What Went In Must Come Out
From chocolate, raisins and nuts to rat bait, household cleaners and poisonous backyard mushrooms, different substances can all have varying levels of toxicity in your dog. Depending on what your dog consumed, your veterinarian may want him to vomit the ingested substance as soon as possible in an attempt to avert detrimental effects. Vomiting within 2 to 3 hours after ingestion of the toxin is the ideal time frame to ensure the most favorable outcome. Veterinarians have several options in their drug cabinets to make this happen. These drugs that induce vomiting, called emetics, usually evacuate 40 to 60 percent of the stomach contents. One of the methods used to induce vomiting in dogs is the administration of an opiate drug called apomorphine.
Apomorphine is the emetic of choice among many veterinarians for use in dogs. It works by directly stimulating the receptors of the central nervous system to induce vomiting. Apomorphine can be injected intravenously or subcutaneously. It can also be administered orally, and another option is topical application to the conjunctiva of the eye. The intravenous route yields the most rapid response, but any route should result in vomiting within 5 to 20 minutes. The induction effect lasts for approximately 30 minutes. Unless your dog has consumed food within the two hours prior to his veterinary visit, he will likely be fed a small meal prior to administering the apomorphine to help facilitate the desired result.
Many of the other drugs traditionally used to induce vomiting carry the potential for some adverse side effects. Ipecac syrup can result in cardiotoxicity, and xylazine can lead to central nervous system depression and a drop in blood pressure. Since apomorphine acts on the central nervous system, depression of such can also occur with this drug. Other effects may include excitement or lethargy, prolonged nausea, compromised muscle coordination and reduced respiratory rate. These effects occur more commonly when apomorphine in administered intravenously, but they are seen in less than 20 percent of dogs treated with apomorphine. An injection of another drug, called naloxone, can reverse any severe effects that are observed.
Efficacy of Inducing Vomiting in Dogs
Inducing vomiting will help minimize the effects of ingestion of a toxic or harmful substance. For the treatment to be useful it must be administered within 2-4 hours of ingestion. Antiemetics only remove about 40 to 60 perent of the stomachs contents, therefore while this is a useful emergency intervention to reduce the effect of a harmful substance being injested, further intervention by a veterinarian will be required. If conditions exist that preclude inducing vomiting, gastric lavage may be another treatment option.
Recovery from induced vomiting will depend on what substance was induced, its toxicity level, timing of intervention, and how successful the treatment was.
Apomorphine can cause central nervous system side effects such as excitement or depression. Dehydration can result if vomiting is prolonged. Your dog may require supportive treatment during recovery for central nervous system (CNS) symptoms, dehydration, or organ damage caused by toxicity. A special diet may be recommended by your veterinarian to provide organ support and restore electrolyte balance to your dog. You should monitor your dog for any concerning symptoms and report them to your veterinarian.
Cost of Inducing Vomiting in Dogs
Treatment for inducing vomiting in your dog can vary widely. Depending on your location, inducing vomiting in your dog can range in cost from $300 to $500. Additional costs associated with treatment of ingestion, e.g. activated charcoal, medications, hospitalization and supportive therapy can range up to $5,000, depending on the severity of your pet’s condition and treatments required.
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Treatment is only effective shortly after ingestion, usually within 2 hours. CNS stimulation or depression is a side effect of apomorphine and dehydration from vomiting is a risk. Both of these side effects can receive supportive treatment from your veterinarian.
Side effects of peroxide can include stomach upset, ulceration, or peroxide-induced brain inflammation.
Animals that are at an increased danger of aspiration have an increased associated risk with emesis treatment of aspiration pneumonia. Dogs with laryngeal paralysis, megaesophagus, upper airway disease, and brachycephalic syndrome may be at increased risk for aspiration during vomiting and treatment with an alternative therapy such as gastric lavage may be considered.
If your dog is already showing signs of toxicity that include central nervous system symptoms, they are at an increased risk for aspiration, and as absorption of toxins has already occurred emesis may not be particularly effective.
Be sure to provide your veterinarian with information regarding any medications or conditions your dog has so they can determine the appropriateness of this treatment.
Dogs are curious creatures. Removing toxic and harmful substances from your dogs environment so they are not apt to sample them or accidentally ingest them will prevent accidental poisonings or ingestions, and eliminate the need to induce vomiting in your dog. Be sure to identify all house and garden plants and check to see if they are toxic to your dog. Many common household and garden plant are not safe for dogs. Avoid giving human food to your dog unless you have checked whether they are appropriate for dogs. Many human foods such as grapes, chocolate, and citrus fruits are toxic to dogs. Remove small choking hazards from your dogs environment and keep all toxic substances such as household cleaners inaccessible to your pets. These precautions will also make your home safer for visitors with children or other pets.
Giving Apomorphine – dog vomits
Emetics can play a key role in the prevention of clinical signs in dogs and cats who have had oral exposures to toxins. These tips will help you know what emetics may work best for you. (And be sure to read this companion article on when NOT to induce emesis!)
Typically, apomorphine and hydrogen peroxide are the emetics of choice with dogs. Published data shows that about 94% of dogs vomit after apomorphine administration and about 90% of dogs vomit after hydrogen peroxide administration. Percentage of the toxin recovered and time to onset of emesis were very similar with both emetics.
Cons: Has to be done at a vet hospital and if the owner is far away the delay can be too long for emesis to be effective; can significantly worsen CNS depression, if the agent is likely to cause those signs. (Note: Naloxone will reverse the depressive effects of the apomorphine without reversing the emetic effects, so it can be safely given if depression is seen.)
Cons: Can cause gastritis; can potentially cause GI ulceration or air embolus, if overdosed; pet needs to be walked for the peroxide to have maximum effectiveness.
Generally see vomiting within five minutes that tends not to be prolonged. Xylazine can cause CNS or respiratory depression, but this can be reversed with Antisedan.
Like xylazine, emesis with dexmedetomidine tends to occur within quickly and is not prolonged. It may be more effective than xylazine. CNS or respiratory depression are still a concern but they can be reversed with atipamizole (AntisedanTM) or yohimbine.
A combination of midazolam and hydromorphone may be good choice, particularly in feline patients who are elderly or having underlying cardiovascular disease. Not only are they easier on the cardiovascular system than xylazine and dexmedetomadine, they are both reversible if needed.
Typically not recommended as it is not likely to be effective, due to species differences between dogs and cats. The dogs chemoreceptor trigger zone (CRTZ) is controlled largely by dopamine receptors, so apomorphine typically induces emesis. However, the CRTZ in the cat has alpha 2 receptors, so xylazine or dexmedetomadine typically produces a better response.
Like apomorphine, hydrogen peroxide is generally not advised in feline patients because it is not highly effective at making them vomit in a timely manner and cats are more prone to develop gastritis or even hemorrhagic gastritis from hydrogen peroxide than dogs are.
The ASPCAs Animal Poison Control Center has a host of publications to help you in treating animals, as well as a monthly newsletter with the latest research, helpful hints, and training opportunities.