CLINICIAN’S NOTEBOOK Managing Ferret Toxicoses J. RICHARDSON AND R. BALABUSZKO

Jill A. Richardson, DVM, Dipl ACFE ASPCA National Animal Poison Control Center 1717 South Philo Road Suite 36 Urbana, Illinois 61802 [email protected]

FERRETS ARE EXTREMELY CURIOUS and adept at accessing areas where PRACTICE TIP baits, cleaners, chemicals and medica- Rachel A. Balabuszko, CVT tions are stored. Ferrets can even pry ASPCA National Animal Poison caps from child-resistant bottles or Control Center chew through heavy plastic contain- ers. Products such as antifreeze, Dr. Jill A. Richardson received her DVM flavored medications or pest control degree from Tuskegee University in baits have an appealing taste. Because 1994. In 1996, following experience in the average weight of the adult ferret small animal practices in Tennessee and is less than 2 kg, even small amounts in West Virginia, Dr. Richardson joined of toxins can be dangerous when the ASPCA National Animal Poison ingested. Therefore, prompt treatment Control Center as a Veterinary Poison of toxicoses is essential. Information Specialist. Rachel Balabuszko, CVT, joined the In cases of oral exposure, ferrets have ASPCA National Animal Poison Control the ability to vomit. However, the Center as a Certified Veterinary length of time since ingestion of the Ferrets can be restrained by scruffing Technician in 1998, after receiving her toxicant, the ferret’s age, its previous the loose skin on the back of the neck. associate degree in veterinary technol- medical history, and the type of ogy from Parkland College. poison ingested all affect the decision to induce emesis. Tom Schaefges Photography Sidney, Illinois [email protected]

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STEPS IN MANAGING FERRET TOXICOSES

START ASSESS THE SITUATION STABILIZE THE FERRET ✖ Is the ferret seizuring? ✖ Administer oxygen if necessary ✖ Is the ferret breathing? ✖ Control seizures ✖ What is the heart rate? ✖ Correct any cardiovascular ✖ What color are the mucous abnormality membranes? Table 1. ✖ Is the ferret in shock? Potentially Lethal Agents ✖ What is the body temperature? Via Oral Exposure ✖ Is there evidence of hemorrhage? ✖ 5-fluorouracil

✖ isoniazid If stable ✖ metaldehyde ✖ strychnine Patient Information ✖ tricyclic antidepressants ✔ age Table 2. ✔ sex Seizurogenic Toxicants ✔ pregnant or lactating? ✔ health problems? ✖ 5-FU ✔ recent abdominal surgeries? ✖ aminopyridine ✔ currently on medication? ✖ amphetamines Exposure history ✖ cocaine ✔ when was the exposure? ✔ how much was ingested? ✖ metaldehyde ✔ when did clinical signs occur? ✖ methylxanthine ✖ nicotine ✖ strychnine ✖ tremorgenic mycotoxins Emesis ✔ is hyperactive Table 3. Hydrogen Peroxide 3% ✔ has recent history of abdominal surgery Corrosive Agents (1 ml/lb PO) ✔ has already vomited or is exhibiting ✖ acids ✔ dilute with milk or clinical signs water in cases of ✖ alkali (e.g., sodium or potassium ✔ has ingested hydrocarbon-containing hydroxide found in some drain corrosive ingestion (1-3 materials ml/lb) cleaners) ✔ has ingested cationic detergents, acids, ✔ causes vomiting through ✖ cationic detergents or alkali mild gastric irritation ✖ phenolics Gastric Lavage ✔ vomiting occurs usually within 15 minutes ✔ use when emesis is contraindicated Table 4. but emptying the stomach is essential ✔ can be repeated once Hydrocarbons ✔ use cuffed endotracheal tube to prevent ✔ most effective shortly after toxin ingestion ✖ butane aspiration ✔ most productive after small moist meal ✖ fuel oil ✔ choose anesthetic agent based on type (e.g., canned cat foot) of toxicant ✖ gasoline Do not induce emesis ✔ isoflurane is optimal anesthetic agent ✖ kerosene if the ferret: ✔ diazepam or a short-acting barbiturate ✖ mineral spirits ✔ has a history of epilepsy or cardiovascular may be appropriate ✖ motor oil disease ✔ do not perform with ingestion of caustic ✔ ✖ propane is debilitated, severely depressed or in a or petroleum distillate products coma ✖ tar ✖ transmission fluid

24 2000 VOLUME 2.4 EXOTIC DVM PREVENT ABSORPTION CONTROL ANCILLARY MEASURES Dermal Exposure CLINICAL SIGNS ✖ monitor the systems most likely to be ✖ bathe the ferret with mild liquid ✖ administer specific “antidote” if affected detergent or non-insecticidal pet applicable ✖ chemistry panels, coagulation panels, shampoo ✖ correct acid base balance, hydration diagnostic tests ✖ may need to be repeated and electrolytes if needed ✖ supportive care offered until full ✖ rinse well with warm water ✖ diuresis may be beneficial for recovery ✖ towel dry to prevent chilling exposures to nephrotoxic agents or to enhance elimination of the ✖ monitor skin for redness, swelling poison or pain Adverse effects of diuresis Ocular Irrigation ✔ pulmonary edema ✖ flush eyes with tepid tap water or ✔ cerebral edema physiological saline for a minimum ✔ metabolic acidosis or alkalosis of 20-30 minutes. After flushing, ✔ water intoxication treat with lubricant ointments ✖ if the substance is corrosive, examine the eyes for corneal ulceration ✖ follow-up examinations Oral Exposure ✖ emesis, gastric lavage, and/or treatment with activated charcoal may be required

Oral Exposure

Activated Charcoal bradycardia, hypotension, and respiratory (1-3 g/kg body weight) depression; do not give magnesium sulfate Table 5. to patients with renal compromise) Toxicants Causing CNS ✔ adsorbs a chemical or Depression toxicant ✖ osmotic: Sorbitol® 3 ml/kg (can be used ✖ barbiturates ✔ helpful for organic poisons, safely with repeated charcoal administration) chemical or bacterial toxins ✖ bulking: Metamucil® psyllium or vegetable ✖ benzodiazepines or if enterohepatic recir- fiber such as canned pumpkin, sweet ✖ ethanol culation occurs potato, bran cereal (indicated with ✖ ethylene glycol ✔ repeated doses of activated charcoal may be ingestion of bulky physical agents) ✖ ivermectin indicated ✔ some commercial products contain both ✖ marijuana ✔ administer via large syringe or gastric tube activated charcoal and a cathartic ✔ ✖ opiods ✔ use cuffed endotracheal tube in sedated or do not use cathartics if ferret has diarrhea or clinically depressed ferrets is dehydrated ✖ phenothiazines ✔ do not use activated charcoal for ingestion Enterogastric Lavage ✖ TCAs of: ✖ caustic materials ✔ may be necessary when potentially lethal oral ✖ heavy metals (iron, lead, mercury) exposures have occurred ✖ arsenic ✔ possible complications may include intestinal Cathartics rupture and gastroenteritis ✔ administer to facilitate removal of the Enemas activated charcoal-bound substance ✔ eliminate toxicants from the lower GI tract ✔ cathartic classifications ✔ use soapy water, plain water or water mixed ✖ saline: sodium or magnesium sulfate with activated charcoal (excess magnesium can cause drowsiness or CNS depression, muscular weakness, ✔ do not use pre-mixed solution for humans

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Table 6. References Nephrotoxic Agents PRACTICE TIP 1. Orcutt CJ: Emergency and critical ✖ cadmium care of ferrets. Vet Clin No Amer Exotic Animal Practice 1(1):99-125, ✖ cantharidin 1998. ✖ cholecalciferol 2. Mason DE: Anesthesia, analgesia, and sedation for small mammals. In ✖ diquat herbicides Hillyer EV, Quesenberry KE (eds): ✖ ethylene glycol Ferrets, Rabbits, and Rodents - Clinical Medicine and Surgery. ✖ mercury Philadelphia, WB Saunders Co, 1997, ✖ nephrotoxic antibacterials: OTC pp 378-391. bacitracin, polymyxin-B, gentamycin, 3. Exotic Animal Formulary - A neomycin Supplement to AAHA’s Practitioner Guides to Exotic Animal Medicine. ✖ nonsteroidal anti-inflammatory drugs Lakewood, CO, The American ✖ oxalic acid Animal Hospital Association, 1995, pp 5-11. ✖ phenolics 4. Beasley VR, et al: Management of ✖ rhubarb toxicoses. Vet Clin No Amer 20(2):307-337, 1990. ✖ zinc 5. Brown SA: Basic anatomy, physiol- ogy, and husbandry. In Hillyer EV, Table 7. Quesenberry KE (eds): Ferrets, Rabbits, and Rodents - Clinical Hepatotoxic Agents Medicine and Surgery. Philadelphia, ✖ acetaminophen Treats can be used as a distraction while WB Saunders Co, 1997, pp 3-13. procedures such as blood collection are 6. Mullen H: Soft tissue surgery. In ✖ amanita mushrooms performed. Hillyer EV, Quesenberry KE (eds): ✖ arsenic Ferrets, Rabbits, and Rodents - Clinical Medicine and Surgery. ✖ blue-green algae Philadelphia, WB Saunders Co, 1997, ✖ copper General supportive care, including pp 131-144. 7. Quesenberry KE: Basic approach to ✖ fluid therapy and nutritional supple- Cycad species veterinary care. In Hillyer EV, ✖ hepatoxic mycotoxins mentation, is an important part of Quesenberry KE (eds): Ferrets, treating a toxicosis. Additional treat- Rabbits, and Rodents - Clinical ✖ iron Medicine and Surgery. Philadelphia, ment may be necessary, such as the ✖ phenolics WB Saunders Co, 1997, pp 14-25. use of gastric protectants or anti- 8. Plumb DC: Veterinary Drug ✖ pyrrolizidine alkaloid plants Handbook 3rd ed. Ames, Iowa State biotics. ✖ tannic acid University Press, 1999, pp 387-388. 9. Rosenthal KL: Respiratory diseases. ✖ vitamin A Ingestion of alkali agents can cause In Hillyer EV, Quesenberry KE (eds): corrosive damage to the mouth, Ferrets, Rabbits, and Rodents - Clinical Medicine and Surgery. Table 8. tongue and stomach, which may Philadelphia, WB Saunders Co, 1997, Drugs That Have an require several days of gastric protec- pp 77-84. Anti-emetic Effect tants and antibiotics. Ingestion of ✖ antidepressants estrogen, lead, or anti-neoplastic ✖ antihistamines medications can cause anemia that ✖ barbiturates may require support. ✖ benzodiazepine ✖ codeine ✖ dimenhydrinate ✖ marijuana ✖ phenothiazines The ASPCA National Animal Poison Control Center, an operating division of the American Society for the Prevention of Cruelty to Animals (ASPCA), is the only animal-oriented poison control center in North America. It is a unique, emergency hotline providing 24-hour-a-day, 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 our everyday surroundings that can prove poisonous or fatal to animals.

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