For many years, veterinarians have adhered to a conventional approach in treating pet intoxications, prioritizing in-clinic interventions for animals that have ingested toxins encountered at home (e.g. human medications [therapeutic and recreational], foods [chocolate, grapes, raisins, etc.], animal medications, household chemicals, rodenticides, etc.). However, this paradigm overlooks the most critical factor for the treatment of intoxicated animals: the time lapse between exposure to a toxin and the start of therapy, specifically, preventing toxicosis through immediate gastric decontamination. Recognizing the urgency of timely intervention can revolutionize how we manage these emergencies. Drawing parallels from human medicine, where tools, such as epinephrine injection, USP and naloxone HCI, facilitate immediate at-home intervention, it is evident similar strategies could be beneficial in veterinary practice. The pivotal role of home-based interventions for intoxications, particularly with the administration of adsorbing agents, such as activated charcoal, offers a timely solution to minimize the effects of intoxications before professional care is available. veterinary technician administering activated charcoal to a patient. Photo courtesy Merill Guarnari The importance of time The window between toxin exposure and treatment is crucial. In many cases, it takes one to two hours from the time of exposure for an animal to be brought to a veterinary hospital and receive treatment.1-3 Several factors contribute to the delay, including the time it takes for pet owners to recognize the signs of intoxication, transporting the animal to a veterinary facility, and the time required for triage, assessment, and treatment initiation. During this period, toxins are being absorbed through the gastrointestinal tract, beginning to exert their effects and cause significant, potentially irreversible damage, complicating the treatment process and prognosis. Additionally, after ingestion of a toxin, stomach contents begin to pass from the stomach into the intestine within five minutes,4 with approximately 25 percent of stomach contents exiting the stomach within one hour,5 where attempts for emesis are ineffective. In some cases, as much as 65 percent of ingested solids with liquids will exit the stomach in the first 60 minutes.4 Further, smaller5 and younger6 animals have considerably shorter gastric emptying times when compared to large dogs, making these pets even more prone to the effects of toxin ingestion. This makes any gastric decontamination treatment after two hours considerably less effective.3 Immediate intervention at home, however, reduces the interval between intoxication and veterinary hospital treatment and can significantly reduce the toxin load in the animal’s system, potentially improving veterinary treatment outcomes.1,7 These findings are echoed in human literature as well.7-12 Traditional methods of decontamination Gastrointestinal decontamination is the mainstay first step treatment in managing intoxications, aiming to prevent further absorption of the toxin, reducing the circulating load of toxin, and reducing the damage to the body. This is a result of the fact that limited finances and a lack of ubiquitous availability of toxicity treatment modalities commonly available in human medicine (plasmapheresis, hemodialysis, mechanical ventilation, and various antidote therapy), are limiting factors in veterinary medicine.2 The main features of decontamination techniques that must be considered when choosing an optimal therapy are ease and consistency of implementation, efficacy of treatment for a wide variety of intoxicants, and safety. The three main methods for gastric decontamination, in human and veterinary medicine, are gastric lavage, induction of emesis, and administering a binding agent such as activated charcoal.3 1) Gastric lavage Gastric lavage involves removing gastric contents under heavy sedation or anesthesia via an orogastric tube. Human studies show the ability of gastric lavage to remove toxicants from the stomach were limited (29-38 percent when lavage was performed within 15-20 minutes, and 8.6-13 percent when performed after an hour).3 Given the significantly reduced efficacy with increased time from intoxication, in addition to the requirement it be performed in the veterinary setting (due to the risk of injury and the necessity for sedation and airway protection), gastric lavage is rarely performed or recommended. 2) Emesis Inducing emesis has been the traditional approach to decontamination in dogs presenting to veterinary hospitals and when it is determined pet owners should initiate decontamination at home. Oddly, these recommendations are consistently made despite there being significant evidence (in veterinary1, 3, 7, 13-16 and human8, 9, 17-19 medicine) that shows a very limited efficacy for emesis to remove toxins. In addition to being ineffective, inducing emesis at homes is potentially dangerous. Hydrogen peroxide is used as a chemical tissue irritant to induce emesis in dogs at home. While having the same efficacy as hydrogen peroxide,2 apomorphine is most commonly used in hospital. In cats2, 20 and humans,21 hydrogen peroxide is not used to induce emesis because of severe mucosal irritation resulting in gastroesophageal ulcerations as well as a lack of clinical efficacy.3 In dogs, hydrogen peroxide causes severe tissue damage in the esophagus, stomach, and duodenum,22 as well as other severe complications.23 Importantly, hydrogen peroxide has been shown to have very poor efficacy in terms of expelling toxins,3 with veterinary research showing it produces toxin through emesis 60 percent of the time—and when it did, only retrieved 48 percent of the toxins.13 In humans syrup of ipecac, an intervention causing emesis by chemical irritation and centrally mediated effects, has historically been used at home to induce vomiting in adults and children, and has been shown to have similar efficacy as hydrogen peroxide in dogs.9, 13 The American Academy of Clinical Toxicology position paper on ipecac states, among other reasons, the inconsistent efficacy of the syrup drives them to conclude it should not be administered routinely in the management of poisoned patients.9 Other publications suggest that emesis after 90 minutes post intoxication had no impact on decontamination.24 If the efficacy of inducing vomiting is questionable in both the home and hospital environment, and there are risks of complications, such as aspiration pneumonia and gastrointestinal damage, why then are we still using it in veterinary medicine? Likely because historically, there have never been better options. Looking at activated charcoal and activated carbon Activated charcoal is an adsorbent that has been used in medicine for hundreds of years and is backed by literature showing its ability to adsorb multiple toxins.12 Once introduced in the gastrointestinal tract, activated charcoal’s large surface area and non-specific nature result in binding of most common veterinary toxins, preventing their absorption into the bloodstream. It has been used in both human and veterinary medicine due to its broad-spectrum efficacy and ability to decontaminate both the gastric and intestinal contents, as well as interrupt enterohepatic recirculation of many toxins.25 Recent advancements have led to the development of activated charcoal products26,27 (See: “Benefits or resin-based products”) designed to mitigate the traditional challenges of activated charcoal administration (See: “Challenges with charcoal”)—making it reasonable for home administration. These products address the traditional challenges through increased density2,3,7-9 (2-4 fold traditional activated charcoal product densities, meaning less volume to administer), having zero mess, and having a more neutral taste and texture. Additionally, they are formulated to minimize the risk of complications associated with traditional activated charcoal through a change in consistency, volume, and lack of confounding excipients. Benefits of resin-based activated charcoal/carbon products Ease of administration. These products are easier for pet owners to administer effectively at home (due to reduced volume and improved consistency), reducing the need to force-feed or use stomach tubes to administer. Reduced mess. The new formulations are clean, making the process more manageable for pet owners. Improved palatability. Enhanced taste and texture increase the likelihood of pets willingly consuming the product. Safety. The new products are free from excipients that can cause additional health issues (electrolyte shifts), in addition to reducing the risk of complications like intestinal impaction or aspiration. A charcoal-kaolin suspension with sorbitol, containing 24 g of charcoal, adjacent to aresin-based activated carbon, containing 30g of charcoal equivalent. Small amountsof both substances have been poured onto a sterile pad, showing the difference instaining properties of both products. Photo courtesy Mat Glassman The author rubs his fingers through the charcoal-kaolin suspension with sorbitol, illustrating the staining nature of traditional activated charcoals. Photo courtesy Mat Glassman The author pours resin-based activated carbon spheres onto a clean, sterile pad,showing its lack of staining and leftover residue. Photo courtesy Mat Glassman Challenges with charcoal Despite its effectiveness, especially when administered close to the intoxication event8, 9, 17 traditional forms of activated charcoal present several challenges: High volume. The volume required for effective dosing can be substantial, making administration difficult especially for people without veterinary training. Messiness. Activated charcoal stains anything it contacts, which, in conjunction with difficult administration, makes home use impractical. Palatability. Animals are often reluctant to consume it due to its texture and taste. Think worst saltine challenge ever when administered without sufficient liquid. Complications. There are risks of intestinal impaction, aspiration pneumonia, and electrolyte disturbances (with cathartics) if not administered correctly. A Labrador mix is administered with activated charcoal while veterinary technicians restrain the patient. Photo courtesy Erin Shore The case for home-based interventions Human medicine has long recognized the benefits of empowering individuals to administer treatments at home—lifesaving and sick care. For example, the widespread availability of EpiPens28-30 for allergic reactions and Narcan31, 32 for opioid overdoses has saved countless lives by providing immediate intervention prior to professional evaluation and continued therapy. A similar approach in veterinary medicine could have a profound impact on animal health and welfare- this includes treatments for home intoxications, but also home over the counter treatments for other minor to moderate health concerns. I have found in practice there is a general reluctance for veterinarians to trust clients to make decisions about their pets, despite time-sensitive home treatments having the potential for improving outcomes. With a continually worsening shortage of veterinarians,33 it is time to amend this type of antiquated veterinary thinking and rethink the involvement of clients in their pet’s health decisions. The introduction of new home-based interventions presents an opportunity to shift the paradigm in managing pet intoxications and other ailments. By enabling pet owners to administer first-line treatment immediately (See: “Implementing home-based detoxification strategies”), we can significantly improve veterinary clinical outcomes by instituting therapy where and when it is most effective and safe. Implementing home-based detoxification strategies Education and training In terms of home intoxication, it is important for veterinary professionals to educate pet owners about the importance of timely intervention. This includes: Encouraging them to understand the importance of their role in their pet’s health care Recognizing signs of intoxication: Educating owners on the early signs of intoxication (as well as understanding what substances are not safe for pets at home) and the importance of immediate action. Proper administration: Providing instructions on when and how to administer activated carbon effectively and safely at home. Emergency protocols: Developing easy-to-follow emergency protocols pet owners can implement before reaching a veterinary hospital. Availability of products Ensuring the new activated carbon products and other treatments are readily available for pet owners for home use is crucial. This can be achieved by: Stock up. Veterinary clinics should be the go-to place for animal care, which includes OTC products and education for home care. Education. Teaching staff when to recommend OTC products for pets, to free the veterinarian from making every decision in the hospital allowing them to be more efficient. Online resources. Providing information and purchasing options through online platforms, ensuring pet owners can obtain the products in anticipation of a potential emergency. As an example of this, empowering pet owners with the knowledge and tools to administer an adsorbent agent, such as activated carbon at home, transforms them into active participants in their pets’ emergency care. This collaboration can bridge the critical gap between toxin exposure and professional treatment, enhancing the overall effectiveness of veterinary interventions. It is our job as veterinarians to include the pet owner and prepare them for urgent medical conditions and emergencies that can be treated most rapidly and effectively at home. A border collie post-activated charcoal administration, with charcoal staining on the muzzle, chest, and front legs. Photo courtesy Jessica Nicole Conclusion It is time for the veterinary industry to embrace a more collaborative approach to animal health and welfare. By empowering pet owners to administer initial life-saving care when and where it is most effective, we can significantly improve outcomes for pets experiencing intoxications. The introduction of new, user-friendly activated carbon products marks a significant advancement in the field of toxicity, offering a practical and effective solution for home-based decontamination. This shift in approach is not novel; it mirrors the successful strategies employed in human medicine, where immediate at-home interventions have proven to save lives. By adopting similar practices in veterinary medicine, we can ensure our patients receive the best possible care, even before they reach the clinic. As veterinary professionals, it is our responsibility to lead this change, providing pet owners with the knowledge, tools, and support they need to protect their pets in emergencies and treat them when they are sick. Together, we can enhance the standard of care and improve the health and well-being of our animal companions. Mat Glassman, MBA, VMD, DACVS, is a board-certified veterinary surgeon with more than 20 years of experience. He is the founder and CEO of Dr. Cuddles, a company dedicated to empowering pet owners to care for their pets at home through education and innovative products. 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