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SLUDGE signs due to toxicosis in a dog | VETgirl Veterinary Continuing Education Videos

In this VETgirl online veterinary continuing education video, we discuss a series of clinical signs commonly referred to as “SLUDGE.” SLUDGE is a mnemonic for the pathological effects associated with excessive stimulation of the parasympathetic nervous system. This category of clinical signs if often encountered with the following toxicants: certain poisonous mushrooms, nerve gases, insecticides (such as organophosphates or carbamates), chlorpyrifos (found in old flea collars), diazinon, fungicides, nicotine, or other agricultural materials.

The mnemonic “SLUDGE” stands for:

  • Salivation
  • Lacrimation
  • Urination
  • Defecation / Diarrhea
  • Gastrointestinal upset
  • Emesis

An extension to the mnemonic is SLUDGE-M, where the additional M indicates: Miosis and Muscle spasming.

In this video, a 7-year-old, female spayed, Labrador Retriever presented for vomiting, shaking, difficulty walking, and inappropriate urinating after spending time on a farm that afternoon. On physical examination, the patient had bilateral miosis, and was hypersalivating, tremoring, tachycardiac, ataxia, and had abdominal pain. As the dog was already symptomatic, emesis induction was not performed (as it is contraindicated). An intravenous catheter was placed, and preliminary blood work was performed; this was fairly unremarkable aside from a mild stress leukogram, hemoconcentration, and hypokalemia. Initial stabilization included a fluid bolus (e.g., 30 mL/kg of a balanced crystalloid). Radiographs taken at the time of presentation revealed fluid filled loops of intestine, suggestive of severe gastroenteritis. Bone fragments were also found within the stomach, suggestive of recent dietary indiscretion. Additional therapy included a potent anti-emetic (e.g., maropitant), a proton pump inhibitor (e.g., pantoprazole), and analgesia (e.g., fentanyl) for abdominal pain. A single dose of activated charcoal, with a cathartic, was also given once the patient was stabilized.

Treatment of dogs showing SLUDGE symptoms is generally supportive, with atropine or other anticholinergics, as well as IV fluids, antiemetics, antacids, muscle relaxants (such as methocarbamol), and anticonvulsants (if seizures develop). With prompt treatment, the overall prognosis is fair to poor, depending on the toxicant. Although some symptoms may persist for days to weeks, the typical duration of hospitalization is typically 24 to 48 hours. Luckily, this patient recovered well with complete resolution of all symptoms within 24 hours.

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