ABSTRACT OF THE WEEK

Journal of the American Veterinary Medical Association
Volume 255 | Issue 4 (August 2019)

Efficacy of intravenous administration of apomorphine for removal of gastric foreign material in dogs: 495 cases (2010-2015).

J Am Vet Med Assoc. August 2019;255(4):459-465.

Kevin S Kirchofer, Gary Block, Justine A Johnson

Abstract

OBJECTIVE:To evaluate the efficacy of IV administration of apomorphine for removal of gastric foreign bodies in dogs.

ANIMALS:495 dogs with gastric foreign bodies.

PROCEDURES:Records of a veterinary hospital were searched to identify dogs that received an injectable formulation of apomorphine between January 1, 2010, and July 30, 2015. Dogs with a gastric foreign body that received an IV injection of apomorphine were included in the study. Information extracted from the record of each dog included signalment, type of foreign material ingested, duration between foreign material ingestion and emesis, dose and number of doses of apomorphine administered, and whether emesis occurred and did or did not result in successful removal of the foreign body. Descriptive data were compared between dogs with and without successful foreign body removal.

RESULTS:Emesis with successful foreign body removal was achieved in 363 and 11 dogs after administration of 1 and 2 doses of apomorphine, respectively. Successful removal was more likely for young dogs and dogs that had ingested fabric, leather, or bathroom waste. Successful removal was less likely as the duration between foreign body ingestion and emesis increased and for dogs that received opioids, sedatives, or antiemetics before apomorphine administration. Minor adverse effects were recorded for only 4 dogs.

CONCLUSIONS AND CLINICAL RELEVLANCE:IV administration of apomorphine was a viable alternative for induction of emesis and removal of gastric foreign bodies in dogs. Dogs should be examined as soon as possible after foreign body ingestion and should not receive any medications that might affect apomorphine efficacy.

Companion Notes

Retrospective report on the efficacy of IV apomorphine for removal of gastric foreign material in 495 dogs

Introduction on apomorphine

- centrally-acting, nonselective dopamine agonist

- induces emesis by direct stimulation of dopamine D₂ receptors

- in medullary chemoreceptor trigger zone

- effective emetic in dogs

- 1n 1 study, use resulted in emesis in 59 of 63 (94%) dogs ingesting toxins

- mean percentage recovery of ingested toxic agents in vomitus: 52%

- ~ 16-50% of foreign bodies in dogs are located in stomach at initial exam

- rather than other areas of GI tract

- in 1 report of a apomorphine ocular insert

- successful emesis induction and removal of foreign body in 82.6% of 596 dogs

- in 1 report of IV use of apomorphine in 32 dogs

- 90.6% vomited at a median of 1 minute after receiving an IV injection

- apomorphine, 0.03 mg/kg IV

Study design

- study population: dogs seen at 24 hour emergency and referral veterinary hospital

- 495 dogs with a gastric foreign body

- inclusion criteria:

- diagnosis based on owner seeing dog ingesting foreign material

- or evidence of foreign material in stomach on diagnostic imaging

- IV injection of apomorphine

- exclusion criteria: ingestion of a toxicant

- history & signalment

- Labrador retriever, 97 (20%)

- golden retriever, 7%

- boxer, 3%

- American bulldog, 15 (3%)

- golden retriever-poodle mixes (goldendoodles), 12

- German shepherd dog, 10 (2%)

- shih tzu, 2%

- procedure: records from 1/1/10-07/30/15 retrospectively reviewed

- IV apomorphine administered to 1704 dogs during study period

- reasons for exclusion included the following:

- 1188 got apomorphine subsequent to toxicant ingestion

- 5 had a small intestinal foreign body

- successful induction of emesis:

- stomach contents expelled: liquid, foam, or foreign material

- satisfactory or successful removal of foreign material from stomach:

- vomitus contained foreign material

- type and amount as described by owner

- or via imaging evidence of absence of foreign material in stomach

- or foreign material likely to safely pass through remaining GI tract

Results

- emesis with successful foreign body removal

- 363 dogs after administration of 1 dose of apomorphine

- 11 dogs after administration 2 doses of apomorphine

- successful removal more likely for the following dogs

- young dogs

- median age of dogs with successful removal: 1.54 years of age

- median age of dogs without successful removal: 4.05 years of age

- dogs that had ingested fabric, leather, or bathroom waste

- successful removal less likely with the following

- increased duration between foreign body ingestion and emesis in 409 dogs

- successful removal rate when emesis induced within 0-2 hours: 85.3%

- successful removal rate when emesis induced within 2-4 hours: 75.7%

- successful removal rate when emesis induced > 24 hours: 56.3%

- dogs that received opioids, sedatives, or antiemetics before apomorphine

- proportion of premedicated dogs with successful removal, 2 of 15 (13.3%)

- proportion of non-premedicated dogs with successful removal, 77.5%

- 9 of the 15 dogs received a combination of drugs

- 6 of these received dexmedetomidine and an opioid

(5 of these dogs also got atipamezole)

- apomorphine efficacy

- injectable formulation prepared by a compounding pharmacy

(Wedgewood Pharmacy, Swedesboro, NJ)

- aqueous compound with apomorphine at 3 mg/mL

- dose determined by attending clinician

- mean IV dose: 0.03 ± 0.01 mg/kg

- failed to induce emesis, 22 of 495 (4.4%) dogs

- did induce emesis in 473 (95.6%) dogs

- 457 (96.6%) of the 473 dogs did so after only 1 dose

- successfully removed gastric foreign body, 374 of the 495 (75.6%)

- none of these needed further intervention for removal of foreign material

- unsuccessful in removing gastric foreign body, 121 of the 495

- 72 underwent additional interventional procedures

- endoscopy, 60

- exploratory laparotomy, 12

- 49 owners declined further intervention and monitored dog at home

- followup obtained for 27 of the 49: none required additional intervention

- 20 dogs got a second dose of apomorphine (no adverse events seen in these dogs)

- first dose of apomorphine in 18 dogs, 0.03 mg/kg

- second dose: 0.01-0.06 mg/kg

- 12 dogs received 0.03 mg/kg

- following 2^nd dose of apomorphine

- 11 dogs had successful removal

- 5 dogs vomited

- but vomitus didn’t have a satisfactory amount of foreign material

- 4 dogs failed to vomit

- adverse effects, minor ones noted in 4 dogs immediately after apomorphine

- signs of nausea, 2

- tachycardia, 1

- ataxia, 1

- foreign material ingested in 20 or more cases

- sock (fabric category), 72 cases

- cloth, 31

- hard plastic, 31

- corn cob, 31

- tampons (bathroom waste category), 28 cases

- dog toy, 22

- underwear, 21

“Anecdotal reports suggest that dogs occasionally reingest vomited foreign material, so careful supervision during induced emesis is advised. The dogs of the present study were closely monitored until emesis was complete, and none of the dogs reingested expelled foreign material.”

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