{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:20:57Z","timestamp":1787016057904,"version":"build-2736575974"},"reference-count":20,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,8,27]],"date-time":"2021-08-27T00:00:00Z","timestamp":1630022400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Vet Emergen Crit Care"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To describe the clinical presentation of a dog with hemolytic anemia secondary to zinc toxicosis after 1\u2010week use of \u201cmax strength\u201d 40% diaper rash cream.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Summary<\/jats:title>\n                    <jats:p>A 2\u2010year\u2010old female neutered Maltese presented for vomiting, lethargy, pigmenturia, and pale mucous membranes. \u201cMax Strength\u201d zinc oxide cream had been applied to the patient daily for a week prior to presentation. Clinical examination revealed light pink to pale mucous membranes and tachycardia. Hematology demonstrated large numbers of spherocytes and a strongly regenerative anemia. Plasma zinc concentrations were markedly increased. A diagnosis of hemolytic anemia secondary to subacute zinc toxicosis was made and supportive therapy was instigated. The patient ultimately recovered uneventfully. Acute or subacute zinc toxicosis resulting in hemolytic anemia is not frequently observed, and this case was also unusual in that the zinc source was diaper cream, which historically has been thought to require very large quantities to cause toxicosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>New or Unique Information Provided<\/jats:title>\n                    <jats:p>To the authors\u2019 knowledge, there is only one previously reported case of hemolytic anemia secondary to diaper cream use in a hospital setting but no previous reports involving toxicosis secondary to prolonged application at home by owners. Most commercial diaper creams contain zinc oxide, which historically was thought to have poor gastrointestinal absorption and would require a large quantity to cause significant toxicosis and hemolytic anemia. Moreover, this case emphasizes the potential risks associated with zinc oxide cream use, the significance of client education if using these creams, as well as the importance of history in elucidating the underlying cause of hemolytic anemia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/vec.13110","type":"journal-article","created":{"date-parts":[[2021,8,27]],"date-time":"2021-08-27T17:15:03Z","timestamp":1630084503000},"page":"125-128","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Suspected hemolytic anemia secondary to acute zinc toxicity after ingestion of \u201cmax strength\u201d (zinc oxide) diaper rash cream"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4686-2119","authenticated-orcid":false,"given":"Neta","family":"Ambar","sequence":"first","affiliation":[{"name":"Department of Clinical Sciences, College of Veterinary Medicine Kansas State University  Manhattan Kansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tricia","family":"Tovar","sequence":"additional","affiliation":[{"name":"Emergency and Critical Care VCA Animal Emergency and Specialty Center  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,8,27]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1476-4431.2009.00418.x"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.2460\/javma.230.8.1174"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-1-4557-0717-1.00084-3"},{"key":"e_1_2_7_5_1","first-page":"8","volume-title":"Blackwell's Five\u2010Minute Veterinary Consult Clinical Companion: Small Animal Emergency and Critical Care","author":"Ashbaugh E","year":"2017"},{"issue":"1","key":"e_1_2_7_6_1","first-page":"27","article-title":"Suspected canine zinc toxicosis caused by ingestion of pennies","volume":"52","author":"Carlson TC","year":"1990","journal-title":"Iowa State Univ. 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