MAR 04, 2010
Just yesterday, one of my clients awoke to a home full of black, tarry stools — a "present" left by her small terrier mix, Mindy.
A fecal exam, as expected, revealed the presence of a large amount of digested blood. Typically, that means something somewhere high up in the digestive tract is bleeding. The esophagus, stomach, and upper sections of the small intestines are the most likely suspects in these cases.
Unfortunately, this tiny young dog also had very pale gums — an indication that she’d been losing a large amount of blood. Blood tests confirmed her red blood cell count was severely low. She’d need a transfusion along with whatever care we could provide to stem the tide of gastrointestinal blood loss.
In case it’s not already apparent, this is a really scary scenario — especially when we have no idea what’s causing it. X-rays were unhelpful, the rest of the labwork was normal, and endoscopy was out of the question due to the high cost of this specialized procedure.
I suspected poisoning. Although this young dog was taking no medications and she lived indoors in a mostly puppy-proofed home (no rat poison or prescription medications). Close questioning revealed that a nearly-full bottle of children's Motrin (ibuprofen) had spilled on the floor three days earlier. One phone call later, this tearful owner explained that the spill she assumed her husband had cleaned up had probably been ingested by Mindy. The delicious bubble-gum flavor must have been too good to resist.
I wasn't surprised. The symptoms were right on target — two to three days later is just about right for the dose she received. At this point (over 36 hours later, presumably), there was no stomach pumping option. It was all about damage control.
A transfusion to replace the lost blood from the bleeding esophagus, stomach, and/or intestines; huge volumes of fluids to minimize kidney damage and flush out the toxic ibuprofen; stomach-protecting drugs to coat the bleeding erosions and/or ulcers, and decrease the production of exacerbating acids. That's all we can do in these cases — at this point, anyway.
Most confirmed ibuprofen toxicity cases I see tend to do well. But it's also true that we get to most cases earlier, which gives us a chance to get the pills or liquid out of the stomach before it can be absorbed. Luckily, this dog seems young and healthy enough to weather a toxic punch. But because we don't have the option of a scope exam (to actually see how much damage has been done), we're currently stuck with the third-world alternative of monitoring pulses and checking other vitals to gauge her progress and determine whether emergency surgery might be needed to close a hole in her stomach (a scary possibility with ibuprofen toxicity).
At least her kidneys don't appear to be shutting down (which usually only happens at toxic doses higher than Mindy received), nor is she suffering any neurological signs (another common sequela to very high-dose ibuprofen toxicity). Blessedly, this dog is somehow defying all our worst expectations — for now, anyway. I promise to keep you posted.
Dr. Patty Khuly
