Hi again XXXXXXXXX,

There are a number of different rodenticides (rat or mouse poisons) available. The most common ones act by preventing the body from forming clotting factors which allow the blood to clot. The body has a store of clotting factors, but no new clotting factors can be made if the animal eats this type of rodenticide. Thus, symptoms do not start immediately, but instead start days to weeks later (depending on the amount of poison eaten).

When a dog eats a rodenticide, they will produce a green or blue stool about 1 day later, and start showing symptoms of illness 1-4 days after that. Rodenticides typically cause internal bleeding, which can cause lethargy, vomiting and inappetance, and finally death. Rat poison is made to taste good so that the rodents will eat it - unfortunately, it tastes good to dogs too and they will also eat it if they find it. Most of the bleeding will be internal (into the belly and lungs) but sometimes we will see blood in the urine, stool or as a nosebleed.

The good news is that there is an antidote! Vitamin K1 (and ONLY vitamin K1, not other forms of vitamin K) given by mouth will act as an antidote. The dog needs to stay on them for weeks to months, and they are expensive. In the USA and Canada you would need a prescription to get this medication. Here is more about Vit K1, including the dose:

http://www.petplace.com/drug-library/vitamin-k1-veta-k1/page1.aspx

Here is more information about rodenticide poisoning:

http://www.petplace.com/dogs/rodenticide-poisoning-in-dogs/page1.aspx

http://www.peteducation.com/article.cfm?cls=0&cat=1540&articleid=1695

http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=1765

So, in an ideal world, your dog would go see a veterinarian immediately as it sounds as though she is anemic from blood loss, and in a very grave condition. I am concerned that she might not survive. If she came to see me, I would immediately do blood tests for rodenticide poisoning and would start treating her immediately if the tests supported that. I would also test her for immune mediated thrombocytopenia (IMT - in which the immune system attacks the platelets, which are essential for blood clotting), the other major problem that causes blood clotting disorders. Given that you have rat poison around, my main concern is that she ate it and is now bleeding internally. I hope that you can get a diagnosis and find treatment for her!!

If this has been helpful, please accept my answer and leave feedback. If you need more information, just click on reply and I will be here to provide it.

The above is given for information only. Although I am a licensed veterinarian, I cannot legally prescribe medicines or diagnose your pet's condition without performing a physical exam. If you have concerns about your pet I would strongly advise contacting your regular veterinarian.

Best wishes to you and to your dog!

Fiona

If your dog has eaten rat poison, there is only one antidote: Vitamin K1.

Nothing else will do the slightest bit of good.

The fact she is a big dog is in her favour as she may have eaten a sublethal dose of rat poison.... but if she has eaten enough, there is nothing other than Vitamin K1 that would stop her bleeding internally.

Is there a medical doctor for humans who would be able to see her? A vet from another island who visits Eleuthera? Can you phone a vet on another island to see if they can send over Vitamin K1, if there is none on Eleuthera? Do you have friends or family who can mail some to you?

Fiona

Oh, you are so welcome! I wish there were a way that I could reach through the computer and help you more. So frustrating for both of us!

Human pharmacies here do carry Vit K1, so maybe one there does? Or, like I said, maybe you can get some sent over from the USA. It has to be pretty fast, though as I am worried about your dog. :-(

Please accept my answer if it has been helpful. You will still be able to post follow up questions to this thread at any time and I will help you with those questions!

Fiona

Sigh. I wish there were!!

THere is just not going to be anywhere NEAR enough naturally occuring Vitmanin K to help her in foods. Green leafy plants contain Vitamin K1. Parsley contains Vitamin K, but it contains MICROgrams, and your dog needs MILLIGRAMS to help her.

Here is more

http://en.wikipedia.org/wiki/Vitamin_K.

If you could do nothing else, feeding her parsley might have some small benefit...but it would have to be a LOT of parsley (many cups a day).

Here is an excerpt from Plumb's Veterinary Drug Handbook, 5th Edition about this medication:

Phytonadione | Vitamin K₁

Prescriber Highlights

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Chemistry

A naphthoquinone derivative identical to naturally occurring vitamin K₁, phytonadione occurs as a clear, yellow to amber, viscous liquid. It is insoluble in water, slightly soluble in alcohol and soluble in lipids.

Storage/Stability/Compatibility

Phytonadione should be protected from light at all times, as it is quite sensitive to light. If used as an intravenous infusion, the container should be wrapped with an opaque material. Tablets and capsules should be stored in well-closed, light-resistant containers.

Because most veterinary clinicians state that phytonadione is contraindicated for intravenous use, and since compatibility is dependent upon factors such as pH, concentration, temperature and diluents used, it is suggested to consult specialized references (e.g., Handbook on Injectable Drugs by Trissel; see bibliography) for more specific information on the compatibility of phytonadione with other drugs.

Pharmacology

Vitamin K₁ is necessary for the synthesis of blood coagulation factors II, VII, IX, and X in the liver. It is believed that Vitamin K₁ is involved in the carboxylation of the inactive precursors of these factors to form active compounds.

Uses/Indications

The principal uses of exogenously administered phytonadione is in the treatment of anticoagulant rodenticide toxicity. It is also used for treating dicumarol toxicity associated with sweet clover ingestion in ruminants, sulfaquinoxaline toxicity, and in bleeding disorders associated with faulty formation of vitamin K-dependent coagulation factors.

Pharmacokinetics

Phytonadione is absorbed from the GI tract in monogastric animals via the intestinal lymphatics, but only in the presence of bile salts. Oral absorption of phytonadione may be significantly enhanced by administration with fatty foods. The relative bioavailability of the drug is increased 4-5 times in dogs given canned dog food with the dose. After oral administration, increases in clotting factors may not occur until 6-12 hours later.

Phytonadione may concentrate in the liver for a short period of time, but is not appreciably stored in the liver or other tissues. Only small amounts are distributed across the placenta in pregnant animals. Exogenously administered phytonadione enters milk. The elimination of Vitamin K₁ is not well understood.

Contraindications/Precautions

Many veterinary clinicians state that the intravenous use of phytonadione is contraindicated because of increased risk of anaphylaxis development, and while intravenous phytonadione is used in human medicine and several intravenous dosage regimens are outlined below in the Dosage section, the FDA-CVM has warned to avoid administering the drug IV. Phytonadione is contraindicated in patients hypersensitive to it or any component of its formulation.

Vitamin K does not correct hypoprothrombinemia due to hepatocellular damage.

Reproductive/Nursing Safety

Phytonadione crosses the placenta only in small amounts, but its safety has not been documented in pregnant animals. In humans, the FDA categorizes this drug as category C for use during pregnancy (Animal studies have shown an adverse effect on the fetus, but there are no adequate studies in humans; or there are no animal reproduction studies and no adequate studies in humans.)

Vitamin K is excreted in maternal milk, but is unlikely to have negative effects in nursing offspring.

Adverse Effects/Warnings

Anaphylactoid reactions have been reported following IV administration of Vitamin K₁; use with extreme caution (See Contraindications above). Intramuscular administration may result in acute bleeding from the site of injection during the early stages of treatment. Small gauge needles are recommended for use when injecting SC or IM. Subcutaneous injections or oral dosages may be slowly or poorly absorbed in animals that are hypovolemic.

Because 6-12 hours may be required for new clotting factors to be synthesized after phytonadione administration, emergency needs for clotting factors must be provided for by giving blood products.

Overdosage/Acute Toxicity

Phytonadione is relatively non-toxic, and it would be unlikely that toxic symptoms would result after a single overdosage. However, refer to the Adverse Effects section for more information.

Drug Interactions

As would be expected, phytonadione antagonizes the anticoagulant effects of coumarin (e.g., warfarin) and indanedione agents.

The following drugs may prolong or enhance the effects of anticoagulants and antagonize some of the therapeutic effects of phytonadione: phenylbutazone, aspirin, chloramphenicol, sulfonamides (including trimethoprim-sulfa), diazoxide, allopurinol, cimetidine, metronidazole, anabolic steroids, erythromycin, ketoconazole, propranolol, and thyroid drugs.

Concomitant administration of Mineral Oil may reduce the absorption of oral vitamin K.

Although chronic antibiotic therapy should have no significant effect on the absorption of phytonadione, these drugs may decrease the numbers of vitamin K producing bacteria in the gut.

Doses

Dogs, Cats

For adjunctive therapy of acute liver failure:

1. 1-5 mg/kg PO or SC q24h (Rosanski 2002)

For anticoagulant rodenticide toxicity:

1. For known warfarin, fumarin, pindone, or valone ingestions: 1 mg/kg PO once daily for 4-6 days.
For known bromadiolone or brodifacoum ingestions: 2.5 mg/kg PO once daily usually for 2-3 weeks (bromadiolone duration unknown).
For known diphacinone or chlorphacinone ingestions: 2.5-5 mg/kg PO for 3-4 weeks.
Note: usual dosages and duration; use oral route (with one teaspoon of canned dog food) if animal not vomiting, otherwise SC route preferred over IV. Therapy must be continued for as long as rodenticide is inhibiting vitamin K₁ epoxide recycling. (Felice and Murphy 1995)

2. For acute cases: Handle animal gently. Avoid IM injections; give fresh, whole blood transfusion 10-20 ml/kg IV (first half rapidly, then at 20 drops/minute). Give oxygen if hypoxic; if dyspneic consider radiographs and thoracentesis for intrathoracic hemorrhage. Then give phytonadione as below.
For subacute cases: Give phytonadione at 2-3 mg/kg SC q12h for large dogs and 5 mg/kg SC q12h for small dogs and cats. Repeat until coagulation times are normal. Follow with oral phytonadione at 2.5-3 mg/kg PO divided tid for 4-6 days if short acting coumarin (e.g., warfarin) or up to 30 days for long-acting agents. (Grauer and Hjelle 1988)

Rabbits/Rodents/Pocket Pets

1. Mice, Rats, Gerbils, Hamsters, Guinea pigs: 1-10 mg/kg IM (Adamcak and Otten 2000)

Cattle

For anticoagulant rodenticide toxicity:

1. Initially 0.5-2.5 mg/kg IV in D₅W at a rate of 10 mg/minute. Subsequent doses may be given IM or SC. Second generation agents may require 3-4 weeks of treatment. (Bailey 1986b)

2. 0.5-2.5 mg/kg IM, if IV use is necessary (avoid if possible), dilute in saline or D₅W/saline and give very slowly (not to exceed 5 mg/minute). (Upson 1988)

3. For acute hypoprothrombinemia with hemorrhage: 0.5-2.5 mg/kg IV, not to exceed 10 mg/minute in mature animals and 5 mg/minute in newborn and very young animals.
For non-acute hypoprothrombinemia: 0.5-2.5 mg/kg IM or SC (Label directions; Veda-K₁®--Vedco)

For sweet clover (dicumarol) toxicity:

1. Give blood if necessary, then phytonadione 1 mg/kg IV or IM; repeat 2-3 times daily for 2 days. (Osweiler and Ruhr 1986)

Horses

For warfarin (or related compounds) toxicity:

1. 500 mg SC q4-6h until one-stage prothrombin time (OSPT) returns to normal control values. Whole blood or fresh plasma may also be necessary early in the course of treatment. (Byars 1987)

2. 0.5-2.5 mg/kg IM, if IV use is necessary (avoid if possible), dilute in saline or D₅W/saline and give very slowly (not to exceed 5 mg/minute). (Upson 1988)

Swine

For warfarin (or related compounds) toxicity:

1. 0.5-2.5 mg/kg IM, if IV use is necessary (avoid if possible), dilute in saline or D₅W/saline and give very slowly (not to exceed 5 mg/minute). (Upson 1988)

Sheep, Goats

For warfarin (or related compounds) toxicity:

1. 0.5-2.5 mg/kg IM, if IV use is necessary (avoid if possible), dilute in saline or D₅W/saline and give very slowly (not to exceed 5 mg/minute). (Upson 1988)

Birds

For hemorrhagic disorders:

1. 0.25-0.5 ml/kg IM of the 10 mg/ml injectable product. Commonly used before surgery where hemorrhage is anticipated. (McDonald 1989)

2. 0.2-2.5 mg/kg IM as needed; usually only 1-2 injections are required. May also be used prophylactically when amprolium and sulfas are administered. (Clubb 1986)

Monitoring Parameters

1) Clinical efficacy (lack of hemorrhage); 2) One-stage prothrombin time (OSPT)

Client Information

Because it may take several weeks to eliminate some of the anticoagulant rodenticides from the body, clients must be counseled on the importance of continuing to administer the drug (phytonadione) for as long as instructed or renewed bleeding may occur. Unless otherwise instructed, oral phytonadione should be administered with food, preferably foods high in fat content. During therapy, animals should be kept quiet whether at home or hospitalized.

Dosage Forms/Approval Status/Withholding Times

Veterinary Products:

Phytonadione Oral Capsules; 25 mg; K-Caps® (Vetus), Veda-K1 Capsules® (Vedco), Veta-K₁® (Bimeda), Vitamin K₁ (Phoenix Pharmaceutical, Butler); (Rx) Labeled for use in dogs and cats.

Phytonadione Aqueous Colloidal Solution for Injection; 10 mg/ml in 30 ml and 100 ml vials; AmTech Vitamin K₁® (Phoenix Scientific), Am-Vet Vitamin K₁® (Neogen), K-Ject® (Vetus), Veda-K₁ Injection® (Vedco), Vita-Jec® (RXV), Vitamin K₁ (Vet Tek, Bimeda, Butler, Phoenix Pharmaceutical), (Rx) Labeled for use dogs, cats, cattle, calves, horses, swine, sheep, and goats. No withdrawal times listed.

Human-Approved Products:

Phytonadione Oral Tablets: 5 mg; Mephyton® (Merck); (Rx)

Phytonadione Injection: 2 mg/ml (aqueous colloidal solution) in 0.5 ml amps and Min-I-ject pre-filled syringes; Aqua-MEPHYTON® (Merck) (Rx); Phytonadione (IMS) (Rx)

Phytonadione may also be known by the following synonyms or trade names: methylphytylnaphthochinonum, phylloquinone, phytomenad., phytomenadionum, phytomenadione, vitamin K₁, Glakay®, K1®, KP®, Kanakion®, Kanavit®, Kavit®, Kaytwo®, Kaywan®, Kenadion®, Konakion®, Konakion Novum®, Pertix-Solo®, Vikatron®, or Vitamon K®.

Fiona