NAVLE® Question of the day

MO TU WED TH FR

May 20, 2024

NAVLE

The night after Valentine's day, a male neutered Schnauzer is presented with a combination of hyperactivity, urinary accidents, and diarrhea.

On physical exam there is muscle rigidity and chocolate wrappers visible in the diarrhea. The dog has a seizure on the exam table. An ECG is shown below.

Which one of the following choices is the best treatment plan?

ecg

Value	Normal
T=103.2°F (39.6°C)	99.5-102.5°F (37.2-39.2°C)
HR=184 bpm	60-120
RR=40 brpm	15-34

A - Diazepam, lidocaine drip

B - Ipecac, theophylline, digoxin

C - Apomorphine, gastric lavage, Na-bicarbonate IV

D - Activated charcoal, sodium sulfate, methocarbamol IV

E - Phenobarbital, glycopyrrolate

Sorry. You chose "C - Apomorphine, gastric lavage, Na-bicarbonate IV" but the correct answer is "A - Diazepam, lidocaine drip"

Treat the ventricular tachycardia with a lidocaine drip and address hyperactivity/seizures with diazepam (Valium ®) or methocarbamol. If response to diazepam inadequate, consider barbiturates like phenobarbital (given slowly).

This is a classic presentation of severe chocolate toxicity, due to toxic methylxanthine alkaloids (e.g., theobromine, theophylline, caffeine). Common around Halloween, Christmas, and Valentine's Day holidays, see excitement, seizures, and arrhythmias. This dog's ECG shows ventricular tachycardia (V-tach).

Most chocolate toxicities are milder - hyperactivity, vomiting, urinating, diarrhea.

Decontamination with emesis (induced with apomorphine) can be helpful up to eight hours after exposure in asymptomatic dogs.

If animal is sedated because of seizures, consider gastric lavage. If vomiting is controlled, give activated charcoal (AC) only if the dog ate a lethal dose. Chocolate will increase the risk of hypernatremia from AC, so the benefit must outweigh the risk. If AC is given, monitor for hypernatremia and associated signs (tremor, ataxia, seizures).

Tx arrhythmias depending on type - usually a tachycardia; give LIDOCAINE for V-tach or BETA-BLOCKERS (propranolol/esmolol) for supraventricular tachycardias.

Chocolate toxicity from most toxic to least toxic: cacao beans and baking chocolate are worse than semisweet chocolate which is worse than milk chocolate. 49 grams of baking chocolate (one 2-oz bar) can kill a 7-kg dog. It would take 420 grams of milk chocolate (about eight 2-oz bars) bars to kill a 7-kg dog.

Image courtesy of Dr. Terri DeFrancesco.