TITLE: Chapter 7: Poison treatment
AUTHORS: Kerri Wolter

[DESCRIPTION]
<div class = "text-blocks"><div class = "text-block">This protocol outlines the steps to take in the event of a likely poisoning incident of multiple vultures.</div></div>

[STEPS]
?. If you attend the site of a likely poisoning incident, i.e. several birds dead or ill around a carcass, consider and respect the site as a ‘crime scene’. It is imperative to avoid any damage to evidence as this is vital information in bringing any future legal action against a suspect.
?. Contact the local law enforcement authorities in the area of the poisoning event.
?. If any vultures remain alive, treat these as a priority. The observed clinical signs will vary with respect to the type of poisoning. The three main categories of poisonings are: agrochemicals, non-steroidal anti-inflammatory drugs (NSAIDs) and lead.
?. [Treatment of Organophosphate Poisoning]
Rapid availability and administration of the correct antidote is imperative. If not treated correctly within 24-48 hours, therapy is often ineffective.
It is important to note, recovered birds will occasionally re-present symptoms long after the initial treatment of the poisoning event. When the bird initially ingests the poison, the body distributes a proportion of the poison into fat reserves. Should the bird lose weight post-recovery, these fat stores are utilised and the poison is released back into the bloodstream. Typically, the symptoms will be mild as the volume of poison is much smaller.
?. [Treatment of Organophosphate Poisoning]
Antidote: treat with 2 PAM (Pralidoxime Chloride), at 50 mg/kg once intravenously slowly over a  -  period, repeated after  if necessary, then every  as required.
?. [Treatment of Organophosphate Poisoning]
Provide supportive care: sling as necessary, control seizures, fluid and nutritional support.
?. [Treatment of Organophosphate Poisoning]
If the poisoning is OP and treatment is not started within 24 hours, therapy may make clinical signs worse. In this event, stop treatment.
?. [Treatment of Carbamate Poisoning]
Antidote: treat with Atropine 2 mg/kg by intramuscular, or better still, intravenous injection. If the bird responds and later deteriorates, treatments can be repeated as often as necessary. If there is no improvement after , but saliva is still present in the mouth, repeat the treatment at 4mg/kg.
?. [Treatment of Carbamate Poisoning]
For as long as there is no improvement and yet also no deterioration and still saliva in the mouth, keep repeating the dose, doubling each time, between each dose.
?. [Treatment of Carbamate Poisoning]
Maintain treatment until post-treatment deteriorations cease.
?. [Treatment of Carbamate Poisoning]
Provide supportive care: sling as necessary, control seizures, fluid and nutritional support.
?. [Treatment of Unidentified OP/Carbamate Poisoning]
Antidote: Atropine at 2 mg/kg plus 2 PAM at 25 mg/kg, repeated as necessary (i.e. if clinical signs improve then deteriorate again). Typically treatment will be required every  - .
?. [Treatment of Unidentified OP/Carbamate Poisoning]
If the poisoning is organophosphate and treatment has not started within 24 hours, therapy may make clinical signs worse. In this event, stop PAM treatment, but maintain Atropine. In such cases, then dose atropine as above under 'Carbamate' heading.
?. [Treatment of NSAID Poisoning]
There is no specific or reliably effective treatment. Give the bird IV fluid therapy via a drip at twice maintenance rates (i.e. give 100 ml/kg/day). This is critical to reduce the severe dehydration.
?. [Treatment of NSAID Poisoning]
Reduce uric acid levels by administering Allopurinol at 30 mg/kg by mouth twice daily until recovery.
Nothing will reverse the kidney damage caused by the toxic effect.
?. [Treatment of NSAID Poisoning]
If the bird is showing significant clinical signs, then death is typically inevitable and euthanasia is indicated.
?. [Treatment of Lead Poisoning]
Administer EDTA – 35 mg/kg twice daily by intramuscular or intravenous injection for 5 days, after any particulate lead has been removed from the gastro-intestinal tract.
?. [Treatment of Lead Poisoning]
If lead is shown to be in the gut, then stabilise initially for 24 hours with intensive fluid and chelation therapy. A veterinary surgeon may then remove the lead from the proventriculus, under anaesthetic, with an entubated patent, the bird is tied to a tilted table, with the body above the head at 45 degrees, the lead particles are removed by gastric lavage.
?. [Treatment of Lead Poisoning]
Do not continue chelation therapy beyond five days after the particles are removed, as it can cause renal damage.
?. [Treatment of Lead Poisoning]
If nervous signs persist, then perform a repeat test of blood lead level 7 days after the cessation of EDTA therapy. If it remains elevated, then a repeat of 5 days of therapy is justified.
?. [Treatment of Lead Poisoning]
Important: in all lead poisoning cases, administer fluid therapy (preferably via IV drip) to reduce the likelihood of kidney failure and to concurrently treat any seizure activity.