Blackwell's Five-Minute Veterinary Consult Clinical Companion. Группа авторов

       WNV.

       WEE, VEE, EEE.

       Rabies.

DIAGNOSTICS

      CBC/Serum Chemistry/Urinalysis

       Routine laboratory work including serum chemistry and urinalysis.

       Transient increase RBC for 1 hour post‐administration.

       Mild increase in lactate and glucose within 1 hour of administration.

       RBCs and urinary epithelial cells in urine.

       ± hypocalcemia.

       Specialized testing for elevated cTnI within 24–48 hours of administration.

      Other Diagnostic Tests

       ECG as needed for tachycardia and cardiac effects.

       Presence in serum and urine:No rapid, commercially available urine tests.ICP‐MS useful for diagnosis, but the time delay would hinder therapeutics.

      Pathological Findings

       No specific lesions reported in horses.

THERAPEUTICS

       The goal of therapy is to provide supportive care.

      Detoxification

       Large ingestions – gastric lavage or reflux with large‐bore tube.

       Supportive care if symptomatic.

      Appropriate Health Care

       Most can be treated in the field.

       Most clinical parameters return to baseline within 2 hours.

      Antidote

       No specific antidote.

      Drugs of Choice

       IV fluids as needed for dehydration and volume expansion; may be helpful to increase elimination.

       Agitation:Acepromazine 0.01–0.05 mg/kg IV, IM, SC prn.Adrenergic agonist: detomidine 10–40 μg/kg IM, IV or xylazine 0.5–1 mg/kg IV.

       GI protectants:Omeprazole 2–4 mg/kg PO q24h.

        Tremors, twitching:Acepromazine 0.01–0.05 mg/kg IV, IM, SC prn/Methocarbamol 4.4–22.2 mg/kg IV to effect. Administer half estimated dose and pause until the horse has relaxed. Administer the remainder of the dose to effect. Repeat as needed but do not exceed 330 mg/kg/day.

      Precautions/Interactions

       Protection to the head and limbs may be necessary in severely agitated horses.

COMMENTS

      Client Education

       There is no purpose for cobalt supplementation in horses.

       ICP‐MS may be useful in legal cases.

      Prevention/Avoidance

       Educate trainers and owners about the adverse effects in horses.

      Possible Complications

       Acute kidney injury.

       Cardiac damage.

       Injury due to ataxia/colic.

       Long‐term potential to cause arrhythmias resulting in sudden death.

      Expected Course and Prognosis

       Toxicity – for experimentally induced cases, prognosis is good with effects generally subsiding after 2 hours.

       Fatality – prevalence of fatality in clinical cases is unknown as reports are limited.

Abbreviations

      See Appendix 1 for a complete list.

Internet Resources

      1 Racing Medication and Testing Consortium, Cobalt. Available at: https://rmtcnet.com/wp‐content/uploads/2015‐10‐Cobalt‐Brochure.pdf (accessed January 15, 2021).

      2 European Food Safety Authority, Scientific Opinion on Safety and Efficacy of Cobalt Carbonate as Feed Additive for Ruminants, Horses and Rabbits. Available at: https://efsa.onlinelibrary.wiley.com/doi/pdf/10.2903/j.efsa.2012.2727 (accessed January 15, 2021).

Suggested Reading

      1 Burns TA, Dembek KA, Kamr A, et al. Effect of intravenous administration of cobalt chloride to horses on clinical and hemodynamic variables. J Vet Intern Med 2018; 32:441–449.

      2 Knych, HK, Arthur, RM, Mitchell MM, et al. Pharmacokinetics and selected pharmacodynamics of cobalt following a single intravenous administration to horses. Drug Test Anal 2015; 7:619–625.

      Author: Dionne Benson, DVM, JD

      Consulting Editor: Dionne Benson, DVM, JD

Chapter 7 Cocaine

      

DEFINITION/OVERVIEW

       A white pearlescent powder in its purest form, usually present as a hydrochloride salt. The street drug typically looks like a fine, white, crystalline powder and often contains substances such as cornstarch, talcum powder, or flour as extenders. Occasionally other drugs such as caffeine, levamisole, fentanyl, aminorex, or amphetamines are mixed with the cocaine.

       “Crack” cocaine is the freebase form that has been precipitated into rocks that can be smoked.

       Schedule II drug used for local anesthesia, where vasoconstriction may be advantageous.

       Cocaine is a tropane alkaloid obtained from leaves of shrubs in the genus Erythroxylaceae, which are domesticated tropical plants native to the Amazon and the eastern slope of the Andes in Bolivia and Peru.

       Although the active ingredient, cocaine, was only isolated in 1859 by German chemist Albert Niemann, the coca leaves have been used for both medicinal and recreational purposes by the native populations in South American for thousands of years.

       Cocaine is the only naturally occurring local anesthetic.