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Emergency Tale - #2, August 2005

Oreo, a 3 year old male, neutered, indoor and outdoor domestic short hair cat presented to Gwynedd Veterinary Hospital Emergency Service for twitching. The patient was acting normally for the previous 2 hours, until his owners had applied an over-the-counter flea product containing Permethrin as the active ingredient. Later, his owners found Oreo collapsed in the garden, twitching, unable to stand and salivating. They rushed Oreo to GVH Emergency Service; he had a seizure during the 20 minute car-ride.

On arriving at the hospital, Oreo was immediately taken into the treatment area and triaged. His body temperature was elevated at 104.5 ° F. He was unable to stand, and was shaking and salivating. His face, whiskers and ears were twitching. His heart rate was elevated at 200 beats per minute, as were his respirations at 48 breaths per minute. The nursing staff started to place an IV catheter into Oreo’s foreleg but he had a grand mal seizure while the fur was being clipped from his leg. He was treated with an injection of valium to stop the seizure.

After a review of his history and discussing the case with his owners, Oreo was admitted to the hospital to be treated for Permethrin Toxicity. Immediate treatments included a thorough bathing to wash off any of the residual over-the-counter flea product, an IV injection of robaxin/methocarbimal to treat the tremors, and valium as needed for the seizures. Fluids and prophylactic antibiotics were also started to maintain hydration. Oreo’s body temperature, respiratory rate and heart rate all normalized within hours of admission to the hospital. Initial routine blood work was normal.

Oreo was hospitalized for three days to treat his tremors. He did not seizure again after the first night and he started eating on his own the following morning. His nursing care included monitoring for tremors and IV robaxin to keep the tremors low. He was also housed in a darkened cage with minimal stimulation to help decrease the tremors. By the 2 nd evening in the hospital, Oreo was able to stand and use the litter pan on his own. By the 3 rd day of hospitalization, he was walking well and was no longer twitching. He was later discharged to his owners.

A diagnosis of Permethrin Toxicity is made from exposure or change in exposure to permethrins, an absence of other toxic exposure and eliminating the likelihood of other diseases such as liver failure, brain damage or trauma.

Permethrin is a synthetic pyrethroid insecticide used in many common household bug sprays and flea treatments. Toxicity for mammals is generally thought to be low, but Permethrins can affect sodium channels and cause toxicity to the nervous system in dogs, cats, rabbits, cows, horses and goats. Permethrin Toxicity is seen more frequently in cats than dogs, and is also weight dependent: a smaller cat is more likely to be affected than a larger cat. Toxicity is manifested as seizures, twitching, tremors, hyperesthesia (increased sensitivity to stimulation) and hyperthermia (increased body temperature). If twitching and tremors are prolonged and uncontrolled, muscle damage can result. If seizures are constant and uncontrolled, brain edema (swelling) and irreversible brain damage can result. Permethrin Toxicity can be fatal.

There are multiple “over the counter” spot-on type flea and tick products available in grocery stores, pet stores and discount stores which contain permethrins. Many of these products are labeled for use in cats as well as dogs. Cases of toxicity in cats have been reported with one time dosage of a product marketed for cats, a repeat dosing of a product previously used without problems, and more rarely from cats interacting with dogs treated with the product.

The individual sensitivity to these products is unpredictable and exposure in some cases has been fatal.

Be sure to purchase appropriate flea and tick products from your Veterinarian to ensure the safety of your pets. If you have questions about new products or products you have seen advertised, please discuss the ingredients with your Veterinarian before you purchase or administer them.

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