What are the general characteristics of mothballs?
-sold as flakes, crystals, powder, cubes, and spheres
-can be inhaled, ingested, or absorbed transdermally
-ingestion is most common in veterinary patients
What are the characteristics of naphthalene mothballs?
-white, crystalline substance
-increased absorption after fatty meals or dermally following oil/lotion application
-readily absorbed through the lungs
-crosses the placenta
What are the toxic effects of naphthelene?
-cellular glutathione depletion limits cell ability to counteract oxidative damage
-leads to hemolytic anemia
What are the characteristics of paradichlorobenzene (PDB) mothballs?
-insect repellent and deodorizer
-less toxic than naphthalene
-primary metabolite is 2,3-dichlorophenol
-causes oxidative damage to liver, kidney, lungs, and CNS
How can naphthalene mothballs be distinguished from PDB mothballs?
-PDB mothballs sink in a 50% dextrose solution, saturated NaCl solution, and water
-naphthalene mothballs float in a 50% dextrose solution and saturated NaCl solution but sink in water
What are the clinical signs of mothball toxicity?
-minutes to hours after exposure
-hypersalivation
-anorexia
-vomiting
-GI pain
-dull mentation
-tremors
-ataxia
-seizures
-hyperesthesia
-dermal irritation
-pale, icteric, or brown mm
-tachypnea
-tachycardia
-weakness
-hypotension
What are the diagnostic findings in mothball toxicity?
*CBC:
-anemia
-heinz bodies
-hemolysis
*CHEM:
-azotemia
-elevated liver enzymes
-elevated Tbili
-decreased Na and Cl
*UA:
-pigmenturia
-hemoglobinuria
-isosthenuria
-positive screening test for naphthalene
*Rads:
-PDB mothballs are densely radiopaque; naphthalene mothballs are radiolucent or faintly radiopaque
What is the treatment for mothball ingestion?
-induction of emesis
-possible gastric lavage
-single dose AC
-flush areas of dermal exposure
-IV fluids
-antiemetics
-anti-convulsive therapy
-methemoglobinemia treatment
What are the options for methemoglobinemia treatment?
*new methylene blue
-rapidly convert MetHb to Hb via formation of leukomethylene
*ascorbic acid
-slowly converts MetHb to Hb
*N-acetylcysteine
-maintains glutathione and sulfate levels
What is the prognosis for mothball toxicity?
good with early treatment
What are the characteristics of paintball toxicity?
-technically non-toxic
-osmotically active ingredients
-draw water into GI tract from interstitial space
-cause free water loss, hypernatremia, and hyperosmolality
What is the mechanism of clinical signs in paintball toxicity?
-free water enters GI tract
-hypernatremia from free water loss acts on central osmoreceptors to increase thirst
-CNS signs occur from free water loss
-cellular dehydration and shrinking
-tearing of cerebral and meningeal vessels
What are the clinical signs of paintball ingestion?
-within 1 hour of ingestion
-vomiting
-diarrhea
-hyper-excitability
-depression
-central blindness
-ataxia
-stupor
-coma
-seizures
-hypovolemia
-tachycardia
-hypotension
-poor pulse quality
What are the characteristics of paintball diagnostics?
-no specific tests
-want to serially monitor electrolytes every 2 to 4 hours
-can look like early EG toxicosis and can cross-react with EG testing
What are the management steps for paintball toxicity?
-emesis in asymptomatic patients
-NO AC; worsens hypernatremia
-warm water enemas
-supportive care for neuro. signs
-treat hypernatremia slowly (dec. by 12 mEq/day)
-fluid therapy
-anti-emetics
What is the prognosis for paintball toxicity?
-good to excellent with appropriate treatment and monitoring
-guarded with severe neurologic signs
What are the characteristics of different detergent surfactant types?
*cationic:
-greatest potential for harm
-usually contain quaternary ammonium compounds
-less detergency than anionic compounds
*anionic:
-relatively less harmful than cationic
-usually contain sulfated/sulfonated compounds
*non-ionic:
-no charge
-minimal effects
*amphoteric:
-charge and effects vary with pH
What are the mechanisms of toxicity for detergents?
-surfactants have polar and non-polar ends that decrease surface tension for more efficient wetting
-complex phosphates emulsify grease and oils
-highest toxicity to veterinary patients seen with single use laundry pods and automatic dishwasher detergents
What are the characteristics of automatic dishwasher detergents?
-contain quaternary ammonium compounds
-high conc. of cationic surfactants
-tissue necrosis with direct exposure
-curare-like effect from quaternary ammonium compounds; blocks post-synaptic Ach receptors
What are the clinical signs of automatic dishwasher detergent toxicity?
-vomiting
-diarrhea
-nausea
-gastritis
-corrosive mucosal injury
-chemical burns
-hair loss
-tissue necrosis
-corneal ulceration
-conjunctival erythema
-ocular pain
-resp. muscle paralysis
-coughing/stridor
-muscle weakness/paralysis
What are the characteristics of laundry pods?
-contents under pressure; rupture easily when bitten/chewed
-can have inadvertent ingestion/aspiration
What are the clinical signs of laundry pod toxicity?
-vomiting
-diarrhea
-nausea
-gastritis
-corrosive mucosal injury
-chemical burns
-hair loss
-tissue necrosis
-corneal ulceration
-conjunctival erythema
-ocular pain
-coughing/stridor
What are the treatment steps for laundry pod toxicity?
-GI decontamination not generally recommended
-emesis ONLY if product is non-corrosive
-irrigation with tap water for dermal and ocular exposure
-IV fluids
-gastroprotectants
-pain medications
-oxygen therapy/mechanical ventilation for resp. failure
