Hypoventilation, cardiac dysrhythmia, and cardiac arrest following acute Brunfelsia species (Yesterday, today, tomorrow) intoxication in a dog

Abstract

Background Intoxication following ingestion of the popular garden shrub 'Yesterday, today, tomorrow' (Brunfelsia sp.) is known to result in gastrointestinal and central nervous system clinical signs in dogs.Case report A 2-year-old dog developed acute-onset vomiting, profuse diarrhoea and ptyalism after unsupervised access to an enclosed backyard that contained a Brunfelsia sp. shrub. During initial assessment the watery diarrhoea contained plant material and the dog appeared painful on abdominal palpation. Soon after admission, severe neurological abnormalities developed. Decontamination was undertaken by gastric and colonic lavage under general anaesthesia, but on recovery the patient had generalised seizures that were unresponsive to benzodiazepines. Following treatment with multiple antiepileptic medications and endotracheal intubation for loss of gag reflex, the patient developed respiratory failure requiring mechanical ventilation. Four days after initial presentation, the patient developed cardiac dysrhythmia leading to fatal cardiac arrest. Plant material recovered from the shrub and the patient's gastrointestinal tract were identified as Brunfelsia spp.Conclusion This is the first report of hypoventilation, severe cardiac dysrhythmia and cardiac arrest associated with Brunfelsia sp. intoxication in a dog. Previous reports described clinical signs of gastrointestinal disease and mild cardiac dysrhythmia progressing to seizure activity and opisthotonus. Electrocardiography should form part of patient monitoring and mechanical ventilation considered for patients that develop respiratory failure, especially if massive ingestion is suspected. P lant poisonings are a relatively uncommon presentation in small animal emergency practice, yet can often prove a significant diagnostic and treatment challenge for the clinician. 1,2 A range of common garden and houseplants can cause severe life-threatening systemic effects and death to dogs and cats. 3 Although the toxidromes of some plants such as lily (Lilium and Hemerocallis spp.), azalea (Rhododendron spp.) and oleander (Nerium oleander) are well described in the literature, that of others such as Brunfelsia spp. is not. 3

In this issue – June 2019: Charles Sturt application process reviewed · Single‐drench doramectin in Bos indicus‐cross beef calves · No evidence for endemic heartworm in South Australia · Anaphylaxis associated with intravenous Alfaxan in a dog · Acute hypoventilation following Brunfelsia sp. Poisoning in a dog

“…A second case report, this time from the University of Sydney describes a case of ‘Yesterday, today. Tomorrow’ poisoning in a dog . The dog had been left in a garden that had a Brunfelsia spp shrub.…”