Journal of Veterinary Emergency and Critical Care

Drobatz, Kenneth J.; Cole, Steven G.

doi: 10.1111/j.1476-4431.2008.00328.xpmid: N/A

Objective: To compare the effect of a balanced isotonic crystalloid solution with that of 0.9% sodium chloride on the acid–base and electrolyte status of cats with urethral obstruction. Design: Randomized prospective clinical trial. Setting: Academic veterinary emergency room. Animals: Sixty‐eight cats with naturally occurring urethral obstruction. Interventions: Cats were randomized to receive either a balanced isotonic crystalloid solution (Normosol‐R, n=39) or 0.9% sodium chloride (n=29) for fluid therapy. Baseline venous blood gas and blood electrolyte values were obtained at the time of admission and at intervals during the course of therapy. Measurements and main results: Baseline values were similar between groups. Cats receiving Normosol‐R had a significantly higher blood pH at 12 hours, a significantly greater increase in blood pH from baseline at 6 and 12 hours, as well as a significantly higher blood bicarbonate concentration at 12 hours and a significantly greater increase in blood bicarbonate from baseline at 6 and 12 hours. Conversely, the increase in blood chloride from baseline was significantly higher at 2, 6, and 12 hours in cats receiving 0.9% sodium chloride. There were no significant differences in the rate of decline of blood potassium from baseline between groups. Subgroup analysis of hyperkalemic cats (K+>6.0 mmol/L) and acidemic cats (pH<7.3) yielded similar findings. Conclusions: While both crystalloid solutions appear safe and effective for fluid therapy in cats with urethral obstruction, the use of a balanced electrolyte solution may allow more rapid correction of blood acid–base status within the first 12 hours of fluid therapy. The use of a potassium‐containing balanced electrolyte solution does not appear to affect the rate of normalization of blood potassium in treated cats with urethral obstruction.

Lee, Seung‐Gon; Moon, Hyeong‐Sun; Hyun, Changbaig

doi: 10.1111/j.1476-4431.2008.00324.xpmid: N/A

Objective: To evaluate the efficacy and safety of biphasic (BP) defibrillation in toy breed dogs (<5 kg of body weight). Design: Prospective, clinical experimental study. Setting: Veterinary teaching hospital. Animals: Five dogs (pilot study) and 10 dogs (comparison study of biphasic versus monophasic defibrillation). Measurements and main results: The efficacy of defibrillation was compared by estimating E80 (80% probability of successful defibrillation) after biphasic (BP) and monophasic (MP) defibrillations. The E80 for BP defibrillation was 7.24±1.33 J (2.24±0.41 J/kg) and 10.24±1.34 J (3.18±0.12 J/kg) for MP defibrillation. BP waveform required 30% less shock energy for a successful defibrillation. In order to compare the safety of defibrillation, we evaluated changes in cardiac biomarkers, electrocardiogram, echocardiographical left ventricular index, and aortic pressure during and after BP and MP defibrillation. All dogs treated by either BP or MP defibrillation survived. Pulseless electrical activity occurred in 2 of 5 dogs during MP defibrillation. The levels of cardiac biomarkers were elevated and sustained for longer periods in the MP defibrillation group. Electrocardiographic changes (e.g., QT prolongation, the time to return to an isoelectric ST segment after shocks) were more severe and longer in the MP defibrillation group. In addition, overall left ventricular cardiac performance was severely depressed in the MP group compared with the BP group. Conclusion: Our findings suggest that BP defibrillation is more effective and safer than MP defibrillation. We determined the acceptable shock energy to be 2–4 J/kg for toy breed dogs.

Diehl, Shenandoah H.; Seshadri, Ravi

doi: 10.1111/j.1476-4431.2008.00323.xpmid: N/A

Objective: To describe the indications, clinical features, outcomes and complications associated with use of continuous renal replacement therapy (CRRT) in 17 client‐owned dogs and 16 client‐owned cats with acute or acute‐on‐chronic renal failure refractory to aggressive medical management. Series summary: Twenty‐nine percent of dogs and 44% of cats had evidence of pre‐existing chronic kidney disease (CKD). Median duration of CRRT was 16.3 hours (range 0.3–83.0 hours) in dogs and 11.5 hours (range 1.0–35.5 hours) in cats. Median canine blood urea nitrogen (BUN) improved from 41.0 mmol/L (115.0 mg/dL) to 11.8 mmol/L (33.0 mg/dL) and creatinine from 636.5 mmol/L (7.2 mg/dL) to 274 mmol/L (3.1 mg/dL). Median feline BUN improved from 46.4 mmol/L (130 mg/dL) to 13.9 mmol/L (39.0 mg/dL) and creatinine from 1069.6 mmol/L (12.1 mg/dL) to 291.7 mmol/L (3.3 mg/dL). Metabolic acidosis resolved in 80% of affected dogs and 71% of affected cats. Hyperkalemia resolved in 100% of affected dogs and 88% of affected cats. Complications noted with CRRT included iatrogenic hypokalemia, iatrogenic metabolic alkalosis, clinical hypocalcemia, total hypercalcemia, filter clotting, anemia, hypothermia, and neurologic complications. Forty‐one percent of dogs and 44% of cats survived to discharge. No dogs and only 1 cat developed newly diagnosed CKD. New or unique information provided: CRRT can be a viable option for the management of acute or acute‐on‐chronic renal failure in dogs and cats that are refractory to aggressive medical management. The frequency of complications associated with CRRT in this study warrants further experience with this modality before its widespread use can be recommended.

Book, Bradley P.; Van Der Woerdt, Alexandra; Wilkie, David A.

doi: 10.1111/j.1476-4431.2008.00329.xpmid: N/A

Objective: To examine ultrasonographic abnormalities in eyes with traumatic hyphema obscuring intraocular structures. Design: Retrospective clinical study. Setting: The ophthalmology services of a private practice and university veterinary teaching hospital. Animals: Twenty‐two dogs, 6 cats, 3 horses, and 2 birds. Measurements and main results: Medical records were reviewed for signalment, history, ophthalmic examination, ultrasonographic findings, treatment, and outcome in all patients that presented to the ophthalmology service with trauma‐induced hyphema obscuring intraocular structures. Thirty‐three patients were included and there were 35 affected eyes (17 left and 18 right). Abnormalities noted on ophthalmic examination included hyphema obscuring intraocular details beyond the iris (100%), corneal laceration (23%), iris prolapse (23%), fibrin clotting within the anterior chamber (17%), and subconjunctival and periocular bruising (17%). Ocular ultrasonography revealed the presence of either vitreous hemorrhage or a retinal detachment in 32 of 35 eyes (91%) with traumatic hyphema. Of the remaining 3 eyes, ocular ultrasonography revealed a lens luxation with posterior eye wall rupture in 1 eye and collapsed globes in the other 2 eyes. Twelve eyes were enucleated and 23 were treated medically. Ten of the medically treated eyes were lost to follow‐up. Blindness was noted in all the affected eyes upon their final discharge and recheck examination. Conclusions: Ocular ultrasonography revealed vitreous hemorrhage or a retinal detachment in 32 eyes (91%) with traumatic hyphema. Blindness was noted on the last available examination of every eye. The prognosis for vision in an eye with traumatic hyphema obscuring intraocular detail is poor.

Beal, Matthew W.; Doherty, Arin M.; Curcio, Keith

doi: 10.1111/j.1476-4431.2008.00322.xpmid: N/A

Objective: To describe the clinical course of a dog presented with peliosis hepatis and hemoperitoneum in concert with anticoagulant rodenticide intoxication. Case summary: A 7.75‐year‐old spayed female Shetland Sheepdog presented with clinical signs consistent with hypovolemia, hemoperitoneum, and a history of bright green stool 3 days before the onset of clinical signs. Initial packed cell volume/total solids were consistent with acute hemorrhage. A coagulation profile showed prolongation in activated clotting time and prolongation of both prothrombin and activated partial thromboplastin time, suggesting abnormal coagulation. Abdominal hemorrhage persisted in the face of normalization of the hemodynamic status and coagulation profile, and treatment with Vitamin K1. Abdominal ultrasound revealed multiple patchy hypoechoic areas throughout the caudate liver lobe. An exploratory laparotomy was performed 24 hours after presentation and revealed the caudate liver lobe as the source of the hemorrhage. Histopathologic examination of a specimen of the liver was consistent with peliosis hepatis. Toxicologic testing identified diphacinone levels in the blood consistent with anticoagulant rodenticide intoxication. Postoperative recovery was uneventful, and within 48 hours the dog was discharged. The dog returned to full function and a hepatic ultrasound performed 15 months postoperatively showed no significant abnormalities. New or unique information provided: Exposure to anticoagulant rodenticides may be associated with the development of peliosis hepatis in dogs.

Smart, Lisa; Jandrey, Karl E.

doi: 10.1111/j.1476-4431.2008.00327.xpmid: N/A

Objective: To describe the case management for a dog diagnosed with a nasopharyngeal polyp. Case summary: A 9‐week‐old Shar‐Pei puppy presented for progressive dyspnea and collapse. Clinical signs were consistent with an upper airway obstruction (UAO) and a temporary tracheostomy was performed. The puppy was at first diagnosed with and treated for brachycephalic airway syndrome but continued to exhibit signs of an UAO after soft palate resection. Nasopharyngoscopy revealed a nasopharyngeal polyp causing the UAO, which was surgically removed. The puppy has been free of clinical signs for 1 year after removal of the polyp. New or unique information provided: This is the first report of a nasopharyngeal polyp causing a life‐threatening UAO in a puppy. It emphasizes the importance of examining the nasopharyngeal space in neonates presenting with UAO.

Atkinson, Kathryn J.; Fine, Deborah M.; Evans, Tim J.; Khan, Safdar

doi: 10.1111/j.1476-4431.2008.00325.xpmid: N/A

Objective: To describe successful treatment of third‐degree atrioventricular (AV) block using temporary noninvasive transthoracic pacing and placement of a permanent transvenous pacemaker in a case of suspected lily‐of‐the‐valley (Convallaria majalis) intoxication in a dog. Case summary: A 2‐year‐old neutered male Beagle weighing 17.8 kg was presented to the emergency service for treatment of bradycardia, vomiting, and lethargy. An electrocardiogram revealed third‐degree AV block that was nonresponsive to atropine. Ten hours after admission, the dog became obtunded. Treatment initially consisted of temporary noninvasive transthoracic pacing and eventually placement of a permanent transvenous pacemaker. The initial history did not suggest that the dog had access to any known cardiotoxins. However, C. majalis, which contains cardiac glycosides, was identified within the dog's environment and the dog's serum did contain digoxin or an immunologically cross‐reactive compound. New or unique information provided: This is the first reported successful management of C. majalis toxicosis in a dog. Temporary noninvasive transthoracic pacing was used in the management of this case as a safe and effective bridge to permanent pacemaker implantation.

Jose‐Cunilleras, Eduard; Hinchcliff, Kenneth W.; Nout, Yvette S.; Geor, Raymond J.

doi: 10.1111/j.1476-4431.2008.00326.xpmid: N/A

Objective: Glucose metabolism is often deranged in septic animals. Bacteremia and sepsis are common in foals and clinical experience suggests that glucose metabolism is abnormal in some of these animals. The purpose of this study was to provide initial estimates of rates of glucose appearance, disappearance, and metabolic clearance rate in septic foals. Series Summary: Rates of glucose entry, and exit from blood were determined by use of infusion of isotopically labeled glucose in 5 foals with confirmed sepsis. Serum concentrations of glucose, insulin, glucagon, and cortisol were measured concurrent with measurement of rates of glucose turnover. Median glucose turnover rate was 24 μmol/kg/min (range 17–53 μmol/kg/min), and median glucose metabolic clearance rate was 3.2 mL/kg/min (range 1.7–6.7 mL/kg/min). Median concentration of serum immunoreactive insulin was 55 pmol/L (range 36–190 pmol/L), median serum immunoreactive glucagon was 65 pmol/L (range 19–120 pmol/L), and median serum cortisol was 207 nmol/L (range 100–333 nmol/L). New or unique information provided: These data, although limited in scope and by the lack of data in healthy foals, demonstrate the magnitude and variation in glucose appearance, disappearance, and metabolic clearance rate in septic foals, provide an estimate of rates of glucose utilization in sick foals, and will be useful in guiding future studies of energy metabolism in healthy and ill foals.

doi: 10.1111/j.1476-4431.2008.00330.xpmid: N/A

doi: 10.1111/j.1476-4431.2008.00331.xpmid: N/A