Bifenthrin Toxicity in a Dog Shimshoni)
Total Page：16
File Type：pdf, Size：1020Kb
Central Annals of Clinical Pathology Case Report *Corresponding author Dr. Jakob A. Shimshoni, The Toxicology Department, Kimron Veterinary Institute, Bet-Dagan, Israel (Cuneah, Bifenthrin Toxicity in a Dog Shimshoni). Tel: +972-3-9688911; Fax: +972-3-9681730; Email: 1 1 1 2 Sigal Klainbart , Yael Merbl , Efrat Kelmer , Olga Cuneah , Submitted: 10 October 2014 2 Jakob A. Shimshoni * Accepted: 02 November 2014 1The Koret School of Veterinary Medicine, The Hebrew University of Jerusalem, Israel Published: 04 November 2014 2 The Toxicology Department, Kimron Veterinary Institute, Bet-Dagan, Israel (Cuneah, Copyright Shimshoni) © 2014 Shimshoni et al. Abstract OPEN ACCESS A 17-month-old male King Charles cavalier was presented with acute onset of generalized body tremors and facial twitching after being exposed to 2 different compounds of the pyrethrins/pyrethroids group and imidacloprid. Bifenthrin toxicity was confirmed by gas chromatography mass spectrometry. Initial therapy consisted of diazepam, metacarbamol and IV fluids, followed by general anesthesia with isofloran and diazepam CRI. Blood specimens were collected for following bifebthrine blood levels over time. Supportive nursing care was provided as needed. Twenty-four hours post admission, the dog was no longer under general anesthesia. Seventy two hours post admission the dog was discharged had no menace response, was alert and responsive when stimulated, ataxic while walking and showed normal eating behavior. Pyretroid toxicosis in dogs was to our best knowledge never been reported before. We describe the clinical signs, bifenthrin pharmacokinetics during hospitalization, and the successful treatment of bifenthrine toxicity in a young dog. INTRODUCTION by choreoathetosis and salivation induced by deltamethrin Pyrethrins are naturally occurring cyclopropyl ester insecticides (pyrethrins I and II, cinerins I and II, and jasmolins and most other cyano-pyrethroids. Some pyrethroids produce Tanacetum both tremors and salivation and were therefore classified as (Chrysanthemum cinerariaefolium) and related species [1,2]. intermediate TS-syndrome [10]. NaturallyI and II) occurring highly prevalentpyrethrins in are the rapidly flowers degraded of by light, dermalPyrethrins absorptionin and pyrethroids most mammals are .fat soluble compounds developed to improve stability [3]. Pyrethroid use became that undergo rapid metabolism and excretion after oral or therefore, synthetic1800 analogues known as pyrethroids, were Following absorption, used home and garden insecticides in the U.S [3,4,5]. Pyrethroids andthey areconjugation metabolized into byglucuronides, hepatic microsomal sulphates, esterases or amino and widespread in the ’s and for decades was the most commonly oxidases. This is followed by rapid hepatic hydroxylation to other mammals appear to be particularly sensitive to the channelsalter the normalresulting function in hyperexitability. of the insectnervous This action system onthe primarily nervous acids which are readily excreted into urine. Cats, as oppose systemby slowing lead the to opening the adverse and closing clinical of signsseenvoltage-sensitive in pyrethroid sodium pyrethroid insecticide commonly used in “spot on” pesticide toxicosis [6,7]. effects of pyrethroids, most prominently permethrin, a class I preparations manufactured for flea control. Deficiency of Numeroushepatic glucuronosyl reports have transferase been published has been in suggestedthe veterinary as a timePrior [8]. to 1970, scarce data was available on acute toxicity potential explanation for their increased sensitivity [7,12]. in mammals from pyrethrins and pyrethroids known at that The discovery of various new pyrethroids with the reportedliterature yet regarding in dogs. permethrinThis Case report toxicity describes in cats acute[7,12-26]. pyrethroid but to potential for widespread use in agriculture, stimulated extensive our knowledge, pyrethrins or pyrethroid toxicity has not been studies on pyrethroid toxicity both for academic research and for agricultureusage of insecticide products. In contrast CASEtoxicity REPORTin a king Charles cavalier dog. dermalto the moderateexposure [9].oral toxicity of most pyrethroids in rats, the pyrethroids exhibit very low levels of systemic toxicity following A 17-month-old intact male King Charles cavalier weighing In mammals, two distinct toxic syndromes have been 7 kg was referred to the Hebrew University Veterinary Teaching pyrethroidsdescribed:the, T- syndrome named after the prominent symptom signsHospital appeared, (HUVTH), Biospotix with a chief®a complaint of generalized tremors, of whole-body tremors is induced by pyrethrins and noncyano- ataxia, tachycardia and tachypnea. Forty-eight hours before clinical e.g., permethrin and the CS-syndrome, characterized spray and Advantage spot on were Cite this article: Klainbart S, Merbl Y, Kelmer E, Cuneah O, Shimshoni JA (2014) Bifenthrin Toxicity in a Dog. Ann Clin Pathol 2(4): 1030. Shimshoni et al. (2014) Email: Central using a commercial pyrethroid (Admiral®c signsapplied appeared on the dog’s. skin. In addition, his household was sprayed and while asleep there were no involuntary movements. Duringn )24 hours before clinical hospitalization vital signs and blood pressure were normal at all The dog was otherwise healthy, fully vaccinated, times. A multidrug resistance protein 1 (MDR1) genotype test lived in an apartment and leash-walked. On the morning of was negative. Seventy two hours postm admission the dog was admission, the dog presented to its referring veterinarian due to discharged to his owners care with continued antimicrobial swaying, hypersalivating and vomiting. It did not fully respond to treatment (amoxicillin/clavulanicacid , 20mg/kg, PO, q12hrs for its owners, and progressed to a single seizure episode. Physical 10 days). At discharge, it had no menace response but was alert examination at the referring veterinarian revealed tachycardia and responsive when stimulated outside, ataxic while walking, (160 beats per minute), panting and tachypnea, generalized and eating willingly. At follow up 2 days, 1 week, and 1.5 months tremors, and four limb ataxia. At the clinic, the dog vomited post discharge, the owners reported the dog was back to normal. once. The veterinarian suspected toxicosis, and therefore the byDuring Shimshoni Hospitalization, et al [29]. whole blood was withdrawn each day for dog was treated with a bolus of isotonic crystalloids (LRS, 120. bifenthrin level determination according to the method published mlsIV), metoclopramide (0.5 mg/kg SQ), diazepam (0.5mg/kg DISCUSSION IV), 3 activate charcoal tablets, and was referred to the HUVTH On presentation, the dog was obtunded and non-ambulatory, noted.with a rectalNeurological temperature examination of 38.80 revealed°C, panting, an andabsent a heart menace rate The broad-spectrum antiparasitic activity of pyrethrins and of 160 beats per minute. Engorged mucous membranes were pyrethroids has revolutionized parasitic control in veterinary exposuremedicine. Effectiveness,had made those low cost,compounds the conception the most of acommonly “natural” response bilaterally, generalized body tremors Abnormalities and facial usedcompound, home andand low garden levels insecticides of systemic in toxicity the U.S following [3,4,5]. dermalIn the twitching were noted with four limb ataxia. Spinal 9reflexes, last decade, reports describing permethrin toxicity in cats anal reflex, and tail muscle tone9 were intact. on CBC9 revealed a mild leukocytosis (WBC9 17.15*10 cells/L [reference range (RR), 5.2-13.9*10 cells/L]); thrombocytopenia reportfrequently describing emerged,whereas pyrethroid toxicitytoxicity in case a dog reports. in dogs are (70*10 cells/µL [RR, 143.3- 400 *10 cells/µL]);9 and mean lacking [7,12-26]. To the best of our knowledge this is the first platelet volume9 of 29 fL [RR, 7.0-11.0fL]. Examination of the blood smear revealed neutrophilia (13.97*10 cells/L [RR, ®, The dog presented in this case was exposed to 2 different 3.9-8.0 *10 cells/L]), platelet count was estimate low than compound of the pyrethrins/pyrethroids® group, namely Admiral normal, and platelets weree estimate to be enlarged. The , an insecticide comprised an insecticide comprised of 7.9 % bifenthrin and 1 % condensed thrombocytopenia and elevated MPV were attributed to its breed. naphthalene sulfonate andBiospotix Serum biochemistry profile was within reference intervals. of natural pyrethrum 0.2 %, geraniol 0,5 % (v/v) (containing® An IV catheter was placedf in the cephalic vein, and the dog was természetespiretringeránium, lavender essential oils, citronella, treated with diazepam (0.5 mg/kg IV). The dog was hospitalizedg aqua exipient, and alcohol qsp.) Concomitantly, Advantage in the intensive care unit and thoroughly washed with liquid spot on (10% imidacloprid, 0.1% butylhydroxytoluene, detergent solution in warm water. Methocarbamol (75mg/kg benzyl alcohol) was applied. The dog was treated with an anti- slow IV), was administered twice, 15 minutesh apart. Since no . convulsing agent (diazepam) while supportive care together improvement was seen and the dog exhibited ongoing severe with tremor controlling means, lead eventually to a full recovery tremors, anesthesia induction with propofol (1 mg/kg, IV) Diagnosis of pyrethrin toxicosis is generally based on history was performed, an endotracheal tube (ETT) was placed and of exposure and typical clinical signs, which commonly include anesthesia was maintained with 100% oxygen and