Veterinary Medicine - January 2008 - (Page 18)

Toxicology Brief PEER-REVIEWED not a consistent ﬁnding in people who have ingested bleach. Whether these animals had other disorders that may have caused or contributed to the calcium-related abnormalities is unknown. The clinical signiﬁcance of the hypocholesterolemia in the female and the increases in alanine transaminase and alkaline phosphatase activities in the male was undetermined. TREATING MILDER CASES OF BLEACH TOXICOSIS Common recommendations for treating less serious cases of bleach ingestion include oral administration of milk or water to dilute the bleach solution.2 Inducing emesis is not advised. Dermal exposure should be treated by washing the affected areas with a mild soap and rinsing thoroughly with water. Evaluating the animal for corrosive injury to the gastrointestinal tract is also recommended. CONCLUSION This report describes a unique case of sodium hypochlorite bleach toxicosis, which resulted in the development of severe metabolic derangements and complications, including hypernatremia and hyperchloremia, metabolic acidosis, renal insufﬁciency, possible cerebral edema, aspiration pneumonia, and possibly a coagulation disorder, which led to the decision to euthanize the dogs. The marked biochemical abnormalities and complications noted in our patients are comparable to those seen in fatal cases in people. The major limitation of this report is the lack of gross and histologic ﬁndings that would have allowed further comparison of animal and human cases. Diagnostic tests were also limited because of owner monetary constraints and the rapid clinical deterioration of both dogs. In conclusion, sodium hypochlorite bleach ingestion is a potentially fatal toxicosis, and affected animals may present with severe clinical signs and metabolic derangements. REFERENCES 1. Ross MP, Spiller HA. Fatal ingestion of sodium hypochlorite bleach with associated hypernatremia and hyperchloremic metabolic acidosis. Vet Hum Toxicol 1999;41(2):82-86. 2. Peterson ME, Talcott PA. Small animal toxicology. 2nd ed. St. Louis, Mo: Elsevier Saunders, 2006;233-234. 3. Racioppi F, Daskaleros PA, Besbelli N, et al. Household bleaches based on sodium hypochlorite: review of acute toxicology and poison control center experience. Food Chem Toxicol 1994;32(9):845-861. 4. Hofmeister AS, Heseltine JC, Sharp CR. Toxicosis associated with ingestion of quick-dissolve granulated chlorine in a dog. J Am Vet Med Assoc 2006;229(8):1266-1269. 5. Campbell A, Chapman M. Handbook of poisoning in dogs and cats. Oxford, Great Britain: Blackwell Science, 2000;238-239. 6. Stockham SL, Scott MA. Fundamentals of veterinary clinical pathology. Ames: Iowa State Press, 2002;340-349. 7. Donaldson CW. Paintball toxicosis in dogs. Vet Med 2003;98(12):995-998. 8. Rose BD, Post TW. Clinical physiology of acid-base and electrolyte disorders. 5th ed. New York: McGraw-Hill, 2001;338-339. 9. DiBartola SP. Fluid therapy in small animal practice. 2nd ed. Philadelphia, Pa: WB Saunders Co, 2000;330-335. Mechanistic basics of bleach-induced hyperchloremic metabolic acidosis* Ingested sodium hypochlorite interacts with gastric hydrochloric acid. Free chlorine gas and hypochlorous acid are produced. Oxidative tissue damage occurs in the stomach and intestines. Free chlorine gas interacts with water, producing hydrochloric acid. Hydrochloric acid and chloride are absorbed across the intestinal mucosa. Bicarbonate is consumed through reactions with hydrochloric acid. Accumulation of chloride leads to hyperchloremia. *Source: Ross MP, Spiller HA. Fatal ingestion of sodium hypochlorite bleach with associated hypernatremia and hyperchloremic metabolic acidosis. Vet Hum Toxicol 1999;41(2):82-86. 1. Ingestion of sodium hypochlorite initiates chemical reactions that result in the perpetuation of hyperchloremia, consumption of bicarbonate, and development of a hyperchloremic metabolic acidosis. 18 January 2008 VETERINARY MEDICINE

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Veterinary Medicine - January 2008 Contents Digital Extra Letters Toxicology Brief Idea Exchange A Challenging Case: Phimosis in a Young Adult Dog The Indications and Technique for Continuous Ambulatory Electrocardiographic Recording in Dogs A Review of Selected Systemic Antifungal Drugs for Use in Dogs and Cats CE Form Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - January 2008

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