30/11/2024
💥 𝑪𝒉𝒐𝒄𝒐𝒍𝒂𝒕𝒆 𝑻𝒐𝒙𝒊𝒄𝒐𝒔𝒊𝒔 𝒊𝒏 𝑪𝒂𝒕𝒔 𝒂𝒏𝒅 𝑫𝒐𝒈𝒔.
Chocolate toxicosis in pets, particularly in cats and dogs, is a serious condition caused by ingestion of methylxanthine compounds found in chocolate.
🔴Etiology:
👉Chocolate is toxic due to theobromine and caffeine.
👉Toxicity depends on the type of chocolate:
👉Baker’s chocolate: ~450 mg/oz theobromine.
👉Milk chocolate: ~64 mg/oz.
👉White chocolate: Negligible.
🔴Pathogenesis:
Theobromine and caffeine inhibit adenosine receptors, leading to CNS stimulation and cardiovascular effects.
Both are absorbed in the GI tract and metabolized by the liver, with a long half-life, especially in dogs.
Pathogenesis Explaination:
Theobromine and caffeine work by blocking adenosine receptors in the body. Adenosine normally makes you feel calm and relaxed, so blocking it leads to increased alertness and stimulation of the central nervous system (CNS). This also affects the heart, increasing heart rate and blood pressure.
Both substances are absorbed in the digestive system and broken down by the liver. However, they stay in the body longer in some animals, especially dogs, because their livers process these substances more slowly. This is why even small amounts of chocolate (which contains theobromine) or caffeine can be dangerous for dogs.
🔴Clinical Signs:
👉Initial signs within 6–12 hours: Vomiting, diarrhea, restlessness.
👉Progression: Tachycardia, tremors, seizures, hyperthermia.
👉Severe cases can result in cardiac arrhythmias or death.
🔴Diagnosis:
👉Based on history of ingestion and presenting signs. Other toxicities to consider include amphetamines and stibilization
🔴Treatment:
👉Initial Assessment and Stabilization-
If ingestion occurred within the last 2-4 hours, induce emesis with Apomorphine (0.03 mg/kg IV or 0.04 mg/kg IM) in dogs, or Xylazine (0.44 mg/kg IM) in cats.
👉Administer activated charcoal (1-by4 g/kg) orally to reduce further absorption. Repeated doses every 4-6 hours can be considered due to enterohepatic recirculation of theobromine and caffeine.
👉Control of CNS Excitation and Seizures
👉Diazepam (0.5-1 mg/kg IV) is the first-line treatment for mild agitation or tremors.
👉Phenobarbital (2-3 mg/kg IV, repeated as necessary) can be used for more severe seizures.
👉For refractory seizures, Propofol (1-6 mg/kg IV bolus followed by 0.1-0.6 mg/kg/min IV infusion) is effective.
👉Tachycardia and Arrhythmias:
👉Propranolol (0.02-0.06 mg/kg IV) or
👉Esmolol (0.5 mg/kg IV loading dose followed by 50-200 µg/kg/min infusion) for persistent tachyarrhythmias.
👉Lidocaine (1-2 mg/kg IV bolus, followed by 20-50 µg/kg/min infusion) can be used for ventricular arrhythmias in dogs.
👉Blood Pressure Management:
👉Monitor for hypotension and treat with fluid therapy (e.g., Lactated Ringer’s solution) at 10-20 ml/kg bolus, repeated as needed.
👉Gastrointestinal Support
👉Administer antiemetics such as Maropitant (Cerenia) at 1 mg/kg SC or IV to prevent further vomiting and reduce nausea.
👉Proton pump inhibitors like Omeprazole (0.5-1 mg/kg PO once daily) or H2 blockers such as Famotidine (0.5-1 mg/kg IV/SC) may be used to protect against gastric ulceration.
👉Fluid Therapy and Monitoring
👉Intravenous Fluids: Begin with isotonic crystalloids (e.g., 0.9% saline) to maintain hydration and promote diuresis, especially if renal compromise is a concern.
👉Monitor urine output and electrolyte levels regularly, correcting abnormalities such as hypokalemia with potassium supplementation as needed.
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