Chocolate - I know we've been here before!!

RE: Chocolate - I know we've been here before!!

Aine Seavers — Tue, 09 Feb 2016 23:49:29 GMT

Had the dog been overwt to this point-if so then likely truely hypot4 as non hypothryoid obese dogs tend to have higher normal TT4s. Did you do a cTSH and was the dog fed or fasted for the blood test. Celery can have an impact on thyroid levels so perhaps dates could..? Also what was the original daily diet-raw chicken necks, raw bones and was it on Frontline at all.

RE: Chocolate - I know we've been here before!!

Aine Seavers — Tue, 09 Feb 2016 23:48:42 GMT

RE: Chocolate - I know we've been here before!!

Michael Woodhouse — Sun, 10 Jan 2016 21:38:01 GMT

The activated charcoal from Krusse comes in a bottle that fits onto these:

http://imseuro.co.uk/veterinary/stomach-tubes-18ch.html

With a bite gag:

Most dogs tolerate it very well. Put 5-10ml tap water down first to check in the right place.

RE: Chocolate - I know we've been here before!!

Kate Richardson — Sun, 10 Jan 2016 21:26:39 GMT

Is anyone aware of activated charcoal in a tablet form? The liquid is very messy as pointed out, and powder would be fine if the dog will eat it, but given often feeling quite nauseus and sedated post apomorphine, not sure that would work either- would be handy to have a tablet form to administer

RE: Chocolate - I know we've been here before!!

Neil Wheadon — Fri, 08 Jan 2016 18:38:15 GMT

I like the powder, using 2g/kilo (agree?)

It mixes well with wet food and dogs seem to eat it

The liquid looks messy!!

Neil

RE: Chocolate - I know we've been here before!!

Harriet Nicholson — Fri, 08 Jan 2016 18:25:28 GMT

I dispense the powder and advise to mix with wet food, the dogs do tend to eat it (although I suspect as known chocolate eaters then will eat anything!)

RE: Chocolate - I know we've been here before!!

Will McMullan — Fri, 08 Jan 2016 17:50:18 GMT

In what form are you all sending charcoal home with these dogs? In liquid for oral drenching? Don't the clients complain about the mess? Or am I just particularly messy? I only ask because I don't think I've ever dispensed charcoal home with an animal. Are the tablets as effective as the liquid?

RE: Chocolate - I know we've been here before!!

John Wessels — Fri, 08 Jan 2016 16:20:37 GMT

Not seen a single case of ''chocolate poisoning'' or ''grape/raisin poisoning'' in 35 years.

Not even in the Springer Spaniel that ate 2 sausages of raw cacao.

But seen loads of dogs hospitalised for chocolate poisoning the last 2-3 years...

RE: Chocolate - I know we've been here before!!

Elliot Kneba — Fri, 08 Jan 2016 15:07:10 GMT

If the chocolate was ingested within 6 hours of presentation I will induce emesis. To be honest, I would probably induce emesis if it was longer than that. The fattiness of chocolate slows down GI motility to the point where it is nearly almost worth while. I have yet to hospitalise a dog or keep them for observation for chocolate INGESTION, but that is because I have yet to come across a case of chocolate TOXICOSIS. I use the APCC iphone app by the ASPCA Animal Poison Control Center to do quick calculations on toxicity.

The recorded death rate from reported chocolate ingestion is something like 0.04%, so it seems as if they are either treated very successfully, or that most dogs eat milk chocolate at sub-toxic doses.

IV fluids are recommended for clinical dogs because methylxanthines are readily absorbable across the bladder wall. IV fluids will encourage more frequent urination and thus faster elimination.

RE: Chocolate - I know we've been here before!!

Gillian Mostyn — Thu, 24 Dec 2015 15:44:46 GMT

[quote user="Neil Wheadon"]I was asking 3 hours post ingestion in the post, so would you leave them alone in this case Gillian [/quote]

I would discuss with the owner but yes, I'd be likely to just send home with charcoal and treatment for the inevitable diarrhoea!

RE: Chocolate - I know we've been here before!!

Neil Wheadon — Thu, 24 Dec 2015 15:41:31 GMT

[quote user="Gillian Mostyn"] It would be a brave person who said 'no need to do anything' when it is so easy to get rid of it....[/quote]

I was asking 3 hours post ingestion in the post, so would you leave them alone in this case Gillian

Merry Christmas

Neil

RE: Chocolate - I know we've been here before!!

Gillian Mostyn — Thu, 24 Dec 2015 15:39:36 GMT

Had 2 cases in 2 days - 11kg cocker yesterday, 3kg chihauhau today. Both seen within an hour of ingestion so both had emesis induced with apomorphine - very successfully! It would be a brave person who said 'no need to do anything' when it is so easy to get rid of it....

If I see a case outwith the time period for vomiting being useful, I would just treat symptomatically as required.

RE: Chocolate - I know we've been here before!!

Martin Atkinson — Thu, 24 Dec 2015 10:35:34 GMT

[quote user="Michael Woodhouse"]Never known a chocolate death [/quote]I haven't but the nearest was the one I mentioned before that had no history of chocolate ingestion. It arrived collapsed in cardiac failure: heart murmur, pale mm, tachycardia, weak pulse. Put on fluids and given pimobendan which made it worse. We discovered next day the daughter had given it cooking chocolate when she baked (which was nearly eVery day) and it was probably an accumulative effect. Pimobendan is of course a calcium channel blocker and theobromine in the chocolate works in a similar way...eek. Still dog survived despite the treatment and was as bright as a button the next day. Still had the murmur but it was a CKCS!!

Moral: don't assume that a history of none or a small known amount of chocolate is not significant and be careful how you treat the symptoms of heart failure.

RE: Chocolate - I know we've been here before!!

Laura Kidd — Thu, 24 Dec 2015 10:08:58 GMT

Glad the dog fine- never seen one that wasn't. I've seen IVFT used in the management of a chocolate poisoning who developed hyperthermia.

In some poisoning cases IVFT can also be used in an attempt to increase excretion.

This is a good resource form the VPIS-

http://www.rcva.co.uk/tt_notes.pdf

Merry Christmas!

RE: Chocolate - I know we've been here before!!

Anthony Dennison — Thu, 24 Dec 2015 09:12:00 GMT

[quote user="CatherineThomas"]Has anyone else seen a date toxicity?[/quote]

2nd year of Vet School, went to a thai restaurant with a girl I fancied. Conversation was awful, turned out we were just not compatible. And I got the trots from the food.

RE: Chocolate - I know we've been here before!!

CatherineThomas — Thu, 24 Dec 2015 07:09:42 GMT

I've never seen a death from chocolate ingestion either.

A colleague recently had a case of a Labrador who had eaten a whole bag of dates, I think it was 2kg. He was ataxic and had diarrhoea and awful flatulence but was back to normal within 2 days on a drip. But weirdly he came in last week, about 3-4 weeks after the date incident, because the owner had noticed a lump in the neck. It appeared to be goitre and bloodwork showed low T4. I haven't seen if the full thyroid profile results are back yet. No idea if this is related to the dates or just a coincidence. Has anyone else seen a date toxicity?

RE: Chocolate - I know we've been here before!!

Michael Woodhouse — Thu, 24 Dec 2015 00:14:27 GMT

We have one in at the moment. 10kg cocker eaten most of a 400g milk chocolate Toblerone. It's a bit tachycardic, but hyper sort of dog so hard to say for sure.

Has had activated charcoal in cat food and is on a drip (as much as anything to secure and maintain IV access overnight as single member of staff will be checking on the dog). Despite all the calculators telling me this is very severe I don't expect to be spoiling anyone's Christmas.

Never known a chocolate death (or a grape death or a raisin death...). Had a labrador last year quite sick (neuro signs) that had gorged on a sack of dark chocolate chips (farm makes own icecream). Two days in and on a drip and dog is fine. Had rather explosive diarrhoea - as much the reason for the drip.

RE: Chocolate - I know we've been here before!!

Neil Wheadon — Wed, 23 Dec 2015 23:16:40 GMT

PS The initial dog was fine

PPS I do value nurses opinions. The main driver for this post was maybe just maybe she had something and I needed to know.

Merry Christmas folks

Neil

RE: Chocolate - I know we've been here before!!

Neil Wheadon — Wed, 23 Dec 2015 23:13:38 GMT

Again another good example of how this forum brings a wide range of experience in that it would be useful to collate.

It seems that most of us will get the 'chocolate dog' in this Christmas, we'll do the calculations and advise we see them, but how many actually come to any harm?

It's interesting that the deaths I've heard reported are all labradors, so is the volume that they eat, are they particularly sensitive?

I find the concept of putting everything on a drip puzzling. You do this to primarily to maintain intravascular volume or to correct acid base balance, neither of which happen in these cases. A quick google search https://books.google.co.uk/books?id=X3cCZQCrrjcC&pg=PA141&lpg=PA141&dq=does+theobromine+alter+acid+base+balance&source=bl&ots=SxQp9AGrtI&sig=dyZBQtIVqra75MUMM_7FEt5GM5c&hl=en&sa=X&ved=0ahUKEwju4sKUjfPJAhWGcRQKHXFTBl4Q6AEIIjAD#v=onepage&q=does%20theobromine%20alter%20acid%20base%20balance&f=false

suggests that no change of blood pH does occur.

So if anyone does have a death due to chocolate this festive season let us know, more likely to be heart related me thinks

Neil

RE: Chocolate - I know we've been here before!!

Glenn Hodgson — Wed, 23 Dec 2015 21:31:35 GMT

"The nurses passing shot....."

Passing shots.....?

Would anyine do anything differently??

I'd probably have taken aim and returned fire

RE: Chocolate - I know we've been here before!!

Rob Loxley — Tue, 22 Dec 2015 13:44:06 GMT

[quote user="Neil Wheadon"]So would anyone do anything differently?[/quote]

Nope, monitor, continue charcoal for a couple of days at home.

If the chocolate has other things in it - some nuts, xylitol (sugar-free chocolate) etc - then other toxicity concerns may come into play.

RE: Chocolate - I know we've been here before!!

Laura Kidd — Tue, 22 Dec 2015 11:41:52 GMT

Hi Neil,

Sorry don't know how to highlight specific lines from your post. Hope the wee dog is ok!

I tutor on one of the VN ECC courses (not sure if your RVN was one of our students or from another course)- Chocolate poisoning is obviously discussed ( as it is in the VN syllabus). We expect RVNs undertaking this course to have a knowledge and understanding of the likely effect of any poison; as well as knowledge and understanding of the likely decontamination protocol/ treatment regime that the VS in charge of the case might follow; and how to nurse affected cases.

It is repeatedly emphasised that, in accordance with the Veterinary Surgeon's Act 1966, the VS has responsibility for diagnosis, investigation, choice of treatment etc.

In relation to chocolate poisoning, our course notes refer to decontamination that might be performed following exposure.

They further discuss the veterinary treatment that might be prescribed for cases where clinical signs have developed- the treatment is outlined as being supportive and symptomatic ( as for most poisonings) and possibly including IVFT. Close monitoring of affected cases is required- depending on the patient's condition electrolytes and renal function may need to be monitored.

Thanks

Laura

RE: Chocolate - I know we've been here before!!

Martin Atkinson — Tue, 22 Dec 2015 09:02:53 GMT

Chocolate poisoning is a double whammy where the pet owning public are both culpable of allowing it to happen then panic when it does. They leave chocolate around then overreact when it has eaten a couple of pieces. There doesn't seem to be a balance between common sense and media hype.

Similar thing yesterday. I saw a dog with a chronic lick sore on a paw the owner had ignored for weeks then came in in a panic after reading about Alabama Rot in the Sun!

RE: Chocolate - I know we've been here before!!

Catriona MacIntyre — Mon, 21 Dec 2015 20:13:17 GMT

Nope I wouldn't have it on fluids. Loads of charcoal definitely, and monitor heart rate etc.

I DID have one on fluids last year, but it was a Patterdale which had consumed a whole chocolate orange, had a heart rate of 188, projectile vomiting, shaking uncontrollably and bordering on seizuring. The IV line was also useful for getting meds in fast and was partly put there in case IV access needed rapidly if she progressed to circulatory shock

RE: Chocolate - I know we've been here before!!

Martin Atkinson — Mon, 21 Dec 2015 17:13:19 GMT

[quote user="Neil Wheadon"]So would anyone do anything differently?[/quote]No, if it 'aint broke don't fix it. The only case of chocolate poisoning I've felt moved to treat was one I didn't even know had eaten it so it was first priciples treatment for the symptoms. But in any case it had been drip fed with tiny bits by the daughter over many days/weeks. The ones that have eaten a chocolate box assortment or a bar of Dairy Milk have been as happy as Larry or just had a bout of squits!