RE: Longer term effects of Chocolate Toxicity

Silvia Maldonado — Fri, 17 Apr 2020 11:52:43 GMT

Good to know that, Beats. I did think that after a few hours the dog would be out of the woods.

RE: Longer term effects of Chocolate Toxicity

Beats — Thu, 16 Apr 2020 19:35:33 GMT

[quote userid="2457" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/29035/longer-term-effects-of-chocolate-toxicity/221800"]hat is the half life? I thought it was just a few hours?[/quote]

There is entero-hepatic recycling (excreted in bile, reabsorbed in guts). To that end, given the clinical signs (consistent I think with theobromine toxicity?) and the large amount of chocolate ingested, then I think some activated charcoal should still be a consideration?

EDIT - half life theobromine is 17.5hours according to: https://aspcapro.org/sites/pro/files/m-toxbrief_0201_0.pdf

RE: Longer term effects of Chocolate Toxicity

Beats — Thu, 16 Apr 2020 19:34:53 GMT

First thing to do if not done already is check urine under microscope - both to check if the red colour is from red bood cells or haemoglobinuria/myoglobinuria (rare in my experience, but would lead me to very different conclusions if was the case) and if is rbcs then check for wbcs and bacteria. If no microscope or no centrifuge, can leave sitting for an hour or two in an upright 1ml syringe and see if the red colour sediments out.

I'm assuming is not a female entire dog. If is I always stick the scanner on to check not a pyometra as the occasional one can have a profuse bloody discharge given false impression of "muddy" haematuria.

The HGB being high in blood means nothing to me in absence of PCV (manual, not machine calculated) and TP.

I have personally only seen one dog die of chocolate toxicity. I didn't see it die actually as it died on route to the clinic. The vast majority of dogs only get GI signs; there appears to be an individual sensitivity and therefore the wide reported fatal dose range.

I would suggest that if cost is a concern, then cystaid is a waste of money.

Personally, I strongly suspect that in this case this could be a toxic effect of the theobromine with hemoglobinuria/myoglbinuria, but I'd like to check out other possibilities also. Definitely not eaten rat poison for instance?

My main supportive care if think toxic rather than UTI etc would be cerenia injection and fluids based on needs. I'm assuming the patient is anorexic, but a question I always like answered from client is to drill down on when was the last time that the dog ate anything at all. If it will take oral water happily and is thirsty, then parenteral fluids may add no benefit. If the dog has a skin tent or is adipsic/anorexic for 24hours or more etc, then I'd give SC fluids (nothing magical about giving into a vein) if that is a cheaper option for you and reassess tomorrow. Gastroprotectants (while can never hurt) would not be a high priority for me. Beta-blockers sounds rational, but would again not be a high priority for me as I'm unconvinced how much benefit this will be. Some nutrition would be a higher priority than both. If I wasn't checking hte urine for a UTI (I can't imagine why I wouldn't though) then I'd give some amoxicillin also - I assume was normothermic on examination?

I treat pancreatitis / GI upsets in a generally similar fashion.

My final thought is this is a rare case where if running bloods I might ideally wish to include a CK slide.

Final extra thought: check no access to amphetamines (e.g. children in house on medicines etc).

RE: Longer term effects of Chocolate Toxicity

Gillian Mostyn — Thu, 16 Apr 2020 17:35:03 GMT

TBH I'd not be particularly worried about the theobromine. If it was going to kill the dog, wouldn't it be dead by now? What is the half life? I thought it was just a few hours?

At this stage my concern would be GI issues and pancreatitis from the sugar and fat.

Or the chocolate could just be a red herring???