The Art of Decontamination

In this article, Megan Brashear, CVT, VTS(ECC), outlines various ways to decontaminate patients and when in the course of treatment each method may be used.

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As long as there are Labrador Retrievers (and like-minded dogs) in this world the veterinary profession will have to deal with toxin ingestions. While identification and treatment of these toxin ingestions are often vital to survival nothing is more important in the treatment plan then decontaminating the patient.  

VOMITING: Vomit induction is often the first line of defense in animals that have recently ingested a toxin. While there are various methods used to induce vomiting patient safety should be a top priority. I have heard some interesting methods from owners (table salt, vinegar, cotton balls, etc. Yes really, cotton balls!), but coming in to the hospital for the pet to vomit in a controlled environment is the best option. While many owners would prefer to give hydrogen peroxide at home, this is not the best idea. Hydrogen peroxide doesn’t always work and then the dog is left with an uncomfortable foamy stomach and still has the toxin. Owners often don’t know how much to give, and a struggling pet could aspirate the hydrogen peroxide. Rarely the wrong concentration of hydrogen peroxide can be administered and the effects are dramatic. One owner gave salon strength hydrogen peroxide to her poodle and his tongue literally sloughed off. Most veterinary practices are giving dogs apomorphine (either as a tablet in the conjuntival sack or as an IV injection). This method is fast, it almost always works, and the effects wear off (especially if using the IV concentration). Cats cannot be given apomorphine and unfortunately, there aren’t any fail-safe medications to induce vomiting in cats. Sometimes xylazine works, sometimes an opioid (like hydromorphone) injection IM will do the trick; we’ve even tried a bolus of cefazolin IV. Whatever the method, if the toxin was recently ingested the first step should be vomit induction.

Enema bag

ENEMA: Many animals ingest toxins when no one is watching them and start to show clinical signs before treatment is started. These patients may have already moved the toxin through their stomach and into their intestines and vomiting won’t be effective. With these patients, never underestimate the power of a good enema! Administering a warm water enema will not only clean out the colon, but multiple enemas administered over time will continue to prevent further toxin absorption. We will often instill multiple liters of warm water during our decontamination enemas until the water is coming back out clear. These patients are often quite sedate and the enema is performed over a grated sink, but we have also taken patients outside and administered large quantity enemas on alert patients. As mentioned before, this may need to be done multiple times as waste moves through the GI tract. A good series of enemas can dramatically shorten the hospital stay for an animal showing signs of toxicity.

Orogasrtric lavage

GASTRIC LAVAGE: Some patients are so debilitated by the toxin they have ingested that it isn’t safe to induce vomiting. There is also a small population that will not vomit even after apomorphine administration. These patients are candidates for gastric lavage. Gastric lavage is performed under general anesthesia and requires some special equipment. The patient needs to be intubated to protect the airway, an orogastric tube is passed, and water is pumped in and out of the stomach until the stomach is empty of contents. This procedure is not without risk, but the benefit to the patient is great when the lavage is successful. Some patients will have a gastric lavage and multiple enemas performed to ensure total decontamination.

Administering charcoal

ACTIVATED CHARCOAL: Never a technician favorite, activated charcoal is also an important decontamination step. Activated charcoal is made up of very small very porous pieces of charcoal that absorb most toxins and allow them to pass through the body without being absorbed. Some activated charcoal contains sorbitol which is a cathartic to propel the toxin through the GI tract faster for quicker elimination. Charcoal can be administered orally to an awake patient (sometimes they’ll even eat it from a bowl with a little canned food ‘frosting’), via the orogastric tube to an anesthetized patient after gastric lavage, or rectally after a cleansing enema. Multiple doses of charcoal are often required for the first 24 hours after toxin ingestion. 

Fast action is important when a toxin is ingested and many of these animals will require hospitalization to treat the symptoms of many toxins, but a thorough decontamination protocol can lessen the severity of clinical signs and lessen the hospitalization time required.

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Megan Brashear's picture

Thanks Emily! I can't take credit for the initial idea but it sure helps in the process!

Amanda Cope's picture

I was discussing decontaminating with a Dr. at our er and we wanted to know what are enemas best recommended for (i.e thc,chocolate or other ingestion), we have not had any issues with our normal protocol of emesis, fluids,cerenia and charcoal. Thanks!

Megan Brashear's picture

Amanda, we will use enemas with any toxin that has made it past the stomach and the patient is experiencing clinical signs. Our main ones are marijuana and slug bait (metaldehyde) but we'll do it with chocolate, medications, anything where the patient is clinical. Especially with the tremorogenic toxins we see a dramatic difference after serial enemas.

Ashley Edlefsen's picture

I agree with the placement of the gown! Genius! Great article thank you :D