A randomized, controlled clinical trial of intravenous lipid emulsion as an adjunctive treatment for permethrin toxicosis in cats.

OBJECTIVE: To assess for any clinical benefit of intravenous lipid emulsion (ILE) for permethrin toxicosis in cats by comparing the progression of clinical signs of cats before and after treatment with ILE to cats treated with a saline control. To accomplish this objective, a clinical staging system for cats with permethrin toxicosis was developed and validated. DESIGN: Prospective, multicenter, randomized, controlled clinical trial. SETTING: University veterinary teaching hospital and 12 private veterinary emergency hospitals. ANIMALS: Thirty-four client-owned cats with permethrin toxicosis. INTERVENTIONS: A clinical staging system was designed based on abnormalities found on physical examination of cats with permethrin toxicosis. The clinical staging system had 6 stages, ranging from Stage A for cats with no abnormalities to Stage F for cats with grand mal seizures. The system was validated for intraviewer and interviewer variability. Cats in the clinical trial were randomized to receive 15 mL/kg of either intravenous 0.9% saline (control) or 20% ILE over 60 minutes. For each cat, a clinical stage was recorded at set time points before and after the randomized treatment was administered. The distribution of clinical stage stratified over time was compared across treatment groups. MEASUREMENTS AND MAIN RESULTS: The clinical staging system showed excellent repeatability (P = 1.0) and reliability (P = 1.0). In the clinical trial, there was a significant difference in the distribution of clinical stages over time (P < 0.001) and from presentation stage to Stage B (P = 0.006), with ILE-treated cats (n = 20) having lower clinical stages earlier than control cats (n = 14). There was no significant difference in signalment, body weight, or supportive treatment between the groups. CONCLUSIONS: The clinical staging system was repeatable and reliable. Clinical stages of permethrin toxicosis in ILE-treated cats improved earlier compared to control cats, suggesting ILE may be a useful adjunctive therapy in the treatment of permethrin toxicosis in cats.

Diagnostic accuracy of the SNAP and Spec canine pancreatic lipase tests for pancreatitis in dogs presenting with clinical signs of acute abdominal disease.

OBJECTIVES: To (i) assess the clinical diagnostic accuracy of SNAP canine pancreatic lipase (cPL) and specific canine pancreatic lipase (Spec cPL) and (ii) assess the agreement of an abnormal test result between SNAP cPL and Spec cPL in dogs presenting with acute abdominal disease. DESIGN: Prospective observational cohort study. SETTING: University teaching hospital emergency center. ANIMALS: Thirty-eight client-owned dogs that presented with acute abdominal disease, with a known final diagnosis between March 2009 and April 2010. Dogs were retrospectively assigned into 2 groups, dogs with acute pancreatitis (AP) (Group 1) and dogs without AP (Group 2). INTERVENTIONS: Paired serum samples obtained within 24 hours of presentation were analyzed using the SNAP cPL test and Spec cPL assay. MEASUREMENTS AND RESULTS: SNAP cPL clinical sensitivity and specificity was 82% (9/11 dogs of group 1) and 59% (16/27 dogs of group 2), respectively. Spec cPL clinical sensitivity and specificity was 70% (7/10 dogs of group 1) and 77% (20/26 dogs of group 2), respectively. Accuracy of the SNAP and Spec cPL for a clinical diagnosis of pancreatitis was found to be 66% and 75%, respectively. Agreement between a positive SNAP (cPL ≥ 200 µg/L) and a clinical diagnosis pancreatitis resulted in κ = 0.33. Agreement between an increased Spec (cPL ≥ 400 µg/L) and a clinical diagnosis of pancreatitis resulted in a κ = 0.43. The agreement between SNAP and Spec cPL (cPL ≥ 200 µg/L) for the entire cohort resulted in κ = 0.78. CONCLUSION: SNAP cPL and Spec cPL results may provide a "false positive" diagnosis of pancreatitis in up to 40% of dogs presenting with acute abdominal disease. There is good overall agreement between SNAP cPL and Spec cPL; however, there were 4/38 dogs with positive SNAP cPL and "normal" Spec cPL.

Candida albicans peritonitis in a dog.

OBJECTIVE: To describe the clinical management of a case of Candida albicans peritonitis in a dog and discuss the pathogenicity of Candida peritonitis along with treatment using the fungistatic agent, fluconazole. CASE SUMMARY: A 15-week-old Papillon developed peritonitis secondary to enterectomy site dehiscence. A pure growth of Candida albicans was obtained from the abdominal fluid. Surgical repair of the dehiscence was performed and antifungal therapy instituted with fluconazole postoperatively. A marked exudative process was noted postoperatively with production of large volumes of fluid from the abdominal drain. Fresh frozen plasma and pentastarch were provided for oncotic support. Recovery was complicated by megaesophagus, however, the patient gradually improved and was discharged 11 days after surgery. NEW OR UNIQUE INFORMATION PROVIDED: To our knowledge, this is the first case report of successful treatment of Candida albicans peritonitis in a dog. A marked exudative process was noted during therapy requiring significant oncotic support. Resolution of the disease process was achieved with surgical intervention and antifungal therapy.