Monday, April 15, 2013

Case 2: Mystery toxin

In the midst of a busy afternoon the receptionist stopped me to say that animal control was on the phone and urgently needed to speak with the vet.  That is never a good thing.  As it turned out they were busy trying to catch a dog that had been running loose for 3 days.  The dog was previously friendly but now would not even approach the owner, was drooling, growling, and tremoring.  As they taught us in school...think rabies first.  I thought great, now I have to stay late and cut off a head today.  But as it turned out it was a well vaccinated adult dog and unlikely to be rabies.

But, when the dog did finally he arrive, he was definitely having a problem.  The poor dude was shaking uncontrollably, and very nervous.  And the more worked up he got, the worse the shaking got.  Unfortunately because of his mental status I didn't get to do more than a visual assessment at a distance.  Toxin of some sort was at the top of my list but primary brain disease like meningitis was also there.  We drew blood, which was all normal, so we started fluids, valium and antibiotics.

The next day he was quite a bit better and in 48 hours he was normal.  This case is the one where I'm not 100% sure if I made the difference or not.  But, he was in bad shape when he came to me and got better after we treated him, so, I count it as a win.  Could have been stopping the tremors and breaking the cycle helped, or fluids to flush whatever it was out of his system, or maybe even the antibiotics   If nothing else he finally got a good (chemically induced) night's sleep! Based on his full and rapid recovery toxin is still my primary differential but the list of possibilities is quite long-ivermectin, chocolate, caffeine  moldy food, amphetamines (legal and illegal) or other drugs just to name a few.


Diana said...

I'm glad you didn't have to cut his head off. My mom worked for the health department and some times I would drive with her to the lab, it was far away, to deliver animal heads for testing.

Sara said...

"cut his head off"?!!!!! Oh my, I now officially know more than I ever wanted to know about veterinary medicine! No idea. Sometimes clueless is a good thing :)

Glad the dog is ok. Poor thing.

Anonymous said...

I had a similar story a few months ago. Cat brought in by ACO, found by a Good Sam tremoring, shaking, classic pyrethrin toxicity signs. Even had the spot on the back of the neck. Clearly SOMEONE thought to put flea preventative on, even if they were a bit misinformed. The poor ACO was sure we were going to recommend euth and rabies test, and had freaked out the poor Good Sam who had found (and handled) the cat. One of the few times as an ER doc I got to deliver good news! (Pyrethrin toxicities in cats, obvious marijuana toxicities, and old vestibular dogs are about the only times that happens.) Strangely, with as much as someone cared about this cat to attempt to treat it for fleas, no one ever claimed him. But ACO did find him a home.