Your job, as the vet tech, is to triage the client’s concern and determine whether the pet needs veterinary care. In some cases, it will be obvious that the client’s concern is unfounded and the item that the pet ate does not pose a risk. In other cases, however, the correct solution will not be so clear.
When in doubt, you can always ask the veterinarian for a recommendation.
However, these 5 tips may increase your ability to be a resource to your clients.
Talk to your hospital leadership about your practice’s plan for handling toxicity cases. Ensure that you have all the supplies you will need to treat common toxicities, and be comfortable with your practice’s protocols regarding toxicities.
Determine whether there are any toxicities that you will refer elsewhere, or whether you will always provide initial treatment at your hospital during business hours. Consider your practice’s capabilities. If your practice does not have any apomorphine in stock, for example, you may want to refer cases requiring emesis to a local emergency hospital. If you do not have N-acetylcysteine at your hospital, cats who have ingested acetaminophen may need to be referred elsewhere. Having protocols established in advance can save time when a client calls with a toxin-related concern.
As a new grad veterinarian, I often found myself spending significant amounts of time researching potential toxin ingestions… at no charge. Often, this occurred when a client called to ask about some pest control product their pet has ingested. I would spend 5 minutes Googling the product to determine which ingredients it might contain, then another 10-15 minutes researching whether those ingredients are toxic in their pet’s species. Unfortunately, that “quick little task” meant that I was taking 15-20 minutes of my time away from patients that were already in the hospital!
Unless you can answer these questions easily or with minimal research, consider referring clients to a trusted poison control source. The ASPCA Animal Poison Control Hotline and Pet Poison Helpline both exist solely for the purpose of assisting with potential toxicity cases. For a small fee, clients can call these hotlines and determine whether their pet requires veterinary care. If the pet does need care, the client will be given a case number. The veterinary team that treats the pet can contact the poison control source the client utilized, provide the pet’s case number, and receive expert guidance on decontamination and treatment. This ensures that the pet is receiving the best possible quality care.
When a client suspects that their pet is at risk of a toxicity, they often immediately want to induce vomiting. They might call the veterinary clinic solely to ask what dose of hydrogen peroxide they should give their pet because they have heard that is an appropriate way to induce emesis. Avoid the reflexive tendency to answer this question without gathering more information!
While hydrogen peroxide can be used to induce emesis, it is rarely the best option. Cats are especially susceptible to the esophagitis and gastritis that can be caused by hydrogen peroxide, so it should never be used in cats. Even dogs can develop significant hematemesis following emesis with hydrogen peroxide, though, so apomorphine is typically regarded as a better option.
Additionally, emesis is not appropriate for all toxin ingestions. Caustic and corrosive substances, for example, can cause significant damage coming back up the esophagus, so they are rarely treated with emesis. Pets with cardiac or respiratory disease may also be poor candidates for emesis, due to the risks of aspiration pneumonia and the stress that vomiting can place on the body. Therefore, it’s important to not recommend emesis without first consulting a veterinarian.
Many client calls about potential toxicities involve chocolate. It’s important to have a good resource on hand that you can use to help owners determine whether their dog has ingested a potentially problematic dose of chocolate.
Print resources, such as the ASPCA Chocolate Wheel, are convenient to keep at your practice’s front desk or in the treatment area, so they can be utilized by all team members. You can typically pick up a Chocolate Wheel at any major veterinary conference, or contact the ASPCA to request them by mail.
Online calculators are another easy option that can be used by the whole staff. Bookmark a good veterinary calculator website, such as the Merck Veterinary Manual, to provide easy calculator access for your entire team.
If you carry your phone at work, apps can also be very helpful. Apps such as Vetcalculators are designed to allow you to do a variety of calculations on your phone, and many of these apps include a chocolate toxicity calculator. The ASPCA Animal Poison Control Center app, designed for pet owners, also includes a chocolate toxicity calculator. When using any new app, however, it’s important to consider the source carefully. Unless you know that the app was created by a reputable source, be sure to spot-check some of the calculations to ensure that they are accurate.
Lilies are a common source of feline toxicity calls. There are many different types of plants that are commonly referred to as lilies, but not all of them are toxic to cats. True lily species, which induce renal failure, include the Asiatic Lily, Day Lily, Stargazer Lily, Tiger Lily, and Easter Lily. Other lily species, such as Lily of the Valley, Calla Lily, and Peace Lily, do not cause renal failure but can be toxic via other mechanisms. Non-toxic lilies include the Peruvian Lily, Ginger Lily, Sand Lily, Corn Lily, Canna Lily, Mariposa Lily, Resurrection Lily, and Scarborough Lily.
If you’re a plant person, these distinctions may be easy for you to remember. If not, find a helpful website list and bookmark it on the desktop of the computers in your treatment area.
Summary
Your veterinarian can be a helpful resource when dealing with client toxicity concerns, and should always be consulted when you have any doubts about the best recommendation for a pet. However, with a little preparation, you will be able to perform telephone triage on many common toxicity calls, making a recommendation to the client or directing them toward appropriate resources, while allowing the vet to continue treating patients.