Zinc Toxicosis

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Zinc Toxicosis

 

Toxicity results from the ingestion of zinc-containing material.

Causes gastrointestinal inflammation and hemolytic anemia; may cause multiple organ failure (e.g., renal, hepatic, pancreatic, and cardiac), DIC, and cardiopulmonary arrest.

 

SIGNALMENT

Most frequently reported in young, small-sized dogs (i.e., < 12 kg); can occur in all species of all sizes.

 

SIGNS

  • Anorexia
  • Vomiting
  • Diarrhea
  • Lethargy
  • Pale or icteric mucous membranes
  • Hemoglobinemia
  • Hemoglobinuria
  • Orange-tinged feces
  • Tachycardia

 

CAUSES & RISK FACTORS

There are a variety of zinc compounds with different bioavailabilities: zinc carbonate and zinc gluconate (dietary supplements), zinc chloride (deodorants), zinc pyrithione (shampoos), zinc acetate (throat lozenges), zinc oxide (sunblock, Desitin, calamine lotion), zinc sulfide (paints), metallic zinc (coins).

Toxic doses have not been well defined.

Brass: alloy of copper and zinc.

Toxicities result from ingestion of zinc-containing material: U.S. pennies minted after 1982 (most common source), nuts, bolts, staples, galvanized metal (e. g., nails), pieces from board games, zippers, miscellaneous toys, jewelry.

Organic forms of zinc (e.g., zinc oxide) generally cause only gastrointestinal inflammation.

Acidic environment within the stomach promotes rapid leaching of zinc from the ingested substance, allowing for zinc to be absorbed.

 

DIAGNOSIS

DIFFERENTIAL DIAGNOSIS

Numerous causes of gastrointestinal upset: viral, bacterial, parasitic, immune mediated.

Numerous causes of hemolysis: immune-mediated hemolytic anemia, Babesia, onion and garlic toxicosis, mothball toxicosis (naphthalene), caval syndrome, acetaminophen, coral snake venom, pit viper venom, brown recluse spider venon, mushrooms, overhydration, skunk spray.

 

CBC/BIOCHEMISTRY/URINALYSIS

  • Hemolytic anemia, with possible Heinz body formation.
  • Regeneration will occur if there is enough time: high nucleated RBC counts, basophilic stippling, polychromasia, elevated reticulocytes.
  • Target cells.
  • Spherocytosis—mild and often inconsistent.
  • Leukocytosis with a neutrophilia.
  • Hemoglobinemia.
  • Bilirubinemia.
  • High liver enzymes AST, ALP; less common are elevations in GGT and ALT.
  • Elevated pancreatic enzymes—amylase and lipase—may indicate multiple organ failure.
  • Proteinuria.
  • Pigmenturia (hemoglobin, bilirubin).
  • Azotemia (high BUN and creatinine)—not common.

 

OTHER LABORATORY TESTS

Serum zinc levels often exceed 5 ppm (approximate normal range: 0.70–2 ppm for dogs and cats).

Blood must be collected in non-zinc-contaminated blood tubes.

Coagulation panel—may indicate DIC (prolonged PT and PTT, hypofibrinogenemia, thrombocytopenia, and high FDPs).

Frequent monitoring of PCV is indicated because the decline in PCV can be rapid.

 

IMAGING

Abdominal imaging—may reveal metallic object(s) in the gastrointestinal tract.

Often the zinc object has passed (via vomit or feces) by the time the patient is admitted.

 

DIAGNOSTIC PROCEDURES

ECG—may reveal arrhythmias and ST-segment abnormalities.

 

TREATMENT

Rapid removal of the zinc object by endoscopy or laparotomy/gastrotomy—imperative.

Intravenous fluid therapy—maintain hydration and diuresis—acute renal failure is a serious sequela.

Severe intravascular hemolysis—may require blood transfusion(s)/packed RBCs, oxygen-carrying substances (Oxyglobin).

Inform client about the hazards of ingesting zinc-containing objects (especially US pennies minted after 1982).

 

PATIENT MONITORING

ECG—monitor for evidence of arrhythmias and ST-segment alterations.

Coagulation profile, PCV, RBC, amylase, lipase, BUN, creatinine, ALP, AST, and ALT—monitor for the first 72 hours after zinc removal.

Monitor serum zinc levels.

 

EXPECTED COURSE AND PROGNOSIS

Multiple organ failure (e.g., kidney, liver), DIC, pancreatic disease, cardiopulmonary arrest—potential outcomes.

Rapid removal of the source of zinc may provide progressive improvement over 48–72 hours; complete recovery possible.

 

MISCELLANEOUS

ABBREVIATIONS

ALP = alkaline phosphatase

ALT = alanine aminotransferase

AST = aspartate aminotransferase

DIC = disseminated intravascular coagulation

ECG = electrocardiogram

GGT = gamma-glutamyltransferase

PCV = packed cell volume

PT = prothrombin time

PTT = partial thromboplastin time

RBC = red blood cells

 

Visit your veterinarian as early recognition, diagnosis, and treatment are essential.

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