Common Toxicities - To Vomit or Not to Vomit

We are often inducing dogs to vomit unauthorized chocolate ingestions.  We have seen some high quality chocolate come back from many canine patients.  Chocolate is tempting to most of us of several species.

There are many other toxins that may be ingested in our patients, as well.   We can induce vomiting, or emesis, for some of them but should not induce vomiting for others.  The veterinary journal “Clinician’s Brief” recently published an article on the top toxins ingested.

The top 5 ingested toxins that require induction of emesis:

  1. Anticoagulant Rodenticides – These compound cause bleeding days after ingestion.  If we get to the patients within the first 6 hours or so after ingestion, we can induce vomiting and give activated charcoal to decrease absorption of any remaining toxin.  Treatment is very effective when started early.

  2. Chocolate – Theobromine, a compound very similar to caffeine, is the toxic component in chocolate.  It causes vomiting, diarrhea, hyperactivity, rapid heart rate and incoordination.  Chocolate can stay in the stomach an extended period, so induction of vomiting and administration of activated charcoal may be effective well outside of 6 hours post ingestion.

  3. Grapes and raisins – These are toxic to the kidneys and there isn’t a direct dose relationship to toxicity.  This means any exposure is too much because it is unclear when toxicity will occur.  The toxic principle is unknown.  Induction of emesis is indicated as soon as possible along with activated charcoal and fluids.

  4. Over the counter pain relievers – Acetaminophen and ibuprofen, along with other medications, account for about 25% of toxic ingestions reported.  They can cause a number of problems including gastric ulceration and kidney and liver issues.  Vomiting should be induced as soon as    possible following significant ingestion.

  5. Xylitol – This is a popular sugar substitute found in gum, candy, dental products, and some baked goods.  It causes hypoglycemia (low blood sugar) at lower doses and acute liver failure at higher doses.  Emesis should be induced if ingestion is discovered.  Activated charcoal doesn’t help decrease its absorption.

The top 5 ingested toxins that do not require induction of emesis:

  1. Acid and alkaline cleansers – These products are too corrosive to risk further esophageal damage trying to have them vomited.  They often cause immediate pain and are bitter so most of their damage is usually in the mouth and throat.

  2. Batteries – If they are punctured, they also cause corrosive damage.  They require surgical or endoscopic removal.

  3. Detergents – Cats may get exposed to these from walking through them and then grooming and dogs may bite into laundry and dishwasher pods.  These also cause corrosive injury.

  4. Hydrocarbons – These are petroleum or wood derived products such as, kerosene, fuel, lubricating oil, paint solvents, stain, or turpentine.  The toxic insult will vary by exposure but all of them may cause aspiration pneumonia if emesis is induced.’

  5. Antidepressant medication – These are medications such as tricyclic antidepressants or serotonin reuptake inhibitors (SSRI’s).  These cause sedation or CNS stimulation, behavioral changes, agitation, or panting.  Treatment includes fluids, sedation as needed, and supportive care.  Since neurologic signs are very common, emesis is not recommended because of the risk of aspiration.  If ingestion is observed, emesis may be considered before clinical signs are seen.

Should you discover any of these ingestions have occurred in your pet, seek medical assistance and advice from a veterinarian as soon as possible, regardless of time of day or night.  Emesis is best induced under medical supervision.