Nonsteroidal Anti-Inflammatory Drug Toxicosis Petra A

Nonsteroidal Anti-Inflammatory Drug Toxicosis Petra A. Volmer, DVM, MS, DABVT, DABT

BASIC INFORMATION (passage of a flexible fiberoptic viewing scope) of the stomach Description may reveal ulcers. Identification of the actual NSAID ingested Nonsteroidal anti-inflammatory drugs (NSAIDs) act against pain, may be possible through an outside laboratory; however, the anal- fever, and inflammation. A number of prescription and over- ysis is not usually available in time to be of much benefit. Other the-counter NSAIDs are available for human use. The following tests may be recommended to rule out other diseases and toxins NSAIDs are approved for use in dogs under the direction of a vet- that can cause similar signs. erinarian: carprofen ( Rimadyl), meloxicam ( Metacam ), deracoxib (Deramaxx ), tepoxalin ( Zubrin), etodolac ( EtoGesic ), ketoprofen TREATMENT AND FOLLOW-UP (Anafen ). Only Metacam is approved for use in cats in the United Treatment Options States. Causes and Toxicity Your veterinarian may recommend induction of vomiting if the NSAIDs reduce prostaglandin synthesis by inhibiting the cyclo- ingestion was recent and the animal is not showing any clinical oxygenase enzymes known as COX-1 and COX-2. The COX-1 signs. Vomiting should be induced only under the direction of a enzyme regulates a number of important functions of the gut, plate- veterinarian. Activated charcoal may be administered to bind with lets, and kidneys. The COX-2 enzyme regulates inflammation, pain, the material in the gut and prevent its absorption into the body. and fever. Many of the NSAIDs currently available are selective for Hospitalization may be recommended in some cases for COX-2 and therefore produce less adverse effects on the stomach administration of intravenous fluids to rehydrate and improve kid- and kidneys. With ingestion of large doses, however, the COX-1 ney function and medications to protect the gut. Other therapy and enzyme is also affected. The end result is that the gut and the kid- supportive care may be indicated for stomach ulcers and bleeding neys can be damaged. Dogs and cats are very sensitive to the effects into the gut. In severe cases with unresponsive kidney damage, of NSAIDs, and seemingly small ingestions can pose problems. your veterinarian may recommend referral to a specialty facility for dialysis treatment, if it is available. Clinical Signs Follow-up Care Initially, animals may exhibit vomiting that sometimes contains blood. Diarrhea, abdominal pain, and lethargy may be noted. Laboratory tests are repeated periodically to monitor recovery of Sudden collapse and death may result from perforated stomach kidney function. Urine output may also be monitored, especially ulcers. Adverse effects on the kidneys can cause increased drink- while your pet is hospitalized. Monitoring may be required for ing and urinating and, eventually, a reduction in urine production several days until kidney function returns to normal. If chronic if kidney failure occurs. If urine production stops entirely, death kidney failure develops, then long-term monitoring is usually will result. needed. Keep all NSAIDs out of the reach of pets. Do not admin- ister NSAIDs to pets unless they are prescribed by a veterinarian. Diagnostic Tests Prognosis Diagnosis is based on evidence of ingestion and consistent clinical Prognosis is favorable for animals that receive prompt and aggres- signs. Laboratory tests may reveal abnormalities in kidney func- sive treatment. For large ingestions and for animals that develop tion tests. Examination of the urine may show blood as well as kidney damage, the prognosis is guarded (uncertain), and severe increased white blood cells and protein. Endoscopic examination cases may result in death.