Lucky Dogs: Treating Human Medicine Toxicity in the Nick of Time 
Pets commonly ingest human medications from countertops, pill minders, mail-order packages, and other sources. In fact, according to the ASPCA® Animal Poison Control Center, year after year, human medications have topped the list of toxins most commonly ingested by pets. Interestingly, over-the-counter (OTC) medications, including herbal and other natural supplements, are now a far more likely culprit than prescription medications.

Recently, the BEVS Emergency Department treated two such cases. 
Bauer – Labradoodle
Patient: Bauer, 2 yo MN Labradoodle, good health

Reason for visit: Biting into an albuterol inhaler. (Used to treat or prevent bronchospasm in patients with asthma, bronchitis, emphysema, and other lung diseases. Also used to prevent bronchospasm caused by exercise.)

Exam/Diagnostics: Upon presentation, Bauer’s heart rate was moderately elevated (170bpm), and he was panting. His blood pressure was normal (98mmHg). Initial blood tests revealed low-normal potassium (3.5) and a mildly decreased phosphorus (4.1), as expected with this type of intoxication. 
Treatment: Hospital admission and close monitoring. His heart rate increased to 190-200 beats per minute, and he was treated with propranolol to help slow the heart rate. Follow-up blood tests revealed low potassium and phosphorous. We began supplementing these electrolytes in his fluids the next morning. By the afternoon they were normal and remained normal throughout the evening off of supplementation. He was discharged. 

Length of Stay: One night.

Takeaway: Asthma inhalers are frequently used by people (and occasionally used by cats and dogs), so their presence in homes has become quite common. Unfortunately, albuterol intoxication has become more common with this increased access to inhalers. Many dogs may accidentally chew on an inhaler, mistaking it for a toy. When they puncture the metal casing, all remaining doses are released into their mouths and rapidly absorbed.

Albuterol generally has few side effects at therapeutic doses (1-2 puffs). However, at significantly higher doses, pets can experience severe symptoms, including vomiting, agitation, panting, trembling, fast heart rate, other heart rhythm changes, or muscle weakness or collapse, among others.

The good news is that the vast majority of pets who get into an albuterol inhaler will do well with immediate, appropriate, supportive care. Most pets will go home within 24-48 hours, and no long-term ill effects are expected.
Merlin – Domestic Longhair Cat
Patient: Merlin, MN 3 yo domestic longhair cat, 11.4 lb., good health

Reason for visit: Ingested two Adderall XR 30 mg capsules. (This combination medication is used to treat attention deficit hyperactivity disorder. It works by changing the amounts of certain natural substances in the brain. Amphetamine and dextroamphetamine are stimulants.)

Exam/Diagnostics: Merlin was very symptomatic on presentation – febrile, panting, trembling, lethargic, and very agitated. Baseline bloodwork was completed. Temp 107.0˚F, severe hyperthermia, hematuria, heart rate 300.0 bpm, moderately distended bladder, BP normal.
Treatment: Started IV fluids and acepromazine. He was admitted to the ICU for seizure and cardiac monitoring. Started on oxygen, methocarbamol IV, and cyproheptadine, and continued to check his blood values. 

The following day he received supportive care with Norm R and continued monitoring of his HR, RR/RE, ECG; no tremors were noted. On the second overnight, we added KCl 20mEq to fluids for added K supplementation and acepromazine as needed for tachycardia, tachypnea, and agitation. We continued to monitor ECG, temp, and HR closely. 

The next day we discontinued cyproheptadine and added acepromazine for agitation. We continued to monitor Merlin overnight with continued monitoring and fluids. We put him in a ThunderShirt® and he seemed to do better when held.

Length of Stay: Three days. Sent home with a prescription for acepromazine.

Merlin's family brought him for a follow-up exam with their primary care veterinarian a few days after discharge and reported he was back to his usual self in the weeks following. 

Takeaway: Dozens of medications are poisonous to cats, but Adderall is particularly problematic because of how appealing felines find it. The combination of four amphetamine salts in Adderall makes cats more likely to eat it if given the chance, according to data gathered by board-certified veterinary toxicologists. Rather than taking a sniff or nip and leaving it be, cats are likely to finish every bit. Only 20 mg of Adderall is enough to do significant damage, meaning a single dropped pill can prove dangerous. 

Adderall is formulated to release at various rates, designed to be taken once a day. If the capsule was crushed or broken into, clinical signs might develop within an hour or so of ingestion. Though amphetamines are a dangerous chemical for a cat to consume, as Merlin’s case shows, Adderall ingestion can be survived if veterinary intervention is begun as soon as possible.
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The best relationships successfully serve the interests of both partners. Our goal is to support you, your practice, and your patients in a manner that works well for all parties.

Each month, we will be sending you information about our services and other items we hope you find helpful. If you have any questions about our Emergency and Critical Care services or would like to discuss a patient, please call us at 802.863.BEVS (2387). To help expedite the referral process, you can fill out our Patient Referral Form online or visit our Referring Veterinary Portal. We’re here to help in whatever way we can.
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We are pleased to welcome our clients and patients into our building. Please visit our COVID-19 web page for updates, including details on all of our safety protocols. We are still experiencing a high demand for emergency veterinary services and continue to triage emergency cases to care for the most critically injured or ill pets first.
Burlington Emergency and Veterinary Specialists
1417 Marshall Avenue, Williston, VT 05495 | 802.863.2387 |
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