Cytokine Adsorption as an Adjunctive Treatment for Patients with Immune-Mediated Hemolytic Anemia Receiving Therapeutic Plasma Exchange: A Case Series of 3 Dogs.

The use of cytokine adsorption is an emerging treatment for inflammatory diseases in human medicine. There are few reports of this treatment modality in veterinary medicine and no reports of the use of a cytokine adsorbent for immune-mediated hemolytic anemia (IMHA). These case reports illustrate the use of a cytokine adsorbent as an adjunctive treatment during therapeutic plasma exchange (TPE). All dogs were unresponsive to conventional treatment or were severely affected by rapid hemolysis of red blood cells. The aim was to treat all dogs with three sequential TPE sessions; however, one dog died before completion of three sessions and one dog required additional sessions. Preliminary evidence indicates that the use of a cytokine adsorption is well tolerated and can be considered as an adjunct in the management of IMHA that is severe or refractory to traditional treatment.

Management of Severe Hypomagnesemia as the Primary Electrolyte Abnormality with a Delayed Onset of Clinical Signs as a Result of Refeeding Syndrome in a Cat.

This case report describes severe hypomagnesemia in a cat attributed to refeeding syndrome with an onset of clinical signs from the magnesium deficiency apparent on the twelfth day following initiation of feeding. The patient initially presented in a state of cachexia from apparent malnutrition after missing from the owners care for five months. The patient was initially discharged five days after the initiation of feeding with only a mild hypokalemia apparent and requiring supplementation and returned for outpatient management. The patient presented through the emergency department on the twelfth day following the onset of feeding with the clinical signs of acute lethargy, vomiting, generalized tremors and a seizure episode and had a severe total hypomagnesemia on diagnostic bloodwork. The patient's clinical signs resolved following emergency treatment with parenteral magnesium sulfate as a continuous rate infusion and was later managed with oral magnesium hydroxide for a prolonged period of time. Electrolyte abnormalities and associated clinical signs typically occur between two and five days after initiation of feeding and up to ten days after starting food intake in humans with anorexia nervosa. This case report highlights that hypomagnesemia, while not the most common electrolyte disturbance to occur with refeeding syndrome, can occur without other significant electrolyte changes and can cause clinical signs greater than ten days following refeeding to a starving patient. This magnesium deficiency required prolonged treatment, but the patient made a complete recovery.

Transient methemoglobinemia suspected secondary to ingestion of Brassica species in a dog.

This case report describes methemoglobinemia in a dog suspected to be the result of consumption of a large volume of fermented bok choy. The patient presented with clinical signs and co-oximetry consistent with methemoglobinemia without ingestion of a known toxin. A large volume of fermented bok choy had been ingested earlier that day and decontamination procedures were performed as a result. Supportive care led to resolution of clinical signs and appropriate clearance of methemoglobin. While erythrocyte oxidant damage is a consequence of ingestion of plants in the genus Brassica (such as bok choy) in ruminant species due to rumen microbiota producing sulfur-containing compounds, specifically dimethyl disulfide, there are potential pathways that can lead to similar effects in monogastric animals. The methemoglobin formation in this patient may have resulted from the large volume consumed with the natural fermentation releasing dimethyl disulfide and leading to oxidant damage analogous with that in ruminants. This case report provides additional mechanisms for methemoglobin formation in dogs and to direct the clinician toward methemoglobinemia in patients with compatible clinical signs with ingestion of specific plant species.