miércoles, 2 de abril de 2008

ENVENENAMIENTO POR RATICIDAS

He querido dejar publicado este articulo para que conosca lo que hay que hacer ante un caso de envenenamiento por raticidas, ya que el desconocimiento nos puede costar la vida de nuestros mejores amigos. Solo quiero decirles que sean cuidadosos son sus mascotas y que si llegan a sospechar que puede tener esto, no pierdan tiempo y llevenlo de inmediato con el veterinario.
Esto lo enocntré investigando en la web a raíz de la perdida de mi querido Arthur.
Los raticidas warfarínicos actúan inhibiendo la vitamina K, que es primordial para la coagulación ya que varios factores en la coagulación dependen de ella. El hígado es el encargado de sintetizarla y por ello en enfermedades de este órgano podemos tener un a sintomatología parecida.
Existen varios tipos de raticidas warfarinicos, básicamente la diferencia esta dada por la mayor potencia y durabilidad del tóxico en la sangre, divergencia muy importante para el pronóstico y el tratamiento.La única forma de identificarlos es por la anamnesis porque los signos clínicos son iguales.
Media toxicidad: 1ª generación: warfarina.
Alta toxicidad: 2ª generación: derivados de la 4-hidroxicoumarina brodifacoum, la bromodiolona, la clorofacinona, el coumatetralil, la difacinona, e lflocoumafén
Los signos tardan entre 2 y 5 días en comenzar, cuando se que agotan los factores de coagulación y la vitamina K en el organismo. Puede producir sintomatología sobreaguda con muerte repentina por colapso vascular, o hemorragia cerebral, pericárdica o torácica, sin signos previos. En otros casos (intoxicación subaguda) hay síntomas de un fallo de la coagulación, como son: hemorragias múltiples : petequias o equimosis (pequeños hematomas) en piel y mucosas, melena (mat fecal con sangre), hematuria (orina con sangre), epistaxis (sangrado por nariz de origen pulmonar), hemotórax (colecta de sangre en torax), hematemesis (vómitos con sangre), hemorragia pulmonar, etc. A la inspección el veterinario puede observar las mucosas pálidas o cianóticas (azuladas), pulso rápido y débil, disnea , letargia y como ya dijimos hematomas en diferentes partes del cuerpo.
El Médico Veterinario llegara al diagnóstico por la anamnesis, la sintomatología y los análisis de laboratorio Las pruebas hematológicas mas utilizadas son las de coagulación con un resultado de :
Aumento del tiempo de coagulación.
Aumento del tiempo de protrombina.
Aumento de tromboplastina parcial .
Normal plaquetas y fibrinógeno

Es importante para llegar a un diagnóstico certero realizar un diagnóstico diferencial, que consiste en descartar otras patologías que cursan con síntomas y signos similares, incluso con resultados de laboratorios parecidos (difícil que igual): CID, Hemofilia, Enfermedad de Von Willebran , Trombocitopenias-Trombocitopatías (enfremedades plaquetarias), Hepatopatías (enfemedades de Hg) , etc..
Es importante identificar cual warfarina fue administrada (de ser posible).
Inducir el vómito o realizar lavado gástrico si la ingestión ha sido reciente. Administrar carbón activado y un catártico de cloruro de sodio (si hace poco tiempo que lo ingerio)* Si el animal está estable se puede empezar directamente administrando el antídoto: Vitamina K1 (Konakion-Roche). Inicialmente administrar 3- 5 mg/kg IM, SC o IV dependiendo de la generación de la warfarina (ojo! en inyección endovenosa existe riesgo de shock anafiláctico), repetir la dosis a las 12 horas y después dar una dosis de mantenimiento de 5mg/kg/día en 2 tomas durante 2-3 semanas o mas para el caso de las de segunda * Si el animal tiene una hemorragia masiva y esta en shock hemorrágico hay que hacer una transfusión sanguínea y tomar medidas de apoyo sintomático para el shock y fluidoterapia. No administrar furosemida ni aminofilina ya que inhiben la función plaquetaria. Una vez controlados los sangrados debe continuarse el tratamiento con la administración bucal de fitonadiona hasta que los tiempos de protombina se normalicen (lo que puede tardar meses con estos "superwarfarínicos"). * Toracocentesis para aliviar la disnea de presentar derrame pleural (riesgo de provocar una nueva hemorragia).
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