Joanna Crouchley’s scientific contributions

Objective To determine the common clinical signs, with onset and duration, treatments given, and outcome in dogs with acute, accidental exposure to salbutamol. Design Retrospective study. Animals Five hundred and one canine cases reported to the UK's Veterinary Poisons Information Service (VPIS). Measurements and Main Results A review of all records in the VPIS database for dogs exposed to salbutamol was carried out. After applying inclusion and exclusion criteria, the records of 501 dogs were further analyzed. The most common clinical signs were tachycardia (80.6%), tachypnea (32.9%), depression (21.0%), and vomiting (19.2%). The dose was unknown in most cases as the dogs typically pierced a salbutamol inhaler. The blood potassium concentration was measured in at least 142 dogs and hypokalemia was reported in 21.2% (106/501), 18 (17%) of which had associated weakness, twitching, or collapse. Three dogs had paralysis probably as a result of hypokalemia, although no potassium concentration was reported in these cases. Arrhythmias occurred in 17 dogs (3.4%), and 7 required pharmacological intervention. There were no reports of persistent cardiac injury or thermal injury from the compressed gas present in some salbutamol products. Signs were rapid in onset, generally within 1–3 h, and, where time to outcome was recorded (n = 172), 78% of dogs recovered within 24 h. Of the 501 dogs, no treatment was required in 27.9%. Beta‐blockers were used in 39.5%, intravenous fluids in 28.7%, and potassium supplementation in 15.8%. Overall, 30 dogs remained asymptomatic (6.0%), 469 recovered (93.6%), and 2 dogs (0.4%) died. Conclusions Most dogs exposed to salbutamol rapidly develop clinical signs; these were commonly increased heart and respiration rates. Hypokalemia and arrhythmias (particularly ventricular arrhythmias) are potential complications. Any dog that chews a salbutamol inhaler should be assessed promptly for signs of toxicosis. Prognosis in dogs with acute salbutamol exposure is good, but more guarded in those with severe tachycardia and at risk of cardiac injury.

Objective: Salbutamol is a selective beta2-adrenoceptor agonist, used as a bronchodilator. Exposure typically causes rapid onset tachycardia, tachypnoea, and more rarely hypokalaemia. Thermal injury consistent with exposure to released compressed gas from an inhaler has been reported.[1] The clinical signs, treatment and outcomes in dogs exposed to salbutamol reported to the Veterinary Poisons Information Service (VPIS), were reviewed. Methods: A retrospective analysis of all canine cases of salbutamol exposure reported to the VPIS between February 1985 and October 2015. All cases with exposure to salbutamol as a single agent and known outcome with returned veterinary surgeon follow up (via postal questionnaire) were included. Results: There were 411 cases of salbutamol exposure in dogs with follow up. Of these 20 (7%) remained asymptomatic, 4 of which received an emetic. Route of exposure was: not specified (42% of cases), chewing and puncturing an inhaler (48%) or ingestion of oral formulations (9%). Dose was known in 8 cases and ranged from 0.08 to 23.5 mg/kg; all of these dogs were symptomatic. The most common signs were tachycardia (78%), tachypnoea (20%), vomiting (19%), lethargy (16%), panting (16%), hypokalaemia (14%) and tremor (12%). Onset of signs was within 2 hours of exposure in 84% of cases (range 2 minutes to 12 hours). Duration of signs was 6 hours to 6 days, but 75% of dogs recovered within 24 hours. Hypokalaemia occurred in 59 dogs, value was known in 17 cases (range 2.4–3.6 mmol/L, normal range 3.9–5.1 mmol/L);15 had associated weakness, twitching or collapse. While there were no reports of thermal injury, 17 dogs had signs of facial, oral or ocular inflammation (4% of cases). Of symptomatic cases (n ¼ 382), 109 (29%) received no treatment or observation only; 33 dogs (9%) received gastrointestinal decontamination with an emetic or adsorbents. The most common treatments were beta-blockers (35%), IV fluids (16%), potassium (13%) and diazepam (11%). Of dogs with hypokalaemia 88% received treatment with potassium (24%), a beta-blocker (31%), or a combination of both (34%). One displayed cyanosis, hypersalivation, tachycardia, tachypnoea and died within 2 hours despite treatment with acepromazine, propranolol and oxygen; another died despite IV fluid therapy after presenting with tachycardia, shock and poor peripheral circulation. One case was ongoing at time of follow up and all other dogs recovered fully. Conclusion: Salbutamol exposure in dogs causes rapid onset of clinical signs in most cases, however fatalities are very rare. Treatment is aimed at correcting tachycardia and hypokalaemia. Reference [1] Mackenzie SD, Blois S, Hayes G, et al. Oral thermal injury associated with puncture of a salbutamol metered-dose inhaler in a dog. J Vet Emerg Crit Care (San Antonio). 2012;22:494–497.