Letters to the Editor Buy-in needed for one health concept to work
We were very interested to read the letter from Buttke et al1 describing how a one health approach was used to bring public health, wildlife health, occupational health, resource management, and communications experts together to respond to a report that a visitor to the Delaware Water Gap National Recreation Area had been bitten by a rabid beaver. In their letter, Buttke et al defined one health in broad terms as the concept that “human, animal, and environmental health are linked and interdependent.” The University of California-Davis School of Veterinary Medicine International Animal Welfare Training Institute has identified “protecting the health and wellbeing of humans and animals during times of disasters and emergency responses” as a specific part of the one health concept.2 Our group, the Oceanographic Environmental Research Society, has a Disaster Response Division that was organized to help animals that required rescue and care during and after disasters. Unfortunately, it has been our experience that, at least in regard to animal rescue and care during disasters, the one health concept has not been widely accepted in Canada. Ever since Hurricane Katrina hit the US Gulf Coast in 2005, the society has been trying to bring interested parties together to not only help animals during disasters but also train as a cohesive unit to make any disaster response more efficient and safer for both humans and animals. However, despite interest from veterinarians, veterinary technicians, and various other volunteers, federal, provincial, and regional government agencies in charge of disaster response have shown little interest in including effective animal responses in their planning or management. In fact, even national and provincial veterinary associations have not been very successful JAVMA, Vol 244, No. 9, May 1, 2014
in having animal response and care included with official government disaster management, training, and planning. The one health concept sounds nice in theory, but turning this concept into a working reality requires one key component: the approval of all of the agencies involved. Without their support of and belief in this concept, failure to produce concrete results is inevitable, which means failure to help the many animals affected by disasters. Carin Wittnich, DVM, MSc University of Toronto Toronto, ON, Canada Michael Belanger Oceanographic Environmental Research Society Barrie, ON, Canada 1.
2.
Buttke DE, Castle K, Wild M, et al. Translating one health into practice (lett). J Am Vet Med Assoc 2014;244:405–406. One Health: Animals in Disasters initiative for the State of California. Available at: www.vetmed.ucdavis.edu/ iawti/one_health/index.cfm. Accessed Mar 17, 2014.
Dog bite prevention and public health
The study by Rhea et al1 on “Use of statewide emergency department surveillance data to assess incidence of animal bite injuries among humans in North Carolina” adds to the growing body
of knowledge on the public health, financial, and social impacts of dog bite injuries. England, Wales, and Scotland have seen the number of hospital admissions for dog bite injuries increase nearly 100% over the past 10 years, to 7,411 cases for the 12-month period from May 2011 through April 2012.2–4 Proportionally, this is a much higher hospital admission rate, as a function of dog population, than the rate for the United States, given a dog population in the United Kingdom of approximately 8.5 million dogs, with 25% of households owning a dog. By contrast, there were 9,500 hospital admissions for dog bite injuries in the United States during 2008, when the US dog population was approximately 70 million dogs, with 36.5% of households owning dogs.5–7 Plastic surgeons admit most patients with dog bite injuries, and children < 10 years of age have the highest admission rate by age in this specialty.1 On the other hand, dog bite fatalities in the United Kingdom remain infrequent, with only 20 cases since 2005. Although individual episodes result in intense media interest, legislation, punishment, familial guilt, canine euthanasia, and education appear to be having little impact on reducing the number of such fatalities. The stark reality of a dog bite attack, along with our pointof-contact in-hospital advice, may
Instructions for Writing a Letter to the Editor Readers are invited to submit letters to the editor. Letters may not exceed 500 words and 6 references. Letters to the Editor must be original and cannot have been published or submitted for publication elsewhere. Not all letters are published; all letters accepted for publication are subject to editing. Those pertaining to anything published in the JAVMA should be received within one month of the date of publication. Submission via e-mail ([email protected]) or fax (847-925-9329) is encouraged; authors should give their full contact information, including address, daytime telephone number, fax number, and email address. Letters containing defamatory, libelous, or malicious statements will not be published, nor will letters representing attacks on or attempts to demean veterinary societies or their committees or agencies. Viewpoints expressed in published letters are those of the letter writers and do not necessarily represent the opinions or policies of the AVMA.
Views: Letters to the Editor
1013
help decrease the risk that victims will be bitten again, but this does little to prevent dog bites in the first place. How we as health-care professionals develop and deploy novel bite prevention strategies is our next challenge in public health. Duncan Bayne, MBBS, BDS Department of Plastic Surgery Queen Victoria Hospital Foundation Trust East Grinstead, West Sussex, United Kingdom 1.
2.
3.
4.
5.
6.
7.
Rhea SK, Weber DJ, Poole C, et al. Use of statewide emergency department surveillance data to assess incidence of animal bite injuries among humans in North Carolina. J Am Vet Med Assoc 2014;244:597–603. Health and Social Care Information Centre. Admissions caused by dogs and other animals. Available at: www.hscic. gov.uk/catalogue/PUB06970/ prov-mont-hes-admi-outp-ae-apr12-toi-rep.pdf. Accessed Mar 1, 2014. Welsh Informatics Service. Annual patient education database Wales tables 2011–2012. Available at: www. infoandstats.wales.nhs.uk/page. cfm?pid=41010&orgid=869. Accessed Mar 1, 2014. Scottish Parliament. Information Services Division. Dog bite admission statistics. Available at: www.scottish. parliament.uk/S4_ChamberDesk/ WA20140123.pdf. Accessed Mar 1, 2014. Pet Food Manufacturers’ Association. Pet population report 2012 for UK pets. Available at: www.pfma.org.uk/ pet-population-2008-2012. Accessed Mar 1, 2014. Holmquist L, Elixhauser A. Emergency department visits and inpatient stays involving dog bites, 2008. Available at: www.hcup-us.ahrq.gov/reports/statbriefs/sb101.pdf. Accessed Mar 1, 2014. Shepherd AJ. Dog ownership. In: US pet ownership and demographics sourcebook. Schaumburg, Ill: AVMA, 2012.
There’s no app for that, yet
We read with interest the recent ECG of the Month article1 regarding a horse that was examined because of decreased appetite, diarrhea, and weight loss. The authors reportedly used a smartphone applicationa to record the initial ECG in this horse and made a diagnosis of atrial fibrillation on the basis of an “absence of P waves, the presence of f waves, and a rapid ventricular response rate.” We respectfully disagree with this diagnosis. Atrial fibrillation is characterized predominantly by an 1014
Views: Letters to the Editor
irregularly irregular (ie, completely unpredictable and unpatterned) supraventricular arrhythmia, together with an absence of P waves and the possible presence of f (fibrillation) waves. Examination of the initial ECG reveals a very regular rhythm with an R-R interval of 720 milliseconds. Although we agree that in cases of atrial fibrillation characterized by a rapid ventricular response rate R-R variability decreases, we have never observed a case of atrial fibrillation with almost no R-R variability and would not expect to see such low R-R variability in horses with atrial fibrillation, in which the ventricular rate, even when rapid, is generally < 100 beats/min. In contrast, we suggest that the initial ECG in this horse most likely represents sinus tachycardia, with the baseline alterations being an artifact. The lack of P waves is most likely also artifactual, produced by use of a device that does not provide sufficient separation between the positive and negative electrodes to accurately record small potentials. We would suggest that this device, and others like it, can serve as screening tools and can permit an ECG rhythm diagnosis if the rhythm alteration is obvious. However, if the ECG is inconclusive, the initial recording should be validated with a proper diagnostic ECG (in this case, a base-apex lead ECG). The addition of wire electrodes to this device in the future might improve the fidelity of ECG recordings, permitting it to become a more accurate diagnostic device. Mark Rishniw, BVSc, PhD Mark Kittleson, DVM, PhD Veterinary Information Network Davis, Calif a.
AliveCor, AliveCor Inc, San Francisco, Calif.
1.
Mullen KR, Kraus MS, Divers TJ. ECG of the month. J Am Vet Med Assoc 2014;244:657–659.
The authors respond: We thank Drs. Rishniw and Kittleson for their comments, but remain confident in our diagnosis and wish to explain our methods and reasoning. The horse described in our report1 underwent cardiac auscultation by multiple clinicians
at the time of admission to our hospital, and the heart rate was consistently reported to be fast and irregular by all of these individuals. At that time, ECG tracings were acquired with both the smartphone application described in our report and a standard ECG machine. The smartphone ECG tracing, in our opinion, contained the most illustrative atrial fibrillatory waveforms (f waves) and was, therefore, chosen for publication. Unfortunately, the short ECG tracing selected for publication does not show the marked variation in R-R interval typically seen with atrial fibrillation. However, other tracings that we obtained had obvious irregularity of the R-R interval, interspersed with periods during which the R-R interval was more regular, and an absence of P waves, supporting the diagnosis of atrial fibrillation. However, the f waves were difficult to discern on these other tracings, and because of this, these tracings were not included in our report. Severe electrolyte disorders (eg, hypokalemia, hypomagnesemia, and hypocalcemia) can predispose horses to develop supraventricular and ventricular tachyarrhythmias.2 Thus, it is possible that the horse described in our report had atrial fibrillation and intermittent accelerated junctional tachycardia or ventricular tachycardia at the time of admission, resulting in episodes of regular-appearing R-R intervals. Intracardiac ECGs would have been required to definitively determine the site of origin of the QRS complexes in this horse. We agree that the smartphone application should be used as a screening tool. If there is any doubt about the findings, a standard base-apex ECG should also be acquired, as was done in our patient, to definitively confirm a rhythm diagnosis. Kathleen R. Mullen, DVM, MS Marc S. Kraus, DVM Thomas J. Divers, DVM Department of Clinical Sciences College of Veterinary Medicine Cornell University Ithaca, NY 1. 2.
Mullen KR, Kraus MS, Divers TJ. ECG of the month. J Am Vet Med Assoc 2014;244:657–659. El-Sherif N, Turitto G. Electrolyte disJAVMA, Vol 244, No. 9, May 1, 2014
orders and arrhythmogenesis. Cardiol J 2011;18:233–245.
Exposure of dogs to single-dose laundry detergent packs
In February 2012, small, single-dose packs (pods) containing concentrated liquid laundry detergent in a water-soluble membrane began to be sold in the United States.1–3 Several months later, US poison control centers began to receive reports of young children experiencing potentially serious exposures to the products, involving symptoms such as vomiting, cough, eye irritation, red eyes, drowsiness, nausea, respiratory distress, and seizures.1,3–5 These laundry detergent packs may be more likely to cause serious adverse effects than traditional products.2,3,5 Suggested reasons for this include differences in ingredients, concentration, and delivery mechanism.5 The packets have been reported to contain highly concentrated chemicals (eg, ethanolamine, alcohol ethoxylate, and benzenesulfonic acid).6 Pets may also be exposed to laundry detergent packs. Although its primary activity is to manage human exposures, the Texas Poison Center Network received 38 calls about canine exposures to laundry detergent between January 2012 and February 2014. Of these, 22 (58%) involved laundry detergent packs. By comparison, of the 3,352 human exposures to laundry detergent reported during the same
JAVMA, Vol 244, No. 9, May 1, 2014
period, 58.3% involved laundry detergent packs. The brand of laundry detergent packs to which dogs were reportedly exposed was Tide for 15 of the 22 (68%) dogs and All for 5 (23%); for the remaining 2 (9%), the brand was not reported. Twenty-one (95%) dogs ingested the product; the route of exposure was not reported for the remaining dog. Twenty calls came from the dog’s owner or caregiver and 2 came from a veterinarian. All 10 of the cases for which the exposure site was reported occurred at the owner’s or caregiver’s home. Reported initial clinical signs were vomiting (n = 9), drowsiness (2), nausea (1), dyspnea (1), and tongue sticking out (1). Texas Poison Center Network staff generally do not manage animal exposures but may refer callers to others who do. For these canine exposures, 12 (55%) of the callers were referred to a veterinarian, 3 (14%) were referred to an animal poison control center, and 2 (9%) were referred to both. Our experiences suggest that, ever since these products have come on the market, laundry detergent packs have accounted for a large proportion of, if not most, canine laundry detergent exposures reported to poison control centers. As with young children, it is recommended that laundry detergent packs be kept out of the reach of pets. Canine exposures to laundry detergent packs might have the potential to be more serious than exposures to traditional products.
Human and animal poison control centers and other pet-care providers might want to consider this when managing canine exposures to laundry detergents. Mathias Forrester, BS Epidemiologist Poison Control Program Environmental Epidemiology and Disease Registries Section Texas Department of State Health Services Austin, Tex 1.
2.
3.
4.
5.
6.
American Association of Poison Control Centers. AAPCC and poison centers issue warning about concentrated packets of laundry detergent. American Association of Poison Control Centers, Alexandria, Virginia. May 17, 2012. Available at: www.aapcc.org/dnn/ Portals/0/Laundry%20Detergent%20 Packs%205.17.2012.pdf. Accessed May 20, 2012. Merchant N. More kids eating detergent packs, docs report. Msnbc.com. May 24, 2012. Available at: www. msnbc.msn.com/id/47557814/ns/health childrens_health/. Accessed May 25, 2012. O’Connor A. New detergent pods pose poisoning risk. The New York Times 2012;Jun 27. Available at: well.blogs. nytimes.com/2012/06/27/new detergent pods pose poisoning risk/. Accessed Jul 10, 2012. Forrester MB. Comparison of pediatric exposures to concentrated “pack” and traditional laundry detergents. Pediatr Emerg Care 2013;29:482–486. CDC. Health hazards associated with laundry detergent pods United States, May June 2012. MMWR Morb Mortal Wkly Rep 2012;61:825–829. Wang Y. Hidden danger in your laundry? Houston Chronicle 2013;112(331):A1, A11.
Views: Letters to the Editor
1015
We were very interested to read the letter from Buttke et al1 describing how a one health approach was used to bring public health, wildlife health, occupational health, resource management, and communications experts together to respond to a report that a visitor to the Delaware Water Gap National Recreation Area had been bitten by a rabid beaver. In their letter, Buttke et al defined one health in broad terms as the concept that “human, animal, and environmental health are linked and interdependent.” The University of California-Davis School of Veterinary Medicine International Animal Welfare Training Institute has identified “protecting the health and wellbeing of humans and animals during times of disasters and emergency responses” as a specific part of the one health concept.2 Our group, the Oceanographic Environmental Research Society, has a Disaster Response Division that was organized to help animals that required rescue and care during and after disasters. Unfortunately, it has been our experience that, at least in regard to animal rescue and care during disasters, the one health concept has not been widely accepted in Canada. Ever since Hurricane Katrina hit the US Gulf Coast in 2005, the society has been trying to bring interested parties together to not only help animals during disasters but also train as a cohesive unit to make any disaster response more efficient and safer for both humans and animals. However, despite interest from veterinarians, veterinary technicians, and various other volunteers, federal, provincial, and regional government agencies in charge of disaster response have shown little interest in including effective animal responses in their planning or management. In fact, even national and provincial veterinary associations have not been very successful JAVMA, Vol 244, No. 9, May 1, 2014
in having animal response and care included with official government disaster management, training, and planning. The one health concept sounds nice in theory, but turning this concept into a working reality requires one key component: the approval of all of the agencies involved. Without their support of and belief in this concept, failure to produce concrete results is inevitable, which means failure to help the many animals affected by disasters. Carin Wittnich, DVM, MSc University of Toronto Toronto, ON, Canada Michael Belanger Oceanographic Environmental Research Society Barrie, ON, Canada 1.
2.
Buttke DE, Castle K, Wild M, et al. Translating one health into practice (lett). J Am Vet Med Assoc 2014;244:405–406. One Health: Animals in Disasters initiative for the State of California. Available at: www.vetmed.ucdavis.edu/ iawti/one_health/index.cfm. Accessed Mar 17, 2014.
Dog bite prevention and public health
The study by Rhea et al1 on “Use of statewide emergency department surveillance data to assess incidence of animal bite injuries among humans in North Carolina” adds to the growing body
of knowledge on the public health, financial, and social impacts of dog bite injuries. England, Wales, and Scotland have seen the number of hospital admissions for dog bite injuries increase nearly 100% over the past 10 years, to 7,411 cases for the 12-month period from May 2011 through April 2012.2–4 Proportionally, this is a much higher hospital admission rate, as a function of dog population, than the rate for the United States, given a dog population in the United Kingdom of approximately 8.5 million dogs, with 25% of households owning a dog. By contrast, there were 9,500 hospital admissions for dog bite injuries in the United States during 2008, when the US dog population was approximately 70 million dogs, with 36.5% of households owning dogs.5–7 Plastic surgeons admit most patients with dog bite injuries, and children < 10 years of age have the highest admission rate by age in this specialty.1 On the other hand, dog bite fatalities in the United Kingdom remain infrequent, with only 20 cases since 2005. Although individual episodes result in intense media interest, legislation, punishment, familial guilt, canine euthanasia, and education appear to be having little impact on reducing the number of such fatalities. The stark reality of a dog bite attack, along with our pointof-contact in-hospital advice, may
Instructions for Writing a Letter to the Editor Readers are invited to submit letters to the editor. Letters may not exceed 500 words and 6 references. Letters to the Editor must be original and cannot have been published or submitted for publication elsewhere. Not all letters are published; all letters accepted for publication are subject to editing. Those pertaining to anything published in the JAVMA should be received within one month of the date of publication. Submission via e-mail ([email protected]) or fax (847-925-9329) is encouraged; authors should give their full contact information, including address, daytime telephone number, fax number, and email address. Letters containing defamatory, libelous, or malicious statements will not be published, nor will letters representing attacks on or attempts to demean veterinary societies or their committees or agencies. Viewpoints expressed in published letters are those of the letter writers and do not necessarily represent the opinions or policies of the AVMA.
Views: Letters to the Editor
1013
help decrease the risk that victims will be bitten again, but this does little to prevent dog bites in the first place. How we as health-care professionals develop and deploy novel bite prevention strategies is our next challenge in public health. Duncan Bayne, MBBS, BDS Department of Plastic Surgery Queen Victoria Hospital Foundation Trust East Grinstead, West Sussex, United Kingdom 1.
2.
3.
4.
5.
6.
7.
Rhea SK, Weber DJ, Poole C, et al. Use of statewide emergency department surveillance data to assess incidence of animal bite injuries among humans in North Carolina. J Am Vet Med Assoc 2014;244:597–603. Health and Social Care Information Centre. Admissions caused by dogs and other animals. Available at: www.hscic. gov.uk/catalogue/PUB06970/ prov-mont-hes-admi-outp-ae-apr12-toi-rep.pdf. Accessed Mar 1, 2014. Welsh Informatics Service. Annual patient education database Wales tables 2011–2012. Available at: www. infoandstats.wales.nhs.uk/page. cfm?pid=41010&orgid=869. Accessed Mar 1, 2014. Scottish Parliament. Information Services Division. Dog bite admission statistics. Available at: www.scottish. parliament.uk/S4_ChamberDesk/ WA20140123.pdf. Accessed Mar 1, 2014. Pet Food Manufacturers’ Association. Pet population report 2012 for UK pets. Available at: www.pfma.org.uk/ pet-population-2008-2012. Accessed Mar 1, 2014. Holmquist L, Elixhauser A. Emergency department visits and inpatient stays involving dog bites, 2008. Available at: www.hcup-us.ahrq.gov/reports/statbriefs/sb101.pdf. Accessed Mar 1, 2014. Shepherd AJ. Dog ownership. In: US pet ownership and demographics sourcebook. Schaumburg, Ill: AVMA, 2012.
There’s no app for that, yet
We read with interest the recent ECG of the Month article1 regarding a horse that was examined because of decreased appetite, diarrhea, and weight loss. The authors reportedly used a smartphone applicationa to record the initial ECG in this horse and made a diagnosis of atrial fibrillation on the basis of an “absence of P waves, the presence of f waves, and a rapid ventricular response rate.” We respectfully disagree with this diagnosis. Atrial fibrillation is characterized predominantly by an 1014
Views: Letters to the Editor
irregularly irregular (ie, completely unpredictable and unpatterned) supraventricular arrhythmia, together with an absence of P waves and the possible presence of f (fibrillation) waves. Examination of the initial ECG reveals a very regular rhythm with an R-R interval of 720 milliseconds. Although we agree that in cases of atrial fibrillation characterized by a rapid ventricular response rate R-R variability decreases, we have never observed a case of atrial fibrillation with almost no R-R variability and would not expect to see such low R-R variability in horses with atrial fibrillation, in which the ventricular rate, even when rapid, is generally < 100 beats/min. In contrast, we suggest that the initial ECG in this horse most likely represents sinus tachycardia, with the baseline alterations being an artifact. The lack of P waves is most likely also artifactual, produced by use of a device that does not provide sufficient separation between the positive and negative electrodes to accurately record small potentials. We would suggest that this device, and others like it, can serve as screening tools and can permit an ECG rhythm diagnosis if the rhythm alteration is obvious. However, if the ECG is inconclusive, the initial recording should be validated with a proper diagnostic ECG (in this case, a base-apex lead ECG). The addition of wire electrodes to this device in the future might improve the fidelity of ECG recordings, permitting it to become a more accurate diagnostic device. Mark Rishniw, BVSc, PhD Mark Kittleson, DVM, PhD Veterinary Information Network Davis, Calif a.
AliveCor, AliveCor Inc, San Francisco, Calif.
1.
Mullen KR, Kraus MS, Divers TJ. ECG of the month. J Am Vet Med Assoc 2014;244:657–659.
The authors respond: We thank Drs. Rishniw and Kittleson for their comments, but remain confident in our diagnosis and wish to explain our methods and reasoning. The horse described in our report1 underwent cardiac auscultation by multiple clinicians
at the time of admission to our hospital, and the heart rate was consistently reported to be fast and irregular by all of these individuals. At that time, ECG tracings were acquired with both the smartphone application described in our report and a standard ECG machine. The smartphone ECG tracing, in our opinion, contained the most illustrative atrial fibrillatory waveforms (f waves) and was, therefore, chosen for publication. Unfortunately, the short ECG tracing selected for publication does not show the marked variation in R-R interval typically seen with atrial fibrillation. However, other tracings that we obtained had obvious irregularity of the R-R interval, interspersed with periods during which the R-R interval was more regular, and an absence of P waves, supporting the diagnosis of atrial fibrillation. However, the f waves were difficult to discern on these other tracings, and because of this, these tracings were not included in our report. Severe electrolyte disorders (eg, hypokalemia, hypomagnesemia, and hypocalcemia) can predispose horses to develop supraventricular and ventricular tachyarrhythmias.2 Thus, it is possible that the horse described in our report had atrial fibrillation and intermittent accelerated junctional tachycardia or ventricular tachycardia at the time of admission, resulting in episodes of regular-appearing R-R intervals. Intracardiac ECGs would have been required to definitively determine the site of origin of the QRS complexes in this horse. We agree that the smartphone application should be used as a screening tool. If there is any doubt about the findings, a standard base-apex ECG should also be acquired, as was done in our patient, to definitively confirm a rhythm diagnosis. Kathleen R. Mullen, DVM, MS Marc S. Kraus, DVM Thomas J. Divers, DVM Department of Clinical Sciences College of Veterinary Medicine Cornell University Ithaca, NY 1. 2.
Mullen KR, Kraus MS, Divers TJ. ECG of the month. J Am Vet Med Assoc 2014;244:657–659. El-Sherif N, Turitto G. Electrolyte disJAVMA, Vol 244, No. 9, May 1, 2014
orders and arrhythmogenesis. Cardiol J 2011;18:233–245.
Exposure of dogs to single-dose laundry detergent packs
In February 2012, small, single-dose packs (pods) containing concentrated liquid laundry detergent in a water-soluble membrane began to be sold in the United States.1–3 Several months later, US poison control centers began to receive reports of young children experiencing potentially serious exposures to the products, involving symptoms such as vomiting, cough, eye irritation, red eyes, drowsiness, nausea, respiratory distress, and seizures.1,3–5 These laundry detergent packs may be more likely to cause serious adverse effects than traditional products.2,3,5 Suggested reasons for this include differences in ingredients, concentration, and delivery mechanism.5 The packets have been reported to contain highly concentrated chemicals (eg, ethanolamine, alcohol ethoxylate, and benzenesulfonic acid).6 Pets may also be exposed to laundry detergent packs. Although its primary activity is to manage human exposures, the Texas Poison Center Network received 38 calls about canine exposures to laundry detergent between January 2012 and February 2014. Of these, 22 (58%) involved laundry detergent packs. By comparison, of the 3,352 human exposures to laundry detergent reported during the same
JAVMA, Vol 244, No. 9, May 1, 2014
period, 58.3% involved laundry detergent packs. The brand of laundry detergent packs to which dogs were reportedly exposed was Tide for 15 of the 22 (68%) dogs and All for 5 (23%); for the remaining 2 (9%), the brand was not reported. Twenty-one (95%) dogs ingested the product; the route of exposure was not reported for the remaining dog. Twenty calls came from the dog’s owner or caregiver and 2 came from a veterinarian. All 10 of the cases for which the exposure site was reported occurred at the owner’s or caregiver’s home. Reported initial clinical signs were vomiting (n = 9), drowsiness (2), nausea (1), dyspnea (1), and tongue sticking out (1). Texas Poison Center Network staff generally do not manage animal exposures but may refer callers to others who do. For these canine exposures, 12 (55%) of the callers were referred to a veterinarian, 3 (14%) were referred to an animal poison control center, and 2 (9%) were referred to both. Our experiences suggest that, ever since these products have come on the market, laundry detergent packs have accounted for a large proportion of, if not most, canine laundry detergent exposures reported to poison control centers. As with young children, it is recommended that laundry detergent packs be kept out of the reach of pets. Canine exposures to laundry detergent packs might have the potential to be more serious than exposures to traditional products.
Human and animal poison control centers and other pet-care providers might want to consider this when managing canine exposures to laundry detergents. Mathias Forrester, BS Epidemiologist Poison Control Program Environmental Epidemiology and Disease Registries Section Texas Department of State Health Services Austin, Tex 1.
2.
3.
4.
5.
6.
American Association of Poison Control Centers. AAPCC and poison centers issue warning about concentrated packets of laundry detergent. American Association of Poison Control Centers, Alexandria, Virginia. May 17, 2012. Available at: www.aapcc.org/dnn/ Portals/0/Laundry%20Detergent%20 Packs%205.17.2012.pdf. Accessed May 20, 2012. Merchant N. More kids eating detergent packs, docs report. Msnbc.com. May 24, 2012. Available at: www. msnbc.msn.com/id/47557814/ns/health childrens_health/. Accessed May 25, 2012. O’Connor A. New detergent pods pose poisoning risk. The New York Times 2012;Jun 27. Available at: well.blogs. nytimes.com/2012/06/27/new detergent pods pose poisoning risk/. Accessed Jul 10, 2012. Forrester MB. Comparison of pediatric exposures to concentrated “pack” and traditional laundry detergents. Pediatr Emerg Care 2013;29:482–486. CDC. Health hazards associated with laundry detergent pods United States, May June 2012. MMWR Morb Mortal Wkly Rep 2012;61:825–829. Wang Y. Hidden danger in your laundry? Houston Chronicle 2013;112(331):A1, A11.
Views: Letters to the Editor
1015
