A comparison of the Sepsis-2 and Sepsis-3 definitions for assessment of mortality risk in dogs with parvovirus.

OBJECTIVE: To evaluate the use of a modified Sepsis-3 (mSepsis-3) definition compared to the currently used modified Sepsis-2 (mSepsis-2) definition to determine whether the mSepsis-2 or mSepsis-3 stratifications were able to identify populations of dogs ultimately more likely to die from canine parvovirus (CPV) infection. DESIGN: Retrospective, January 2009 to March 2020. SETTING: A private, small animal, urban, referral emergency and specialty hospital. ANIMALS: Fifty-nine client-owned dogs hospitalized for treatment of CPV. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Dogs were divided into mSepsis-2 and mSepsis-3 categories based on the highest level of illness severity reached during hospitalization. Greater illness severity based on mSepsis-2 criteria (ie, sepsis, severe sepsis, septic shock) was associated with an increase in average length of stay (P < 0.001), increase in average cost of stay (P < 0.01), and presence of leukopenia (P < 0.05). An increase in illness severity within the mSepsis-2 criteria was not associated with hyperlactatemia (P = 0.29), presence of neutropenia (P = 0.12), or mortality (P = 0.35). Greater illness severity based on mSepsis-3 criteria (ie, infection only, sepsis, septic shock) was associated with an increase in mortality (P < 0.05), increase in average length of stay (P < 0.001), increase in average cost of stay (P < 0.01), presence of leukopenia (P < 0.01), and presence of neutropenia (P < 0.05). The mSepsis-3 criteria were not associated with the presence of hyperlactatemia (P = 0.68). There was no significant difference between survivors and nonsurvivors in the presence of leukopenia (P = 0.19), neutropenia (P = 0.67), or hyperlactatemia (P = 0.58). CONCLUSIONS: The mSepsis-3 diagnostic criteria appear to better identify dogs with CPV at higher risk for mortality compared to the mSepsis-2 criteria.

Ultrasonic Doppler-guided catheterization of the dorsal pedal artery in dogs and cats under general anesthesia.

BACKGROUND AND OBJECTIVE: Noninvasive blood pressure measurements are less accurate than direct measurements but arterial catheterization for direct blood pressure monitoring can be challenging especially in patients with a nonpalpable pulse. The purpose of this study is to describe a novel technique of locating the dorsal pedal arterial pulse using a portable ultrasonic Doppler for arterial catheter placement. KEY FINDINGS: Using the described technique in anesthetized dogs and cats with strong (n = 13) to weak dorsal pedal pulses (n = 6), the overall success rate of arterial puncture was 70% (19/27) with successful catheterization in 53% (10/19) of those. The overall success rate of arterial catheterization was 37% (10/27). The pulse strength did not significantly affect the success rate. Neither were patient weight, blood pressure, heart rate, and premedication significantly different between the 2 groups. SIGNIFICANCE: This study describes a novel technique for locating the dorsal pedal artery for arterial catheterization. Having another technique of pulse detection may increase the likelihood of arterial catheter placement for direct blood pressure monitoring and aid in arterial puncture for obtaining a sample for blood gas analysis in critical patients.

Retrospective evaluation of albuterol inhalant exposure in dogs: 36 cases (2007-2017).

OBJECTIVE: To describe the clinical features, clinicopathological features, treatment, and outcome of dogs presented for albuterol exposure. DESIGN: Retrospective case series from January 2007 to December 2017. SETTING: Tertiary veterinary facility. ANIMALS: Thirty-six client-owned dogs presenting for known or suspected albuterol exposure secondary to chewing on albuterol metered-dose inhalers (MDIs). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: All dogs presented with clinical signs attributable to albuterol exposure. The most common physical examination abnormality was sinus tachycardia, noted in 34 of 36 (94%) dogs. Twenty-seven patients (75%) were admitted to the hospital for therapy, with a median length of hospitalization of 20.5 hours (16.75-24.5). Thirty-two of 36 dogs had serum electrolytes evaluated at admission, with 22 of 32 (69%) presenting with hypokalemia ([K+] < 3.62 mmol/L]). Hyperlactatemia ([lactate] > 2.80 mmol/L) was noted in 23 of 28 (82%) dogs. A negative correlation was found between serum lactate and potassium (r = -0.64, r2  = 0.40, P = 0.0003). Hyperglycemia ([glucose] > 6.44 mmol/L) was noted in 20 of 30 (67%) dogs. Beta antagonist therapy was utilized in 20 of 36 (56%) of dogs. CONCLUSIONS: Although uncommon, albuterol intoxication can lead to significant clinical and electrolyte abnormalities. Albuterol-induced hypokalemia and associated tachyarrhythmias can be successfully managed, and albuterol intoxication has an excellent prognosis for survival to discharge. A minimum database should be evaluated in all dogs presenting for suspected albuterol exposure, with lactate and glucose monitored carefully in dogs with moderate or severe hypokalemia given the correlation found.

Effect of peritoneal lavage on bacterial isolates in 40 dogs with confirmed septic peritonitis.

OBJECTIVE: To evaluate bacterial isolates, antimicrobial drug susceptibility, and change in resistance among pre- and post-lavage culture samples in dogs with septic peritonitis. DESIGN: Prospective observational study. SETTING: Private practice referral hospital. ANIMALS: Forty client-owned dogs with confirmed septic peritonitis requiring surgical intervention. INTERVENTIONS: All dogs had perioperative abdominal lavage following source control with 200 to 300 mL/kg 0.9% sterile saline. Pre- and post-lavage aerobic and anaerobic culture samples were evaluated. MEASUREMENTS AND MAIN RESULTS: Thirty-five of 40 dogs (87.5%) survived to hospital discharge. The likelihood of an aerobic organism to have multidrug resistance (resistance to 3 or more antimicrobial classes) post-lavage was a third of that pre-lavage (odds ratio [OR] 0.34, 95% CI [0.17-0.68], P = 0.01). Thirty-nine of 40 dogs (97.5%) received appropriate empiric antimicrobial therapy based on pre- and post-lavage culture results, of which 5 (12.8%) did not survive to discharge. The single dog with inappropriate antimicrobial therapy survived to discharge. The most frequent isolates detected included Escherichia coli, Clostridium perfringens, and Enterococcus faecalis. The same organism based on species was isolated in pre- and post-lavage cultures in 32 dogs, accounting for 59 anaerobic and aerobic isolates. There was a new bacterial isolate detected in 20 dogs, accounting for 46 isolates and an overall total decrease of 14 isolates between pre- and post-lavage culture (P = 0.09). CONCLUSIONS: This study suggests that there is a significant decrease in the likelihood of isolating a multidrug resistant organism following peritoneal lavage, and aerobic and anaerobic culture results have the potential to change following peritoneal lavage, although this cannot be confirmed without further studies. Overall survival rates were higher than previously reported in the literature for septic peritonitis.

Retrospective evaluation of the effectiveness of xylazine for inducing emesis in cats: 48 cats (2011-2015).

OBJECTIVE: To determine the effectiveness of xylazine for the induction of emesis in cats that were suspected of ingesting potentially toxic substances or foreign objects. DESIGN: Retrospective study. SETTING: Private emergency and specialty referral hospital. ANIMALS: Forty-eight client-owned cats that were administered xylazine to induce emesis for decontamination of a toxic substance or expulsion of an ingested foreign object. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The medical records of 48 cats presenting for known or suspected ingestion of foreign material that underwent decontamination with xylazine were reviewed. Signalment, material ingested, dose and route of xylazine administration, success of emesis and recovery of foreign material ingested, use of a reversal agent, and adverse effects were noted. The induction of emesis was successful in 29/48 (60%) of cats. Sedation was the most common adverse effect and was noted in 15/48 (31%) of patients. CONCLUSIONS: Xylazine is safe and reasonably effective at inducing emesis in cats.

Outcomes in dogs with uncomplicated, presumptive bacterial pneumonia treated with short or long course antibiotics.

This is a prospective, observational investigation without a placebo arm to evaluate the resolution rate of pneumonia when using 14 days or less of antibiotic therapy compared to longer therapy in dogs. There was no significant difference in radiographic resolution or relapse rates between the 2 treatment groups.

Résultats chez les chiens atteints d'une présumée pneumonie bactérienne sans complication traitée à l'aide d'un traitement aux antibiotiques de courte ou de longue durée. Il s'agit d'une enquête prospective observationnelle sans groupe placebo pour évaluer le taux de résolution de la pneumonie lors du recours à 14 jours ou moins de traitement antibiotique comparativement à des thérapies plus longues chez les chiens. Il n'y avait aucune différence significative dans la résolution radiographique ou les taux de rechute entre les 2 groupes de traitement.(Traduit par Isabelle Vallières).

Escalator-related injuries in 30 dogs (2007-2014).

OBJECTIVE: To describe a population of dogs affected by escalator-related injuries, and to characterize the types of injuries sustained and describe treatment administered. DESIGN: Retrospective study from March 2007 to November 2014. SETTING: Large urban referral and emergency facility. ANIMALS: Thirty client-owned dogs presenting with injuries acquired while riding an escalator. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: All injuries in this study occurred secondary to entrapment of 1 or more paws in the moving parts of an escalator; 39 paws were injured in total. The median body weight of the patients in this study was 4.25 kg, with 73.3% of the patients weighing less than 10 kg. Fifteen patients (50.0%) were treated surgically, the remainder were managed conservatively. Eight patients (26.7%) underwent digit or partial-digit amputation. Of the conservatively managed patients, 10 were treated with bandaging of the wounds. Antimicrobials, opiate analgesics, and nonsteroidal anti-inflammatory drugs were administered in both surgically and conservatively managed patients. CONCLUSIONS: While uncommon, escalator accidents can result in significant injury to dogs. Measures can be taken to prevent these injuries from occurring, whether through client education, dog training, structural modifications in the escalators themselves, or avoidance of escalators. In the present study, the survival rate of dogs injured on escalators was 100%.

Use of 20% intravenous lipid emulsion for the treatment of loperamide toxicosis in a Collie homozygous for the ABCB1-1∆ mutation.

OBJECTIVE: To describe the successful treatment of loperamide toxicosis in a dog using intravenous lipid emulsion (ILE). CASE SUMMARY: An 8-month-old male neutered Rough Collie weighing 20.0 kg was given a total dose of 0.75 mg/kg loperamide over 3 days as treatment for diarrhea. The dog was subsequently evaluated for signs of dull mentation, anxiety, ptyalism and ataxia, thought to be a result of loperamide intoxication. The dog was treated with a 1.5 mL/kg IV bolus of 20% ILE solution followed by 0.25 mL/kg/min of the same solution for 2 hours. The dog's mentation improved rapidly following ILE infusion, and he was neurologically normal 3 hours after initiation of ILE treatment. The dog was subsequently found to be homozygous for the ATP-binding cassette (ABC) transporter gene (ABCB1-1∆) mutation. There were no adverse effects noted during or following ILE infusion. NEW OR UNIQUE INFORMATION PROVIDED: ILE was successful in the treatment of loperamide toxicosis in a Collie with the ABCB1-1∆ mutation. ILE may be of benefit for treatment of other intoxications in dogs with ABCB1-1Δ mutations.

Retrospective Study of 122 Dogs That Were Treated with the Antifibrinolytic Drug Aminocaproic Acid: 2010-2012.

Antifibrinolytic drugs are used to promote hemostasis and decrease the need for red blood cell transfusion. Medical records of 122 dogs that were prescribed either oral or intravenous aminocaproic acid between 2010 and 2012 were evaluated retrospectively. Of the 122 dogs, three experienced possible drug-related adverse effects. No significant differences were identified between dogs that experienced adverse effects and those that did not and the possible adverse effects noted were all minor. All dogs that received packed red blood cell transfusions were evaluated for correlations between baseline packed cell volume or dose of red blood cells and aminocaproic acid dose and no correlation was identified. Dogs that received aminocaproic acid as a treatment for active bleeding were divided by cause of hemorrhage into the following groups: neoplastic, non-neoplastic, and unknown. No significant differences in aminocaproic acid dose or the percentage of patients requiring a blood transfusion were identified between groups.

Administration of fenoldopam in critically ill small animal patients with acute kidney injury: 28 dogs and 34 cats (2008-2012).

OBJECTIVE: To describe the clinical features and outcomes of critically ill dogs and cats with acute kidney injury (AKI) receiving fenoldopam infusions compared to patients with AKI that did not receive fenoldopam. DESIGN: Retrospective clinical study from May 1, 2008 until June 1, 2012. SETTING: Private emergency and specialty referral hospital. ANIMALS: Client-owned dogs (28) and cats (34) with AKI that received fenoldopam compared with similar patients with AKI (30 dogs and 30 cats) that did not. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The medical records of 62 critically ill dogs and cats with AKI that received fenoldopam were reviewed. Presenting clinical signs, physical examination findings, and primary and secondary disease processes were identified in all patients. The mean number of days on fenoldopam was 1.5 days (range 0.3-4.0 days) for dogs and 1.9 days (range 1.0-4.0 days) for cats. Eleven of 28 (39%) dogs survived to discharge and 13 of 34 (38%) of the cats survived to discharge. Of the animals in the group receiving fenoldopam that died, the majority (84%) were euthanized. Potential adverse reactions were evaluated, with hypotension being the most commonly encountered adverse effect (7% of fenoldopam group [FG] dogs and 23% of FG cats). When compared with patients with AKI that did not receive fenoldopam, no significant differences were found between the groups with regards to survival, length of hospital stay, adverse effects, or changes in creatinine, BUN, or sodium concentrations except that patients receiving fenoldopam were significantly more likely to have received other renally active medications. CONCLUSIONS: In this study of patients with AKI, fenoldopam administration at 0.8 µg/kg/min in dogs and 0.5 µg/kg/min in cats appeared relatively safe but was not associated with improvement in survival to discharge, length of hospital stay, or improvement in renal biochemical parameters when compared to patients with AKI not receiving fenoldopam.

Presumptive pseudohypoaldosteronism secondary to chronic urinary tract obstruction from sloughed urinary bladder mucosa and urinary tract infection in a cat.

OBJECTIVE: To describe a case of presumptive secondary pseudohypoaldosteronism (PHA) in a cat with urinary tract infection and chronic urethral obstruction. The obstruction was believed to have resulted from sloughed urinary bladder mucosa secondary to pressure necrosis. CASE SUMMARY: A 5-year-old, 4 kg, castrated male Siamese cat presented for vomiting and stranguria. Medical history included a perineal urethrostomy for urethral obstruction. Physical examination revealed a large, painful, nonexpressible urinary bladder. Point-of-care testing demonstrated electrolyte derangements consistent with a postrenal azotemia and metabolic acidosis. Results of urine culture was positive for bacterial growth. Diagnostic imaging revealed presence of retroperitoneal fluid, marked urinary bladder wall thickening, bilateral hydroureter, mild bilateral pyelectasia, and small nephroliths. The patient was treated for a urinary tract obstruction and infection. In the 3 weeks following initial discharge, the patient was evaluated on multiple occasions for lethargy, intermittent vomiting, inappropriate urination, and progressive polyuria and polydipsia. Although the urinary bladder was easily expressed during repeat examinations, it was persistently distended and subjectively thickened upon palpation. Repeat ultrasound of the urinary tract showed evidence of sloughed tissue in the bladder lumen, likely secondary to chronic urethral obstruction and pressure necrosis. A cystotomy was performed to remove the necrotic tissue, and a revised perineal urethrostomy was done due to a partial urethral stricture. Bladder biopsies were obtained at this time. Postoperatively, the cat was reported by the owners to be urinating normally but continued to be polyuric and polydipsic in the week following discharge. One week after surgery, the cat presented in hypovolemic shock with laboratory findings consistent with a presumptive diagnosis of secondary PHA. NEW OR UNIQUE INFORMATION PROVIDED: PHA has not been reported previously in a cat. This case report suggests that aldosterone resistance should be considered in cats with consistent laboratory findings and a history of documented obstructive uropathy and urinary tract infection.

Fournier's gangrene in a cat.

OBJECTIVE: To describe the clinical course of a cat diagnosed with Fournier's gangrene. CASE SUMMARY: A 2-year-old castrated male cat was presented to an emergency hospital for evaluation of acute onset of lethargy, mucoid anal discharge, and fever. During hospitalization, with provision of supportive care, an area of necrotizing fasciitis around the prepuce and anus developed and surgical debridement was performed. Severe sepsis developed secondary to the necrotizing fasciitis and the cat was eventually euthanized. NEW INFORMATION PROVIDED: The purpose of this report is to document the first case of Fournier's gangrene in a cat that presented for mucoid anal discharge, lethargy, and mild ataxia, and to alert emergency clinicians to this disease process. Early detection of the disease with prompt, aggressive supportive care and surgical debridement is necessary for successful treatment.

Hypothalamic-pituitary axis deficiency following traumatic brain injury in a dog.

OBJECTIVE: To describe endocrine dysfunction associated with traumatic brain injury in a dog. SUMMARY: A 12-week-old dog presented with traumatic brain injury and did not respond to traditional supportive care. Continued hypothermia, electrolyte derangements, hypotension, and hyposthenuria prompted screening for and detection of several hypothalamic-pituitary disorders including: hypoadrenocorticism, central diabetes insipidus, hypothyroidism, and growth hormone deficiency. Electrolyte abnormalities, urine osmolarity, and blood pressure improved with treatment for the associated disorders. NEW OR UNIQUE INFORMATION PROVIDED: This is the first report of generalized hypothalamic-pituitary dysfunction or panhypopituitarism following traumatic brain injury in a dog.