UT-VMC emergency room tails: happy hour

utvmc web headerBy Dr. Amanda Rainey

I had just finished up discharging a happy young Golden Retriever with an upset tummy when one of our ER students answered an emergency page overhead. “It’s a dog that drank antifreeze,” the student stated as he quickly donned his stethoscope and walked briskly out of triage to assess the patient. I shook my head, as this was the third case we had seen in less than a week, not to mention fielding several phone calls about the often deadly toxicity from worried owners. Spring was upon us, so people and their pets were spending more time outdoors and were more likely to have exposure to things that could be potentially harmful. Ethylene glycol is the actual name of the chemical, but most people know it as antifreeze. It tastes very sweet and that combined with a dog’s natural curiosity makes it easy to ingest.

“Here’s Lola, Dr. Rainey. Thankfully she seems fine at the moment. She maybe got two laps of it mixed with water.” The student relayed to me as we began examining a large hound mix that was bouncing excitedly around the room. Lola had no signs of intoxication, which in the early stages includes an unsteady or wobbly gait, dull behavior, excessive thirst, and evidence of nausea. We quickly performed some blood tests to check her kidneys, as antifreeze targets these organs and can cause kidney failure within 24 hours that is irreversible without long term dialysis. Her values were normal, unlike the other patients we had attempted to treat earlier in the week.  Those poor animals were already so severely affected that even though we tried to intervene, it was just too late.

“Well, this girl looks like she has a chance. Let’s go chat with her owner and get moving with treatment!” I said to the student with a smile, feeling hopeful for Lola’s prognosis. The treatment for antifreeze toxicity involves using either a very expensive specifically formulated antidote given intravenously, or 95% ethanol, strikingly similar to Everclear that can be found at the local liquor store. Both work by preventing the metabolism of the antifreeze compound, thus stopping further absorption and damage. Lola’s owner wished to begin treatment, and due to her size and cost of the antidote, ethanol was our best option. I explained to Lola’s owner that just like a human that imbibes, the main side effect of using the ethanol would be intoxication, and we would need to monitor her closely to ensure she did not become too sedate and have trouble breathing.

We quickly placed an intravenous catheter and began giving Lola her “cocktail”, diluting the ethanol in saline before administering it. Over the next 48 hours ICU was able to enjoy the antics of one drunken hound dog, which suddenly thought she could sing and kept us all entertained with her vocal acrobatics! We checked her kidney values once daily, and we were all relieved when they continued to be normal. Lola was able to go home after two days of treatment, and we all felt grateful we were able to save her, and just a tiny bit glad that her happy hour serenades were over!

(Dr. Amanda Rainey, DVM, is a clinical assistant professor in the small animal clinical sciences department at the University of Tennessee Veterinary Medical Center in Knoxville.)

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