I think he might have got into some illicit drugs perhaps on…

COCAINENatural alkaloid from the leaves of Erythroxylum coca
Found in a powder, flake, crystal and rock formMany other chemicals can be mixed in which can add to the toxic effect, also you may be faced with the situation where a bag has been ingested but no clinical signs showingIf the bag has remained sealed the best option would be endoscopic removalHIGH DANGER RISKCocaine blocks serotonin, dopamine and norepinephrine reuptake as well as increasing catecholamine release
Has a direct effect on the myocardium and also hypothalamus effecting body temperature
10-20% excreted unchanged in the urine and the remainder as a metabolised form
Crosses the blood brain barrier and a CNS stimulantONSET OF SIGNS
Can be in the region of 10-60 minute
Lethal dose by SC injection 3.5mg/kgDURATION
Peak plasma between 15 minutes to 2 hoursCLINICAL SIGNSGASTROINTESTINAL
Hypersalivation, vomitingNEUROMUSCULAR
Hyperactivity, mydriasis, ataxia, tremors, seizures, hyperthermia
Sometimes followed by neurological depressionCARDIOPULMONARY
Tachycardia, tachypnoea, hypertension, arrhythmias and cardiac arrest is possibleBLOOD GLUCOSE
Hypoglycaemia is possibleTREATMENTGASTRIC DECONTAMINATION
With a rapid onset of signs it is unlikely emesis will be possible, if large quantities ingested then perform gastric lavageEMESIS
Do not use if onset of clinical signs
Extreme care as could induce a seizure
Apomorphine 0.02ml/kg (dogs) - Naloxone 0.04mg/kg to reverse IV SQ IM
or
3% Hydrogen peroxide 1-3ml/Kg, can repeat after 5-10 minutes if no vomitingGASTRIC LAVAGE
Sedation and gastric lavage with coughed ET tube is a safer option regards ***** ***** of onset of clinical signs followed by charcoal administration by the stomach tubeACTIVATED CHARCOAL
Activated charcoal by mouth or stomach tube
1-3gm/kg in 50-100ml of water
1 heaped teaspoon in 40ml of water /2.5kgCHLORPROMAZINE
Chlorpromazine 12mg/kg IV can antagonize the effects of cocaine by reducing the severity of seizures (may reduce threshold) and maintain correct body temperatureCARDIOVASCULAR
Only use if possibly life threatening
Propranolol Dogs 0.02-0.04 mg/kg for tachyarrhythmiaSEIZURES ANXIETY AGGRESSION
Diazepam 0.25-2mg/kg IV (1st choice)
If Not Effective
Phenobarbital 2-5mg/kg slow IV to effect, care with sedative effect, can take 20 minutes for full effect
If Still Not Effective
Propofol 1-4mg/kg slow IV, intubate and ventilateSUPPORTIVE IV FLUIDS
Fluids therapy maintains renal blood flow and promotes diuresis and elimination (care if hypertensive)
Maintenance rate taken as 50-80 ml/kg/dayANTIEMETICS
Avoid metoclopramide as could add to stimulative effect
Maropitant 1mg/kg SC Q24HYPERTHERMIA
Monitor temperature closely and use cold wet towels and fans to cool and if severe consider cold water enemasPROGNOSISDepending on dose but if treatment started early and with survival through 12 hours then prognosis should be goodEPHEDRINECocaine can contain a high percentage of ephedrine - about 15 percent sometimesMEDIUM DANGER RISKTOXIC EFFECT
Sympathomimetic drug similar to amphetamines
Stimulates cardiovascular system, by effects on alpha and beta adrenergic receptors, resulting in hypertension and tachycardia
Stimulates central nervous system by causing the release of norepinephrineTOXIC DOSE
Clinical signs can be seen at 5 - 6 mg/kg
Ingestion dose of 10 - 12 mg/kg could prove fatal in dogsONSET OF CLINICAL SIGNS
Signs can appear within 30 minutes to 4 hours after ingestion
Extended release capsules can delay onset up to 8 hours and extend durationCLINICAL SIGNSCARDIOPULMONARY
Bradycardia or tachycardia, hypertension, sinus arrhythmia, can result in Disseminated Intravascular Coagulation (DIC)
Panting, tachypnoea, dyspnoea, upper respiratory harshnessNEUROMUSCULAR
CNS stimulation or depression, agitation, anxiety, disorientation, ataxia, hiding away, hyperactivity, tremors, head shaking, head bobbing, mydriasis, dysuria
Hyperthermia and seizuresSECONDARY RENAL
Muscular tremors and seizures can result in myoglobinuria and rhabdomyolysis, with secondary renal damage
Protracted hyperthermia can also result in secondary renal damageGASTROINTESTINAL
Vomiting, diarrhoea, abdominal discomfortSerotonin syndrome and hypoglycaemia may be seenSEROTONIN SYNDROMEGASTROINTESTINAL
Diarrhoea, abdominal pain, hypoglycaemiaNEUROMUSCULAR
Sedation, lethargy, recumbence, weakness, hyperexcitability, agitation, aggression, ataxia, behavioural abnormalities, hyperreflexia, hyperaesthesia, vocalization, muscle rigidity, transient blindness, muscular tremors, seizures, coma , mydriasis, nystagmus, hyperthermia, opisthotonusCARDIOVASCULAR
Tachycardia or bradycardia , tachypnoea, arrhythmias and hypertension, or hypotension
Serotonin syndrome can progress to acute respiratory distress syndromeHEPATORENAL FAILURE
Hepatic and renal failure may be seen
Secondary renal failure can follow rhabdomyolysis, from protracted seizuring or refractory hyperthermia
Metabolic acidosis or lactic acidosis, may be seenTREATMENTGASTRIC DECONTAMINATION
Window for emesis will be short due to rapid absorption, only consider if no clinical signs are evident and under 1 hour from ingestion
Otherwise consider gastric lavage, if aspiration risks don't allow emesisActivated charcoal is beneficial, unless aspiration risks outweighEMESIS
Apomorphine 0,02-0.04mg/kg SC - Naloxone 0.04mg/kg to reverse IV SQ IM
or
3% Hydrogen peroxide 1-3ml/Kg, can repeat after 5-10 minutes if no vomitingGASTRIC LAVAGE
Sedate, place cuffed ET tube and lavage with stomach tubeACTIVATED CHARCOAL
Activated charcoal by mouth or stomach tube
1-3gm/kg in 50-100ml of water
1 heaped teaspoon in 40ml of water /2.5kg
If large ingestion of extended release formula, consider repeat half dose in 4 hoursCATHARTIC
Administer With Activated Charcoal, If Given
Cathartic if no diarrhoea or dehydration to eliminate charcoal bound toxin from the body
Saccharide cathartic sorbitol 70% solution 1-3ml/kg ORALANTIEMETICS
Maropitant 1mg/kg SC Q24
or
Metoclopramide 0.2-0.5 mg/kg IV IM SC Q 8-12 or 1-2 mg/kg IV Q24 as CRIPAROXYSMAL ARRHYTHMIAS
The episode of arrhythmia may start abruptly and end abruptly
Extreme caution with cardiac medications,only consider in life threatening casesTachyarrhythmia
Propranolol 0.02-0.04mg/kg slow IV for tachycardia (can repeat)Ventricular Arrhythmia
Lidocaine 2-8mg/kg IV bolus in 2 mg/kg boluses then CRI 0.025-0.1 mg/kg/min
or
Procainamide 6-20 mg/kg IV as 2mg/kg/min IV boluses then CRI 0.025-0.05 mg/kg/min minAGITATION/ANXIETY/HYPERTENSION
No strong evidence that seizure threshold is reduced
Acepromazine 0.01-0.02mg/kg SQ IM slow IV to effect
or
Chlorpromazine 0.5-1mg/kg SQ IM IVNEUROMUSCULAR
Avoid diazepam if possible as could aggravate anxiety
Anticonvulsants
Diazepam 0.25-0.5mg/kg IV
Repeat after 10 minutes if needed, up to 3 times
If Not Effective
Phenobarbital 1-4mg/kg slow IV to effect, care with sedative effect, can take 20 minutes for full effect
If Still Not Effective
Propofol 1-4mg/kg slow IV to effect, intubate and ventilateSEROTONIN SYNDROME
Cyproheptadine 1.1mg/kg every 4-6 hours oral or via rectumGASTROINTESTINAL PROTECTANTS
H2 Antagonists
Famotidine 0.5-1mg/kg IV IM SQ Oral Q12-24
or Ranitidine 1-2 mg/kg IV SQ Oral Q8-12
or Cimetidine 5-10mk/kg IV IM Oral Q6-8
Slow IV over 30 minutes if arrhythmia present
Proton Pump Inhibitor
Omeprazole 0.5-1.5mg/kg oral Q24HYPOGLYCAEMIA
Dextrose 50% 1-5ml IV slowly over 10 minutes
Recheck blood glucose regards ***** ***** needed
Minimum maintenance requirements 1ml/kg/hourSUPPORTIVE IV FLUIDS
Crystalloid fluids and electrolyte therapy
Rate based on clinical signs of hypotension, hydration, shock and oliguria
Maintenance rate taken as 50-80 ml/kg/day
Consider rates of up to 4-6ml/kg/hour as needed, only if no hypertensionACIDIFY URINE
Urine acidification speeds up excretion
Must monitor acid-base status
Ammonium chloride 25-50 mg/kg/day ORAL every 6 hours
(Ammonium slight CNS depressant effect)
Ascorbic acid 20-30 mg/kg ORAL SC IM IVOLIGURIA / ANURIA
Place urinary catheter and measure urine production
Oliguria (0.5ml urine/kg/hour)
Anuria (less than 0.5ml/kg/hr)
Increase fluid rate to 2-3 times maintenance
Monitor hydration and respiratory rateTEMPERATURE CONTROL
Monitor and support normal body temperature
If hyperthermic cool with cold water towels and fans, if extreme consider cold water enemaRESPIRATORY ASSISTANCE
Provide oxygen as supportive treatment for respiratory distress, be ready to intubate and ventilate if neededPROGNOSISLarge ingestions can result in a rapid death from cardiovascular and neurological stimulation, rapid aggressive supportive prognosis improves prognosisSeizures and serotonin syndrome are poor prognostic indicatorsPHENACETINCocaine is 'cut' with phenacetin and on average is 30 percent but can be higher
Phenacetin is metabolised to acetaminophen
Can also be combined with ephedrineHIGH DANGER RISKCats are the most sensitive to acetaminophen toxicity due to their limited glucuronidation pathway, relying on the other pathways which can quickly result in toxic effects
Methaemoglobinaemia can be rapid in cats and can quickly prove fatal much before any signs of hepatic failure developOVERDOSE
Once acetaminophen levels reach a certain quantity glucuronidation and sulphation pathways become saturated
Greater amounts are then converted to the toxic metabolite NAPQ1 which starts draining glutathione reserves and glutathione is depleted from the liver and the red blood cells
Once glutathione stores drop below 30% of normal NAPQ1 instead bind to cellular macromolecules than contain cysteine
This binding occurs in several sites, but mainly in centrilobular levels of the liver and these are the main areas of hepatic necrosisCATS POOR GLUCURONIDATION PATHWAY
Cats are deficient in the enzyme glucuronyl transferase which is needed in the glucuronidation pathway to metabolise acetaminophen, so even with small doses they soon start to produce toxic metabolitesTOXIC DOSE
This toxicological process starts to occur with acute ingestions of
75-100mg/kg in dogs
10mg/kg in cats
150mg/kg in children
7.5g total dose in adultsOver 40mg/kg can result in Keratoconjunctivitis sicca 72 hours post ingestion
Canine dosages of 200mg/kg produced 18% methaemoglobinaemia in 4 hours and 500mg/kg 52% methaemoglobinaemiaPRE FASTING CONCERNS
These toxic doses can be me reduced considerably if the patient was in a fasting state at the time of ingestion and this believed to be related to a decreased glutathione storeGlutathione stores can also be depleted in animals with a pre-existing illnessHEINZ BODY AND METHAEMOGLOBIN FORMATION
Ingestion doses above 60mg/kg in cats
Ingestion doses above 200mg/kg in dogs
With glucuronidation, sulphation pathways and glutathione stores depleted, alternate metabolic pathways result in the formation of oxidising metabolites that induce Heinz body formation and methaemoglobin formation
The Heinz bodies render the blood cells fragile and resulting haemolysis occurs
The methaemoglobin is where the Hb iron is oxidised from the ferrous to the ferric state, taking away it's ability to transport oxygenMETHAEMOGLOBINAEMIA
With glutathione methaemoglobin can be reduced to haemoglobin, so without methaemoglobin level increases, this can become life threatening well before hepatic failure, as removes the ability for red blood cells to carry oxygen
Blood tends to have a chocolate brown colourationELIMINATION HALF LIFE
With normal metabolic pathways saturated, the clearance half life dramatically increases
A half life of 1.2 hours has been recorded after canine ingestion of 200mg/kg, increasing to 3.5 hours at an ingestion dose of 500mg/kgCLINICAL SIGNSClinical signs can depend on levels ingested and the time from ingestion
Early clinical signs reflect gastrointestinal irritation, methaemoglobin formation and haemolytic anaemia
Onset of methaemoglobinaemia can start 4-12 hours post ingestion with a maximum delay up to 48 hours
Later clinical signs reflect fulminant (abrupt) hepatic failure which may be around 24-96 hours post ingestionDeath can occur in the first 24 hours from methaemoglobinaemia or several days later from acute liver failureGASTROINTESTINAL SIGNS
30 Minutes To 24 Hours Post Ingestion
Inappetence, vomiting, diarrhoea, salivation, abdominal discomfortMETHAEMOGLOBINAEMIA
A Few Hours To Several Hours Post Ingestion
Cyanosis, dyspnoea, tachypnoea, chocolate brown mucous membranes, tachycardia, collapse, cardiovascular collapse, coma, hypothermia, sudden death
Facial oedema and oedematous paws may also be seen
Haemolytic anaemia and haematuria may be evidentINITIAL SIGNS HEPATIC FAILURE
24-48 Hours Post Ingestion
Abdominal pain may return, in the cranial abdomen area, metabolic acidosis, oliguria, elevated bilirubin and liver enzymes, increased prothrombin timeFULMINANT HEPATIC FAILURE
72-96 Hours Post Ingestion
Liver figures begin to peak, inappetence returns, vomiting starts again, lethargy, metabolic acidosis worsens, jaundice, hypoglycaemia, possible hepatic encephalopathy, haemoglobinuria returns, intravascular haemolysis, coma, seizures, pulmonary oedema and possible deathRENAL FAILURE
Oliguric, anuric renal failure can occur from hepatorenal syndrome and/or from damage to renal tubules from their production of NAPQ1 toxic metaboliteTREATMENTGASTRIC DECONTAMINATION
Window for effective emesis will be short as nearly 100% can be absorbed in an hour, if extended release formula has been ingested then worth performing emesis up to 3 hours post ingestion
If clinical signs have started, emesis contraindicated and consider lavage if less than 1 hour for immediate release or under 4 hours with extendedActivated charcoal is of proven benefitEMESIS
Apomorphine 0,02-0.04mg/kg SC - Naloxone 0.04mg/kg to reverse IV SQ IM
or
3% Hydrogen peroxide 1-3ml/Kg, can repeat after 5-10 minutes if no vomitingGASTRIC LAVAGE
Sedate, place cuffed ET tube and lavage with stomach tubeACTIVATED CHARCOAL
Activated charcoal by mouth or stomach tube
1-3gm/kg in 50-100ml of water
1 heaped teaspoon in 40ml of water /2.5kg
One off dose or will bind N-Acetylcysteine and reduce effect
In human medicine activated charcoal binding of oral N-Acetylcysteine is believed not to alter effectivenessCATHARTIC
Administer With Activated Charcoal, If Given
Cathartic if no diarrhoea or dehydration to eliminate charcoal bound toxin from the body
Saccharide cathartic sorbitol 70% solution 1-3ml/kg ORALANTIDOTAL TREATMENT
N-Acetylcysteine can significantly reduce acetaminophen toxicity
- As a precursor to glutathione
- Acts on the toxic metabolite formed from oxidation via P450 pathway
- Oxidised to form sulphate which can be used in the sulphation pathwayN-Acetylcysteine (200mg/ml solution)
Most Effective If Given Within 8 Hours
150 mg/kg IV infusion in 200ml 5% glucose solution over 15 minutes
Followed By
50mg/kg IV infusion in 500ml 5% glucose solution over 4 hours
Followed By
100mg/kg IV infusion in 1000ml glucose solution over 16 hoursIF ONLY ORAL AVAILABLE
If Vomiting Occurs Within 1 Hour Of Dose, Repeat Dose
140mg Acetylcysteine Oral once
Followed By
70mg/kg Oral every 4 hours for 17 dosesCIMETIDINE
Inhibits cytochrome P-450 oxidation in the liver preventing metabolism of acetaminophen into toxic metabolites
Cimetidine 5mg/kg IV every 8 hoursMETHAEMOGLOBIN
VITAMIN C
To Try To Convert Methaemoglobin
Ascorbic acid 30-40mg/kg SC Q6 for 7 treatmentsMETHYLENE BLUE
Only consider in severe cases as may result in Heinz bodies
IV reduces methaemoglobin to haemoglobin
Methylthioninium Chloride (methylene blue) 1.5mg/kg slow IV 1% solution (1-2 doses)HEPATIC SUPPORT
SAM's OR SILYBIN
S-Adenosylmethionine 20mg/kg Oral Q24
or
Silymarin (milk thistle) 50-250 mg/kg/day oral
LACTULOSE
For Acute Hepatic Encephalopathy
Retention enema for 4-8 hours, give 18-20ml/kg of 3 parts lactulose 7 parts water solution per rectum
VITAMIN K
Vitamin K1 0.5-1 mg/kg SC Q12 (multi sites) for 2 daysLOW PCV
If severe clinical signs and low PCV consider transfusion
Packed red blood cells 10ml/kg over 4 hours
or
Whole blood 20ml/kg over 4 hours
or
Oxyglobin 5-15ml/kg IVHYPOGLYCAEMIA
Dextrose 50% 1-5ml IV slowly over 10 minutes
Recheck blood glucose regards ***** ***** needed
Minimum maintenance requirements 1ml/kg/hourSUPPORTIVE IV FLUIDS
Crystalloid fluids and electrolyte therapy
Rate based on clinical signs of hypotension, hydration, shock and oliguria
Maintenance rate taken as 50-80 ml/kg/day
Consider rates of up to 4-6ml/kg/hour as neededOLIGURIA / ANURIA
Place urinary catheter and measure urine production
Oliguria (0.5ml urine/kg/hour)
Anuria (less than 0.5ml/kg/hr)
Increase fluid rate to 2-3 times maintenance
Monitor hydration and respiratory rateHYPOTENSIVE SHOCK
For hypotension start rates at 4-6ml/kg/hour and if severe consider giving 20-30ml/kg IV over 20-30 minutes in aliquots, while blood pressure is monitoredCOLLOID
Consider if hypotension non responsive to higher rates of fluid
Gelatine (Oxypolygelatine) 20ml/kg maximum in 24 hour periodLAST RESORT VASOPRESSORS
Only consider in life threatening cases
Dopamine 2-10 mcg(micro)/kg/min IV as a CRI
or
Epinephrine 0.05-0.4 mcg(micro)/kg/min IV as a CRI
or
Norepinephrine 0.1-1.0 mcg(micro)/kg/min IV as a CRISEIZURES
May occur secondary to hypoxia, or fulminant liver failure, try to address primary cause
Anticonvulsants
Diazepam 0.25-0.5mg/kg IV (1st choice)
Repeat after 10 minutes if needed up to 3 times
If Not Effective
Phenobarbital 1-4mg/kg slow IV to effect, care with sedative effect, can take 20 minutes for full effect
If Still Not Effective
Propofol 1-4mg/kg slow IV to effect, intubate and ventilateTEMPERATURE SUPPORT
Monitor closely if hypothermia support body temperature as required with heat padsKERATOCONJUNCTIVITIS SICCA
Apply artificial tears as necessarySEVERE ACIDOSIS
If acid base status can be closely monitored
Sodium bicarbonate added to fluids mEq dose of bicarbonate calculated byWeight in kg x base deficit (mEq/l) x 0.3Administer 25% in IV fluids over 30 minutes then 75% over 4-6 hours
IF NOT POSSIBLE TO CALCULATE
Sodium bicarbonate 0.5 - 1 mmol/kg over 1-2 minutes and repeat at 0.5 mmol/kg every 10 minutes if neededPROGNOSISDepending on dosage and speed of treatment, acetylcysteine administrated within 8 hours of ingestion can be life saving even at extremely high dosesSHORT TERM
Can be fatal if ingestion is 200mg/kg or greaterLONG TERM
Can result in chronic liver failure, hepatic damage tends to show 24-36 hours post ingestion

I’m keeping an eye out for a video from you. If he seems severely affected and narcan doesn’t get him back to himself then you may need to find an ER vet.

Thank you again for trusting JustAnswer with your question. If you have any additional concerns or need me to clarify anything, please let me know. I am happy to help!