We’ve all been given that fun job once or twice. The one to get the gloves on and sift through some dog vomit for that pair of pants, the delightful smelling chocolate orange vomit, or for the white cylinder-shaped thing he “found in the park”. It’s the task that makes us love the job…
As nurses, we try see the funny side of the cute dog with the scrunchie pinned back ears, or the more “exotic” objects eaten, but from the pet’s point of view, the situation is nothing to be mocked.
Careful consideration
When inducing vomiting there are some considerations to be adhered to. For instance, if the item swallowed is sharp (meat skewers), or abrasive (chemicals), induced vomiting is contraindicated as this can further damage the stomach, oesophagus or mouth. Instead, we regularly use activated charcoal and supportive care (usually intravenous fluid therapy), given for some time to ensure the toxins are flushed out, or further investigations, such as x-rays, are carried out.
For dogs presented as having eaten something toxic/poisonous/obstructive within two hours that is safe to make its way back up to the outside without damage, the medical intervention of making them sick prevents absorption of toxins, or an obstruction.
To do this, the drug used is apomorphine…
Either/or
This is a topic that interests me, as to how it is given and the effects of such.
Apomorphine, when sold as apomorphine, can be administered both intravenously (IV) and subcutaneously (SC). However the brand used widely across veterinary practises within the UK is Emedog, which is only licensed to be administered SC1. When given SC, the drug takes effect within 10 minutes1 and can leave the dog vomiting, even when just bile, for a long period afterwards. The dogs tend to be sent home with an incontinence pad and look very sorry for themselves.
However, I have previously seen apomorphine administered IV, which, when looking at the care of the patient, I much prefer. This has a rapid onset of within two minutes, but the dogs usually hop, skip and wag their tails as they leave the building. This also seemed to reduce the number of patients given an antiemetic after the intervention. There are some studies out there to demonstrate the differences, but the topic has always interested me as, from a nurse’s point of view, it would be nice to send our cheeky doggos out the door a little less guilty-faced.
But what do we do if we cannot give apomorphine?
Alternative intervention
If a patient has been given opioid medications then apomorphine is contraindicated as this mix of medications can cause both respiratory depression and central nervous system depression2. When presented with a possible foreign body dog the first line is usually induced vomiting, but, in some cases, they may present with signs relating to other problems, resulting in pain relief or premedication made up partially with opiates being given.
In some rare cases, inpatients receiving opioids may get hold of and swallow blankets or toys left in with them, requiring intervention. In these cases, Tranexamic acid can be used.
When administered IV quickly, tranexamic acid induces vomiting3. Although safe for most patients, there are some contraindications. Disorders contraindicated include, but are not limited to, those with history of seizures, blood clots, neoplasia, and any other conditions with the possibility of thrombosis, as the drug acts to encourage clots to stay formed4.
Retch research
After witnessing this used, and admiring how well it worked, I carried out some research as it was something I did not know others used.
It turns out there are many studies on this topic – all demonstrating similar results – yet one specifically piqued my interest. This study demonstrates successfully induced vomiting in 94.2% of dogs used for the study (129 out of 137 dogs)5. This was based on a 50mg/kg dose given IV, and the ability to provide a second or third dose of 20-50mg/kg if required. The time until vomiting was averaged at just under two minutes, and the duration of emesis was an average time of around two-and-a-half minutes. This study, however, does not discuss whether the patient is exhausted or lively after this, which is something I wish had been observed.
Overall, both methods are proven to work and the ultimate decision is down to the vet at hand. However, this topic grabbed my interest and is worth a discussion point.
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