Page 73 - Cote clinical veterinary advisor dogs and cats 4th

14 Acid or Alkali (Corrosives) Toxicosis

• Evidence/history of exposure to a household • Viral or bacterial gastroenteritis • Protect GI mucosa
cleaning product • Garbage toxicosis ○ Proton pump inhibitor (preferred over
VetBooks.ir in cats), vomiting (within a few minutes to Initial Database ■ Omeprazole, dogs/cats: 0.5-1 mg/kg
H2-antagonist)
• Salivation, protrusion of tongue (common
PO q 12h
• CBC (stress leukocytosis possible)
hours of exposure) may be noted by owners.
PHYSICAL EXAM FINDINGS • Serum biochemistry profile: electrolyte ■ Pantoprazole, dogs/cats: 0.7-1 mg/kg
changes due to vomiting, dehydration are
IV q 24h; before oral therapy
• Oral ulcers (lips, gingiva, tongue) possible ○ H2-receptor antagonist
○ Initially, corrosive burns appear milky • Urinalysis: usually unremarkable ■ Famotidine, dogs/cats: 0.5-1 mg/kg PO,
white or gray, then become black. • Thoracic radiographs: indicated if coughing, SQ, IM, IV q 12h
• Dysphagia dyspnea, or fever of unknown origin. May ○ Sucralfate, dogs: 0.5-1 g PO q 8-12h; cats:
• Hypersalivation/excessive licking show evidence of pleural effusion (rare; due 0.25-0.5 g PO q 8-12h; administer as a
• Protrusion of tongue/swelling to esophageal rupture) and/or aspiration liquid
• Corrosive burns on the skin pneumonia • Ensure patent airway if respiratory noise or
• Signs of pain (abdominal or generalized) • Abdominal radiographs: may show evidence effort apparent (p. 1166)
• Vomiting, diarrhea of peritonitis if perforation has occurred • Supportive care
• Lethargy ○ IV crystalloid fluids (e.g., lactated Ringer’s
• Hyperthermia Advanced or Confirmatory Testing solution) for rehydration or maintenance
• Anorexia • Abdominal ultrasound if peritonitis is sus- ○ Broad-spectrum antibiotics (e.g., ampicil-
• Signs indicating esophageal perforation (rare), pected on physical exam or radiographically lin 22 mg/kg IV q 8h plus enrofloxacin
such as discomfort when swallowing, or signs • Upper gastrointestinal endoscopy to evaluate 5 mg/kg IM or diluted 1 : 1 with sterile
of mediastinitis or of sepsis mucosal damage or to assess esophageal or saline and given slowly IV q 12h [5 mg/
• Corneal ulcer, blepharitis (ocular exposures) gastric perforation, using great care to avoid kg q 24h maximum in cats]) if GI mucosal
• If concurrent laryngeal swelling, stridor and/ causing a perforation of damaged tissue; integrity is compromised and/or secondary
or respiratory distress perform within 24 hours of exposure to infection is identified
minimize risk for perforations. ○ Glucocorticoids (controversial); may help
Etiology and Pathophysiology prevent esophageal stricture due to esopha-
Sources: TREATMENT gitis but may delay healing and predispose
• Common household products that contain to infection; concurrent broad-spectrum
acids include antirust compounds, gun barrel Treatment Overview antibiotic use is of unproven benefit. If
cleaning fluids, some toilet cleaning liquids, With oral exposure, immediately dilute with used, dexamethasone 0.05-0.1 mg/kg IV
automobile batteries, and swimming pool water or milk to protect the gastrointestinal or IM or prednisolone 0.5-1 mg/kg PO;
cleaning agents. (GI) mucosa. With dermal or ocular exposure, q 12h for no more than 3 to 5 days.
• Alkali-containing products include drain wash the exposed area or flush eyes with tepid ○ Manage pain: opiates (e.g., buprenorphine
cleaner, laundry products, automatic dish- water for 20 to 30 minutes. Follow up with 0.005-0.02 mg/kg IM, IV, or SQ; or
washer detergents, many toilet bowl cleaners, evaluation and treatment as needed. Whether fentanyl transdermal patch)
alkaline batteries, and radiator cleaning to hospitalize the patient depends on the ○ Antiemetics: maropitant 1 mg/kg SQ or
agents. amount of toxic exposure, extent of lesions, IV or 2 mg/kg PO q 24h for 5 days
Mechanism of toxicosis: time course (if only minutes to 2 hours since ○ Nutrition/dietary therapeutics
• Acids and similar corrosive agents cause exposure, full extent of lesions may not be ■ Severe oral ulcerations may cause
rapid coagulative necrosis, resulting in pain. apparent), and owner’s emotional/financial/ dysphagia; give liquid food only for
Mucosal penetration or perforation is rare. logistical concerns. several days.
• Concentrated alkali solutions can penetrate
the mucous membranes by dissolving the Acute General Treatment Nutrition/Diet
lipoprotein matrix of cell membranes and • Decontamination of patient (p. 1087) Temporary feeding tube placement (esopha-
destroying nerve endings. They can induce ○ Dermal: Flush exposed area with water gostomy, p. 1106) if oral lesions; gastrostomy
deep, penetrating lesions, including liquefac- for 20 to 30 minutes. For severe burns, (percutaneous endoscopic gastrostomy [PEG]
tive necrosis and vascular hemolysis. Perfora- surgical debridement may be necessary. for esophageal lesions, p. 1109) can help meet
tion is more likely compared to acids. ○ Ocular: Flush eyes with tepid tap water the patient’s nutritional needs if he/she is not
(or isotonic saline) for 20 to 30 minutes. eating due to mucosal lesions (visual inspection
DIAGNOSIS Stain the cornea with fluorescein to assess for oral lesions; endoscopic observation for
for corneal ulcers (p. 209). esophageal lesions).
Diagnostic Overview ○ Oral exposure: Immediately dilute with
History of exposure to a product containing milk or water. Chemical neutralization Possible Complications
acid or alkali is the cornerstone of diagnosis and with weak acid or alkali is contraindicated. • Aspiration pneumonitis/pneumonia
is supported by typical physical exam findings: This can cause an exothermic reaction and • Esophageal perforation and mediastinitis;
any combination of hypersalivation, excessive more thermal injuries. gastric/enteric perforation and peritonitis
licking, protrusion of tongue, lethargy, hyper- ○ Induction of vomiting: contraindicated • Esophageal stricture
thermia, vomiting, and oral lesions (ulcers). (can cause more damage) • Upper airway obstruction if laryngeal edema/
○ Activated charcoal: contraindicated (inef- inflammation
Differential Diagnosis fective against caustic agents)
• Uremic stomatitis ○ Gastric lavage: contraindicated (risk of Recommended Monitoring
• Liquid potpourri toxicosis perforation) • Acutely: blood pressure, respiratory effort,
• Cationic detergent exposure (similar to ○ Inhalation (rare): In case of inhalation monitor for shock, body temperature
alkaline burns) exposure, move animal to fresh air. • Chronically: thoracic radiographs, CBC (for
• Calicivirus (cats) ○ If esophageal perforation is suspected, do evidence of esophageal rupture and medi-
• Foreign body obstruction (intractable not allow food or water until the extent astinitis or aspiration pneumonia possibly
vomiting) of injury is evaluated. due to esophageal stricture)

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