Grape Toxicity - Anyone seen one?

Re: Grape Toxicity - Anyone seen one?

Bob Russell — Mon, 14 Jan 2013 13:43:14 GMT

The debate still comes back to is there really such a thing as GIARF!

Are these odd cases just idiosyncratic reactions rather than a true toxicity?

May I suggest that vets ask clients (perhaps over the next week or so) whether their dogs have ever eaten grapes, raisins or anything containing them accidentally or not. If they have were there any signs of ill-health?

Not a peer reviewed double blind trial but might be interesting!

Re: Grape Toxicity - Anyone seen one?

Rajat — Mon, 14 Jan 2013 13:27:22 GMT

[quote user="Andrew Kent"]Experimental work in ischaemic renal injury in rats showed that fluid therapy earlier on did improve outcome. [/quote]

Kinda makes sense, increasing flow to a kidney where flow has been reduced artificially till the point of damage helps... different situation (potentially) to grape ARF- I guess I would be more convinced of fluid therapy in maintaining renal perfusion in these cases if there was some degree of evidence that this is the aetiology behind grape induced ARF..my other issue with respect to fluids is how do we know we are increasing renal perfusion and should we be monitoring this better in these cases?

Just thinking aloud

Raj

Re: Grape Toxicity - Anyone seen one?

Claire Godfrey — Mon, 14 Jan 2013 13:20:03 GMT

Another anecdotal one!

Left 2 mince pies on the side, dog ate both, didn't realise until nearly 24 hours later when found the packaging under the coffee table. Absolutely fine.

Has also unfortunately eaten many grapes in his time, I am terrible at dropping them and he's too fast. Never any problems.

What to tell a client? Worth discussing the risks but wouldn't rush to see them. Depends on the owner I think.

Have heard the fungus theory before, can't remember where though.

Re: Grape Toxicity - Anyone seen one?

Andrew Kent — Mon, 14 Jan 2013 11:50:49 GMT

I have treated 2 dogs with acute renal failure after known large quantity ingestion of raisins, one of which required very aggressive management to pull through and has been left with chronic renal changes after this.

the problem is that if we leave it until dogs show clinical or blood changes instituting fluid therapy at that stage may worsen outcome because they will already have had a period of reduced renal perfusion. Experimental work in ischaemic renal injury in rats showed that fluid therapy earlier on did improve outcome.

so, while the risk is small, if I see a known ingestion I would still encourage fluid therapy so that I know I am maintaining renal perfusion in the event that an acute kidney injury occurs and therefore I may make the outcome from that injury better if it occurs. Andy

Re: Grape Toxicity - Anyone seen one?

Mark Hedberg — Mon, 14 Jan 2013 11:30:47 GMT

Out of idle curiousity, has anyone tried tracking if white grapes or red grapes made any difference?

Re: Grape Toxicity - Anyone seen one?

Bob Russell — Mon, 14 Jan 2013 10:21:34 GMT

Three days on a drip does not come risk free! I have questioned a number of owners and most admit their pet has had grapes (intentionally or accidentally), mine certainly have.

I have never seen a case of grape toxicity so would give the owner options. I don't believe for a second the risk is 1 in 100. Discussion with owner but no scare mongering!

I am afraid I agree that Hannah's comment was 'not particularly sensible'.

Re: Grape Toxicity - Anyone seen one?

Charlotte Marshall — Sun, 13 Jan 2013 14:20:27 GMT

Personally I have not seen a case of ARF but I have made a couple of animals vomit. One of our staff' dogs ate some christmas cake yesterday I made it vomit within half an hour and we saw plenty of dried fruit in the vomit. as it had brought it all up I saw no reason to drip it. The VPIS says they sit in the stomach for quite some time and can be vomited up apparently whole several hours later making it worth inducing vomiting. If an animal came in and it had been several hours after eating them I might consider dripping but if it is fairly soon afterwards and you manage to make them empty their stomach it feels a bit excessive.

Re: Grape Toxicity - Anyone seen one?

Neil Wheadon — Sat, 12 Jan 2013 15:22:06 GMT

[quote user="Mark Holmes"]What evidence is there that fluids are protective?[/quote]

Mark and Rajat have illustrated the point that I was trying to make. Yes it exists, but where is the evidence that putting these dogs on fluid makes any difference to the outcome? I've just dealt with a Doberman that's had fluid for 2 days at twice maintanence in a practice where the nursing is impeccable. The final SG this morning showed that the urine was more concentrated than when it arrived despite the fluids and eating like a horse (Doberman and had produced 1750ml of urine yesterday)The urea and creatinine were normal (no surprise there) and it's been discharged for a further blood sample tomorrow. This followed advice on VIN/VPIS

What will I do in future? Let the client decide having given the facts - very rare but can kill. Do I think treatment helps - totally unconvinced,

Neil

Re: Grape Toxicity - Anyone seen one?

Rajat — Sat, 12 Jan 2013 12:59:13 GMT

[quote user="James Laidlaw"][quote user="Rajat"]

[quote user="James Laidlaw"]I was just making a point Rajat. I'm convinced and don't need in clinic proof.[/quote]

I was only kidding around mate, and sharing my latest stressful GDV experience...chill...

[/quote] Me too! I just meant that I don't want a GDV to turn up tomorrow!!! Needed to put my "I'm joking" quotation marks on. Time for a wee dram I think!

[/quote]

LOL cool, I thought I'd offended ya! All good - and yes I had a nice wee dram me-self last night! Here's to no more GDVs (well at night anyways, I quite like the challenge during regular working hours)!!

Re: Grape Toxicity - Anyone seen one?

Mark Holmes — Sat, 12 Jan 2013 09:22:11 GMT

[quote user="Hannah Wynne Richards"]
Prosecute the owner if they opt not to drip knowing the dog has eaten grapes

Wynne
[/quote] Complete rubbish, I have never considered dripping my dog when she has eaten grapes. Firstly the risk is tiny, but more importantlt given the toxicity is unknown. What evidence is there that fluids are protective? There seems to be this assumption that just because something affects the kidneys that fluids are the answer. They may help diurese a toxin but what evidence is there any toxin is renally excreted? It seems that it is either an idiosyncratic reaction to the grape or associated mycotoxin (which could be heat stable) I don't worry about my children eating peanuts. Or the dog having bone for that matter.

Re: Grape Toxicity - Anyone seen one?

James Laidlaw — Fri, 11 Jan 2013 19:42:19 GMT

[quote user="Rajat"]
[quote user="James Laidlaw"]I was just making a point Rajat. I'm convinced and don't need in clinic proof.[/quote]

I was only kidding around mate, and sharing my latest stressful GDV experience...chill...
[/quote] Me too! I just meant that I don't want a GDV to turn up tomorrow!!! Needed to put my "I'm joking" quotation marks on. Time for a wee dram I think!

Re: Grape Toxicity - Anyone seen one?

tess — Fri, 11 Jan 2013 19:39:28 GMT

It's interesting that both cooked and uncooked grapes can cause it. You would think the heat would break down the a fungus, or break down a water soluble compound.

Re: Grape Toxicity - Anyone seen one?

Rajat — Fri, 11 Jan 2013 19:25:16 GMT

[quote user="James Laidlaw"]I was just making a point Rajat. I'm convinced and don't need in clinic proof.[/quote]

I was only kidding around mate, and sharing my latest stressful GDV experience...chill...

Re: Grape Toxicity - Anyone seen one?

James Laidlaw — Fri, 11 Jan 2013 19:07:39 GMT

I was just making a point Rajat. I'm convinced and don't need in clinic proof.

Re: Grape Toxicity - Anyone seen one?

Rajat — Fri, 11 Jan 2013 18:48:21 GMT

[quote user="James Laidlaw"] I've never seen a GDV, but they exist. Don't they...?[/quote]

Yeah I had one 3 days ago. 75 KG mastiff, me and a 45 kg nurse. Owner was having angina and SVTs in front of me and vigorously doing carotid massage. I had fever. It was an interesting half hour! Needless to say I sent it down the road to the RVC ! Don't worry, you'll be convinced of their existence soon James! ;)

I am somewhat sceptical of the benefit of 2 days on fluids. I mean, either you go the whole hog or you don't. The whole hog for me means we put in a central line, measure CVP and insert a U cath + measure Urine output regularly. Cakculate ins and outs. Check a urine sediment bid for casts. Check GFR every other day. But putting them on fluids for 2 days at 2x maintenance? We all know in ARF, just fluid loading the patient aint gonna do much once the patient is volume replete - more fluid just puts more pressure on the glomeruli and can worsen renal function. So what we need to know is the pathophysiology behind grape/raisin induced ARF which appears to be elusive.

If emesis has not been successful or the grapes were ingested too long ago for this to be successful I definitely recommend daily urea creat measurements, fluids and indirect Urine output measurements. But in cases of recent grape ingestion where the grapes are brought up I have to say while offering owners fluids I give them my opinion that it does not make a lot of sense - if the dog is eating and drinking normally, IV fluids would have a similar effect as oral rehydration so they can syringe water very regularly at home as an alternative.

Most people opt for IVFT for 1-2 days - I am still waiting for the *tubelight* moment where the pathophysiology of this toxicity is revealed!!

Re: Grape Toxicity - Anyone seen one?

James Laidlaw — Fri, 11 Jan 2013 17:25:29 GMT

I suspect that if the toxicology can be nailed down and understood that we may all change the way we approach these cases. I'd think it would be as inappropriate to charge an owner who couldn't afford or declined IVFT in a clinically well dog that had eaten a grape as it would to not advise them properly of the known risks and potentially serious consequences of the toxicity in this situation. People have seen these cases, just because you haven't doesn't mean it doesn't exist. I've never seen a GDV, but they exist. Don't they...?

Re: Grape Toxicity - Anyone seen one?

Arlo Guthrie — Fri, 11 Jan 2013 17:01:06 GMT

[quote user="Michael Woodhouse"]I suspect the best thing to give a dog that has hoovered up a stray grape or two is a little stilton and a small tot of port..........[/quote]

Re: Grape Toxicity - Anyone seen one?

Michael Woodhouse — Fri, 11 Jan 2013 16:52:22 GMT

[quote user="Hannah Wynne Richards"]

Prosecute the owner if they opt not to drip knowing the dog has eaten grapes

[/quote]

Don't be so daft. Really.

I wouldn't drip my dog if it ate grapes (and she has). Of the vets who have contributed to this thread how many have actually seen a case?

The condition seems very, very rare. The risk of harm to the dog would be greater going out for a walk.The risk from a bitch spay would be much higher but we do them daily (I suspect [almost] every single vets has had one bleed at some point).

You really do take this too far.

In other places I spend my time defending vets and their charges. If on the minuscule chance of kidney toxicity we drip anything that hoovers a stray grape then I hold no hope for the profession. Give it as an option to the owner, but I'd 'steer' them away from it. I appreciate there is cross over with the other thread, but owners are looking for your opinion and guidance - not a list on a white board of every possible option ranked in order of preference.

I suspect the best thing to give a dog that has hoovered up a stray grape or two is a little stilton and a small tot of port..........

Re: Grape Toxicity - Anyone seen one?

Hannah Wynne Richards — Fri, 11 Jan 2013 16:02:29 GMT

Prosecute the owner if they opt not to drip knowing the dog has eaten grapes

Wynne

Re: Grape Toxicity - Anyone seen one?

Michael Woodhouse — Fri, 11 Jan 2013 15:54:37 GMT

[quote user="Hannah Wynne Richards"]It's a criminal offence to fail to protect an animal from illness[/quote]

What do you mean by that? Prosecute the owner for giving the grape? Prosecute Mr Kipling for making mince pies?

Re: Grape Toxicity - Anyone seen one?

Hannah Wynne Richards — Fri, 11 Jan 2013 15:44:03 GMT

It's a criminal offence to fail to protect an animal from illness

Wynne

Re: Grape Toxicity - Anyone seen one?

James Laidlaw — Fri, 11 Jan 2013 15:35:39 GMT

[quote user="Neil Wheadon"]

[quote user="James Laidlaw"]

Call the VPIS - they probably have case data.

Acute renal failure and death isn't what I'd call a tiny risk either.

[/quote]

Not necessarily

Working for Vets Now, as an organisation there are lots and lots of calls on toxicology and we don't call the VPIS for every case. I know what grapes cause, have looked on Vetstream and VIN (Veterinary Information Network - An American database that you pay for) so know a lot on this subject and so won't call them. As stated it's the commonest enquiry out there along with chocolate.

My problem with this is how common is acute renal failure after ingestion? It's interesting that few have seen a case and one is heresay'

Following on, what do you do and what are the options.

If I had a dog and was told that in 99% of cases it will be OK, but in 1% it causes death what would I do? It's one of the most black and white toxicities out there.

I can accept that if untreated, cases die of acute renal failure.

The issue is that by putting a dog on fluids for 3 days we will save them. Is this true? It would be interesting to hear a case that had rising urea/creatinine and put on fluids that then subsequently got better.

Neil

[/quote]

I know what I do. I follow advice from VPIS and VIN (similar advice). If they've eaten recently make them vomit. Offer fluids and bloods to monitor, but not every client will want to spend and if they want to take the risk, we can advise it's a small risk, but potentially a very serious one. Some people chance it and yes most are fine, but I wouldn't change the advice I give based on a hunch that it might not be genuine.

Re: Grape Toxicity - Anyone seen one?

James Laidlaw — Fri, 11 Jan 2013 15:33:09 GMT

[quote user="Michael Woodhouse"]75% of those apparently affected lived[/quote]

Or 1 in 4 died if you want to use statistics differently.

Re: Grape Toxicity - Anyone seen one?

Neil Wheadon — Fri, 11 Jan 2013 15:17:24 GMT

[quote user="James Laidlaw"]

Call the VPIS - they probably have case data.

Acute renal failure and death isn't what I'd call a tiny risk either.

[/quote]

Not necessarily

Working for Vets Now, as an organisation there are lots and lots of calls on toxicology and we don't call the VPIS for every case. I know what grapes cause, have looked on Vetstream and VIN (Veterinary Information Network - An American database that you pay for) so know a lot on this subject and so won't call them. As stated it's the commonest enquiry out there along with chocolate.

My problem with this is how common is acute renal failure after ingestion? It's interesting that few have seen a case and one is heresay'

Following on, what do you do and what are the options.

If I had a dog and was told that in 99% of cases it will be OK, but in 1% it causes death what would I do? It's one of the most black and white toxicities out there.

I can accept that if untreated, cases die of acute renal failure.

The issue is that by putting a dog on fluids for 3 days we will save them. Is this true? It would be interesting to hear a case that had rising urea/creatinine and put on fluids that then subsequently got better.

Neil

Re: Grape Toxicity - Anyone seen one?

Michael Woodhouse — Fri, 11 Jan 2013 15:08:23 GMT

[quote user="James Laidlaw"]Acute renal failure and death isn't what I'd call a tiny risk either.[/quote]

75% of those apparently affected lived

http://veterinaryrecord.bmj.com/content/164/14/430.full.pdf+html?sid=f50608e7-f32f-4a90-b32f-a472764da732

How many RTA's have you seen? Stick injuries etc? The risk of the dog suffering with problems is very very tiny. [almost] so tiny to be negligible.

Sounds like a great income stream dripping and treating every dog for 48 hours after it sneaks a stray grape or dropped piece of mince pie....