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ARTHROPODS

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Classification   |    Detailed evidence-based information

Substances Included Synonyms

Therapeutic Toxic Class

    A) There are approximately 900,000 species of arthropods. Many bite or sting, and some bite and sting. Some contain body fluids which irritate or even desquamate, and a few spray defensive secretions which can cause injury. Some have irritating hairs, and some are poisonous to eat. The Phylum Arthropoda (joint legged animals) is composed of the Class Arachnida (spiders, ticks, mites, scorpions), Class Crustacea (shrimp & copepods), Class Diplopoda (millipedes), Class Chilopoda (centipedes), and Class Insecta (all insects).
    B) Bites or stings of insects or other arthropods may appear similarly. Other related documents include:
    1) ANTS
    2) CENTIPEDES
    3) HYMENOPTERA STINGS
    4) LATRODECTUS ANTIVENIN
    5) LEPIDOPTERISM
    6) PAEDERUS BLISTER BEETLES
    7) SCORPIONS, ANDROCTONUS SPECIES
    8) SCORPIONS, CENTRUROIDES SPECIES
    9) SCORPIONS, MESOBUTHUS TAMULUS
    10) SCORPIONS, TITYUS SPECIES
    11) SPIDER-FUNNEL WEB
    12) SPIDER-LATRODECTUS SPECIES
    13) SPIDER, OTHER
    14) TICKS
    15) TRIATOMA SPECIES

Specific Substances

    A) CONSTITUENTS OF THE GROUP
    1) Assassin bugs
    2) Bedbugs
    3) Chiggers
    4) Cockroaches
    5) Deerflies
    6) Earwigs
    7) Gnats
    8) House Fly
    9) Lice
    10) Locusts
    11) Midges
    12) Millipedes
    13) Mites
    14) Mosquitoes
    15) Nabis rosipennis bug
    16) Sawfly
    17) Water Bugs
    18) Arthropod venom poisoning

Overview

Life Support

    A) This overview assumes that basic life support measures have been instituted.

Clinical Effects

    0.2.1) SUMMARY OF EXPOSURE
    A) GENERAL INFORMATION: This document covers bites/stings from a variety of arthropods including mosquitoes, bed bugs, chiggers, flies, gnats, lice and mites. Scorpions, spiders, ants, centipedes, hymenoptera, lepidoptera, ticks, triatoma, and blister beetles are covered in separate managements.
    B) TOXICOLOGY: The secretions of some arthropods contain substances that can be irritating or provoke histamine release. Some arthropods can transmit infectious diseases.
    C) EPIDEMIOLOGY: Bites and stings are extremely common worldwide but cause mostly local effects.
    D) WITH POISONING/EXPOSURE
    1) MILD TO MODERATE TOXICITY: Pain, erythema, and edema at the bite site are common. Macules, papules, urticaria and various types of dermatitis are common. Allergic reactions are also common. Bites can become secondarily infected.
    2) SEVERE TOXICITY: Systemic effects are extremely uncommon. Severe allergic reactions can occur.

Laboratory Monitoring

    A) No laboratory studies are necessary unless otherwise clinically indicated.
    B) Evaluate for clinical evidence of secondary infection or hypersensitivity reaction.

Treatment Overview

    0.4.7) BITES/STINGS
    A) MANAGEMENT OF MILD TO MODERATE TOXICITY
    1) Most pain can be treated with a cube of ice placed over the injured area. Oral acetaminophen or nonsteroidal antiinflammatory agents can also be used. A topical corticosteroid, antihistamine, and local anesthetic combination may be of value for itching and inflammation. Oral antihistamines may also be useful. Monitor for the development of secondary infection.
    B) MANAGEMENT OF SEVERE TOXICITY
    1) Treat severe allergic reactions with antihistamines, corticosteroids, inhaled beta agonists and epinephrine if necessary.
    C) SCABIES
    1) Scabies can be treated with topical permethrin, lindane or crotamiton.
    D) PATIENT DISPOSITION
    1) HOME CRITERIA: The vast majority of patients with local reactions can be managed at home.
    2) OBSERVATION CRITERIA: Patients with secondary infection or significant allergic reaction should be referred to a healthcare facility.
    3) ADMISSION CRITERIA: Patients with severe secondary infection or anaphylaxis should be admitted.
    E) DIFFERENTIAL DIAGNOSIS
    1) Other bites/stings (eg spiders), puncture wound, cellulitis, primary dermatologic diseases.

Range Of Toxicity

    A) TOXICITY: Usually one bite or sting will produce a local reaction. The extent of local and systemic reaction varies, depending on the arthropod, the number of envenomations, and the sensitivity of the patient. A severe allergic reaction may result in a fatality with only one bite or sting.

Clinical Effects

Summary Of Exposure

    A) GENERAL INFORMATION: This document covers bites/stings from a variety of arthropods including mosquitoes, bed bugs, chiggers, flies, gnats, lice and mites. Scorpions, spiders, ants, centipedes, hymenoptera, lepidoptera, ticks, triatoma, and blister beetles are covered in separate managements.
    B) TOXICOLOGY: The secretions of some arthropods contain substances that can be irritating or provoke histamine release. Some arthropods can transmit infectious diseases.
    C) EPIDEMIOLOGY: Bites and stings are extremely common worldwide but cause mostly local effects.
    D) WITH POISONING/EXPOSURE
    1) MILD TO MODERATE TOXICITY: Pain, erythema, and edema at the bite site are common. Macules, papules, urticaria and various types of dermatitis are common. Allergic reactions are also common. Bites can become secondarily infected.
    2) SEVERE TOXICITY: Systemic effects are extremely uncommon. Severe allergic reactions can occur.

Vital Signs

    3.3.3) TEMPERATURE
    A) FEVER: Chills and fever may occur following a black fly bite (Chevrier et al, 1995).

Heent

    3.4.3) EYES
    A) CONJUNCTIVITIS has been reported.
    1) MUSA SPECIES: The common housefly (Musa domestica) and face fly (Musa autumnalis) are not venomous, but while feeding on lacrimal secretions or open wounds may produce a local reaction causing blepharitis, conjunctivitis, and keratitis (Pascoe, 1989).
    3.4.4) EARS
    A) EARDRUM PUNCTURE has been attributed to invasion of the ear canal by an earwig.
    1) CASE REPORT: One case of punctate lesions in the eardrum, and extrusion of the earwig was reported. The lesions healed and the ear was normal within 3 months (Taylor, 1978).
    3.4.5) NOSE
    A) RHINITIS is a symptom of the allergic response to house dust mites (Wikel, 1984).

Respiratory

    3.6.2) CLINICAL EFFECTS
    A) BRONCHOSPASM
    1) WITH POISONING/EXPOSURE
    a) Various respiratory/allergic symptoms, such as asthma and wheezing, may be seen (Wikel, 1984).

Neurologic

    3.7.2) CLINICAL EFFECTS
    A) HEADACHE
    1) WITH POISONING/EXPOSURE
    a) Chills, fever, and headache may occur following a black fly bite (Chevrier et al, 1995).
    3.7.3) ANIMAL EFFECTS
    A) ANIMAL STUDIES
    1) COMA
    a) Coma may occur in animals with arthropod stings, bites, or ingestion.
    b) SAWFLY LARVAE: Ingestion may produce CNS depression or coma in animals that ingest it. Severity is determined by dose (Calloway, 1955; Roberts, 1932; Dadswell, 1985; Blood & Radostits, 1989).
    2) MANIC REACTION
    a) Mania may occur in animals with arthropod stings, bites, or ingestion.
    b) SAWFLY LARVAE: Ingestion may produce mania in animals that ingest it. Severity is determined by dose ingested (Calloway, 1955; Roberts, 1932; Dadswell, 1985; Blood & Radostits, 1989).

Gastrointestinal

    3.8.2) CLINICAL EFFECTS
    A) VOMITING
    1) WITH POISONING/EXPOSURE
    a) MITES: Children who handled the mite Holothyrus coccinella and then put their hands to their mouths developed gastrointestinal illness (Hirst, 1922).

Hepatic

    3.9.2) CLINICAL EFFECTS
    A) VIRAL HEPATITIS
    1) WITH POISONING/EXPOSURE
    a) Bedbugs have been implicated as a probable vector for hepatitis B, however, this is not yet substantiated in the literature (Elston & Stockwell, 2000).
    3.9.3) ANIMAL EFFECTS
    A) ANIMAL STUDIES
    1) HEPATOCELLULAR DAMAGE
    a) SAWFLY LARVAE: Ingestion may produce hepatic insufficiency or degeneration in animals that ingest it. Severity is determined by dose ingested (Calloway, 1955; Roberts, 1932; Dadswell, 1985; Blood & Radostits, 1989).

Genitourinary

    3.10.3) ANIMAL EFFECTS
    A) ANIMAL STUDIES
    1) RENAL FUNCTION ABNORMAL
    a) SAWFLY LARVAE: Ingestion may produce renal insufficiency, renal degeneration, and polyuria in animals. Severity is determined by dose ingested (Calloway, 1955; Roberts, 1932; Dadswell, 1985; Blood & Radostits, 1989).

Hematologic

    3.13.2) CLINICAL EFFECTS
    A) APLASTIC ANEMIA
    1) WITH POISONING/EXPOSURE
    a) Bone marrow aplasia has occurred after the bites or stings of unknown arthropods in Italy. Two patients died (Torregiani & Cavera, 1989).

Dermatologic

    3.14.2) CLINICAL EFFECTS
    A) SKIN NODULE
    1) WITH POISONING/EXPOSURE
    a) Dermatofibroma has been linked to arthropod bites. A study of the histologic characteristics of 100 dermatofibromas found no traces of arthropod tissues associated with them (Evans et al, 1989).
    B) EOSINOPHILIC CELLULITIS
    1) WITH POISONING/EXPOSURE
    a) Eosinophilic cellulitis (Wells' Syndrome) as been diagnosed in a number of cases of arthropod bites.
    b) MITES: A 16-year-old received several arthropod bites. Skin testing with crude mite extract confirmed a hypersensitivity to arthropods' bites (Clark & Anderson, 1988).
    c) Five other cases with histologic findings of "flame figures" were reported following arthropod bites (Schorr et al, 1984).
    C) CELLULITIS
    1) WITH POISONING/EXPOSURE
    a) Secondary bacterial infection, with common skin pathogens, may occur at the bite site, particularly if the integrity of the dermis is disrupted. The following findings may be seen with secondary bacterial infections (Kemp, 1998):
    1) Increasing erythema, edema or tenderness beyond that expected with a bite
    2) Regional lymphadenopathy
    3) Lymphangitis, a reliable sign suggesting streptococcal involvement
    D) BULLOUS ERUPTION
    1) WITH POISONING/EXPOSURE
    a) Millipedes have a glandular secretion that may cause a burning sensation or blistering when contacting the skin (Fowler, 1993).
    b) CASE REPORT: A case of millipede burn on the clitoral region of an 8-year-old girl has been reported. She presented with a 4-day history of painful swelling of her external genitalia. Physical examination revealed swelling and brownish-red discoloration of the vulval region with a small amount of desquamation, marked swelling of the clitoral region with mahogany discoloration and a linear fissure, and a mild mucopurulent discharge. Following supportive therapy, her symptoms gradually resolved (Dar et al, 2008).
    c) A papulovesicular eruption, caused by an arthropod bite in a patient with chronic lymphocytic leukemia (CLL), may be an exaggerated and persistent response. A case report describes a 63-year-old patient with CLL who presented with an exaggerated arthropod-bite reaction of a pruritic papulonodulovesicular eruption on his trunk and extremities of 8 months duration (Rongioletti & Rebora, 1999).
    E) URTICARIA
    1) WITH POISONING/EXPOSURE
    a) FLIES: Erythema and urticarial weals are sometimes seen after the bites of deer and horse flies, in sensitive individuals (Fowler, 1993).
    1) Sandflies (Phlebotomus and Lutzomyia species) may produce papular urticaria occurring up to a month after exposure. Lesions persist 2 to 3 weeks (Elgart, 1990). Papular urticaria may progress to pseudolymphomatous violaceous nodules (Elston, 1998).
    b) MITES: Skin lesions seen after mite bites were described as papular, vesiculopapular, urticarial, or a combination of these (Frazier, 1969). Types of occupational dermatitis due to mites includes (Wikel, 1984); (Moser, 1975):
    1) Baker's Itch (Tyrophagus farinae)
    2) Dried Fruit Dermatitis (Carpoglyphus lactis)
    3) Grocer's Itch (Tyrophagus putrescentiae and Glycyphagus domesticus)
    4) Straw Itch Mite (Pyemotes tritici)
    F) MACULOPAPULAR ERUPTION
    1) WITH POISONING/EXPOSURE
    a) Myiasis may produce papular swellings.
    b) The larva of Cordylobia anthropophaga (tumbu fly) may imbed in the skin, causing 1 to 3 mm papular swellings and local pain (Dalton & Haldane, 1990).
    c) Ceratopogonidae (biting midges) are 1- to 3-mm flies which produce tiny punctures, a small erythematous papule, and urticaria in sensitized individuals (Elgart, 1990).
    d) Bites of the bedbug (Cimex) are often noted in linear groups of three and present as erythematous papules, with exaggerated local responses in some persons (Elston & Stockwell, 2000).
    G) BITE - WOUND
    1) WITH POISONING/EXPOSURE
    a) FLIES
    1) Greater than 80% of black fly bite cases experience local pain, heat, itching, edema and erythema; 20% have local blistering; and 15% to 25% will experience regional symptoms of cellulitis, plaque formation, adenopathy and lymphangitis (Chevrier et al, 1995). Hyperpigmentation may remain after healing, particularly if excoriation occurred (Kemp, 1998).
    2) Simulium flies such as the buffalo and black fly, produce a slashing or tearing bite which bleeds and feeds the fly. Local swelling and pruritus ensue (Elgart, 1990).
    3) Tsetse flies feed on human blood. The bite damage itself is minimal, but the flies carry trypanosomiasis.
    4) Tabanidae (deerfly and horsefly) produce deep, painful bites. Secondary infection is seen. Bites are usually single (Elgart, 1990).
    b) MILLIPEDES
    1) Millipedes have a glandular secretion that may cause a burning sensation or blistering when contacting the skin (Fowler, 1993).
    2) CASE REPORT: A 4-year-old girl developed a burning sensation and yellow/brown discoloration of her toes after wearing her shoes. After arrival to the emergency department, a millipede was found in the patient's shoe (Hendrickson, 2005).
    c) BED BUGS
    1) Bed bugs typically produce maculopapular lesions that are pruritic, 2 to 5 mm in diameter with a central hemorrhagic punctum and are most common on uncovered areas of the body. Commonly there are 3 or 4 lesions in a curved or linear array. Pruritus without visible lesions, papules, nodules or bullous eruptions may also occur but are less common. Diffuse urticaria can also occur. Reactions to the bites may be delayed up to 11 days (Bernardeschi et al, 2013; Patel & Elston, 2012).
    H) ATOPIC DERMATITIS
    1) WITH POISONING/EXPOSURE
    a) BED BUGS: Dermal reactions to bed bug bites appear to be secondary to allergens in their saliva (Goddard & Edwards, 2013). Only about 30% of people living in bed bug infested homes develop cutaneous reactions to the bites (Bernardeschi et al, 2013).

Musculoskeletal

    3.15.2) CLINICAL EFFECTS
    A) RHABDOMYOLYSIS
    1) WITH POISONING/EXPOSURE
    a) CASE REPORT: Rhabdomyolysis was reported in two patients in Italy, after stings by an unknown arthropod. Bone marrow aplasia developed and the patients died (Torregiani & Cavera, 1989).

Immunologic

    3.19.2) CLINICAL EFFECTS
    A) URTICARIA
    1) WITH POISONING/EXPOSURE
    a) An urticarial reaction is most commonly seen.
    b) COCKROACH: Cases of urticarial rash due to inhalation or tactile contact have been reported as allergy to cockroach debris (Monk & Pembroke, 1987). Nine major antigenic proteins were isolated from cockroaches; two of these bound 100% of the sera of seven atopic patients tested (Wu & Lan, 1988).
    c) DEERFLIES: A case report describes generalized urticaria due to deerfly bites (Wilbur & Evans, 1975).
    d) LOCUST: A case report describes urticaria due to allergy to the peritrophic membrane lining the gut of the locust, and excreted with the feces (Tee et al, 1988).
    e) SCABIES: This mite could be antigenic and stimulate autoantibodies leading to a pemphigoid-like reaction (Anon, 1993a).
    B) ANAPHYLAXIS
    1) WITH POISONING/EXPOSURE
    a) Life-threatening reactions may occur to bites, stings, or simple exposure to arthropod body parts or excreta (Kunkel, 1988). Symptoms range from allergic skin reactions, to respiratory reactions, and anaphylaxis.
    b) Anaphylaxis may occur after exposure to various arthropods (Kunkel, 1988). This occurs most commonly to stings by Hymenoptera species such as bees and wasps.
    c) DEERFLIES: Three cases of wheezing and anaphylactic shock were reported (Wilbur & Evans, 1975).
    d) MOSQUITOES: Two cases of anaphylactic reactions were reported. Systemic symptoms included angioedema, dyspnea, urticaria, nausea, headaches, chest tightness, dizziness, and lethargy (McCormack et al, 1995).
    e) BEDBUGS: Can occasionally cause more widespread hypersensitivity reactions such as wheezing and anaphylaxis(Bernardeschi et al, 2013; Patel & Elston, 2012).
    C) BRONCHOSPASM
    1) WITH POISONING/EXPOSURE
    a) Wheezing or asthma-like symptoms have been reported after arthropod exposure.
    b) DEERFLIES: Three cases of wheezing associated with anaphylactic shock were reported (Wilbur & Evans, 1975).
    c) LOCUSTS: Three patients exposed to locusts developed asthma- like symptoms (Tee et al, 1988).
    d) BEDBUG: The dung of bedbugs, in heavily infested areas, may contribute to asthma-like symptoms (Elston & Stockwell, 2000).
    D) DISORDER OF RESPIRATORY SYSTEM
    1) WITH POISONING/EXPOSURE
    a) Respiratory allergies my occur after exposure to live arthropods or to body parts of these creatures.
    b) MITES: Respiratory allergies such as rhinitis and extrinsic asthma are caused by house dust mites such as Dermatophagoides species (Voorhorst et al, 1964); (Green & Woolcock, 1978; Voorhorst & Spieksma, 1967).

Laboratory Monitoring

Monitoring Parameters Levels

    4.1.1) SUMMARY
    A) No laboratory studies are necessary unless otherwise clinically indicated.
    B) Evaluate for clinical evidence of secondary infection or hypersensitivity reaction.
    4.1.2) SERUM/BLOOD
    A) OTHER
    1) Significant abnormalities have not been reported. Rhabdomyolysis and bone marrow aplasia were reported in 2 patients after bites from arthropods of unknown species (Torregiani & Cavera, 1989).

Treatment

Life Support

    A) Support respiratory and cardiovascular function.

Patient Disposition

    6.3.6) DISPOSITION/BITE-STING EXPOSURE
    6.3.6.1) ADMISSION CRITERIA/BITE-STING
    A) Patients with severe secondary infection or anaphylaxis should be admitted.
    6.3.6.2) HOME CRITERIA/BITE-STING
    A) The vast majority of patients with local reactions can be managed at home.
    6.3.6.5) OBSERVATION CRITERIA/BITE-STING
    A) Patients with secondary infection or significant allergic reaction should be referred to a healthcare facility.

Monitoring

    A) No laboratory studies are necessary unless otherwise clinically indicated.
    B) Evaluate for clinical evidence of secondary infection or hypersensitivity reaction.

Range Of Toxicity

Summary

    A) TOXICITY: Usually one bite or sting will produce a local reaction. The extent of local and systemic reaction varies, depending on the arthropod, the number of envenomations, and the sensitivity of the patient. A severe allergic reaction may result in a fatality with only one bite or sting.

Minimum Lethal Exposure

    A) Lethal doses have not been determined. A severe allergic reaction may result in a fatality with only one bite or sting.

Maximum Tolerated Exposure

    A) Usually one bite or sting will produce a local reaction. The extent of local and systemic reaction varies, depending on the arthropod, the number of envenomations, and the sensitivity of the patient.

Pharmacology Toxicology

Toxicologic Mechanism

    A) MILLIPEDES: The glandular secretion of the millipede contains phenols and hydrocyanic acid which may cause a burning or blistering sensation (Fowler, 1993).
    B) SAWFLY: The larvae of the Australian sawfly (Lophyrotoma interrupta) contain the octapeptide, Lophyrotomin, (Leonard, 1972) which may result in hepatic and renal insufficiency.

Animal Toxicology

Clinical Effects

    11.1.1) AVIAN/BIRD
    A) MITES -
    1) Ducks and geese who have swallowed the mite Holothyrus coccinella have died (Wikel, 1984).
    2) Mites commonly infest chickens and other fowl (Dermanyssus gallinae, Onithonyssus sylviarum, and other mite species) producing cutaneous reactions (Wikel, 1984).
    3) Stenostoma tracheacolum mites may produce a potentially fatal acariasis in birds (Jolivet, 1975).
    11.1.2) BOVINE/CATTLE
    A) SAWFLY -
    1) The larvae of the Australian sawfly (Lophyrotoma interrupta) causes death in cattle and sheep who ingest them while grazing. The larva contain the octapeptide lophyratomin (Leonard, 1972) that produces hepatic and renal insufficiency.
    2) Depression, polyuria, mania, and coma are possible, severity is determined by dose ingested (Calloway, 1955; Roberts, 1932) Dadswell et al, 1985; (Blood & Radostits, 1989).
    B) GNATS -
    1) Massive numbers of buffalo gnat (Cnephia pecuarum) have been responsible for death of cattle in the Mississippi valley (Fowler, 1993).
    11.1.3) CANINE/DOG
    A) MITES -
    1) Pneumonyssus caninum produces sinusitis in dogs (Christensson & Rehbinder, 1971).
    11.1.5) EQUINE/HORSE
    A) GNATS -
    1) Massive numbers of buffalo gnat (Cnephia pecuarum) have been responsible for death of horses and mules in the Mississippi valley (Fowler, 1993).
    11.1.9) OVINE/SHEEP
    A) SAWFLY -
    1) The larvae of the Australian sawfly (Lophyrotoma interrupta) cause death in cattle and sheep that ingest them while grazing. The larvae contain the octapeptide lophyratomin (Leonard, 1972) which produces hepatic and renal insufficiency.
    2) Depression, polyuria, mania, and coma are possible; severity is determined by dose ingested (Calloway, 1955; Roberts, 1932) Dadswell et al, 1985; (Blood & Radostits, 1989).
    B) MITES -
    1) Hypersensitivity reactions have occurred after infestation of the sheep scab mite Psoroptes ovis. This has included epileptiform seizures as well as allergic dermatitis (Bygrave et al, 1993).
    11.1.13) OTHER
    A) OTHER
    1) MITES -
    a) The mite Pneumonyssus (spp) will produce pneumonia and pleuritis when they infest the lungs of monkeys and baboons (Kim, 1974; Kim & Kalter, 1975).

Treatment

    11.2.1) SUMMARY
    A) GENERAL TREATMENT
    1) Treatment should always be done on the advice and in consultation with a veterinarian.
    2) Additional information regarding treatment of poisoned animals may be obtained from a Board Certified (ABVT) Veterinary Toxicologist (check with nearest veterinary school or veterinary diagnostic laboratory) or the National Animal Poison Control Center.
    B) ANIMAL POISON CONTROL CENTERS
    1) ASPCA Animal Poison Control Center, An Allied Agency of the University of Illinois, 1717 S. Philo Rd, Suite 36, Urbana, IL 61802, website www.aspca.org/apcc
    2) It is an emergency telephone service which provides toxicology information to veterinarians, animal owners, universities, extension personnel and poison center staff for a fee. A veterinary toxicologist is available for consultation.
    3) The following 24-hour phone number is available: (888) 426-4435. A fee may apply. Please inquire with the poison center. The agency will make follow-up calls as needed in critical cases at no extra charge.
    11.2.2) LIFE SUPPORT
    A) GENERAL
    1) MAINTAIN VITAL FUNCTIONS: Secure airway, supply oxygen, and begin supportive fluid therapy if necessary.
    11.2.4) DECONTAMINATION
    A) GASTRIC DECONTAMINATION
    1) GENERAL TREATMENT
    a) Remove the patient and other animals from the arthropod infested area if possible.
    b) Remove the offending arthropod if it is still on the animal. If none can be found, consider an insecticide dip, especially with large animals, to remove the arthropods.
    11.2.5) TREATMENT
    A) DOGS/CATS
    1) ANAPHYLAXIS -
    a) AIRWAY - Maintain a patent airway via endotracheal tube or tracheostomy.
    b) EPINEPHRINE - For severe reactions.
    1) DOGS - 0.5 to 1 milliliter of 1:10,000 (DILUTE) solution intravenously or subcutaneously.
    2) CATS - 0.5 milliliter of 1:10,000 (DILUTE) solution intravenously or intramuscularly.
    3) DILUTION - Be sure to dilute epinephrine from the bottle (1:1000) one part to 9 parts saline to obtain the correct concentration (1:10,000).
    4) REPEAT DOSES - If indicated, doses may be repeated in 20 minutes.
    c) FLUID THERAPY -
    1) If necessary, begin fluid therapy at maintenance doses (66 milliliters solution/kilogram body weight/day) intravenously or, in hypotensive patients, at high doses (up to shock dose 60 milliliters/kilogram/hour.
    2) Monitor for urine production and pulmonary edema.
    d) ANTIHISTAMINES - Administer doxylamine succinate (1 to 2.2 milligram/kilogram subcutaneously or intramuscularly every 8 to 12 hours)
    e) STEROIDS - Administer dexamethasone sodium phosphate (1 to 5 milligrams/kilogram intravenously every 12 to 24 hours), or prednisone (1 to 5 milligram/kilogram intravenously every 1 to 6 hours).
    B) RUMINANTS/HORSES/SWINE
    1) ANAPHYLAXIS -
    a) AIRWAY - Maintain a patent airway via endotracheal tube or tracheostomy.
    b) FLUIDS -
    1) HORSES - Administer electrolyte and fluid therapy as needed. Maintenance dose of intravenous isotonic fluids: 10 to 20 milliliters/kilogram per day. High dose for shock: 20 to 45 milliliters/kilogram/hour.
    a) Monitor for packed cell volume, adequate urine output and pulmonary edema. Goal is to maintain a urinary flow of 0.1 milliliters/kilogram/minute (2.4 liters/hour) for an 880 pound horse.
    2) CATTLE - Administer electrolyte and fluid therapy, orally or parenterally as needed. Maintenance dose of intravenous isotonic fluids for calves and debilitated adult cattle: 140 milliliters/kilogram/day. Dose for rehydration: 50 to 100 milliliters/kilogram given over 4 to 6 hours.
    c) EPINEPHRINE -
    1) HORSES - 3 to 5 milliliters/450 kilograms of 1:1000 epinephrine intramuscularly or subcutaneously.
    2) CATTLE & SWINE - 0.02 TO 0.03 milligrams/kilogram of 1:1000 epinephrine subcutaneously, intramuscularly, or intravenously.

Continuing Care

    11.4.1) SUMMARY
    11.4.1.2) DECONTAMINATION/TREATMENT
    A) GENERAL TREATMENT
    1) Treatment should always be done on the advice and in consultation with a veterinarian.
    2) Additional information regarding treatment of poisoned animals may be obtained from a Board Certified (ABVT) Veterinary Toxicologist (check with nearest veterinary school or veterinary diagnostic laboratory) or the National Animal Poison Control Center.
    B) ANIMAL POISON CONTROL CENTERS
    1) ASPCA Animal Poison Control Center, An Allied Agency of the University of Illinois, 1717 S. Philo Rd, Suite 36, Urbana, IL 61802, website www.aspca.org/apcc
    2) It is an emergency telephone service which provides toxicology information to veterinarians, animal owners, universities, extension personnel and poison center staff for a fee. A veterinary toxicologist is available for consultation.
    3) The following 24-hour phone number is available: (888) 426-4435. A fee may apply. Please inquire with the poison center. The agency will make follow-up calls as needed in critical cases at no extra charge.
    11.4.2) DECONTAMINATION
    11.4.2.2) GASTRIC DECONTAMINATION
    A) GASTRIC DECONTAMINATION
    1) GENERAL TREATMENT
    a) Remove the patient and other animals from the arthropod infested area if possible.
    b) Remove the offending arthropod if it is still on the animal. If none can be found, consider an insecticide dip, especially with large animals, to remove the arthropods.

References

General Bibliography

    1) Almaviva M, Hailu B, & Borgnolo G: Louse-borne relapsing fever epidemic in Arssi Region, Ethiopia: a six months survey. Trans R Soc Trop Med Hyg 1993; 87:153.
    2) Anon: 1989 sexually transmitted diseases treatment guidelines. MMWR 1989; 38(suppl 8):1-43.
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