Chocolate poisoning

Published at September 09, 2018 12:35 AM 0Comment(s)1449views


Dr.Abrar Ul Haq Wani

dr.abrar79@gmail.com

Chocolate is a delicacy which does not entail any introduction, it is likely considered a heavenly pleasure for everyone with a sweet tooth. It is having tangible benefits by contributing towards health when eaten in moderation and convoyed with regular exercise.

Chocolates are loaded with fiber and lot of minerals like iron and magnesium. Dark chocolates boost brain health and produce dopamine in the brain which promotes a sense of wellbeing.

Chocolates are rich in flavonoids that lower blood pressure and improve blood flow overall. Not only this, dark chocolate is a skin-friendly element that lends a hand in the maintenance of healthy skin and keeping it glowing and just flawless.

Despite its high nutritional value, chocolates are rich in caffeine and theobromine alkaloids that limit its potential as a nourishing food. 

The pathophysiology of chocolate toxicity is well studied in mammals and also in humans which is due to the effects of its methylxanthine components, in particular, (caffeine, theophylline and theobromine).

In animals currently, the most common agents concerned with animal toxicities are chocolate, rodenticides, pharmaceuticals, glycols, metals, pesticides, plants and a few miscellaneous agents. 

As far as our fuzzy friends are concerned, they get exposed to chocolate poisoning by putting their life in jeopardy. Chocolate ingestion is commonly noticed in dogs along with cats, rodents, rabbits, cattle and also reported in birds like the parrot.

Chocolate is one of the most eminent noxious foods that pet owners are aware of in the west but in India majority of the populace is unacquainted. 

Chocolate is made from the fermented, dried, roasted beans of Theobroma cacao. The chief toxic principle of Chocolate is methylxanthines such as theobromine and caffeine.

As we know chocolates are being used in various confectionery items like biscuits and cakes, these are the most common sources of chocolate in our companion animals.

In case of other animals, cocoa waste from processing or restaurant waste is an additional source. Chocolate-coated foods such as raisins, nuts and coffee beans may present an additional hazard.

Dark chocolate contains around four times the quantity of theobromine compared to the milk chocolates available in the market.  

Theobromine and caffeine are readily absorbed from the gastrointestinal tract and widely disseminated all through the body. The metabolism happens in the liver and experiences enterohepatic recycling.

Methylxanthines in chocolates antagonize cellular adenosine receptors resulting in CNS stimulation, vasoconstriction and tachycardia.

In addition, it also inhibits cellular phosphodiesterase, causing an increase in Cyclic Adenosine Monophosphate (CAMP), increased release of catecholamines and increased entry of calcium and inhibition of calcium sequestration by the sarcoplasmic reticulum, causing increased muscular contractility in both skeletal and cardiac muscle.

When our animals consume chocolate in toxic doses, a muddle of clinical signs can be observed like anxiety, nausea, vomiting, diarrhea, panting, tachycardia, polyuria, hyperthermia, muscle tremors, and seizures.

Toxic effects in dogs occur at theobromine doses of 20 mg/kg, with severe signs at 40–50 mg/kg and seizures at 60 mg/kg. Clinical signs of theobrominetoxicosis can be seen within a few hours, up to 10-12 hours. Pancreatitis may occur 24–72 hours after intake of some chocolate products with high fat content.

Sometimes chocolate poisoning can also lead to renal dysfunction but with rare incidence and secondary aspiration pneumonia is also reported.

It should be kept in mind that some chocolate and chocolate products, particularly those for diabetics can contain xylitol as a sweetener that could, therefore, lead to xylitol toxicity.

Talking about the fatality, it is usually due to the cardiac arrhythmias and less commonly owing to respiratory failure.

On necropsy, a clinician can spot congestion and hyperaemia of the stomach and intestines, cyanosis, pulmonary congestion along with ecchymotic haemorrhaging of the kidneys, liver and pancreas.

Diagnosis of chocolate or caffeine toxicity is most often made by the combination of compatible history and clinical signs.

Supporting evidence can come from stomach contents (that is the presence of chocolate in vomitus).  In addition, a vet doctor executes a complete physical examination, together with a blood chemical/electrolyte panel, and a urine investigation which helps help in determining the chocolate/caffeine overdose.

An ECG is performed to determine the abnormalities in the rhythm or conduction of heartbeats. Prognosis is more guarded in dogs with seizures and arrhythmias.

If we talk about its management, the first and foremost step is that doctors must obtain a full history from the owner as per amount, type, and time of chocolate ingestion together with confirming the ingestion of a potentially toxic dose of more than 20 mg/kg of chocolate followed by gut decontamination. 

There is no specific antidote for chocolate or caffeine toxicosis and treatment is symptomatic. Theobromine has a half-life of 17 hours so, treatment may be necessary for 72-96 hours.

Additionally, decontamination includes the administration of manifold doses of activated charcoal. In addition, treatment includes gastrointestinal support (for example anti-emetics), supportive care, IV fluid therapy, frequent walks to prevent reabsorption of methylxanthines from the urine across the bladder wall, sedatives for agitation (for exampleacepromazine, butorphanol), beta-blockers for persistent tachycardia or hypertension (for example propranolol), methocarbamol for tremors, and anticonvulsants for seizures.

A urinary catheter should be placed to prevent reabsorption of urinary methylxanthines through the bladder wall.

Administration of corticosteroids and erythromycin should be avoided because these medications interfere with the excretion of methylxanthines. Therapeutic interventions should be continued for two to three days.

So, the important points to ponder are that the Pet/animal owners should be appropriately educated on how to pet-proof the house, and be trained on what common human medications can be toxic to pets. Pet owners should also be appropriately educated on crate training to help minimize toxin exposure.

When in suspicion, get in touch with your veterinarian or Pet Poison Helpline to notice if a poisonous amount of chocolate was ingested. If a toxic amount is ingested, you should have your dog examined by a veterinarian immediately.

The sooner the theobromine is removed from the body or the dog is stabilized, the better your dog's prognosis. So be wary of feeding your pet anything that might contain chocolate and always keep it out of reach.

 

Author is a research scholar at Department of Vet Medicine, SKUAST-K

 

 

 

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