Renal failure after raisin ingestion?

RE: Renal failure after raisin ingestion?

Miriam Lodewyks — Tue, 01 Feb 2022 21:37:45 GMT

I grew up in a warm climate where we had a huge sprawling grapevine in the garden. Our faithful labrador would spend many many happy hours snuffling about underneath that vine, hoovering up each and every morsel of grape she could find. She lived to a ripe old age of 16.

Now I know that n=1 does not a conclusion make but, that combined with 23 years in practice and not seeing a single one of these… does leave me in the “sceptics” group.

RE: Renal failure after raisin ingestion?

Peter Rushton-Taylor — Tue, 01 Feb 2022 14:32:19 GMT

Having been in the game for 40 years similarly sceptical. Especially as about 35 years my much loved labrador ate the entire uncooked christmas cake mixture - at least 2-3Kg, I had not hear of grape toxicity in those days. Only untoward effect was an unsteady gait for a few hours as my wife had already added the brandy. For what it's worth, I tell owners that a few dogs might develop ARF ao if they phone soon after ingestion I offer immediate emesis. Don't routinely offer bloods or fluid therapy. Must be me getting old but putting animals on IVFT seems to be a reflex action rather than a carefully considered treatment option for all sorts of things !

RE: Renal failure after raisin ingestion?

George Cooper — Sat, 29 Jan 2022 00:45:17 GMT

Mel?? You?? A”sceptic”????

well well well!!

PS - “hi” from Hereford!

RE: Renal failure after raisin ingestion?

mel kavanagh — Fri, 28 Jan 2022 23:42:54 GMT

Wow! and i thought itwas only me that was unconvinced about grape poisoning. I've been in the game for over 30 years and really can't remember it being a topic even maybe 10 years ago. Not all dogs affected, toxin unknown, dose unknown !! Sounds ludicrous really but it took a long tme to prove smoking causes cancer so maybe early days? What I find most curious is why the average dog owner would even consider that their dog eating a few grapes or a mince pie was potentially toxic to their dog in the first place. Really good to see some rational scepticism on this site. Well done to the initiator of this post.

RE: Renal failure after raisin ingestion?

Bob Russell — Fri, 28 Jan 2022 10:50:28 GMT

Poisons book just says ensure adequate hydration which is not really a paraphrase for ivft.

I give tiny doses of apomorphine i/v or s/c depending on the product. A few drops i/v seems to get them vomiting. Smaller doses may just take a bit longer?

I really struggle with these because we know the vast majority will be fine. I don't like leaving the decision up to the owner because they are not qualified to make the best decision. I do ask the depth of their pockets because this tends to rule out the most extreme options.

I will sometimes advise them what I would do if it was my pet. Default position for recent ingestion would be inducing vomiting if safe to do so.

RE: Renal failure after raisin ingestion?

Clive Ansell — Fri, 28 Jan 2022 10:48:04 GMT

[quote userid="13609" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30147/renal-failure-after-raisin-ingestion/235467#235467"]my impression is a lot of vets don't really check how much per kg dog been ingested and check if it actually is a toxic dose. Most dogs I see with ingested chocolate are well below the toxic dose[/quote]

I always ask and calculate the dose ingested where posible, but often clients don't know or are unsure. If below the toxic thresehold, that is what I tell the client, some still choose to induce emesis though - given them the information to make an informed choice.

I had one 2 weeks ago that had ingested 10 times the toxic dose of rat poison, unable to vomit because on cerenia for ongoing vomiting related to campylobacter from raw chicken diet. Declined GA for gastric lavage. Home on charcoal and vit K . so far fine as far as we know, but not returned for follow up. Recently tested positive for lungworm too - so looking out for coagulopathy if they ever return for a recheck.

RE: Renal failure after raisin ingestion?

Andreas Ege — Fri, 28 Jan 2022 09:58:25 GMT

[quote userid="8958" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30147/renal-failure-after-raisin-ingestion/235406#235406"]

Emedog

Licenced product, so gallons of it in the DD cupboard

The doses are far higher than we used before. I have successfully used it at half dose on bigger dogs, any thoughts folks?

[/quote]

Which is apomorphine.

I agree, I think it needs higher doses and takes longer to have effect than what we had before. I've locumed for a practice where they said they had 2 cases it didn't work at all, though not seen it myself yet. To compensate, it's more expensive, unless it's a fairly small dog.

Never tried conjunctives though one of my previous bosses did for a while (before emedog) and stopped it again because she didn't see any benefits over subcut.

[quote userid="10813" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30147/renal-failure-after-raisin-ingestion/235424#235424"]I think this whole poisoning thing (chocolate, chewing gum, raisins) is driven by the OOH centres creating work and like Pandora’s box can’t now be put back in. [/quote]

I think it's rather a case of defensive medicine. Chocolate toxicity certainly exists, I've seen one case that had been critical for a couple of days. I've seen this behaviour both in OOH centres and privat practices, even with chocolate ingestion that was clearly below toxic range.

Which, I think is another problem - my impression is a lot of vets don't really check how much per kg dog been ingested and check if it actually is a toxic dose. Most dogs I see with ingested chocolate are well below the toxic dose, I've send dogs that had rat poison home without treatment and no problems and as far as I'm aware it needs a really high dose of onions.

Which is another reason I don't quite by into the raisin theory. A poison that's dose independent just doesn't sound like poison. After all "all things are poison, and nothing is without poison; the dosage alone makes it so a thing is not a poison".

RE: Renal failure after raisin ingestion?

Joyce Whitehead — Thu, 27 Jan 2022 22:48:13 GMT

We had a break in some years ago and yes, they took the apomorphine. As well as the safe contents. It gave me great pleasure to imagine them trying it. The police publicised well after, as somulose was also taken, and of course could be very dangerous.

RE: Renal failure after raisin ingestion?

Allison Gleadhill — Thu, 27 Jan 2022 22:37:25 GMT

I have seen a fatal case of onion poisoning (once). The dog had consumed the remains of2 Chinese takeaways that the owner hadn’t eaten & left on the floor as they were ‘ too oniony’. That was & 36h earlier. Was haemoglobinuric due to intravascular haemolysis & developed acute renal failure unresponsive to fluids &. diuretics. At post-mortem I sliced into kidneys & there was an obvious blue hazy line at the corticomedullary junction & on histopath the proximal convoluted tubule cells had vesicles (with haemoglobin) in them ( presumably) Pathologist I discussed it with had seen cases in Australia & thought the pathology typical. So it’s massive haemoglobnuria occurring if haemolysis severe enough that knackers the kidneys and not that the onions are directly nephrotoxic. I think it takes a good amount of onions to be harmful but would give emetics to a dog that had recently eaten any. If it was too late to puke then I would do a pcv to look at haematocrit & colour of serum as a cheap quick & practical prognostic clue. I think I saw this dog too late to do anything constructive.

RE: Renal failure after raisin ingestion?

Clive Ansell — Thu, 27 Jan 2022 22:19:03 GMT

[quote userid="3169" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30147/renal-failure-after-raisin-ingestion/235456#235456"]Genuinely interested if anyone works for an OOH provider - are you told from above via a protocol to offer this extensive treatment, or is it left to individuals?[/quote]

Its 14 years ago, so things have probably changed. Not really with the independents, but with the larger well known chain there were protocols in place they liked you to follow, such as minimum database bloods and blood gases on every admission (Cat bite abscess or before injecting Metacam etc). I was a locum so was not pressured into it, but I gather the permanent staff were to a point. It was encouraged with commission, sorry I meant performance related pay. As I say long time ago.

Not confined to the OOH sector, or to corporates, either!

RE: Renal failure after raisin ingestion?

Michael Woodhouse — Thu, 27 Jan 2022 21:40:34 GMT

Genuinely interested if anyone works for an OOH provider - are you told from above via a protocol to offer this extensive treatment, or is it left to individuals?

My view of the 'emergency and critical care' team at RVC (16 years ago) as a student was they were very keen on putting their pants on outside of their trousers whilst seeing a lot of mundane basic OOH cases than any of us could have dealt with for vastly less money.....

RE: Renal failure after raisin ingestion?

Clive Ansell — Thu, 27 Jan 2022 21:14:45 GMT

[quote userid="7269" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30147/renal-failure-after-raisin-ingestion/235446#235446"]My knowledge of onion poisoning was that it needed to be consumption regularly over a series of days (this was from cpd a few years ago). I certainly wouldn’t even induce vomiting in those circumstances and I’m not sure what ivft is mean to help with, I thought it caused Heinz body anaemia? [/quote]

Thats was my understanding too, but when the report from the OOH provider came through mentioning monitoring of renal values, I had to go and check - as you say Heinz body anaemia, and hepatotoxicity, not renal. Can't see the logic of IVFT either.

RE: Renal failure after raisin ingestion?

George Cooper — Thu, 27 Jan 2022 18:28:21 GMT

Far far more likely that the opportunistic dog in the region of a BBQ would have consumed SO MUCH more than would be desirable of the fats dripping from the cookery , resulting in an *explosive* gut reaction!

personal experience that curtailed a Mull adventure colours responses to this thread!!

RE: Renal failure after raisin ingestion?

Lucy Fleming — Thu, 27 Jan 2022 18:19:54 GMT

It does - if anything whacking on IVFT and diluting the remaining RBCs might be the opposite of the right thing to do? I don't think i've ever considered an onion ingestion an emergency. If a dog ploughed into a bucket of onions cooked up for a barbecue at a village fete, maybe some apo might be indicated...

I've heard apocryphal stories about break-ins at vet clinics where the apomorphine has been pinched by drug seekers..

RE: Renal failure after raisin ingestion?

Thomas Johnson — Thu, 27 Jan 2022 17:36:24 GMT

[quote userid="8958" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30147/renal-failure-after-raisin-ingestion/235406#235406"]gallons of it in the DD cupboard[/quote]

Despite having morphine in its name apomorphine is not a controlled drug, there is no need to keep it in the Controlled Drugs Cabinet.

RE: Renal failure after raisin ingestion?

Joyce Whitehead — Thu, 27 Jan 2022 16:09:06 GMT

My knowledge of onion poisoning was that it needed to be consumption regularly over a series of days (this was from cpd a few years ago). I certainly wouldn’t even induce vomiting in those circumstances and I’m not sure what ivft is mean to help with, I thought it caused Heinz body anaemia?

RE: Renal failure after raisin ingestion?

Clive Ansell — Thu, 27 Jan 2022 10:26:04 GMT

Thats partly my take on it too. A cynic could argue its a real Arthur Daley style "nice little earner"

Last weekend, a client with a 3 month labradoodle puppy that had chewed a small amount of onion attended local OOH clinic. Emesis induced within 30 minute of ingestion, no onion as probably spiited out anyway. Bloods all normal. Adv and quoted £1500 for 48 hours "intensive care and IVFT" and repeat bloods every 24 hours. Owners declined the IVFT because they cannot afford it.

Saw the puppy yesterday, all fine normal EDDU. Owners requested follow up bloods which were all normal. Discharged.

Even if the puppy had been on fluids, it would only have needed babysitting, the occasional check, it was NAD on c/e.

RE: Renal failure after raisin ingestion?

Neil Wheadon — Thu, 27 Jan 2022 09:48:33 GMT

Subject of various discussion on a Vet ECC facebook group (USA biaised)

Acute Renal Failure in Dogs After the Ingestion of Grapes or Raisins: A Retrospective Evaluation of 43 Dogs (1992–2002)

A review of records from the AnTox database of the American Society for the Prevention of Cruelty to Animals Animal Poison Control Center identified 43 dogs that developed increased blood urea nitrogen concentration, serum creatinine concentration, or both as well as clinical signs after ingesting grapes, raisins, or both. Clinical findings, laboratory findings, histopathological findings, treatments performed, and outcome were evaluated. All dogs vomited, and lethargy, anorexia, and diarrhea were other common clinical signs. Decreased urine output, ataxia, or weakness were associated with a negative outcome. High calcium × phosphorus product (Ca × P), hyperphosphatemia, and hypercalcemia were present in 95%, 90%, and 62% of the dogs in which these variables were evaluated. Extremely high initial total calcium concentration, peak total calcium concentration, initial Ca × P, and peak Ca × P were negative prognostic indicators. Proximal renal tubular necrosis was the most consistent finding in dogs for which histopathology was evaluated. Fifty-three percent of the 43 dogs survived, with 15 of these 23 having a complete resolution of clinical signs and azotemia. Although the mechanism of renal injury from grapes and raisins remains unclear, the findings of this study contribute to an understanding of the clinical course of acute renal failure that can occur after ingestion of grapes or raisins in dogs.

https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1939-1676.2005.tb02744.x?fbclid=IwAR3S1QliEK2wPinxXJyTOGNEkBGF92fRZickX3A0GC4ybUeI43MX6IpLX8Q

Retrospective evaluation of the clinical course and outcome following grape or raisin ingestion in dogs (2005–2014): 139 cases

Measurements and Main Results

Among dogs with biochemical data, the prevalence of AKI was 6.7% (8/120). The prevalence of AKI in the early presentation (3/67) and late (5/53) presentation groups were 4.5% and 9%, respectively. The prevalence of AKI was not significantly different between groups (P = 0.27). Four dogs (3.3%) were azotemic at presentation and 4 dogs (3.3%) had increases in creatinine of ≥26.5 µmol/L (0.3 mg/dL) at recheck (3 from the early and 1 from the late group). Vomiting was the most common clinical sign (18/139). One hundred twenty-two dogs (88%) underwent gastrointestinal decontamination and significantly more dogs in the early group were decontaminated (P < 0.0001). Two dogs received continuous renal replacement therapy. One hundred thirty-eight dogs survived and 1 died.

Conclusions

The prevalence of AKI and mortality was low in dogs with confirmed grape or raisin ingestion. Due to the retrospective nature of the study, conclusions about the utility of gastrointestinal decontamination and other therapies cannot be made.

https://onlinelibrary.wiley.com/doi/full/10.1111/vec.12905?fbclid=IwAR3S1QliEK2wPinxXJyTOGNEkBGF92fRZickX3A0GC4ybUeI43MX6IpLX8Q

Couple of 'selected' comments

Very few studies out there and those that exist involve very small numbers over long time periods (such as those above) with basically no conclusions. Nobody seems to know anything. I

The neurologist I work for claims his buddy has isolated the gene in canines that is responsible for their intolerance, and that not all dogs have this gene.

However he’s currently working on publishing his findings.

AND THE REPLY

I'd love to see a test for this intolerance. Treating all of these in the ER is exhausting and expensive for owners when it's all a "maybe" and "we're not sure" conversation.

There you go

Neil

RE: Renal failure after raisin ingestion?

David Shepherd — Thu, 27 Jan 2022 08:57:23 GMT

[quote userid="2792" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30147/renal-failure-after-raisin-ingestion/235415#235415"]It's a difficult one to discuss with clients would be teally interesting if someone could collate actual cases in the uk![/quote]

I’m not sure there are any! When I looked at it a few years ago I could only find a report from USA of (I think) around 4/5 cases and the aetiology was opaque to say the least. I think this whole poisoning thing (chocolate, chewing gum, raisins) is driven by the OOH centres creating work and like Pandora’s box can’t now be put back in.
Call me old and cynical

RE: Renal failure after raisin ingestion?

Claire Godfrey — Wed, 26 Jan 2022 17:21:14 GMT

I have never seen a case or known anyone that has personally.

My own dog ate 3 mince pies, only found out 3 days later when found the cases under the sofa. He also did hoover everything the childrens dropped including grapes and raisins. I didn't encourage him to eat them but just not panic if he did. Never made him sick but did seem to have a stomach of steel.

It's a difficult one to discuss with clients would be teally interesting if someone could collate actual cases in the uk!

RE: Renal failure after raisin ingestion?

Beats — Wed, 26 Jan 2022 13:19:02 GMT

[quote userid="8958" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30147/renal-failure-after-raisin-ingestion/235406#235406"]

Julian Earl said:
What emetic do eople use now? Still Apomorphine or A.N.Other compound?

Emedog

Licenced product, so gallons of it in the DD cupboard

The doses are far higher than we used before.

[/quote]

Give it iv at lower dose until you use your supply up, then get the more concentrated stuff instead which works fast SC.

RE: Renal failure after raisin ingestion?

Neil Wheadon — Wed, 26 Jan 2022 12:43:01 GMT

[quote userid="3094" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30147/renal-failure-after-raisin-ingestion/235405#235405"]What emetic do eople use now? Still Apomorphine or A.N.Other compound?[/quote]

Emedog

Licenced product, so gallons of it in the DD cupboard

The doses are far higher than we used before. I have successfully used it at half dose on bigger dogs, any thoughts folks?

Anyone tried this in the conjunctiva?

Neil

RE: Renal failure after raisin ingestion?

Julian Earl — Wed, 26 Jan 2022 11:39:38 GMT

Justa general comment...: What a fabulous thread?! The real essence of vetsugeon.org! An interesting topc that many people are clearly aware of bt not nrecessarily seen many or even any cases but still generating very useful therapeutic advive and discussuion thereof! Such as me; Ihad not knowingly seen a case and out of practice now never will! Though I still get asked for advice about friend's dogs and other pets and on principle like to keep my damaged brain active and as up to date as possible! Now if anyone mentions how their Labrador stole the Christmas cake have a clearer idea of what to tell them! get him/her to the vet now as it could be very serious left unattended? Would that do please? Thanks

I don't think my cat would eat raisins! Even he, "Wiggo"**, has his limits!!

What emetic do eople use now? Still Apomorphine or A.N.Other compound?

Cheers everybody. You al deserve brownie points for enlightening me for a start!

Everyone stay safe and well!!

** So-named in 2013 because he is ginger and white looking like ginger sideburns a la Sir Bradley Wiggins, so there was only onen ame that I consdered when we collected him on my day of discharge from hospital in November/ December 2012! Much to the horror of the physioherapists! Me, very, very nsteady with my head injury getting a new kitten!!? But he has accompanied my recovery in every lovely way ever since!!

RE: Renal failure after raisin ingestion?

Lucy Fleming — Fri, 21 Jan 2022 18:23:24 GMT

[quote userid="3169" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30147/renal-failure-after-raisin-ingestion/235330#235330"]

Lucy Fleming said:
whenever my own dog's snaffled anything with raisins in it I have made her vomit them back up.

With my own dogs I never have bothered to make sick. It's been a dropped stray grape or a bit of a mince pie, not a kilo bag of raisins.

[/quote]

Ironically, mine's in stage 3 CKD, so there's a confounding factor for you! (it is definitely entirely unrelated to her eating some welsh cakes several years ago...)

RE: Renal failure after raisin ingestion?

Arlo Guthrie — Fri, 21 Jan 2022 13:58:48 GMT

[quote userid="2122" url="~/001/veterinary-clinical/small-animal/emergency-critical-care/f/discussions/30147/renal-failure-after-raisin-ingestion/235336#235336"]'And who is invariably guilty of such posts... ... ... ...' [/quote]

Hahahaha. Laughed out loud. I know. Try not to these days.