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CLINICIAN’S NOTEBOOK Managing Pet Bird Toxicoses J.A. RICHARDSON, L.A. MURPHY S.A. KHAN AND C. MEANS

J.A. Richardson, DVM, Dipl ACFE L.A. Murphy, VMD S.A. Khan, DVM, PhD C. Means, DVM ASPCA Animal Poison Control Center 1717 South Philo Road Suite 36 Urbana, Illinois 61802 [email protected]

Jill Richardson received her DVM degree from Tuskegee University in 1994. In 1996, following experience in small animal practices in Tennessee and West Virginia, Dr. Richardson joined the ASPCA Animal Poison Control BIRDS ARE CURIOUS BY NATURE, AND SOME HAZARDOUS OBJECTS Center as a Veterinary Poison may be attractive to them. Birds with free household access are more likely to Information Specialist. be exposed to toxicants.

Sources of Toxicoses Affecting Pet Birds Reported to the APCC*

11% 27% 12% Pesticides Cleaning products Acknowledgements Plants Medicines The authors would like to thank 25% 25% Harold and Joyce Hamilton, Other, including heavy metals Cindy Dorner, Morgan Wilson, and Information collected between January 1996 - December 2000. Dr. Tracei Holder and the entire staff of the Animal Emergency Clinic of Champaign County. *The ASPCA Animal Poison Control Center, an operating division of the American Society for Photos: Tom Schaefges Photography the Prevention of Cruelty to Animals (ASPCA), is the only animal-oriented poison control Sidney, Illinois center in North America. It is a unique, emergency hotline providing 24-hour-a-day, [email protected] 7-day-a-week telephone assistance. The Center’s hotline veterinarians can quickly answer questions about toxic chemicals, dangerous plants, products or substances found in everyday surroundings that can prove poisonous or fatal to animals.

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CLINICIAN’S NOTEBOOK MANAGING PET BIRD TOXICOSES

STEPS IN MANAGING PET BIRD TOXICOSES

START ASSESS THE SITUATION PREVENT ABSORPTION ✖ Is the bird seizuring? Ocular Exposure ✖ Is the bird breathing? ✔ Gently flush eyes with tepid tap water or Table 1. ✖ Is the bird in shock? saline for 20-30 minutes (fig a). Examples of Noxious ✖ Is there evidence of hemorrhage? ✔ Use eyedropper to flush in small birds. Inhalants ✔ Perform fluorescein staining and follow-up ✖ Some nonstick surfaces (irons and exams in cases of exposures to corrosive ironing board covers, pots and pans, agents or if redness, pain or ocular woks, drip pans) discharge occurs. ✖ Gasoline fumes ✖ Smoke (any source) STABILIZE THE BIRD Dermal Exposure ✖ ✖ Automobile exhaust/ Administer oxygen if necessary ✔ Stabilize bird first! carbon monoxide ✖ Control seizures ✔ Do not remove toxicants from feathers if ✖ Self-cleaning ovens ✖ Correct any cardiovascular bird is seriously ill. ✔ With light dermal exposures, wash gently ✖ Insecticide sprays and foggers abnormality with solution of mild liquid dishwashing ✖ Chemical sprays (e.g., disinfectants, detergent (e.g., Dawn®) and warm water, deodorizers, furniture polish) rub gently, then rinse with plain warm ✖ Glues, paints, nail polish water to remove soap. Repeat if needed. ✔ With heavy dermal exposures, a thorough ✖ Ammonia or bleach If stable bath may be indicated. Pat dry, keep warm ✖ Mothballs and monitor for signs of hypothermia. ✖ Burning foods and cooking oils ✔ Because detergent may seep between the Patient Information feather barbs, multiple rinses may be ✖ Fumigants (sulfuryl fluoride, ✔ required (fig b). aluminum phosphide) age ✔ sex ✔ An E-collar may be necessary to prevent ✖ Aerosols ✔ health problems? ingestion of toxicant. ✔ recent abdominal surgeries? Table 2. ✔ currently on medication? Inhalant Exposure Common Cardiotoxic Plants Exposure History ✔ when was the exposure? ✔ Remove bird from source and supply fresh ✖ Lily of the Valley Convallaria majalis ✔ how much was ingested? air immediately! ✖ ✔ Humidify oxygen therapy. Oleander Nerium oleander ✔ when did clinical signs occur? ✔ Provide diuretics for pulmonary edema. ✖ Rhododendron species ✔ Bronchodilators may be helpful. ✖ Yew Taxus species ✔ Give anti-inflammatory drugs* and broad- ✖ Foxglove Digitalis purpurea spectrum antibiotics. b ✔ Provide thermal regulation and nutritional support. ✔ Hydration therapy may be necessary.

*If corticosteroids are indicated, use with extreme a caution in birds to avoid adverse side effects.

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J.A. RICHARDSON, L.A. MURPHY, S.A. KHAN, C. MEANS

CONTROL ANCILLARY CLINICAL SIGNS MEASURES Oral Exposure ✖ administer specific “antidote” if ✖ monitor the systems most likely ✔ Crop lavage, with or without activated applicable (fig d) to be affected charcoal ✖ correct thermal regulation, hydration ✖ diagnostic tests ✔ Administer bulking cathartics ✖ diuresis may be beneficial for ✖ supportive care offered until Emesis exposures to nephrotoxic agents full recovery (fig e) ✔ Do not induce emesis in a bird. Emesis is or to enhance elimination of the considered unsafe in birds due to the poison potential for aspiration and the ineffective- ness of emetic medications in birds. Adverse effects of diuresis ✔ pulmonary edema Crop Lavage ✔ cerebral edema ✔ Consider crop lavage for early ✔ metabolic acidosis or alkalosis decontamination (fig c). ✔ ✔ Sedate frightened or fractious birds. water intoxication ✔ Use isoflurane gas and endotracheal tube to prevent aspiration. Contraindications to crop lavage are ingestion of corrosive substances or petroleum distillates. ✔ For lavage, gently flush the crop with warm saline and aspirate repeatedly c d (3-4 times). Activated Charcoal ✔ As an effective adsorbent for toxicants, give activated charcoal with a gavage tube. ✔ Dosage of activated charcoal is 1-3 g/kg (or 1-3 mg/g body weight) ✔ Activated charcoal is not very effective in adsorbing petroleum distillates, corrosive agents and most heavy metals. Cathartics ✔ Increases elimination of activated charcoal- bound toxicants. ✔ Use cautiously in birds. ✔ Do not use in dehydrated birds. Bulking Cathartics ✔ Bulking agents can be useful in removing small solid objects, such as lead paint chips, e from the bird’s GI tract. ✔ One-half teaspoon psyllium (Metamucil®) mixed with 60 ml baby food gruel is administered with a dosing syringe or eyedropper. Repeat to ensure complete removal of the objects 1-2 times daily. ✔ A less effective bulking agent is dilute peanut butter.

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CLINICIAN’S NOTEBOOK MANAGING PET BIRD TOXICOSES

HEAVY METAL TOXICOSES

TOXIN SOURCES CLINICAL SIGNS Zinc Galvanized wire cages, toys, chains and Lethargy Diarrhea Regurgitation water or food bowls (galvanized coatings Shallow respiration Hemolytic anemia Feather picking may contain up to 99.9% zinc) Anorexia Kidney dysfunction Pale mucous Zinc hardware (washers, nuts, wire) Decreased Cyanosis membranes U.S. pennies minted after 1983 body weight Possible liver and Shivering Weakness pancreatic Melena Polyuria, polydipsia abnormalities Death Greg Harrison Lead Lead paint chips Plumbing material Depression Polydipsia Blindness Some artist paints Solder in stained Weakness Greenish-black Circling Lead weights glass/Tiffany style Anorexia diarrhea Hematuria Lead hardware lamps Regurgitation Ataxia (Amazon parrots) Lead-containing Lead shot Abnormal droppings Head tilt Death Venetian blinds Tile, linoleum Polyuria Seizures Lead-coated Improperly glazed

Greg Harrison household bowls Effects on the Body products Some antiques Absorbed lead is retained by soft tissues and eventually by bone Some wine/ Curtain weights and is slowly excreted through the kidneys. champagne Fishing sinkers Lead affects the CNS, renal, hematopoietic, neurologic and bottle foils Tire weights gastrointestinal systems. Lead can cause cerebral edema and neuronal damage, demyelination and decreased peripheral nerve conduction peripherally. Lead can cause anemia through increasing RBC fragility. Bone marrow suppression is also a potential effect.

In some clinicians’ experience, ingestion of heavy metals and other toxins appears to occur most often in a seed-eating bird, suggesting the bird may be seeking nutrients missing from its diet.

COMMON HOUSEHOLD HAZARDS*

TOXIN SOURCES CLINICAL SIGNS

Nicotine — alkaloid derived Tobacco products Occur quickly after ingestion, usually within 15-45 minutes. from dry stems and leaves of Excitation, tachypnea, salivation and emesis. Nicotiana sp. With severe cases, muscular weakness, twitching, depression, tachycardia, dyspnea, collapse, coma or cardiac arrest. Death occurs secondary to respiratory paralysis.

Products containing Liquid potpourri, fabric softeners, Dermal exposure: erythema, edema, intense pain and ulceration. cationic detergents germicides and sanitizers Ocular exposure: mild irritation to severe corneal injury. Oral exposure: tissue necrosis and inflammation of the mouth, tongue, pharynx, and esophagus.

Polytetrafluoroethylene Overheated (above 280°C) cooking Rales, dyspnea, ataxia, depression, restless behavior and acute death. (PTFE)-coated utensils utensils with nonstick surfaces

Avocado (Persea Americana) Leaves, fruit, bark and seeds of some Small birds: respiratory distress, generalized congestion, hydropericardium, species (toxic principle unknown) anasarca and death. Onset occurs after 12 hours of ingestion, with death occurring within 1-2 days of the time of exposure. Large birds: nonspecific signs = reduced activity, fluffing of feathers and labored respiration.

Plants containing Dieffenbachia (dumb cane), philodendron, Dysphagia, regurgitation, inappetence. If ingested, crystals can cause oral calcium oxalate crystals pothos, peace lily, schefflera irritation, intense burning and irritation of oral cavity.

*Birds are also susceptible to the potentially toxic effects of alcoholic drinks, pesticides and human medicines.

26 EXOTIC DVM VOL 3.1 MAR 2001 birdtoxic.qxd 6/15/014:56PMPage27 † * Diagnosisshouldbemadewithbloodlevelsinassociationclinicalsigns. (250 Both cockatoosandeclectusparrotstendtohaveahigherphysiologiczincconcentrationmaynormallevelsup of leadtoxicity.* ographs. involved isnotgrosslyvisibleonradi- ically; however, inmanycases, thelead or EDTA shouldbesubmitted. suggestive ofazinctoxicosis. for zincanalysis.Levels>1000 containers (avoidcontactwithrubber). syringes androyalblue-stoppered suggestive ofatoxicosis(>2.5-3.0ppm).* Blood leadlevelsof11 Lead particlesmayshowupradiograph- For leadanalysis,wholeblood,heparinized If postmortem,collectpancreatictissue Plasma zincconcentrations>200 Collect bloodinall-glassorall-plastic History, radiographs www.exoticdvm.com References J.A. RICHARDSON,L.A.MURPHY, S.A.KHAN,C.MEANS µ 5. POISINDEX to SystemAffected Approach VR: A Beasley 4. 3. Haddad LM:LSD,naturalhallucinogens 2. Shannon MW, HaddadLM:Theemergency 1. LaBonde J:Toxicity inpetavianpatients. /dL), respectively. Zinclevelsinallotherpsittacineshavephysiologiczincconcentrationsoflessthan2.0ppm(200 820. Urbana, IL,1997,pp157-165,218,416,819- Veterinary Toxicology. Universityof Illinois, 1187-1195. Philadelphia, WBSaundersCo,1998,pp Poisoning andDrug Overdose 3rd ed. and miscellany. ClinicalManagement of Saunders Co,1998,pp2-31. Overdose 3rd ed.Philadelphia,WB Management ofPoisoningandDrug management ofpoisoning.Clinical Sem Avian ExoticPetMed4(1):23-31,1995. detergents, Avocado). Managements: Nicotine,Zinc,Cationic MICROMEDEX, Englewood,CO.2000. (eds): POISINDEX DIAGNOSING ® editorial staff: (Toxicologic µ /dL areindicative ® System, Vol 100, In µ Rumack BH,etal /g are µ /dL are † first course,waitseveraldaysbeforerepeattreatment. cerebral edema. for seizuresanddexamethasone(1-2mg/kgIM) cathartics, surgeryorendoscopy. or asmallamountofMgSO (usually fromtheGItract),istoadministeramildlaxative GI tractuntilthelead-containingobject(s)canberemoved may die. even beforethesourceofleadisremoved,orpatient enhance theabsorptionoflead,chelationshouldbegin twice aday. cathartics firstwithapyslliummixturetube-orhand-fed If thebloodleadconcentrationsarestillhighafter Offer supportivecaresuchasdiazepam(0.5-1.0mg/kgIM) Remove leadfromthegastrointestinaltractviabulking One waytohelpdecreasetheabsorptionofleadby Although parenteralchelation(usuallyCaEDTA) can Remove leadfromthetissueswithchelatingtherapy. Tube orhand-feedingmayberequired. Intravenous orintraosseousfluidsmaybeneeded. Keep birdhydrated tohelpexcretemetalions. Chelation therapymaybeneeded. Monitor successofremovalprocesswithradiographs. Remove sourceofzincfromtheGItract—trybulk Most casesaresub-clinicalandthebirdsnotincrisis. 11. PuschnerB,St.LegerJ,GaleyFD:Normal 10. Dumonceaux G,HarrisonGJ:Toxicology. 7. Bauck L,LaBondeJ:Toxic diseases. 6. Richardson JA:Potpourrihazards incats. 9. Samour J:Toxicology. 8. Woods LW, etal: Avian toxicology. Proc 11(6):522-527, 1999. to genusdifferences. JVet DiagnInvest plasma andliverofpsittacineswithrespect and toxiczincconcentrationinserum/ Vet Med94:12,1999. 180-193. Avian Medicine.London,Mosby, 2000,pp pp 1-11. Assoc Avian Vet Core Seminar, 1994, 1997, pp604-613. Surgery. Philadelphia,WBSaundersCo, Quesenberry K(eds): Avian Medicineand Altman RB,ClubbSL,Dorrestein GM, 1041. Delray Beach,FL,HBDIntl,2001,pp1036- Avian Medicine:Principlesand Application. Ritchie BW, HarrisonGJ,LR(eds): TREATMENT 4 In (Epson salts)inwater. Samour J(ed): In In µ /dL) inserumorplasma. 3.0 ppm(300 EX then q12h x10daysoruntilrecovery. andrepeatifneeded. weeks on,off1week compromise. it maybecontradinciatedinbirdwithrenal dose andfrequency. NaCl (4mg/ml)andgivenSCatthesame then 5daysoffandrepeatifneeded. PO q24hx5days. 5 daysoff, thenrepeatifneeded. 1 drop/100gPO).Keep birdhydrated. ment cost(125mgcapsulein15mllactulose: and betube-fedbyownertoreducetreat- and repeatafter5daysifneeded.Easytomix Dimercaprol at2.5mg/kgIMq4hx2days, at55mg/kgPOq12hD-penicillamine x1-2 Because CaEDTA isexcretedbythekidneys, Alternatively, CaEDTA canbedilutedwith CaEDTA at30mg/kgIMq12h x5days, 2, 3dimercaptosuccinicacid(DMSA)30mg/kg CaEDTA at35mg/kgIMq12hX5days,then at55mg/kgPOq12hx5 days D-penicillamine O TIC Lead andZincLevels: Some LabsthatEvaluate 217-333-1620 Urbana, IL61802 2001 S.LincolnAve. Veterinary DiagnosticLab Univ. ofIllinois College ofVet. Med., 225-578-9777 Baton Rouge, LA 70894 1909 S.StadiumDr. College ofVet. Med.,LSU Diagnostic Laboratory 208-885-7081 (fax208-885-8937) Moscow ID83844-2203 W. 6thSt.Extension Univ. ofIdaho,HolmResearch Ctr. Analytical SciencesLaboratory Toxicology Service Veterinary Diagnostic Patricia Tarcott µ /dL) and2.5ppm 11 CHELATORS DVM , MS, DVM, P VOL 3.1 MAR 2001 H D, DABVT "

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