Goose's Medical Puzzle: Exploring Salt Toxicity in Dogs
Join Dr. Sugerman on a riveting journey through the perplexing case of Goose, a 12-week-old Labrador puppy who experienced a sudden onset of neurological symptoms. As Dr. Sugerman delves into Goose's medical mystery, listeners gain valuable insights into the diagnosis and treatment of salt toxicity in pets. With a blend of storytelling and veterinary expertise, this episode offers a compelling exploration of veterinary medicine and the resilience of our furry companions.
What You’ll Learn:
Recognize classic symptoms of salt toxicity in pets and understanding the importance of timely diagnosis and treatment
Explore the underlying mechanisms of salt toxicity in pets, including the effects of sodium imbalance on the body
Learn about the diagnostic thresholds for identifying salt toxicity in pets and the significance of monitoring sodium levels during treatment
Understand the potential dangers of rapid rehydration in cases of salt toxicity and the importance of cautious fluid therapy to prevent neurological complications
Gain insights into practical considerations for managing salt toxicity in veterinary practice, including treatment strategies and prognosis assessment
Ideas Worth Sharing:
"The sodium pulls the water over to its side of the container. The water wants to go from a lower concentration of salt to a higher concentration of salt." - Dr. Tyler Sugerman-McGiffin
"If we give water back too quickly, it makes the brain swell. And then we still are having neurological problems.” - Dr. Tyler Sugerman-McGiffin
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Read The Transcript:
Dr. Sugerman: [00:00:00] Hey everybody, I decided that I was going to take you on one of my journeys today. This is what I do every day in my life, is try to figure out all these weird puzzles and how everything fits together. So I decided to go through this case literally as it was unfolding for me. So today I'm going to be taking you on this weird mysterious journey that I went on the other night at work with a puppy named Goose, who went from like this normal crazy lab puppy to a neurological mess.
Dr. Sugerman: Listen in to find out more.
Dr. Sugerman: Hi, and welcome to Vetsplanation. I'm your veterinary host, Dr. Sugerman, and I'm going to teach you about veterinary medicine. In this podcast, we can dive deeper into the understanding of what our pets are going through and break down medical terms into easier to understand chunks of information. Just a quick disclaimer, this podcast is for informational purposes only.
Dr. Sugerman: This is not meant to be a diagnosis for your pet. If you have questions about diagnostics or treatment options, please talk to your [00:01:00] veterinarian about those things. Remember, we are all practicing veterinary medicine and medicine is not an exact science. Your veterinarian may have different treatment options and different opinions.
Dr. Sugerman: The information I provide here is to help pet parents have a better understanding about their pets. If you like our podcast, please consider sharing this podcast with at least one friend or just somebody else who has pets as well. Now, let's jump into this week's episode.
Dr. Sugerman: Alright, welcome back to Vetsplanation pet parents. I am your host, Dr. Sugerman. If you've been listening to this and haven't subscribed yet, and we like what we do, please hit subscribe and even consider rating us. The better ratings we have, the more pet parents we're able to help. Alright, let's get back to our story about Goose.
Dr. Sugerman: So Goose, he's a 12 week old crazy little Labrador puppy. His parents had brought him in because he was really wobbly. He was falling over, collapsing, dribbling urine. And if you haven't already heard my podcast on THC toxicity, you should definitely listen to it because as [00:02:00] soon as I heard all of these symptoms, I told my technician to get an approval for a toxicology screen, which is literally just a drug screen.
Dr. Sugerman: He had all the classic symptoms. There aren't a lot of things that are going to cause a pet to dribble urine. So my technician had talked to his pet parents, asked if they could bring him back. He came back and she asked if there was any THC in the house and the pet parents said, no, there's no, no THC in the house. No way that he could get into anything like that.
Dr. Sugerman: But they said that they would approve the toxicology screen cause he actually wasn't with them when all of this started happening. So I was like, great. Whoever it was, somebody left their pot out. No big deal. So before we got that THC tox screen though I did examine Goose and thought he was acting a bit strange, even for a THC toxicity dog.
Dr. Sugerman: Typically for these dogs who are high on THC, if you put your hand like in front of their face like this, it makes them flinch. And he [00:03:00] didn't really do that. He screamed a lot, and that can happen on THC, but it's not as common. And one minute he would be standing up, and the next minute he would just collapse and unable to use like any of his legs.
Dr. Sugerman: That's weird. He was dribbling the urine just like I said before, but then he suddenly just was flooding the potty pads like he peed in his kennel and flooded six potty pads. Six times in the matter of an hour. And that is not normal for a THC toxicity. This is really weird. So I still tested him anyways, there are weird drugs that it can come back as so we tested him just to make sure. But everything came back negative.
Dr. Sugerman: So I looked at him on ultrasound to see if his bladder was still full after urinating so much, and surprisingly, it was. I looked at the rest of his abdomen and saw that his stomach was super full of fluid, and so were all of his intestines as well. So I went and talked to the pet parents because this [00:04:00] is just strange, right?
Dr. Sugerman: We have a stomach full of fluid, intestines full of fluid, a bladder full of fluid, collapsing episodes. So I was like, okay, so what else could this be? So when I went and talked to his parents. I asked them about any access to large bodies of water. At this point with all that water in his guts.
Dr. Sugerman: I'm thinking it's got to be a water toxicity, that can have some of those similar signs. And if you haven't listened to my water toxicity episode, then you can go back and listen to that one as well. But it makes them neurological because of this really low sodium in their body.
Dr. Sugerman: The sodium gets dropped down because they have so much fluid that's in there. So I asked about things like a river, a stream on the property, a pond. Was he biting at the sprinklers? Anything where he could have just had tons of access to water. They said that he had been at the guy's parents house for the last four hours.
Dr. Sugerman: They didn't have any bodies of water, nor did they really take him anywhere. There wasn't like a swimming [00:05:00] pool or anything. So I asked about anything else that he could have gotten into, and his parents said that he did eat one pig ear and a couple of pill pockets. I was like that's really not that much of anything.
Dr. Sugerman: I wouldn't really think that this was going to be a problem. I doubt that it's going to be that. Otherwise, they couldn't think of anything else. At that point, I suggested, why don't we perform blood work on him? His parents agreed, luckily. And so I was expecting the results to show a really low sodium, which is called hyponatremia.
Dr. Sugerman: Hypo meaning low, and then natremia refers to sodium. This dog shocked me though once again because when we did his blood work, his sodium was not low in fact. In fact, it was really high, and that term is hypernatremia. So was the chloride. The chloride was also high, so that's called hyperchloremia.
Dr. Sugerman: So, do you know what sodium and chloride put together are? NaCl, that's going to be salt. So this dog had a salt [00:06:00] toxicity. Alright, so let's talk about some common things that can cause a salt toxicity in our domesticated pets, because now I have to start thinking about what else could this dog have eaten to cause this really weird salt toxicity.
Dr. Sugerman: So this could be from things like dogs who grew up in a barn, if they eat some of those salt licks from the barn. Or if they eat the salt that you put on the road from keeping the ice from forming on the roads. ingesting like a large amount of salt water from the ocean. Random fact, by the way, the ocean is about 3.5 percent sodium. I didn't know that, so that's interesting to find out.
Dr. Sugerman: Baking soda has a lot of salt in it. Sodium phosphide enemas. Some people will try to give their pets an enema. This happened a lot, I'd say I don't know, like 10, 20 years ago when people would try to give their cats enemas and they were dying from sodium or salt toxicity because they were giving a very specific type of enema, which would cause the salt toxicity.
Dr. Sugerman: It can be from ingesting like the brine from like turkey dinner when you're [00:07:00] doing Thanksgiving. And then one that parents of little humans probably know is ingesting Play Doh. Play Doh can also cause a salt toxicity as well.
It can also be in like some forms of treatment. So if you have an improperly mixed electrolyte solution or some remedies for diarrhea and then also by giving activated charcoal. So it's just a little tangent, but this is why I don't like sending home activated charcoal or having people buy activated charcoal online. Because when you give it at home, there are risks to it.
Dr. Sugerman: It's not a benign thing like it can have problems and it can cause really high sodium in them. And then we don't know if that pet already had really high sodium or if the really high sodium was created from that charcoal. And so I asked Goose's parents at this point if he could have gotten into any of these things.
Dr. Sugerman: Are there little kids in the house that had Play Doh? Anything? And they said, no, there's no way. Like, all they had was just the pig ear and a couple of pill pockets. I was like at this point we got to try [00:08:00] to figure out what we need to do. So let's talk a little bit about what hypernatremia or aka high sodium is and how it affects dogs and cats.
Dr. Sugerman: So to do that we're going to have to dive a little bit into chemistry here. The technical definition of this is that water wants to move along something called its osmotic gradient.
Dr. Sugerman: Now, the not so technical explanation of that. So if I were to take some really tall rectangular container and I fill it halfway with water, the whole container would be half filled with water, right?
Dr. Sugerman: I guess that depends on if you're a half glass full or half glass empty person. A cat would obviously see this as a glass half empty and think they're going to die of starvation. But anyways, if I fill this tall rectangular container with water and I'm going to put a special filter in the middle of the container, so that just splits the container down the middle and half.
Dr. Sugerman: This filter can only allow water to go through it, like no chemicals or anything else can cross this, only water. The container would still be half full of water on [00:09:00] both sides, because the water can evenly flow from one side to the other. Now if we put a bunch of salt on the left side of the container, initially the water would still be half full on both sides, because salt doesn't really add that much, it's not adding that much to it.
Dr. Sugerman: But over a little bit of time, you actually start to see that the water on the left will rise and the water on the right is going to fall. So by the time it like figures out where the water wants to be, you're going to have the left side of the container be roughly three quarters full and the right side of the container be roughly a quarter full.
Dr. Sugerman: So the left side that has the salt in it will be higher than the right side that does not have the salt in it. So why did the water on the left side rise just because we added salt to it? That's because of this thing called the osmotic gradient. The sodium pulls the water over to its side of the container.
Dr. Sugerman: The water wants to go from a lower concentration of salt to a higher concentration of salt. So what does [00:10:00] this have to do with the body now, right? So Goose ingested a bunch of salt and that salt does go into the stomach and the intestines where it gets absorbed into the bloodstream.
Dr. Sugerman: Now there's essentially water in your organs, your cells, the space between your cells. That's called the interstitial space, and in all of your blood vessels. We're made up of this really large amount of water, so our body's roughly 66 percent water, and about 30 percent of that is in the blood vessels.
Dr. Sugerman: So goose ingested the salt, and it gets absorbed into the bloodstream, specifically into the blood vessels essentially. Now that water is going to want to go follow all of that sodium or all that salt from the lower level, which was in the cells and the organs and the interstitium, remember that's around all the cells, to where the higher level of salt or sodium is in the bloodstream.
Dr. Sugerman: So it's going to want to move from our cells into the bloodstream. The water starts to leave all those vital places now, that's not good. Our cells and our [00:11:00] organs and the space around our cells need that water. So the water is pulled from all these important places, things like the brain, leaving us with a really dehydrated brain and that can be deadly.
Dr. Sugerman: So when this happens the brain shrinks and it's essentially pulled away from the main blood supply of the brain and that causes the blood vessels to tear or hemorrhage or bleeding around the brain is what that means. But it basically means that you're bleeding into and around your brain. This can cause some really severe neurological symptoms, including death.
Dr. Sugerman: And if that's not bad enough, if the pet is deprived of water and then suddenly is given water too quickly, that can actually make the brain swell up now inside this really confined skull that we have. That brain swelling is called cerebral edema. And the cerebral just refers to the brain, whereas edema refers to swelling.
Dr. Sugerman: When we have so much salt in there, all the water gets pulled from all the important cells into the blood vessels. If we give water back too quickly, it [00:12:00] makes the brain swell. And then we still are having neurological problems. So now that we know what happens in the body, let's talk about the signs that we would see.
Dr. Sugerman: So signs typically occur usually within about 30 minutes after ingesting it. First, that really high sodium would make the pet drink tons of water. Just like you would eat a really large bag of like salty chips, you'd be looking for something to drink to chase it down, right?
Dr. Sugerman: Because your kidneys sense that you have too much salt in your bloodstream, you need to send a signal to your brain to drink more water. All while your kidneys are trying to keep more water in your body. The pet drinks more water. That also may make them very nauseous.
Dr. Sugerman: They may vomit after several hours after ingesting salt or even having so much water or have massive amounts of diarrhea. They'll also show neurological signs like Goose did. So they'll collapse. They'll walk in as if they're drunk. We call that ataxia. They could have muscle tremors or even seizures. If they're given water too quickly, then [00:13:00] we could have a really dull mentation at first.
Dr. Sugerman: And this means that that really crazy hyper puppy just may lay there. That is really abnormal for them, right? They can also have their pupils in their eyes be two different sizes. We call that anisocoria. These things happen because of that cerebral edema or that brain swelling that I was talking about. So really we have two sides of the coin there causing neurological symptoms all because of this sodium.
Dr. Sugerman: Next let's talk about what we test for for salt toxicity. The easiest way is just for the pet parent to tell us that that's what they got into. So if they knew, that would be the easiest thing. Or if pets could talk to us, that would be amazing as well.
Dr. Sugerman: When the pets get into these things, most of the time it's without us knowing, right? So really the only test that we have in the clinic is a blood test. There are other ways, like you could test for cerebral spinal fluid, that's known as CSF fluid, but it's just really extreme to do that because that's all the fluid that's around your spinal cord.
Dr. Sugerman: So instead we run [00:14:00] blood work to see if the sodium levels are really high. Just to give you an example of what a normal sodium in the blood is, it's between 144 and 160 millimoles per liter. That's just a form of how we measure things. A blood sodium level above 170 then, is a concern for salt toxicity.
Dr. Sugerman: Initially when Goose came in, his sodium was actually 170. Exactly. But after 8 hours, even in the hospital, on fluids, his jumped up to above 180 and was too high for our machine to even read.
Dr. Sugerman: Alright, so let's talk about treatment because we alluded a little bit to that. If we had known that Goose had ingested a large amount of salt and his parents could have gotten him in before showing any signs, we could just have made him vomit to get as much of that salt out as possible.
Dr. Sugerman: At that point of when I hospitalized Goose, though, there was no way for me to know what he had gotten into for sure. If he had actually had a salt toxicity. At this point, I have to just make my best [00:15:00] guess on what I can see on his blood work and what I see from him.
Dr. Sugerman: So all I could do at this point is just treat his symptoms and for the suspected salt toxicity. And he was already showing clinical signs. So I couldn't make him vomit unfortunately. It would actually have been detrimental if I tried to make him vomit because he was already showing these neurological signs.
Dr. Sugerman: It could actually make him aspirate or basically like inhale his vomit. And now we have multiple big problems we have to deal with. Now we have both the salt toxicity, the neurological problems, and potentially him getting aspiration pneumonia. In general, at home, just a forewarning, if there's ever a pet that's showing neurological symptoms or showing symptoms, do not make them vomit.
Dr. Sugerman: All right, so now let's talk about the treatment that we did do. So first we have to rehydrate the patient and this doesn't mean by making them drink a lot of water. Unfortunately, even though he drank a lot of water, he's not going to absorb it very well and so he cannot rehydrate himself.
Dr. Sugerman: This [00:16:00] means that we have to put the fluid directly into his veins and we need to rehydrate them. And even with rehydrating them, Goose is still going to be urinating a lot of water out. He's also having large amount of diarrhea. So he's losing a significant amount of water that he had already drank and that we're giving him as well.
Dr. Sugerman: So when we rehydrate them though, this has to be done very slowly because like I said, if we don't do it slowly, we actually cause brain swelling. So basically we need to get them back to a normal sodium over about two to three days in order to avoid really significant brain swelling.
Dr. Sugerman: I just wanted to point it out that in activated charcoal, that should not be given as well. Activated charcoal pulls water from the cells and the interstitium and the bloodstream into the GI, that means their stomach and their intestines. This makes the concentration of sodium even higher in the bloodstream and will cause more dehydration and more neurological problems.
Dr. Sugerman: So it's really important that we do not make pets vomit when they have neurological symptoms or other [00:17:00] symptoms. And it's very important not to give them activated charcoal when they have a salt toxicity, because that's just going to make them more dehydrated and cause a worsening of the salt toxicity.
Dr. Sugerman: Alright, so these were the things that we did for Goose. We had him on fluids, we brought his sodium down very slowly, addressed his other things like his diarrhea, and unfortunately, there's not a lot we can do for his urinating a lot, but we just had to clean him up quite a lot. .
Dr. Sugerman: So let's talk about how Goose did. So the next day the sodium started to come down and it came down to a readable amount and we were able to slowly bring it down to normal.
Dr. Sugerman: Goose's diarrhea was much more manageable at this point and then also after talking to his pet parents, Goose's parents found out that he had ingested not a few pill pockets but he had ingested three bags of pill pockets. So I don't know which pill pockets it was for sure. I looked up the hickory smoke flavor and found out that each pill pocket itself contained [00:18:00] 17.15 milligrams of sodium. Not that much, but the bag that he ate contained 90 pill pockets. So three bags of that would be 270 pill pockets, which means that he ingested about 4,630.5 milligrams of sodium. And it's recommended for the average adult size medium dog that they should only ingest about 500-1000 milligrams a day.
Dr. Sugerman: But Goose got four times that amount and he's probably half the size of a normal medium sized dog. So it definitely got a lot. The prognosis is actually pretty good for when they recover too. If they have seizures or cerebral edema, that brain swelling, then we have to worry about some long term effects then, but otherwise they do really well after this and no long term damage luckily is expected.
Dr. Sugerman: So Goose got to go home by the way and he was a crazy puppy again by the time he left. His parents were very happy about that. [00:19:00] Alright I'm going to talk about our animal fact today. After we've talked about this weird salt toxicity thing. I'm going to be talking about something that is not as exotic and weird.
Dr. Sugerman: We're actually going to be talking about the only marsupial that is found in North America. In case you don't know what makes an animal a marsupial, just real quick I'll give you a rundown. A marsupial is a mammal that when they're born, they're not completely developed, and therefore the baby is usually carried in a pouch on mother's belly until it is fully developed.
Dr. Sugerman: Marsupials are mostly found in Australia and New Guinea, but we have our very own here, just one of them in North America. So if you guessed it it's going to be the opossum. Technically it's the Virginia opossum, but it's the opossum. There are actually about 330 species of marsupials in the world, and crazy enough we only have one of them in North America.
Dr. Sugerman: There are possums in Australia, but those are a totally different [00:20:00] animal, so you'll have to look those up. Besides our North American opossum. The opossum gives birth to babies as small as a honeybee, and when they're born they actually crawl up mom's fur up to the pouch. It's just crazy to think, like, how they know where to go in order to survive.
Dr. Sugerman: I will say, though, that a mom gives birth to about 20 babies in a litter. But less than half of them actually survive or even make it to the pouch. So mom is only pregnant for 13 days. That's it. And then she's able to give birth. Then they live in mom's pouch exclusively for about two months.
Dr. Sugerman: Between months two and four, the babies go in and out of the pouch. As well as hang out on mom's back while they ride around on her. Can you imagine having eight, ten babies just like riding around on your back? Alright, a fact that people probably do know is that they do have something called a prehensile tail, which means they can use it like an appendage for when they're climbing.
Dr. Sugerman: Unlike the movies though, they don't actually hang upside down by that tail. We also know about [00:21:00] the playing possum, right? And by the way, I'll just clear this up really quickly. Possum, opossum, technical name is opossum, but people call them the possum. When they talk about how they're playing possum, that's where they play dead, and they're pretty dramatic and convincing too.
Dr. Sugerman: They'll lay on their side, they'll have their tongue hanging out, their eyes closed, and then they'll have this really fixed straight forward stare. They'll even foam at the mouth. And they usually do this when they feel like they're in danger. Scientists have found though that this is not a voluntary thing.
Dr. Sugerman: So you would think that they would see something like, okay I'm going to play dead, and then that's what they do. But that's not what happens. This is actually a physiological response that they have no control over. So it's similar to fainting in humans. So this can happen for minutes or even hours before the opossum just feels better, gets up, and goes on its way.
Dr. Sugerman: Alright, now for some facts that you probably didn't know. Did you know that the opossum has more [00:22:00] teeth than any other mammal in North America? They have about 50 teeth, and that's a lot of teeth. They could potentially fight back if they wanted to and do some damage, but instead they have this physiological thing where they just play dead.
Dr. Sugerman: Also, did you know that opossums are immune to things like venom from animals from bees and scorpions and rattlesnakes? They're also unaffected by toxins such as things like botulism.
Dr. Sugerman: This is because they actually have a neutralizing factor in their blood that helps them be immune to these toxins. So this really could be like extremely beneficial for us in the future when we're trying to make things like antivenom along with their really amazing immune system against like venoms and toxins, they rarely contract rabies due to their really low normal body temperature.
Dr. Sugerman: The virus cannot really survive in those really low temperatures or replicate and so they don't really contract the disease. They're also really unlikely to contract Lyme [00:23:00] disease from tick bites due to, again, their really low body temperature. Speaking of Lyme disease, you could also thank them for keeping these populations of ticks down for you to decrease the chances of us getting Lyme disease.
Dr. Sugerman: A single opossum can eat up to 5,000 ticks in a season, plus they eat other pests for us like cockroaches, and mice, and rats, and even dead animals. And for the weirdest fun fact of them all, this is probably not as child friendly, just a heads up on this. So for the weirdest fact of all for them male opossums have a bifurcated or a forked penis.
Dr. Sugerman: Weird story for you real quick. It was actually thought at one time that since the males had a forked penis, that they had bred with the females through their nose, because they had two, the two nares of their nose, and they thought that they would sneeze the babies out, like a booger, into their pouch.
Dr. Sugerman: I'm not 100 percent [00:24:00] sure how they thought the anatomy of this worked, but that's, that's what their theory was at one point. Now we know better. We know that that's not what actually happens. Females actually have two sets of female reproductive organs. So that being two vaginal canals and two uteri, which makes them very unique, which is also probably how they're able to have 20 babies at a time.
Dr. Sugerman: Alright, on that note, I hope you enjoyed this weird salt toxicity adventure with me and learned a bit about opossums that you probably didn't know. Don't forget to share our podcast with a friend. We really appreciate you helping us spread the word. Until next time, please keep your pets happy, healthy, and safe.
Dr. Sugerman: Thank you guys.
Dr. Sugerman: Thank you guys for listening this week. If you have any questions, comments, suggestions, or you just want to say hi, you can email me at Suggs, S U G G S @ VetsplanationPodcast.com or visit the website at VetsplanationPodcast.com or find us on Facebook, Instagram, or TikTok at Vetsplanation. Thank you all for [00:25:00] listening and I'll see you back here next week.