Influence of the Respiratory Cycle on Caudal Vena Cava Diameter Measured by Sonography in Healthy Foals: A Pilot Study.

BACKGROUND: Intravascular volume assessment in foals is challenging. In humans, intravascular volume status is estimated by the caudal vena cava (CVC) collapsibility index (CVC-CI) defined as (CVC diameter at maximum expiration [CVCmax ] - CVC diameter at minimal inspiration [CVCmin ])/CVCmax × 100%. HYPOTHESIS/OBJECTIVES: To determine whether the CVC could be sonographically measured in healthy foals, determine differences in CVCmax and CVCmin , and calculate inter- and intrarater variability between 2 examiners. We hypothesized that the CVC could be measured sonographically at the subxiphoid view and that there would be a difference between CVCmax and CVCmin values. ANIMALS: Sixty privately owned foals <1-month-old. METHODS: Prospective study. A longitudinal subxiphoid sonographic window in standing foals was used. The CVCmax and CVCmin were analyzed by a linear mixed effect model. Inter-rater agreement and intrarater variability were expressed by Bland-Altman and intraclass correlation coefficients, respectively. RESULTS: Measurements were attained from 58 of 60 foals with mean age of 15 ± 7.9 days and mean weight of 75.7 ± 17.7 kg. The CVCmax was significantly different from CVCmin (D = 0.515, SE = 0.031, P < 0.001). Inter-rater agreement of the CVC-CI differed by an average of -0.9% (95% limits of agreement, -12.5 to +10.7%). Intrarater variability of CVCmax was 0.540 and 0.545, of CVCmin was 0.550 and 0.594, and of CVC-CI was 0.894 and 0.853 for observers 1 and 2, respectively. CONCLUSIONS AND CLINICAL IMPORTANCE: These results indicate it is possible to reliably measure the CVC sonographically in healthy foals, and the CVC-CI may prove useful in assessing the intravascular volume status in hypovolemic foals.

Effect of Dexamethasone on Resting Blood Lactate Concentrations in Horses.

BACKGROUND: Blood lactate concentration is a marker of tissue perfusion and helps guide therapeutic interventions in critically ill horses. In both humans and dogs, administration of corticosteroids can increase blood lactate concentration, leading to type B hyperlactatemia. This effect could be a consequence of the impact of corticosteroids on glucose metabolism. OBJECTIVES: To investigate the effects of daily IM dexamethasone administration on blood lactate and glucose concentrations in horses. ANIMALS: Nine healthy adult horses. METHODS: A randomized, blinded, controlled, cross-over study design was used. Horses were randomly assigned to 1 of 2 groups, either receiving 0.05 mg/kg of dexamethasone IM or an equivalent volume of saline, daily for 7 days. Blood was collected to determine lactate and glucose concentrations at baseline, 2 hours after the daily injections and 24 hours after the last injection. RESULTS: Dexamethasone treatment had a statistically significant effect on lactate (P = .006) and glucose (P = .033) concentrations. The least squares mean lactate concentration was 0.93 mmol/L (95% CI: 0.87-0.99) in the dexamethasone group compared to 0.71 mmol/L (95% CI: 0.70-0.73) for the saline group. A positive relationship between blood lactate and glucose concentrations was identified, with a 0.07 mmol/L (95% CI: 0.05-0.09) increase in lactate concentration per unit increase in glucose (P < .0001) concentration. CONCLUSIONS AND CLINICAL IMPORTANCE: Dexamethasone induces statistically significant increases in blood lactate and glucose concentrations in healthy horses. Awareness of the potential for corticosteroids to induce type B hyperlactatemia might be important in the management of critically ill horses receiving dexamethasone.

Sound Pressure Levels in 2 Veterinary Intensive Care Units.

BACKGROUND: Intensive care units (ICUs) in human hospitals are consistently noisy environments with sound levels sufficient to substantially decrease sleep quality. Sound levels in veterinary ICUs have not been studied previously, but environmental sound has been shown to alter activity in healthy dogs. HYPOTHESIS: Veterinary ICUs, like those in human medicine, will exceed international guidelines for hospital noise. ANIMALS: NA. METHODS: Prospective, observational study performed consecutively and simultaneously over 4 weeks in 2 veterinary ICUs. Conventional A-weighted sound pressure levels (equivalent continuous level [a reflection of average sound], the sound level that is exceeded 90% of the recording period time [reflective of background noise], and maximum sound levels) were continuously recorded and the number of spikes in sound >80 dBA were manually counted. RESULTS: Noise levels were comparable to ICUs in human hospitals. The equivalent continuous sound level was higher in ICU1 than in ICU2 at every time point compared, with greatest differences observed on week day (ICU1, 60.1 ± 3.7 dBA; ICU2, 55.9 ± 2.5 dBA, P < .001) and weekend nights (ICU1, 59.9 ± 2.4 dBA; ICU2, 53.4 ± 1.7 dBA, P < .0001) reflecting a 50% difference in loudness. Similar patterns were observed for the maximum and background noise levels. The number of sound spikes was up to 4 times higher in ICU1 (162.3 ± 84.9 spikes) than in ICU2 (40.4 ± 12.2 spikes, P = .001). CONCLUSIONS AND CLINICAL IMPORTANCE: These findings show that sound in veterinary ICUs is loud enough to potentially disrupt sleep in critically ill veterinary patients.

Blood concentrations of D- and L-lactate in healthy rabbits.

OBJECTIVES: To determine whole blood and serum concentrations of l-lactate and serum concentrations of d-lactate in healthy rabbits and compare three methods of analysis for l-lactate measurement. METHODS: Prospective study using 25 rabbits. Concentrations of whole blood l-lactate were measured using a portable analyser and a blood gas analyser. The remainder of the sample was allowed to clot for centrifugation. Serum was stored at -20°C for determination of l- and d- lactate by high-performance liquid chromatography. RESULTS: d-lactate values by high-performance liquid chromatography were 0 · 17 ± 0 · 08 mmol/L. l-lactate values were 5 · 1 (±2 · 1) mmol/L by high-performance liquid chromatography, 6 · 9 (±2 · 7) mmol/L with the portable analyser and 7 · 1 (±1 · 6) mmol/L with the blood gas analyser. No significant difference (P > 0 · 05) was found between the two analysers. Significant difference existed between serum l-lactate values obtained by high-performance liquid chromatography and the whole blood values obtained with the blood gas analyser (P < 0 · 01) and portable analyser (P < 0 · 05). CLINICAL SIGNIFICANCE: Serum concentrations of d-lactate in healthy rabbits are in the range of those of other mammals. l-lactate values in healthy rabbits are higher compared with other mammals. Good correlation was found between the portable and blood gas analysers for whole blood l-lactate measurement in healthy rabbits.

Prospective evaluation of clinically relevant type B hyperlactatemia in dogs with cancer.

BACKGROUND: Cancer is considered a cause of type B hyperlactatemia in dogs. However, studies evaluating cancer as a cause of clinically relevant type B hyperlactatemia (>2.5 mmol/L) are lacking. Cancer cells have a higher lactate production because of increased aerobic glycolysis, known as the "Warburg effect." The mechanisms through which aerobic glycolysis occurs are not well elucidated, but neoplasia may cause type B hyperlactatemia via this process. OBJECTIVES: To determine if malignant tumors of dogs are associated with clinically relevant type B hyperlactatemia (>2.5 mmol/L). ANIMALS: Thirty-seven client-owned dogs with malignant tumors: 22 with hematopoietic and 15 with solid tumors. METHODS: Histology was used to confirm the diagnosis (cytology was considered adequate for diagnosis of lymphoma). Confounding conditions associated with hyperlactatemia were excluded. Lactate measurements were immediately performed on free-flow jugular whole blood samples using the LactatePro analyzer. RESULTS: All dogs had lactate concentrations<2.5 mmol/L. Mean blood lactate concentration was 1.09 mmol/L. Mean blood lactate concentrations for solid and hematopoietic tumors were 0.95 and 1.19 mmol/L, respectively. Dogs with lymphoma (n=18) had a mean blood lactate concentration of 1.15 mmol/L. CONCLUSIONS: Malignant tumors were not considered a cause of clinically relevant type B hyperlactatemia. Therefore, cancer-related type B hyperlactatemia in dogs is uncommon, and hyperlactatemia should prompt careful investigation for causes other than cancer.

Effects of prednisone on blood lactate concentrations in healthy dogs.

BACKGROUND: Glucocorticoids affect carbohydrate and lactate metabolism. HYPOTHESIS: Administration of prednisone to healthy dogs will result in clinically relevant hyperlactatemia. ANIMALS: Twelve healthy adult Beagle dogs. METHODS: Prospective, controlled experimental study. Twelve healthy adult Beagles were divided into 2 groups (3 of each sex per group). One group served as control. The other group received 2 treatments: low, 1 mg/kg prednisone PO q24h for 2 weeks; high, 4 mg/kg prednisone PO q24h for 2 weeks. A washout period of 6 weeks separated the treatments. Blood samples were drawn for whole blood lactate measurement on day (D) 0, D4, and D14 and measured in duplicate. RESULTS: Compared with the control group, low and high groups had significantly higher blood lactate concentrations at D4 and D14. There was no difference at D0. There was no effect of time within the control group. In the low and high groups, blood lactate concentration was increased at D4 and D14 versus D0. Blood lactate concentration was greater in the high group than the low group at D14 only. CONCLUSIONS AND CLINICAL IMPORTANCE: Dogs treated with prednisone experience statistically significant increases in blood lactate concentrations, which can result in type B hyperlactatemia. In such cases, improving tissue perfusion, treatment for the commonest form of hyperlactatemia (type A) would be unnecessary.

One-step method for catheterising the jugular vein of cats to enable repeated blood sampling.

A one-step method for catheterising the jugular vein of cats for taking multiple blood samples was developed, with the aid of radiography, to determine an appropriate internal catheter length for adult cats. The effects of multiple blood sampling and heparin flushes on the cats' haematocrit and blood total solids were also assessed. Seven healthy adult cats were used. A total of 128 of 132 (97 per cent) blood samples were collected successfully through a 19 G, 30.5 cm catheter introduced as a central venous catheter and maintained in place during two periods of 48 hours. The haematocrit and total solids were significantly decreased in all the cats, but no clinically significant blood loss or coagulation disorders were observed.