Survival and death risk in dogs after cycad palm poisoning

Abstract

BACKGROUND: Cycad palms are commonly used in landscaping and ingestion by dogs can cause disease or death. OBJECTIVES: Determine the morbidity and case fatality of cycad palm toxicosis in dogs from Louisiana, and examine putative prognostic factors. ANIMALS: Thirty-four client-owned dogs with confirmed cycad palm toxicosis between 2003 and 2010. METHODS: Retrospective cohort study. Search of all medical records for animals with cycad palm toxicosis. RESULTS: Seventeen of 34 (50%) dogs died or were euthanized as a direct consequence of cycad intoxication. There were no differences in presenting signs and physical examination findings between survivors and nonsurvivors. Nonsurvivors had higher serum alanine transaminase activity (median 196 U/L; range 16-4,123 versus 113.5; 48-1,530) and total bilirubin concentration (0.5 mg/dL; 0.1-6.2 versus 0.25; 0-1.7) upon presentation, and their initial serum concentrations of albumin (2.9 g/dL; 1.4-4.1 versus 3.3; 2.2-3.9) were lower than those of survivors. Nadir serum albumin concentration was also lower in nonsurvivors (1.9; 1.4-3.7 versus 3.2; 1.8-3.5). A higher proportion of nonsurvivors had prolonged coagulation times, prothrombin time. and partial thromboplastin time. In a multivariate model, administration of charcoal at initial presentation was associated with longer survival (heart rate [HR] 0.019, 95% CI 0.001-0.644), while high serum aspartate aminotransferase activity was a negative prognostic factor (HR 118.2, 95% CI 2.89-4,826). CONCLUSIONS AND CLINICAL IMPORTANCE: Cycad intoxication is associated with a higher case fatality than previously published. Several laboratory parameters might help differentiating potential nonsurvivors from survivors. Administration of charcoal as part of the emergency treatment appears to have a protective effect.