{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T04:47:38Z","timestamp":1770785258515,"version":"3.50.0"},"reference-count":40,"publisher":"American Animal Hospital Association","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>An 8 yr old castrated male Cavalier King Charles spaniel dog was presented for an acute onset of an abnormal mentation and ataxia. After vomiting a large volume of material containing paintball shells, the diagnosis of paintball intoxication was made. Despite mild hypernatremia (157 mmol\/L) that was unchanged from presentation, the dog developed tonic-clonic seizures 4 hr after admission. Approximately 11 hr after admission, the patient\u2019s plasma sodium increased to 170 mmol\/L; the dog became comatose and required endotracheal intubation. Gastric lavage was performed to remove a conglomerate of residual paintball material. The dog\u2019s free water deficit was corrected to safely reduce plasma sodium to baseline levels over 12 hr. The patient remained comatose for 7 hr following correction of the acute hypernatremia and developed a Cushing reflex that responded to hyperosmolar therapy. With continued intensive care, his neurological status made gradual improvements and he was successfully discharged after 68 hr with a normal neurological examination. Two weeks after discharge, the owners reported that the patient was bright and alert, with no persistent clinical signs and normal blood parameters on recheck blood work. This case report highlights successful treatment of a dog that developed severe neurological signs following \u201cnontoxic\u201d paintball ingestion both before and after the development of acute hypernatremia.<\/jats:p>","DOI":"10.5326\/jaaha-ms-7492","type":"journal-article","created":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T11:29:55Z","timestamp":1762342195000},"page":"179-184","source":"Crossref","is-referenced-by-count":0,"title":["Severe Neurological Signs and Hypernatremia Secondary to Polyethylene Glycol Paintball Ingestion in a Dog"],"prefix":"10.5326","volume":"61","author":[{"given":"Bruce","family":"Graves","sequence":"first","affiliation":[{"name":"From Emergency and Critical Care, BluePearl Emergency and Specialty Center, Levittown, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Kielb","sequence":"additional","affiliation":[{"name":"From Emergency and Critical Care, BluePearl Emergency and Specialty Center, Levittown, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nolan","family":"Chalifoux","sequence":"additional","affiliation":[{"name":"From Emergency and Critical Care, BluePearl Emergency and Specialty Center, Levittown, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3280","reference":[{"key":"i1547-3317-61-6-179-b1","series-title":"Arch Pediatr Adolesc Med","first-page":"661","article-title":"Safety of polyethylene glycol 3350 for the treatment of chronic constipation in children","volume":"157","author":"Pashankar","year":"2003"},{"issue":"4","key":"i1547-3317-61-6-179-b2","series-title":"Gastroenterology","first-page":"933","article-title":"Osmotic effects of polyethylene glycol","volume":"94","author":"Schiller","year":"1988"},{"key":"i1547-3317-61-6-179-b3","series-title":"Pharmacotherapy","first-page":"147","article-title":"Glycerol: a review of its pharmacology, pharmacokinetics, adverse reactions, and clinical use","volume":"1","author":"Frank","year":"1981"},{"issue":"1","key":"i1547-3317-61-6-179-b4","series-title":"Clin Pharmacokinet","first-page":"23","article-title":"Osmotherapy for elevated intracranial pressure: a critical reappraisal","volume":"38","author":"Nau","year":"2000"},{"key":"i1547-3317-61-6-179-b5","series-title":"ASPCAPro Toxicology Brief. Vet Med","first-page":"995","article-title":"Paintball toxicosis in dogs","author":"Donaldson","year":"2003"},{"key":"i1547-3317-61-6-179-b6","series-title":"StatPearls.","article-title":"Polyethylene glycol","author":"Dabaja"},{"key":"i1547-3317-61-6-179-b7","series-title":"J Vet Emerg Crit Care","first-page":"690","article-title":"Severe hypernatremia and transient azotemia in a cat following inadvertent intravenous administration of a commercial polyethylene glycol solution","volume":"29","author":"Hoehne","year":"2019"},{"key":"i1547-3317-61-6-179-b8","article-title":"GI SPORTZ, EMPIRE, DXS & Zap BRANDED PAINTBALLS","author":"Paintball Material Safety Data Sheet"},{"key":"i1547-3317-61-6-179-b9","series-title":"J Vet Emerg Crit Care","first-page":"290","article-title":"Paintball intoxication in a pug","volume":"17","author":"King","year":"2007"},{"issue":"11","key":"i1547-3317-61-6-179-b10","series-title":"Gut","first-page":"1525","article-title":"Consensus guidelines for the safe prescription and administration of oral bowel-cleansing agents","volume":"61","author":"Connor","year":"2012"},{"key":"i1547-3317-61-6-179-b11","series-title":"Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice.","first-page":"45","article-title":"Disorders of sodium and water: hypernatremia and hyponatremia","author":"DiBartola","year":"2012"},{"issue":"2","key":"i1547-3317-61-6-179-b12","series-title":"Vet Clin North Am Small Anim Pract","first-page":"209","article-title":"A quick reference on hypernatremia","volume":"47","author":"Guillaumin","year":"2017"},{"issue":"3","key":"i1547-3317-61-6-179-b13","series-title":"J Vet Intern Med","first-page":"794","article-title":"Incidence, severity and prognosis associated with hypernatremia in dogs and cats","volume":"29","author":"Ueda","year":"2015"},{"key":"i1547-3317-61-6-179-b14","series-title":"J Vet Emerg Crit Care","first-page":"196","article-title":"Hypernatremia secondary to homemade play dough ingestion in dogs: a review of 14 cases from 1998 to 2001","volume":"14","author":"Barr","year":"2004"},{"key":"i1547-3317-61-6-179-b15","series-title":"Vet Clin North Am Small Anim Pract","first-page":"533","article-title":"Hypernatremia and hypertonic syndromes","volume":"28","author":"Marks","year":"1998"},{"key":"i1547-3317-61-6-179-b16","series-title":"Vet Clin North Am Small Anim Pract","first-page":"231","article-title":"Hypernatremia","volume":"19","author":"Hardy","year":"1989"},{"key":"i1547-3317-61-6-179-b17","series-title":"J Vet Emerg Crit Care","first-page":"294","article-title":"Successful treatment of severe salt intoxication in a dog","volume":"17","author":"Pouzot","year":"2007"},{"key":"i1547-3317-61-6-179-b18","series-title":"J Small Anim Pract","first-page":"420","article-title":"Essential hypernatraemia in a young dog","volume":"32","author":"Hawks","year":"1991"},{"key":"i1547-3317-61-6-179-b19","series-title":"Occupational Toxicants: Critical Data Evaluation for MAK Values and Classification of Carcinogens.","first-page":"247","article-title":"Polyethylene glycol","author":"Greim","year":"1998"},{"issue":"6","key":"i1547-3317-61-6-179-b20","series-title":"J Am Pharm Assoc Am Pharm Assoc","first-page":"340","article-title":"The absorption and excretion of a liquid polyethylene glycol","volume":"39","author":"Shaffer","year":"1950"},{"key":"i1547-3317-61-6-179-b1","series-title":"Arch Pediatr Adolesc Med","first-page":"661","article-title":"Safety of polyethylene glycol 3350 for the treatment of chronic constipation in children","volume":"157","author":"Pashankar","year":"2003"},{"issue":"4","key":"i1547-3317-61-6-179-b2","series-title":"Gastroenterology","first-page":"933","article-title":"Osmotic effects of polyethylene glycol","volume":"94","author":"Schiller","year":"1988"},{"key":"i1547-3317-61-6-179-b3","series-title":"Pharmacotherapy","first-page":"147","article-title":"Glycerol: a review of its pharmacology, pharmacokinetics, adverse reactions, and clinical use","volume":"1","author":"Frank","year":"1981"},{"issue":"1","key":"i1547-3317-61-6-179-b4","series-title":"Clin Pharmacokinet","first-page":"23","article-title":"Osmotherapy for elevated intracranial pressure: a critical reappraisal","volume":"38","author":"Nau","year":"2000"},{"key":"i1547-3317-61-6-179-b5","series-title":"ASPCAPro Toxicology Brief. 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