to a cleaning product and phenol in dogs and cats):
the presence of oral/dermal ulcers, hypersaliva- • Omeprazole 0.5-2 mg/kg PO q 24h, or Technician Tips
tion, vomiting, excessive licking motions, and/ • Pantoprazole 0.7-1 mg/kg IV over 15 • Rapid oral dilution with milk or water will
or diarrhea. minutes q 24h limit the extent of signs.
• Sucralfate 0.5-1 g PO q 8-12h (dogs); • Emesis induction and activated char-
Differential Diagnosis 0.25-0.5 g PO q 8-12h (cats) coal administration are typically not
• Corrosives toxicosis (alkali, acids) Control vomiting: recommended.
• Uremia (oral ulcers) • Maropitant (Cerenia) 1 mg/kg SQ or 2 mg/ • Ingestion of laundry pods often results in
• Acute vomiting kg PO q 24h, or vomiting and aspiration pneumonia.

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