Poisonous Pennies

Pennies can be dangerous!

Passing the Scope	Pennies removed from Rudy's stomach

Rudy is a two-year-old Cairn terrier that came to the hospital after a week of decreased appetite and vomiting. Two days before his visit, he vomited up three pennies, which were in a state of erosion. On physical examination, his gums were pale, his abdomen was tense on palpation, his heart rate was elevated and his pulses were weak. Rudy was very sick, weak and depressed.

Diagnostic tests performed indicated:

• CBC: anemia (decreased number of red blood cells)
• Chemistry: elevation in bilirubin, likely due to red blood cell destruction
• Urinalysis: red-tinged urine consistent with hemoglobin in the urine

Abdominal x-rays were then taken which proved foreign objects, suggestive of remaining pennies, in the stomach.

In 1983, the US Government began minting pennies that have a zinc core and a copper exterior. Unfortunately, at high levels, zinc can be quite toxic in 3 fashions:

1. Gastric irritant: zinc can cause irritation where it contacts the stomach lining. Clinical signs of this include vomiting, diarrhea, anorexia.
2. Red blood cells: the metallic zinc can leak out by the acid of the stomach where it is then absorbed into the bloodstream, causing damage to red blood cells, resulting in breakage of red blood cells (hence Rudy's anemia), and damage to existing red blood cells (Rudy's intact blood cells showed damage when viewed under the microscope). Red blood cell damage was also evident by an abnormal port-wine colored urine (due to excessive hemolysis—or breakdown of red blood cells).
3. Other organ systems: The zinc could also cause damage to other internal organs (pancreas and kidney) and luckily, at the time of admission, Rudy's kidney blood values were still normal.

Other tests to diagnose further Rudy's problems were sent to an outside lab: zinc level and PLI (to test his pancreas for inflammation).

Rudy was very sick and penny removal became an emergency situation! In general, gastric foreign bodies can be removed by three different routes: inducing vomiting (this was attempted and unsuccessful); Gastroscopy (passage of a fiberoptic scope into the stomach); or surgery. Unfortunately, Rudy was so anemic (normal red blood cell level is 37-55% and Rudy's was 14%), he was not stable for an immediate penny removal, therefore, he received a blood transfusion from a canine buddy, Bogie.

Six hours after admission, having administered fluid therapy and a blood transfusion, Rudy was more hemodynamically stable and was then anesthetized and underwent gastroscopy to remove the pennies. Unfortunately, the pennies were coming out in small pieces and other pennies were found to be adhered to the lining of his stomach. At that point, Rudy was taken into surgery for the pennies to be successfully removed from Rudy's stomach.

Post-op	Rudy is monitoried in ICU

Postoperatively, Rudy still needed ongoing support in the ICU. He was still anemic,and his stomach was still irritated causing vomiting and anorexic. Additionally, his PLI (pancreatic test) returned consistent with pancreatitis. To help him with these ongoing problems, Rudy received a second blood transfusion. He was also supported with intravenous fluids, gastric protectants, and anti-vomiting medications. He was given a chelating agent, penicillamine, to help eliminate any remaining zinc circulating in his body. Bloodwork was performed to monitor kidney function and a urinary catheter helped to quantitate his urine output.

After three days of hospitalization, Rudy's red blood cell level stabilized, his vomiting ceased, he began eating again and was sent home on a balanced commercial dog food diet.

Dr. Steinheimer with Rudy and his "mom"	After his ordeal, Rudy looked pretty perky with Drs. Hadley and Rha

On recheck one week later, Rudy's red blood cell level was normal at 42%. His bilirubin was almost normal. His original zinc level was 26.1 ppm (normal is 0.70-2.00, toxic is considered >10.0ppm). Two-week follow-up zinc level was: 1.88ppm. He is clinically back to himself and doing great.