Grapes and Raisins
-
Upload
erin-connolly-dvm -
Category
Documents
-
view
30 -
download
0
Transcript of Grapes and Raisins
OverviewSpecific mechanism is unknownNot definitely known to be dose-
related Toxic dose for dogs: 0.7 oz/kg for grapes Toxic dose for dogs: 0.1 oz/kg for raisinsSome dogs may show no adverse
signsReports of cats and ferrets
developing signsSigns have been seen with currant
ingestion
EtiologyMycotoxins or pesticide residuesInability to metabolize a component of the fruitOrganic, homegrown, seedless, seeded
NephrotoxicGrapeseed extract has not been shown to be
toxic
Metabolism
Not rapidly broken down or absorbedMay be seen intact several hours after
ingestionMetabolism and excretion suspected within
kidneys
Signalment and HistoryAny age, sex, and breed of dogPreexisting renal disease is a risk factorWitnessed or suspected ingestionVomiting within 24 hours following
ingestionAnorexia, lethargy, and diarrhea follow
Clinical FindingsPhysical exam: Dehydration, lethargy, uremic
breathElevated creatinine, phosphorus, BUNHypercalcemia and hyperphosphatemia
mineralizationElevated serum calcium levelsDecreased urine outputOliguric or anuric renal failure: -Hyperkalemia, metabolic acidosis, hypertension
Differential DiagnosesARFDrug/toxicities: NSAIDs, AGs, ethylene glycolRenal ischemia: Hypovolemia, trauma,
sepsis/SIRSSystemic: leptospirosis, pyelonephritis, neoplasia
Differential DiagnosesVomitingDietary indiscretion, foreign body, infectious disease, pancreatitis, pancreatitis, Addison’s disease
HypercalcemiaHyperparathyroidism, Cushing’s disease, rodenticide
DiagnosticsCBC
Mild anemiaThrombocytopenia
ChemistryElevated BUN and creatinineElevated liver enzymesElevations in amylase/lipaseDecreased TCO2Electrolyte abnormalities
DiagnosticsUrinalysisIsosthenuria/hyposthenuria, proteinuria, glucosuria
RadiographyGenerally WNL, may appreciate soft tissue mineralization
Abdominal UltrasonographyRenomegaly, hyperechoic renal cortices, pelvic dilation
Pathological FindingsModerate to severe renal tubular necrosisProteinaceous debris within damaged renal tubules Intact basement membranes
DecontaminationEmesisRisk for aspiration pneumoniaActivated charcoalRepeated doses not currently recommended Assess hydration and serum sodium levels
Supportive CareIV fluid therapy for asymptomatic patientsDiuresis preserves renal blood flow, increases
excretionGastric protectants and antiemeticsCritically ill patients may require dialysis
Expected Course and PrognosisPrognosis good to poor depending on clinical
signsPet Poison Hotline: 500 cases between 2004-
2009Overall, prognosis good with aggressive
therapy ASPCA: Poorer prognosis if vomiting for 24-48
hours prior to presentation
Expected Course and PrognosisFor more than 50% of dogs that ingest
grapes or raisins, there will be minimal to no clinical signs
For patients with fulminant ARF, prognosis is poor to grave
Long TermMost will have no long-term renal
insufficiencyLong-term follow-up in veterinary studies
has not been evaluated
“Emma”9-year-old FS Bichon FriseExposure to trail mix containing raisinsDistended abdomen, otherwise normal
afterwardThe next morning, continued abdominal
distension, ataxia, and lethargyNo previous medical problems
Physical ExaminationWt: 8.6 kg, T: 101.7, P: 108, R: 72Quiet and depressed, disoriented, ataxic Abdominal distension with slightly
tympanic stomach, uncomfortable on palpation
Diagnostics and TreatmentAbdominal radiographsInduced emesisVomitus contained large amount of peanuts
and 22 raisinsChemistry/electrolytes: All values WNL
Diagnostics and TreatmentASPCA consulted: -Ataxia is sometimes reported -IV fluid diuresis: 2x maintenance for 48 hours -Recheck chemistry profile in 48 hours -Prognosis good to guarded150 mL bolus LRS, then 40 mL/hr IV60 mL activated charcoal with sorbitol PO
21 hours post-admissionBright and interactive, ataxia resolvedAdequately hydratedAbdomen relaxed and comfortableAte baby food wellUrinating wellChemistry panel: All values WNLTransfer to RDVM for continued care