ANSWERS

1. What is the name given to a substance that specifically counters the action of a poison?
   An antidote.
2. What is the name of the UK organisation that provides a 24-hour information service to veterinary surgeons with regard to cases of poisoning?
   The Veterinary Poisons Information Service (VPIS).
3. If a specific antidote is not available for a certain poison, what is the broad term used to describe the treatment of the case?
   Supportive therapy.
4. Why is it sensible to reserve a sample of vomit, faeces or urine in a case of suspected poisoning?
   The sample may be sent to an external laboratory for examination and forensic analysis. This is essential in cases where a deliberate poisoning is suspected in order to gain evidence. In cases where the type of poison is unknown, confirmation will aid with the diagnosis and treatment of the animal.
5. State 3 reasons why a veterinary nurse should maintain a diplomatic silence in cases of suspected malicious poisoning.
   • A false accusation would reflect very badly on the practice, and it is therefore best to leave any incrimination to a court of law.
   • Some clients are quick to assume that an acute illness is due to poisoning, but thankfully such incidences are very rare.
   • If a case does go to court, a prosecution is often difficult since it is usually impossible to prove that the poison was deliberately placed within reach of the animal.
6. A client telephones the surgery and is distraught because her bull terrier puppy has just eaten 6 month's supply of contraceptive pills. What advice would you give?
   
   • Take a full history as you would for any telephone emergency (in actual fact this is NOT an emergency but is perceived as such by the client and therefore should be dealt with professionally without belittling the client's concerns).
   • Advise that contraceptive pills are not poisonous to puppies even when taken in large quantities. Explain that the hormones contained within the tablets are usually metabolised quickly with no ill effects.
   • If tablets have been very recently consumed, advise inducing the pup to vomit.
   • Advise that the puppy be closely monitored for 72 hours. Any incidences of vomiting, diarrhoea, lethargy or inappetance must be reported immediately. If the puppy has also ingested the packaging, then this may cause complications.
   • If you have not heard back from the client after 24 hours, then a courtesy call is a good idea. The client will appreciate your concern and this will reflect positively on the practice.
7. A client telephones the surgery. His cat has been in the garage and was observed by his son drinking antifreeze. What advice would you give?
   
   • Take a full medical history as described in Module 2.
   • Advise that the antifreeze is removed to prevent further ingestion.
   • Advise that vomiting is not induced since the substance is corrosive.
   • Reassure the client that a specific antidote (ethanol) is available and this may be given by intravenous injection at the surgery. However, there may still be medical complications as a result of ingestion of antifreeze at a later date.
   • Ensure that the cat is immediately brought to the surgery. Even in an emergency, the cat should be restrained within a secure carrier. Advise that the client should keep the cat warm, offer nil by mouth and transport the animal as smoothly as possible. A second person should ideally travel with the cat to ensure that the airway is clear and that any instances of vomiting or unusual behaviour are noted.
   • Recommend that a sample of antifreeze be brought to the surgery along with the original container. In emergencies, it could be that the identity of the suspected poisonous substance is mistaken.
   • Once the client is on his way, inform a veterinary surgeon.
   • Prepare the necessary equipment as requested by the veterinary surgeon.
   • Prepare for supportive therapy such as the provision of heat pads, soft clean bedding and fluid therapy equipment.
   • Prepare an admission/consent form ready for the arrival of the client.
8. List 4 possible sources of lead poisoning.
   
   • Linoleum.
   • Old lead pipes.
   • Lead paint.
   • Putty.
9. What is the antidote to lead poison?
   Sodium calcium edetate injection.
10. State 2 medical conditions that may be mistaken by a client as a poisoning case.
    
    • Epilepsy.
    • Haemorrhagic gastro-enteritis.
11. Which common over-the-counter painkiller is poisonous to cats and may prove fatal if as little as half a 500mg tablet is ingested?
    Paracetamol. NB. Ibuprofen and many other nonsteroidal anti-inflammatory drugs are also potentially harmful and may cause irreversible liver damage in both cats and dogs.
12. Cats are allergic to phenols. State 3 products that contain phenols.
    
    • Creosote (wood preservative).
    • Some disinfectants.
    • Tar/pitch (used for roofing).
13. List 3 products suitable for removing creosote from the coat of a cat.
    
    • Swarfega.
    • Liquid paraffin.
    • Cooking oil.
    NB. 3-4 Baths of detergent are necessary following the removal of the creosote with any of the above.
14. When would the administration of an inert adsorptive substance by mouth be indicated?
    This is specially recommended for use in toxic conditions of the stomach and intestines and in cases of poisoning where a protective and adsorptive action is required. (eg: granular charcoal).
15. List 5 substances with adsorptive properties (these bind the poison to the ingesta in the gut lumen and prevent absorption).
    
    • Charcoal.
    • Fuller's earth.
    • Universal antidote.
    • BCK granules.
    • Kaolin.
16. Emetics are indicated in many poison cases (but remember that they are contraindicated if the poison is caustic/corrosive). Of the following emetics state which is the most efficient: mustard, saline, washing soda crystals, hydrogen peroxide, apomorphine & Rompun. What are the shortcomings of the others?
    
    • Apomorphine - this is the safest option and is given intravenously.
    • Mustard, saline, hydrogen peroxide & washing soda crystals - potentially dangerous or may be ineffective as impossible to give an accurate quantity; in addition these are given orally and may cause aspiration pneumonia if inhaled whilst the animal vomits (In addition, saline may be absorbed and upset the animal's electrolyte balance).
    • Rompun - this has the advantage of being administered by injection rather than per os (by mouth) but its sedative effect must not be overlooked.
17. State 3 instances in which inducing vomiting is contraindicated.
    
    • If the poison is caustic/corrosive.
    • If the animal is collapsed or unconscious.
    • If the animal is fitting.
18. What is the name of the procedure whereby the stomach is flushed and drained under general anaesthesia?
    Gastric lavage.
19. State 2 instances when gastric lavage would be contraindicated.
    
    • If the poison was ingested more than 4 hours ago.
    • If the animal is conscious (gastric lavage must only be performed on unconscious or anaesthetised animals).
20. Why might laxative preparations such as sorbitol be administered in cases of poisoning?
    Laxatives hasten the passage of ingesta enabling the poison to pass along the alimentary tract as quickly as possible (and thus reducing the amount absorbed).
21. What is a demulcent?
    A preparation given by mouth to coat the alimentary mucosa with a soothing substance. This may help to lessen damage to the alimentary tract in cases of corrosive poisoning.
22. Name one poison that lowers the body temperature.
    Alphachoralose.
23. Name one group of poisons that raise the body temperature.
    Dinitro herbicides.
24. What is the antidote for Warfarin-type rat poisons?
    Vitamin K (Konakion).
25. What is the antidote for organophosphorus compound poisons?
    Atropine sulphate.
26. What is the name of the poisonous chemical contained within slug bait which many dogs and cats seem to find particularly palatable?
    Metaldehyde.
27. A client telephones the surgery and is concerned since the family dog has just come in from the garden and is retching and salivating excessively. The client thinks that the dog may have drunk too much water from the pond. What is the most likely cause of these symptoms?
    Toad venom.
28. What is the name of the only indigenous venomous snake in the UK?
    The adder (Vipera berus).
29. What is the name of the antidote for adder venom?
    Zagreb (this may be obtained from human hospital pharmacies).
30. Why should an animal that has been bitten by an adder be immobilised?
    In order to slow the general circulation as much as possible and thus help to prevent the spread of the poison.
31. A splint or Robert Jones dressing applied to a limb affected by an adder bite will help to prevent movement and thus decrease venous return from that limb helping to prevent toxins from entering the rest of the circulation. What other benefits are achieved by the application of a firm dressing?
    
    • Minimisation of swelling.
    • Reduction of pain.
32. What is the name of the toxic fumes produced from over-heated fat?
    Acrolein.
33. State the therapy necessary in cases of calciferol (a rodenticide) poisoning.
    
    • Provide a diet high in fluid and salt but low in calcium.
    • Ensure that the patient avoids sunlight.
34. What common vegetable is poisonous to dogs if given raw and ingested in large quantities?
    The onion.
35. Why should dogs not be given chocolate?
    Chocolate contains theobromine, which is poisonous to them.