EMERGENCY MEDICINE
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Take the history of exposure (eg, timing, toxin)
and evaluate the patient (eg, for status, medical
history) to determine whether emesis is appropriate (Table 2).
Consider appropriate use of and contraindications for emesis induction.
Salts, liquid dish soaps, mustards, and syrup of ipecac are not generally recommended.
For dogs, the use of hydrogen peroxide and apomorphine is appropriate.
• Hydrogen peroxide, which acts as an emetic
by direct gastric irritation, is the only recommended at-home emetic agent for owners.
• The use of α-adrenergic agonists as an emetic
agent in dogs is not routinely recommended,
as they are typically not as effective as hydrogen peroxide or apomorphine.
For cats, there are no current recommended athome emetic agents.
• The use of hydrogen peroxide is not recommended because of risk for hemoptysis.
In cats, an α-adrenergic agonist (eg, xylazine, dexmedetomidine) should be used.
• Yohimbine or atipamezole can be used to reverse severity of sedation.
If emesis induction is unproductive or contraindicated (eg, from severe clinical signs such as obtundation, seizures, coma), consider gastric lavage to remove gastric contents
Although labor intensive, gastric lavage is warranted in severely affected patients, for life-threatening ingestion, and with certain toxicants that have
a narrow margin of safety (eg, calcium channel
blockers, baclofen, metaldehyde, organophosphates).
• It is vital to ensure the correct placement of a
well fitting, cuffed ET tube to avoid aspiration.
(Editor)
• neuromuscular weakness can sometimes
complicate entubation. (Editor)
Consider use of activated charcoal and cathartics
that prevent further systemic absorption of the
toxicant.2
While rarely used in human medicine, AC is considered a primary treatment for the poisoned veterinary patient.
Administration of AC is contraindicated with toxicants unable to bind to it, such as alcohols (eg,
ethylene glycol, xylitol, methanol) and heavy metals.
EMERGENCY MEDICINE
Table 1: Emesis Induction: Indications and Contraindications
Table 2: Appropriate Emetic Agents & Toxicology - Drugs