A 9-year-old female spayed Dachshund was referred to the Cornell Emergency Service for an upper airway obstruction and respiratory distress. Earlier that day, she presented to her primary veterinarian after a two day history of change in bark and increased respiratory noise and effort. There was no known history of trauma or toxin exposure. Physical exam was limited due to the patient’s markedly increased respiratory rate and effort, but was concerning for an upper airway obstruction. Cervical and thoracic radiographs revealed a mass in the laryngeal region and a sedated oral exam revealed inflammation within the laryngeal region.
On presentation to Cornell, the patient had severely increased respiratory effort on inspiration with stridor and normal lung sounds. A 4cm X 4cm soft swelling was palpated within the laryngeal region of her neck. Despite attempts to stabilize the patient with sedation and oxygen therapy, her respiratory status progressed to distress and concern for impending respiratory arrest. She was emergently anesthetized for a tracheostomy tube placement. During intubation, the laryngeal region was noted to be diffusely markedly swollen and bruised. A mild amount of blood and bruising was noted within the connective tissue overlying the trachea. A tracheostomy tube was placed without any apparent complications. Recovery from anesthesia was uneventful, however moderate bleeding from the tracheostomy site in the ensuing hours was noted. Point of care diagnostics revealed packed cell volume 42%, total solids 6g/dL, metabolic and respiratory acidosis, estimated platelet count within normal limits, hematuria (from a voided sample), and the prothrombin time and activated partial thromboplastin time were above the reference values. A thoracic focused assessment with sonography for trauma (TFAST) revealed B lines and consolidation within the left cranial lung field. An abdominal focused assessment with sonography for trauma (AFAST) was negative for free fluid. Based on the initial examination and point of care blood work, our problem list included upper airway obstruction and coagulopathy. An anticoagulant rodenticide screen was positive for diphacinone exposure, supporting the diagnosis of anticoagulant toxicosis.
This seminar will review anticoagulant rodenticide toxicosis and treatment.