Severe Neurological Signs and Hypernatremia Secondary to Polyethylene Glycol Paintball Ingestion in a Dog

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's 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's 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 "nontoxic" paintball ingestion both before and after the development of acute hypernatremia.