The Question:

I have been working with the local animal hospital that supports us in updating the contents of the cache.

The issue that has come up is regarding the medication 4-methylprazole for Ethylene Glycol poisoning. The animal hospital has been very generous about holding meds in our K9 medical cache for deployment and pulling them for the hospital use prior to expiration which results in no cost to our TF. However the 4-methylprazole is a medication that they don’t often use and are therefore unwilling to bear the cost. They have offered to purchase it at a cost of ~ $400 and they advised that the shelf life is only 1 year. They advised our Program Manager that an acceptable alternative is using drinking alcohol, specifically vodka administered intravenously. They said they would prepare a dosage schedule for us. I have done some research and I have found that this practice is not uncommon. I was hoping that you might share your thought on this. I’m fine if the vodka antidote is acceptable. I just want to insure that our K9’s aren’t neglected due to a cost measure. Thoughts? Do you know if the veterinarian who deploys to the IST might carry this medication for us?

Our Response:

So whenever faced with a question of a high cost treatment for a low probability but high risk event – you have to weigh those risks versus alternatives. Without a doubt untreated ethylene glycol intoxication will kill a dog. I have treated ethylene glycol intoxication with both 4MP and vodka and hands down 4MP is the way to go from the management standpoint. I think I would argue for 4MP but with the following considerations –
Any use of vodka should be done in a full service veterinary hospital and preferably not in the field – those dogs can be really challenging to manage (mean drunks some of them).

Do you also carry the ethylene glycol test kit? If you can’t confirm the diagnosis then you shouldn’t start treatment. Without the kit there are key changes in the blood values and urine (most caches have an I-stat so you might be able to reach a high level of suspicion) along with behavioral changes that might be enough to initiate treatment (but this decision is best made by a veterinarian)

Isn’t our aim to stabilize patients and get them transported to definitive care as soon as possible – if that is indeed the case it makes the probability of needing the 4MP or vodka for that matter in the field even lower -most e-clinics will have access to 4MP or if not then they will be able to utilize vodka – this is not something I would expect any of our medics to manage and even if we get vets deployed in the field with the teams it might only mean the first dose and then transport.

So I have successfully avoided giving you a definitive answer . . .but am happy to continue the conversation based on what you and the other vets in our group have to say – In an ideal world yes 4MP – in the real world – have your support services lined up and make sure the local e-clinics have access – that gets really complicated if you are working internationally -but in this country it can likely be managed. I just looked at the VMAT list of drugs and we do not have 4MP on it . … Dr. Otto

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