Article

Effects of oral 3% hydrogen peroxide used as an emetic on the gastroduodenal mucosa of healthy dogs

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Objective: To characterize the extent of mucosal injury on the upper gastrointestinal tract following oral administration of 3% hydrogen peroxide (H2 O2 ) to induce emesis in normal dogs. Design: Prospective clinical study. Setting: Specialty referral hospital. Animals: Seven staff-owned, healthy, adult dogs. Interventions: Six dogs were assigned to the H2 O2 group and 1 dog was assigned as the apomorphine control. Dogs were anesthetized for gastroduodenoscopy with gross inspection and gastroduodenal biopsies at time 0 and 4 hours, 24 hours, 1 week, and 2 weeks following administration of oral 3% H2 O2 or subconjunctival apomorphine. Gross esophageal, gastric, and duodenal mucosal lesion scoring was performed by 2 blinded, experienced scorers. Biopsy samples were evaluated histologically by a veterinary pathologist. Measurements and main results: Grade I esophagitis was noted in 2 dogs at 4 hours and in 1 dog at 2 weeks, while grade III esophagitis was observed in 1 dog 1 week following H2 O2 administration. At 4 hours, gastric mucosal lesions were visualized in all dogs, and lesions worsened by 24 hours. Mild to moderate duodenal mucosal lesions were visualized up to 24 hours after administration. Histopathology identified the most severe gastric lesions at 4 hours as hemorrhage; at 24 hours as degeneration, necrosis, and mucosal edema; and at 1 week as inflammation. By 2 weeks, most visual and histopathologic lesions were resolved. No histopathologic lesions were identified at any time point in the dog administered apomorphine. Conclusions: Significant visual and histopathologic gastric lesions occurred following administration of 3% H2 O2 in all dogs. Less severe visual duodenal lesions were identified. As compared to H2 O2 dogs, minimal gross gastroduodenal lesions and normal histopathology were identified in the apomorphine control.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Hydrogen peroxide had an overall incidence of adverse events in 14% of cases, with lethargy and persistent nausea most commonly identified (Khan et al, 2012). These are considered to be generally mild and self-limiting (Khan et al, 2012); however, 3% hydrogen has also been associated with significant gross and histopathologic gastric lesions following administration in dogs (Niedzwecki, 2017) and necroulcerative haemorrhagic gastritis in a cat (Obr et al, 2017). The duration of effect of apomorphine and 3% hydrogen peroxide in one study was 27 and 42 minutes respectively (Khan et al, 2012). ...
Article
Full-text available
Apomorphine is a non-selective dopamine agonist commonly used in veterinary medicine for the emergency management of toxicoses in dogs, through the induction of emesis. This review evaluates the currently reported effectiveness, adverse effects and recommendations of apomorphine as an emetic and considers alternatives. This is complemented by a retrospective study of 1126 dogs treated with apomorphine in emergency practice, to determine the efficacy of apomorphine in a clinical setting, and to provide identification of population characteristics, indications and outcomes of treated patients. The literature recognises apomorphine as a successful and consistent emetic for the retrieval of ingested harmful substances, with generally mild and self-limiting adverse effects. The retrospective study found that the most common reasons for presentation of the treated population were chocolate (26.8%), rodenticide (26.5%), foreign material (20.7%), and medication ingestion (11.6%). In this study, the two most influential factors on emetic and clinical outcome were the type of intoxicant and length of ingestion-to-presentation time. Breed size was an important determinant for the type of substance ingested, with variations noted between small, medium and large breed dogs. The most commonly estimated time from ingestion to presentation was 1–2 hours, with the substance, or parts thereof, successfully identified in the vomitus of 68.9% of cases. Apomorphine remains a valuable veterinary therapeutic for use in small animal emergency and critical care, providing a high rate of successful induction of emesis.
... A recent prospective study demonstrated that dogs that were administered an oral solution of 3% hydrogen peroxide to induce emesis developed endoscopic evidence of mucosal injury despite appearing clinically normal. 9 This supports the notion that the safety of an emetic agent such as sodium carbonate cannot be inferred simply by the lack of reported complications. The recent increase in patients presenting to our emergency clinic with severe complications following the administration of powdered sodium carbonate raises concerns about the safety of the powdered formulation in particular. ...
Article
Case series The administration of emetic agents in dogs for the purpose of gastric decontamination is not without risk, although the incidence of adverse effects is unknown and likely under‐reported. This case series describes gastrointestinal and respiratory side effects observed in five dogs that were administered powdered sodium carbonate to induce emesis. Clinical significance The safety of inducing emesis in dogs using powdered sodium carbonate is discussed.
Article
A 6‐year‐old, male, neutered Dalmatian was evaluated as an emergency due to retching, hypersalivation and haematemesis, which developed after ingestion of medium‐density fibreboard. Radiographs of the neck, thorax and abdomen revealed gas tracking within the cervical oesophageal wall. Endoscopy revealed changes suggestive of severe generalised oesophagitis, oesophageal laceration in caudal oesophagus and gastritis. Treatment with prokinetics, antiemetics, gastroprotectants and antibiotics was administered. However, progressive regurgitation noticed 4 weeks after discharge prompted a second endoscopy, which excluded oesophageal stricture but confirmed persistent severe oesophagitis. Aspiration pneumonia occurred 4 weeks later after an episode of suspected regurgitation secondary to quick ingestion of food. Five months after initial presentation, hand‐feeding from a height and administration of metoclopramide and omeprazole were still required to prevent retching and regurgitation. Therefore, permanent damage to the oesophagus associated with ingestion of medium‐density fibreboard was suspected.
Article
Full-text available
Pet hayvanı hekimliğinde potansiyel olarak toksik olan ve kullanımı günden güne artan çok sayıda tezgah üstü (Over the counter / OTC) ilaç bulunmaktadır. OTC grubu ilaçların çoğu, piyasada yaygın olarak bulunan, ucuz ve hekim kontrolü olmadan reçetesiz satın alınabilinen ilaçlardır. Bu ilaçlar, veteriner hekimlikte hekim kontrolü dışında hasta sahibi tarafından satın alındığında kafa karışıklığına veya telaffuz hatalarına bağlı olarak yapılan terapötik yanlışlıkların yanı sıra beşeri hekimlikte suistimal veya intihar amaçlı da kullanılabilmektedir. Çocuklarda ve ev hayvanlarında OTC ilaç zehirlenmeleri, kazara yutma veya bakıcının gözetimi dışında ilaca maruz kalma sonucu gelişmektedir. Günümüzde hem veteriner hekimliğinde hem de beşeri hekimlikte OTC grubu ilaçların kasıtlı yanlış kullanımı halen önemini korumaktadır. Bu sebeple ev hayvanlarının, özellikle kedi ve köpeklerin, ölümle sonuçlanabilen OTC grubu ilaç intoksikasyonlarına maruz kalmasının önüne geçmek ve tekrar oluşumunu önlemek için gerekli önlemler alınmalı; bakıcılar, yetiştiriciler ve hayvan sahipleri bu konuda bilgilendirilmelidir. Bu derlemede yaygın kullanılan ve kolay erişilebilen aspirin, ibuprofen, asetaminofen gibi non steroid antienflamatuvarlar, H2 reseptör antagonistleri, proton pompa inhibitörleri gibi gastrik protektanlar, ipekak şurubu gibi emetikler, difenhidramin, loratidin gibi antihistaminikler ve dekonjestanlar, göz damlaları, vitaminler, laksatifler, anti diyaretikler ile anti tüssifler gibi OTC grubu ilaçların toksisiteleri, yanlış kullanımı sonucu ortaya çıkan klinik sonuçları ve bu ilaçlarla intoksikasyona sebep olabilen çevresel risk faktörleri ile birlikte bu ilaçlara maruz kalma durumunda uygulanabilecek tedavi seçenekleri incelenmiştir.
Article
Objective: To determine the success rate and complications associated with inducing emesis in dogs that have ingested foreign material. Design: Retrospective case series, 2010-2014. Setting: Private practice and referral center. Animals: Sixty-one client-owned dogs that had emesis induced for the treatment of ingestion of foreign material. Interventions: None. Measurements and main results: Emesis was successfully induced in 59 of 61 (97%) dogs administered an emetic. Of those 59 dogs, 46 (78%) produced the foreign body. There were no complications reported in any of the dogs in which emesis was successfully induced. Dogs in which emesis was successfully induced were likely to produce the foreign body (P = 0.01). Conclusion: Based on the results of this study, emesis appears to be a safe and effective means for the removal of certain gastric foreign bodies in dogs.
Article
Background: There are two types of intoxicated patient that present to veterinary practices: the asymptomatic patient with a known exposure and the patient with clinical signs that may (or may not) be due to a toxin or poison. Deciding when (or if) to treat these patients is often an inexact science and the decision must be made based on numerous risk factors, the owner’s level of comfort with risk and any financial constraints. Aim of the article: This article is the first in a series of four and aims to provide a basic overview of the approach to decontamination of an asymptomatic patient presented with a known intoxication. It also outlines therapies that may be considered in both symptomatic and asymptomatic patients, and these will be discussed in more detail in future articles.
Article
Full-text available
There is a need for an effective and safe emetic agent that dog owners could easily administer to their dogs following veterinary advice in cases of potential poisoning. As a response to this need, a randomised, double-blind, multi-site, clinical field study was performed to assess the efficacy, safety and usability of ropinirole eye drops to induce vomiting in dogs. Ropinirole (target dose 3.75 mg/m ² ) was applied to eyes of 100 dogs, and 32 dogs received placebo. The drug was administered by the dog owner at a veterinary clinic under the supervision of a veterinarian and led to vomition in 95% of the ropinirole-treated dogs within 30 min. The median time to first vomit was 10 min (range: 3–37 min). None of the dogs receiving placebo vomited in this time period. All owners were able to administer the product and 96% of them assessed the administration to be very easy or easy, which was confirmed by the observing veterinarian. Some ocular signs were seen both with ropinirole and placebo, hyperaemia being the most common. All observed signs were transient and in most cases mild. Ropinirole eye drops provided an effective, safe and reliable means to induce emesis in dogs.
Chapter
Pharmacists play a key role in maintaining healthy communities by providing their expertise to assist people purchasing over the‐ counter (OTC) drug products and nutritional supplements. This chapter helps pharmacists to recognize some of the risks that some OTC drugs pose to companion animals as well as recognize which OTC drugs are relatively safe. Non‐steroidal anti‐inflammatory drugs (NSAID) metabolism in cats and dogs can vary widely relative to that of humans, depending on the particular drug. There are several OTC antihistamines that can be used therapeutically in both humans and veterinary patients. Pharmacologic effects of antihistamines are widely distributed throughout the body, and in overdose scenarios, adverse effects can involve the cardiovascular, gastrointestinal, and nervous systems. Treatment options for poisoned patients may include decontamination measures, anticonvulsant medication for seizure control, and general supportive care. Contraindications for inducing emesis in veterinary patients are the same as those for inducing emesis in poisoned human patients.
Chapter
[fo]One of the main goals of treatment in the poisoned veterinary patient is decontamination, which includes appropriate emesis induction, gastric lavage, and the administration of activated charcoal. When treating the poisoned patient, the clinician should have an understanding of the toxicokinetics (including absorption, distribution, metabolism, and excretion), the underlying mechanism of action, and the potential clinical signs that can be observed with the toxicant. The clinician should be well versed in how to decontaminate the poisoned patient, and understand the appropriate indications and contraindications for the use of emetic agents, emesis induction, gastric lavage, and administration of activated charcoal. When in doubt, an Animal Poison Control Center (APCC) should be consulted for life‐saving advice. Routine and advanced diagnostic toxicological testing of blood, urine, gastric contents, and tissues may be useful for confirmation of toxicity.
Chapter
Drug action or pharmacology is one of the most fundamental aspects to being a successful veterinary emergency and critical care nurse. This chapter addresses all three domains of pharmacology: pharmacokinetics, pharmacodynamics and clinical pharmacology. Four key physiological processes govern the time course of a drug in the body: absorption, distribution, metabolism, and elimination. Drug distribution may be altered in the pediatric patient due to increased total body water, decreased fat stores, and hypoproteinemia. Geriatric patients, on the other hand, are at increased risk for concurrent disease states, including chronic kidney disease, which will often reduce glomerular filtration rate and decrease drug clearance. Apomorphine is derived by heating morphine in an acid solution or alternatively synthetizing it from other starting materials. Metoclopramide is an antiemetic and prokinetic agent with dopamine and serotonin antagonist and cholinergic agonist properties. Xylazine is an alpha‐2 adrenergic agonist that is often considered the emetic of choice in cats.
Chapter
Toxicity should always be considered as a potential differential whenever a patient presents with an illness of unknown cause. Toxins can gain entrance into the body predominantly through four routes: ingestion, inhalation, injection, or topical exposure. The main goal of the decontamination phase is to prevent initial absorption or further absorption of a toxin. Apomorphine is used primarily as an emetic in dogs and is considered the emetic of choice by many clinicians. Dexmedetomdine and xylazine are alpha‐2 adrenergic agonists with profound sedative and analgesic qualities. Three percent hydrogen peroxide (H2O2) causes vomiting by direct gastric irritation. Gastric lavage was historically used when the induction of emesis was contraindicated or when a large dose of toxin had been ingested. Activated charcoal is an extremely porous form of carbon that, having a large surface area, can act as an effective absorbent.
Article
Full-text available
Hydrogen peroxide is a commonly used oxidizing agent with a variety of uses depending on its concentration. Ingestion of hydrogen peroxide is not an uncommon source of poisoning, and results in morbidity through three main mechanisms: direct caustic injury, oxygen gas formation and lipid peroxidation. A case of a 39-year-old man who inadvertently ingested 250 mL of unlabelled 35% hydrogen peroxide intended for natural health use is presented. Hydrogen peroxide has purported benefits ranging from HIV treatment to cancer treatment. Its use in the natural health industry represents an emerging source for accidental poisonings.
Article
This chapter presents analytic methods for matched studies with multiple risk factors of interest. We consider matched sample designs of two types, prospective (cohort or randomized) and retrospective (case-control) studies. We discuss direct and indirect parametric modeling of matched sample data and then focus on conditional logistic regression in matched case-control studies. Next, we describe the general case for matched samples including polytomous outcomes. An illustration of matched sample case-control analysis is presented. A problem solving section appears at the end of the chapter.
Article
Objective: To determine the effectiveness and adverse effects of apomorphine and 3% hydrogen peroxide solution used for emesis in dogs. Design: Prospective observational study. Animals: 147 dogs that received apomorphine (IV or placed in the conjunctival sac) or 3% hydrogen peroxide solution (PO) to induce emesis after exposure to toxic agents. Procedures: Data regarding signalment; agent information; type, dose, route, and number of emetic administrations; whether emesis was successful; number of times emesis occurred; percentage of ingested agent recovered; and adverse effects were collected via telephone during American Society for the Prevention of Cruelty to Animals Animal Poison Control Center operations and stored in a database for analysis. Mann-Whitney and Fisher exact tests were used to evaluate emetic success rates. Results: Apomorphine and 3% hydrogen peroxide solution successfully induced emesis in 59 of 63 (94%) and 76 of 84 (90%) of dogs, respectively. Mean time to onset of emesis after the first dose of emetic was 14.5 and 18.6 minutes when hydrogen peroxide (n = 37) and apomorphine (31) were used, respectively, with mean durations of 42 and 27 minutes, respectively. Mean estimates for recovery of ingested agents were 48% for hydrogen peroxide and 52% for apomorphine. Adverse effects were reported in 16 of 112 (14%) dogs for which information was available. Conclusions and clinical relevance: 3% hydrogen peroxide solution and apomorphine effectively induced emesis in dogs when used as directed. Emesis occurred within minutes after administration and helped recover substantial amounts of ingested agents. Adverse effects of both emetics were considered mild and self-limiting.
Article
Objective: To characterize the presence of esophagitis in dogs after esophagoscopy for diagnosis and treatment of esophageal foreign body and to relate the degree of esophageal injury to clinical signs and outcome.Design: Retrospective study.Animals, intervention, and measurements: Medical records of 60 dogs with esophageal foreign bodies diagnosed between January 1999 and December 2003 were reviewed. Information obtained from the medical records included age, breed, and sex; type and duration of clinical signs; physical examination, radiographic, and esophagoscopy findings; type and location of foreign body; surgical intervention; morbidity, and outcome. Animals were divided into 2 cohorts based upon the degree of esophageal injury detected during esophagoscopy: mild esophagitis or moderate-to-severe esophagitis. Data were then compared between the groups.Results: Dogs with moderate-to-severe esophagitis had a longer duration of clinical signs, were more likely to present for lethargy and regurgitation/vomiting, and had a longer time to recovery. This cohort had significantly greater morbidity including esophageal stricture, perforation, necrosis, and diverticulum formation, as well as aspiration pneumonia, pneumothorax, severe tracheal compression, and death. Dogs with mild esophagitis were more likely to present to the hospital for gagging.Conclusions: This study demonstrated a wide range of injury associated with esophageal foreign bodies. The degree of esophagitis appears to relate to the duration and severity of some of the clinical signs.
Article
Ingestion of concentrated hydrogen peroxide (H(2)O(2)) has been associated with venous and arterial gas embolic events, hemorrhagic gastritis, gastrointestinal bleeding, shock, and death. Although H(2)O(2) is generally considered a benign ingestion in low concentrations, case reports have described serious toxicity following high concentration exposures. Hyperbaric oxygen (HBO) has been used with success in managing patients suffering from gas embolism with and without manifestations of ischemia. Poison center records were searched from July 1999 to January 2010 for patients with H(2)O(2) exposure and HBO treatment. Cases were reviewed for the concentration of H(2)O(2), symptoms, CT scan findings of portal gas embolism, HBO treatment, and outcome. RESULTS; Eleven cases of portal gas embolism were found. Ages ranged from 4 to 89 years. All but one ingestion was accidental in nature. In 10 cases 35% H(2)O(2) was ingested and in 1 case 12% H(2)O(2) was ingested. All abdominal CT scans demonstrated portal venous gas embolism in all cases. Hyperbaric treatment was successful in completely resolving all portal venous gas bubbles in nine patients (80%) and nearly resolving them in two others. Ten patients were able to be discharged home within 1 day, and one patient had a 3.5-day length of stay. HBO was successful in resolving portal venous gas embolism from accidental concentrated H(2)O(2) ingestions.
Article
Consensus Statements of the American College of Veterinary Internal Medicine (ACVIM) provide the veterinary community with up-to-date information on the pathophysiology, diagnosis, and treatment of clinically important animal diseases. The ACVIM Board of Regents oversees selection of relevant topics, identification of panel members with the expertise to draft the statements, and other aspects of assuring the integrity of the process. The statements are derived from evidence-based medicine whenever possible and the panel offers interpretive comments when such evidence is inadequate or contradictory. A draft is prepared by the panel, followed by solicitation of input by the ACVIM membership, which may be incorporated into the statement. It is then submitted to the Journal of Veterinary Internal Medicine, where it is edited prior publication. The authors are solely responsible for the content of the statements. © 2010 by the American College of Veterinary Internal Medicine.
Article
The coadministration of prednisone and ultralow-dose aspirin has been recommended for the management of various diseases, but the safety of this combination in dogs has not been studied. The gastroduodenal lesions associated with prednisone and ultralow-dose aspirin administration will be similar to those caused by prednisone alone, but both treatments will result in more severe lesions than placebo. Eighteen healthy adult purpose-bred dogs. Randomized, blinded, placebo-controlled study of 3 treatment groups for 27 days: placebo, prednisone, and prednisone and aspirin. Gastroduodenoscopy was performed before and on days 5, 14, and 27 of treatment and mucosal lesions scores were assigned. Mucosal lesion scores were compared by a Kruskal-Wallis test. Clinical signs were compared by the Friedman's chi-square test (significance at P < .05). There were no significant differences in the gastroduodenal lesion scores among groups, or within groups at any time during the study. Significantly more dog-days of diarrhea occurred in the prednisone and aspirin group during treatment, compared with baseline. No significant differences in clinical signs were found among any of the groups. The concurrent use of prednisone and ultralow-dose aspirin did not increase the severity of gastroduodenal lesions compared with prednisone or placebo. Coadministration of prednisone and ultralow-dose aspirin increases the frequency of mild, self-limiting diarrhea in some dogs.
Article
Reliability coefficients often take the form of intraclass correlation coefficients. In this article, guidelines are given for choosing among 6 different forms of the intraclass correlation for reliability studies in which n targets are rated by k judges. Relevant to the choice of the coefficient are the appropriate statistical model for the reliability study and the applications to be made of the reliability results. Confidence intervals for each of the forms are reviewed. (23 ref) (PsycINFO Database Record (c) 2006 APA, all rights reserved).
Article
To present a child who developed gastric ulcers and duodenal erosions after ingestion of hydrogen peroxide 3% and delineate the epidemiology, medical outcomes, and toxicity of exposures to this agent managed by a poison control center. A retrospective chart review of exposures to hydrogen peroxide 3% reported to the Long Island Regional Poison Control Center from January 1992 to April 1995 was conducted. Data extracted included age, route of exposure, amount of agent, symptoms, therapy, and medical outcome. There were 670 exposures to hydrogen peroxide 3% of 81,126 total exposures reported during the 40 months. Most exposures were by oral route (77%), occurred in children < 17 years old (67%), and were asymptomatic (85.6%). All but one exposure resulted in a benign outcome. One child, who presented with bloody emesis, developed multiple gastric ulcers and duodenal erosions after ingestion of hydrogen peroxide 2-4 oz. Exposure to hydrogen peroxide 3% is usually benign, however, severe gastric injury may occur following small ingestions in children. Patients who report persistent vomiting or bloody emesis require medical evaluation and consideration of endoscopy to evaluate gastrointestinal injury.
Article
It is well known that ingestion of low concentrations of hydrogen peroxide is usually nontoxic; this does not produce gas embolism and is only a mild irritant to the gastrointestinal tract. We report the case of a 25-year-old woman who ingested one mouthful of 3% hydrogen peroxide and presented to the Emergency Department with persistent vomiting and epigastric pain. The radiographic evaluation found portal venous gas emboli. In addition, upper gastrointestinal endoscopy performed 2 h after ingestion revealed diffuse hemorrhagic gastritis. She showed a decrease of hemoglobin concentration and a positive test result for occult blood in stool. She was observed for 14 days and discharged. Follow-up endoscopy showed erythematous gastritis. This case illustrates that a low concentration of hydrogen peroxide can cause portal venous gas embolism and severe gastrointestinal injuries even if only a small amount is ingested.
Apomorphine. In: Plumb's Veterinary Drug Handbook
  • Plumb DC
Hydrogen peroxide. In: Plumb's Veterinary Drug Handbook
  • Plumb DC