How to treat cocaine poisoning in dogs | Dr. Justine Lee

Posted by justinelee in Blog, Veterinary

In the animal emergency room, I occasionally see dogs poisoned by illicit substances. This is more prevalent in working police dogs who are often exposed to these potentially life-threatening drugs (e.g., as part of a drug bust or during training). In the next few blogs, I’m going to review overall management and treatment of some common toxins that I see. In today’s blog, we’ll talk about how to treat cocaine poisoning in dogs.

Keep in mind that this information is directed for veterinary professionals only. IF YOU THINK YOUR DOG HAS INGESTED SOMETHING POISONOUS: seek immediately veterinary attention if you think your dog or cat got into anything poisonous or toxic. When in doubt, call ASPCA Animal Poison Control Center (APCC) at (888) 426-4435  for life-saving advice also.

Cocaine

• Typically a white power containing 12-16% cocaine salts and adulterants (this may include caffeine, lidocaine, amphetamines, miscellaneous other substances)¹
• Natural plant alkaloid of Erythroxylon coca and E. monogynum
• Nicknames: blow, snow, dust, toot, white lady, coke, bernies, rock, crank, flake, ice, beamers¹
• Mechanism of action: sympathomimetic effects
• Pharmacokinetics:

o   Rapidly absorbed within 12-15 minutes of exposure¹

o   Readily crosses blood-brain-barrier (BBB)

o   Minor urinary excretion (10-20%)¹

o   Dog: LD₅₀ PO: 6-12 mg/kg¹

Clinical signs seen in dogs:
In dogs exposed to cocaine, clinical signs typically develop rapidly (within 12-15 minutes). Clinical signs include central nervous system (CNS) signs such as stimulation, mydriasis, hyperactivity, tremors, seizures. Gastrointestinal signs (including hypersalivation and vomiting) can also be seen. Cardiac signs (e.g., tachycardia, tachyarrthymias) and miscellaneous other signs (such as hyperthermia, elevated CK, etc.) can also be seen.

Treatment:
Unfortunately, by the time a dog presents to the emergency veterinarian for cocaine toxicity, clinical signs are already present and therefore it is typically too late for decontamination due to rapid absorption. If the patient is asymptomatic and a large amount of cocaine was ingested, veterinarians should induce emesis and administer one dose of activated charcoal if the gag reflex is appropriate (and the patient is not at risk for developing secondary complications such as aspiration pneumonia, etc.). Note: If clinical signs are not present within 1 hour, it’s typically unlikely that a toxic ingestion as clinical signs develop quickly, particularly with inhalational exposure.

Next, treatment should be aimed at fluid therapy, gastrointestinal support, neurologic support, and symptomatic supportive care. A balanced, isotonic crystalloid should be used to treat hypotension and to aid in perfusion. Antiemetic therapy (e.g., to help prevent aspiration) should be considered (e.g., maropitant, 1 mg/kg, SQ or IV q 24 hours). Thermoregulation and appropriate cooling measures should be initiated if the temperature is > 105°F to prevent secondary disseminated intravascular coagulation. Cooling measures should be discontinued once the rectal temperature reaches  103.5F° to prevent the patient from becoming hypothermic.

CNS support should include the use of muscle relaxants (if tremoring). Methocarbamol can be used at 22-220 mg/kg IV PRN. Anticonvulsants should be administered intravenous for seizures (e.g., diazepam 0.25-0.5 mg/kg IV PRN, phenobarbital 4-20 mg/kg IV PRN, etc.). CARDIAC support should include blood pressure and ECG monitoring. If the patient is persistently tachycardiac (e.g., HR > 180 bpm), one should consider the use of beta-blockers (e.g., propranolol). The use of anti-arrthymics (e.g., lidocaine, procainamide) should be used for ventricular arrhythmias (e.g., lidocaine at 2-4 mg/kg IV, followed by CRI 25-75 mcg/kg/minute IV). Lastly, in patients with a severe metabolic acidosis (pH 7-7.1) and presence of arrhythmias, the use of sodium bicarbonate can be considered (e.g., 1-2 mEq/kg IV slow).

With 24/7 care, these dogs can do well, depending on how severe the clinical signs are. When in doubt, as with any poisoning, the sooner veterinary attention is sought, the better the prognosis.

This information is not meant to replace veterinary care. Keep in mind that this information is directed for veterinary professionals only. When in doubt, seek immediately veterinary attention if you think your dog or cat got into anything poisonous or toxic. When in doubt, call ASPCA Animal Poison Control Center (APCC) at (888) 426-4435  for life-saving advice. The contents of this website are for informational purposes only, and are not intended to be a substitute for professional veterinary advice, diagnosis or treatment.

Copyright 2014 Justine Lee Veterinary Consulting, LLC.

Photo by Steve Rotman // cc