Marijuana Toxicity

I came across this very interesting article in the "Veterinary Practise News" Journal and reproduce it here in it's entirety.  I found it to be informative, comprehensive and in line with my experience with these cases which have been handled in a similar manner, usually while working at after hours emergency clinics.  
Dr Mark Rubensohn

Treating Marijuana Toxicity
Posted: June 23, 2011, 3 p.m., EDT

By Patrick Mahaney, VMD
For Veterinary Practice News

When veterinarians think of regionally specific illness, toxicity caused by consumption of native plants and exposure to infectious organisms typically comes to mind.

In preparation for a move to Southern California, I studied the effects of sago palm ingestion and inhalation of Coccidioidomycosis with the anticipation of the conditions I would be diagnosing and treating in my clinical practice.

I did not anticipate that I would end up treating such a large number of dogs presenting with clinical signs consistent with marijuana (cannabis sativa) consumption. As the sale of medical marijuana is legal in many California cities, dispensaries provide human patients with smokable or edible products.

Unfortunately, humans can carelessly leave these products in locations accessible to their curious pets, leading to ingestion.

Clinical Signs

Although a pet could show signs of marijuana toxicity post-inhalation, the majority of cases I see are due to suspected or known oral ingestion. I have treated dogs almost exclusively, yet cats can be similarly affected. A 2002 study of 250 cases of marijuana exposure showed dogs to be the primary cannabis consumption culprits (96 percent). Cats followed in a distant second place (3 percent), and other species made up the smallest portion (1 percent).1

Mild cases present with lethargy, altered response to visual or verbal stimuli, injected (blood engorged) conjunctiva and behavior changes.

More severe cases display ataxia, hypothermia, hypotension, bradycardia, ptyalism, emesis, anorexia, urinary incontinence, diarrhea and dysphoria (vocalization). Coma and death are also possible in severe cases.

Clinical signs can occur within minutes to hours and can last for hours to days, in part due body fat storage of the active ingredients in marijuana.

A 2004 study of 213 dogs with oral marijuana exposure showed neurologic signs (lethargy, ataxia, dilated pupils, etc.) in 99 percent of patients. Gastrointestinal signs, such as vomiting, were seen in 30 percent of patients.2

Although marijuana can have an anti-nausea effect, the volume consumed in proportion to the patient’s body weight, other ingested ingredients, and the induced release of “feel-good” hormones like serotonin, can cause vomiting.

In a video available at VeterinaryPracticeNews.com/MarijuanaToxicity, an Italian greyhound that ingested marijuana overreacts to visual and audible cues, appears to have difficulty standing and walking, and ultimately ends up lowering itself to a sternal position on the ground in a staggered fashion.

Mechanism of Action

Marijuana contains delta-9-tetrahydrocannabinol (THC), which causes the release of the neurotransmitters acetylcholine, dopamine, norepinephrine and serotonin in the brain’s frontal cortex and cerebellum. The increased release of these neurotransmitters leads to the various clinical manifestations.

As the attending veterinarian, I consider the possibility of other factors contributing to the overall picture of health or illness. Did the pet consume only cannabis? Could prescription or over-the-counter human or veterinary medications, other recreational drugs or unknown intoxicating substances be involved?

Differential Diagnoses

Cannabis toxicity has a variety of differential diagnoses. Options include stimulants (ephedrine and ephedrine-like compounds, amphetamines, nicotine and methylxanthines found in chocolate), opioids, benzodiazepines, antidepressants, amitraz (such as that used in anti-parasitic collars), ivermectin (from heartworm preventives), bromethalin (rodenticides), ethylene glycol (antifreeze), and alcohol (ethanol from rotting fruit, bread dough, etc.).
The majority of cases I have treated presented with multiple clinical signs, leading to the top differential diagnosis of cannabis consumption. The diagnosis, however, may not necessarily be confirmed by the owner, who may be completely unaware that a pet was exposed to the drug.

Others are up front about their pets’ ingestion of cannabis. Most are somewhat reluctant to share the truth, but ultimately concede under gentle, direct questioning.

I always ask questions in a manner conveying my intention to help the pet and its treatment. In doing so, I create an environment where the owner can tell the truth, a realistic diagnosis can be achieved and I can expeditiously start the diagnostic and treatment process.
Besides the effects of THC, “edibles” can contain substances potentially adversely affecting a pet’s health. These include carbohydrates, fat, proteins, and other ingredients. Vomiting, diarrhea, anorexia, pancreatitis and other clinical signs can ensue and lead to further complications. The Italian greyhound in the video that ate the chocolate-, sugar- and butter-filled marijuana brownie created a rather unfavorable situation for itself after inquisitively snatching the goodie from the owner’s bag.

Treatment

Having treated innumerable cannabis toxicities, I feel comfortable that my patients will make a full recovery with the appropriate care. If other toxins are suspected or known, I start a case file with the National Animal Poison Control Center (use weblink aspca.org/pet-care/poi
son-control/).

I perform baseline blood diagnostics to evaluate organ function. Knowing the status of the liver, kidneys and other body systems helps to rule out other underlying metabolic derangement that could contribute to the presenting clinical signs. I also recommend abdominal radiographs to look for gastrointestinal foreign bodies or other abnormalities.
For exposures occurring less than two hours before presentation, emesis is induced to clear the stomach of the intoxicant.

Once vomiting is under control, administration of activated charcoal can reduce absorption of certain toxins and speeds their evacuation through the gastrointestinal tract.

Provided a pet is not vomiting or comatose, administration of activated charcoal is a component to treating many cases of toxic exposure because of its ability to reduce enterohepatic recirculation of a toxic substance. Enterohepatic recirculation occurs after a toxin enters the bloodstream through the digestive tract, gets processed by the liver, then is excreted back into the small intestine via bile from the gall bladder.

Patients showing more profound sedation, ataxia, hypothermia, vomiting or other clinical signs are hospitalized for supportive care. Intravenous fluids, thermoregulatory support and anti-nausea and antacid medications promote a more rapid recovery and positive outcome.
Marijuana toxicity patients are typically discharged upon resolution of clinical signs and once they can hold down water and food.

Prevention is Best

The best way to avoid illness secondary to toxic exposure to any substance, including marijuana, is through prevention. Owners must pet-proof their homes with the same effort and attention to detail as they would baby proof for a human child.

Pets are intrigued by all sorts of smells, sounds and appearances, often curiously using their nasal and oral openings to evaluate anything within  reach.

Clients can help prevent a pet’s toxic exposure by not bringing specific substances into the home or at least storing foods, medications and other household products where the animals can’t get them.

Dr. Mahaney is a Southern California veterinarian offering integrative veterinary medicine on a house call and in-facility basis through his business, California Pet Acupuncture and Wellness (CPAW) Inc., including acupuncture, Chinese herbs, nutritional and environmental modification and emergency medicine.

FOOTNOTES

1. Janczyk P, Donaldson CW, Gualtney S: Two hundred and thirteen cases of marijuana toxicoses in dogs. Vet Hum Toxicol 2004 Vol 46 (1) pp. 19-21.
1. Shell, L: Marijuana Poisoning. Veterinary Information Network, 2006.

Chicken Jerky Treats

IMPORTANT ALERT !!!!!! Chicken Jerky Treats manufactured in China have been implicated in causing disease in dogs in Ontario. Signs include decreased activity, vomiting and increased drinking and urinating. Blood tests may show increased kidney enzymes and increased blood glucose levels. Therefore at this stage we are recommending that all jerky type treats that come from stores be stopped till further information is available.

Fluoridation of Drinking Water

It over the past 50 years one of the greatest public health advances and medical improvements that have been made in out society is the fluoridation of public drinking water. It has been a major factor responsible for the decline in tooth decay. Although other fluoride containing products are available, addition of fluoride to drinking water has proven to be the most cost-effective and efficient method of providing fluoride to all members within the community regardless of age, education, or level of income. The safety, efficiency and effectiveness of adding fluoride to water has been extensively and scientifically studied across numerous continents encompassing hundreds of cities and millions of people.

It has been shown that a community can expect to save $40 for every $1 invested to fluoridation of its public drinking water. In the review of numerous studies on the rate of tooth decay, it has been shown to be valuable not only for children but also for adults, with each new age group of older adults retaining more natural teeth than the generations before them. Safety has not been in question with the exception of abuse, generally in children who are swallowing toothpaste or over ingesting fluoride containing supplements, both generally occurring due to poor parental supervision. Dental staining or spotting has been reported where mild excess of fluoride has been ingested over time, with no damage to either the teeth or the subject.

Guidelines to the addition of fluoride have changed over the past 10 years due to the universal addition of fluoride to toothpastes. This has resulted in the increased exposure of individuals to fluoride. Thus Calgary City and Alberta Health Services as part of their ongoing review of the water fluoridation program reduced the level of fluoride to 0.7 mg/L (from the previous 1 mg/L) in 1998. (Fluoride naturally occurs in the Bow and Elbow Rivers, in concentrations varying throughout the year, between 0.1 and 0.4 mg/L).

As of  May 2011, Calgary city Council has voted to remove the fluoridation of the city’s water due to pressure of self interest groups and against advice and recommendations of the region's chief medical officer of health, of Alberta health region, and they opted not to consult with the expert panel that was offered by the University of Calgary for free. Interestingly Major Nenshi was absent during this critical Council vote which impacts the health of all Calgarian's. Reasons for the vote to stop fluoridation included the cost to the city of $750,000 a year for implementation, plus additional costs to upgrade the fluoridation equipment. Other factors claimed included the rights of counsel to impose addition of fluoride to drinking water which might not be approved by 100% of the population.

References:

1. City of Calgary  “Fluoride discontinued in Calgary’s drinking water”
2. Community Water Fluoridation and Dental Health in the U.S

      http://www.healthyteeth.us/documents/FluoridationWilliamMaaspublicstatement.pdf

Recommended Sources for further information:

1. http://en.wikipedia.org/wiki/Water_fluoridationhttp://www.cdc.gov/fluoridation/index.htm

Free Nature Walks | Birds Calgary

Free Nature Walks | Birds Calgary: "Sun May 8, 8am: Visit Frank Lake to look at the birds – and the insects that support them! Learn the reason for the varied birdlife – and the diverse aquatic invertebrates that the lake supports. Meet Anderson LRT Station, Macleod Tr., S of pedestrian overpass, or at 8:45am, at the gate to Frank Lake, S off Hwy 23, about 5 km E of High River. Bring lunch. Leaders, aquatic specialist, Danita Mazlankowski, 403-771-2461 and Greg Wagner, 403-601-3893."

Urine Grass Burn

At this time of the year our grass is most susceptible to urine burn from our dogs.  Also, unfortunately the bluegrass that is our most common lawn grass, is also the most susceptible to urine burn.  The cause is the high nitrogen concentration of urine, due to it’s the ammonium content.  Just as over fertilization will kill the grass, so does the urine.  The only real cure is to liberally water the lawn where your pet is urinating.  Once we get into the wetter and warmer time of the year, and we actually get into the growth phase of the grass, this is no longer such a problem.  During the snow covered winter months the urine is often sufficiently diluted by the snow cover and so causes less damage.  So if you are concerned about the spots of killed lawn, now is the time to start watering where your dog urinates. 

Females dogs are more damaging to the lawn as they squat and localize their urine.  Male dogs often urinate up against objects and so are urinating into the flower beds or have a disseminated stream.

For the most part many of the products that are recommended to prevent grass burn which are sold for dogs are poorly effective or potentially harmful.  After many years of experience with a variety of products, we have yet to find anything that works any better than water, re-seeding and time. 

Raw Food Diets

We at Bridlewood Veterinary Clinic have used home prepared and raw food diets for many years (Dr Mark has fed his own and clients pets for over 20 years) with the greatest success.  We have found our pets to not only love this diet, but to gain many benefits.  It can be used for both weight loss and gain with good results.  The pet’s coats are always shinier and softer, they display increased energy, this food is good for allergies, dogs at risk for gastric torsion, and stool volume is hugely decreased.  Dental condition improves, especially where raw bones are used as part of the protocol.

In the past we have fed Mountain Dog Food which is mainly a chicken based diet.  Currently we are using Farm Fresh Pet Foods which comes as either cooked or raw preparations.  It is also available as a beef base with oatmeal which is our preference.  However for dogs that have allergies there is a Bison and Berry formulation and there is also a grain free beef formulation, where this is a requirement.

Ranula (Sialocele) in a Cat

This is a very uncommon condition to be found in a cat. In fact after 35 years in veterinary practice this is the first one that I have ever seen. This condition is more commonly seen in dogs, and even then we would not commonly see more than 1-2 in a year.

This is caused by the inflammation of the sublingual and sub-mandibular saliva glands. It is generally associated with trauma, but could also be associated with inflammation or infection. The condition causes a large swelling under the tongue. It is usually only on one side, however it could also be bilateral. This particular cat was presented with the typical very large swelling under the tongue, and inability to swallow due to the swelling and thus an inability to eat. The mouth was wet with excess saliva due to the inability to swallow. The cat had a fever, was lethargic and dehydrated. Antibiotics anti-inflammatories and pain medication was administered, but after 24 hours there was very little improvement. Therefore, after discussion with a medical and surgical specialists, we performed surgery on this patient. The large inflamed and edematous salivary ducts were resected on both sides below the tongue, using a method called marsupialization.

Within hours there was a huge improvement, the patient displayed a significant increase in it’s amount of comfort and was able to begin eating within 12 hours. Shortly thereafter it was in a sufficiently stable condition to be able to bedischarged, and on subsequent follow-up it has continued to do well, is able to eat well, and is returning to full and normal activity.

This was a rare and very interesting case particularly because it was in a cat, and we are all very gratified that the results which turned out so favorably.