Nonsteroidal anti-inflammatory drugs (NSAIDs) toxicosis is the ingestion of a toxic or lethal dose of a NSAID.
• NSAIDs are common medications which are used to treat pain and fever, and can be toxic to dogs at low doses
• Any ingestion (outside of veterinary guidance) of a human-grade NSAID by a dog is an emergency
• Ingestion of a toxic dosage can lead to vomiting, abdominal pain, diarrhea, seizures, and coma
• If ingestion is witnessed, emesis under vet supervision within 2 hours will lead to the most optimal outcome for the pet
• If ingestion is not witnessed, diagnosis involves urine and blood tests and can delay time-sensitive treatment
• Once absorption has progressed, treatment shifts to symptom management including intravenous fluids, kidney monitoring, and GI ulcer treatment/prevention
• Prognosis varies depending on the quantity of drug ingested, the speed of intervention, and the progression of absorption prior to treatment
NSAIDs are a very common class of drugs to have in a home and are a common source of drug toxicosis in dogs. If the pet has consumed a toxic or lethal dose of an NSAID, this is a life-threatening condition and requires immediate vet assistance. In order to prevent severe organ damage, it is essential to get treatment as soon as possible. If the amount ingested is unknown, it is best to reach out to a vet to ensure the pet is safe.
Note: Tylenol (acetaminophen) is not an NSAID, however it is also toxic to pets. Any drug can be toxic at a high enough dose and should be treated with caution and stored out of reach of cats and dogs.
The symptoms of NSAID toxicosis vary based on the amount of medication ingested. A low but prolonged dose produces ulcers of the gastrointestinal tract, which may result in vomiting of blood or bloody diarrhea. An acute overdose results in gastrointestinal symptoms (vomiting or diarrhea, which may be bloody) within 24 hours. A toxic overdose greatly increases the probability of developing kidney damage/failure. Seizures or comas are also common symptoms associated with toxic overdoses.
The specific doses will vary depending on the specific NSAID ingested and body size, but dogs have a low tolerance for most NSAIDs.
NSAID toxicosis is caused by the ingestion of a toxic or lethal dose of a NSAID class drug. This can be fairly common: the dog-safe NSAIDs are generally in chewable form and if the pet gets into a bottle, it will often eat all of the pills. There are a number of common NSAIDs which include:
• Acetylsalicylic acid (brand name Aspirin) • Ibuprofen (brand name Advil) • Naproxen (brand name Aleve)
• Diclofenac (brand name Voltaren)
Vomiting or diarrhea may include blood, due to damage to the intestinal tract caused by the drug.
If ingestion is witnessed, it is best to bring the drug and any information about it to aid in severity assessment. If ingestion was not witnessed and only suspected, it is still advised to bring in the suspected source of NSAID ingestion to assist risk assessment. Urinalysis, blood work, and physical assessment can be used to determine the likelihood of NSAID toxicosis.
Once NSAID ingestion is confirmed as the cause of symptoms, there are a number of treatment strategies available. If ingestion occurred within 2 hours, vomiting can be induced under veterinary supervision to remove some of the drug from the system. Activated charcoal can also be used to bind and remove remaining NSAIDs from the stomach. Note: it is not safe to induce vomiting or administer activated charcoal without guidance from a veterinarian. Do not attempt to induce vomiting at home.
Further treatment is symptomatic, including preventing or managing gastrointestinal ulcer formation. Intravenous fluids are used for 48 hours after ingestion to flush out the kidneys, followed by repeated bloodwork to assess for additional kidney damage.
The prognosis is best when veterinary care begins immediately after witnessing ingestion. If treatment starts before the majority of the drug enters the bloodstream, prognosis is favorable. If ingestion of a toxic or lethal dose goes untreated within 24 hours, prognosis is poor.
The condition can last anywhere from hours to weeks depending on how quickly treatment begins. If the condition has affected the kidneys, this will lengthen the time required for recovery. The sooner treatment begins, the easier recovery is.
This condition can be prevented by not allowing consumption of NSAIDs by dogs. This includes speaking with vets before administering any medication, following dosages given by the vet, and keeping all medication out of reach of pets.
Ingestion of human NSAIDs is common in dogs.
• Vet-supervised vomiting induction • Activated charcoal • Gastrointestinal protectants • IV fluids
• Long term monitoring of kidney function
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