Feasibility, complications, and quality of visualization using video capsule endoscopy in 40 dogs with overt or questionable gastrointestinal bleeding.

BACKGROUND: Prospective studies describing video capsule endoscopy (VCE), its feasibility, and complications in dogs are limited. OBJECTIVE: To assess VCE, quality of visualization, complications, and risk factors for incomplete studies in dogs with overt or questionable gastrointestinal bleeding (GIB). ANIMALS: Forty dogs with overt or questionable GIB. METHODS: Prospective, multicenter, interventional study. From August 2017 to March 2020, dogs were examined by VCE (ALICAM) because of overt or questionable GIB. Reported outcomes included diagnostic results of VCE study, quality of visualization, and complications. Risk factors for incomplete studies were evaluated using logistic regression. RESULTS: In total, 40 dogs (13 overt, 27 questionable GIB) were included. The capsules were administered PO in 29 and endoscopically in 11 dogs (6 duodenum, 5 stomach). One capsule was not retrieved. In 24 of 39 recordings, bleeding lesions were identified (10 overt GIB, 14 questionable GIB). Overall, the quality of visualization was poor to limited in the stomach and colon, and adequate to good in the small intestine. The most common complication was an incomplete study in 15/39 studies, particularly after oral administration (13/28). Risk factors for incomplete study after oral administration included administration of simethicone or opioids, chronic enteropathy, and capsule gastric transit time >6 hours. CONCLUSIONS AND CLINICAL IMPORTANCE: Video capsule endoscopy can be used to diagnose a variety of lesions causing bleeding in the gastrointestinal tract of dogs with questionable GIB. Incomplete studies are the most common complications in dogs after oral administration of capsules.

Diagnostic evaluation of urea nitrogen/creatinine ratio in dogs with gastrointestinal bleeding.

BACKGROUND: Urea nitrogen/creatinine ratio (UCR) is a marker for upper gastrointestinal bleeding (GIB) in people. OBJECTIVES: To assess the usefulness of UCR to predict occult GIB and distinguish upper from lower GIB in dogs. ANIMALS: Eighty-nine dogs with GIB and 65 clinically healthy dogs. Dogs were grouped according to 65 overt GIB and 24 occult GIB, and based on lesion localization (37 upper, 13 lower, and 8 both). METHODS: Seventy-four dogs were included retrospectively and 15 dogs prospectively. Serum urea nitrogen and creatinine concentrations, UCR, hemoglobin concentration, hematocrit, mean corpuscular volume, and mean corpuscular hemoglobin concentration were compared between groups. Logistic regression models were fitted to assess if variables could distinguish occult GIB from being healthy and upper from lower GIB. RESULTS: The UCR was significantly higher in dogs with overt GIB compared to control dogs (P = .02) and dogs with occult GIB (P = .05). The UCR was not significantly associated with occult GIB vs being healthy, or upper vs lower GIB (P > .05 each). Dogs with higher hemoglobin concentration and hematocrit had significantly lower odds of having occult GIB than being healthy (P < .0001 each). CONCLUSIONS AND CLINICAL IMPORTANCE: The UCR does not seem to be a clinically useful marker of occult GIB and appears to have poor discriminatory ability between upper and lower GIB. An increased UCR in a dog without signs of overt GIB, especially if its hematocrit is within the middle or upper reference interval, does not appear to warrant prompt prescription of gastrointestinal protectants.

Evaluation of the Distribution and Elimination of Balanced Isotonic Crystalloid, 5% Hypertonic Saline, and 6% Tetrastarch 130/0.4 Using Volume Kinetic Modeling and Analysis in Healthy Conscious Cats.

This prospective, randomized, blinded, interventional cross-over study investigated the distribution, elimination, plasma volume expansion, half-life, comparative potency, and ideal fluid prescription of three commonly prescribed intravenous (IV) fluids in 10 healthy conscious cats using volume kinetic analysis that is novel to veterinary medicine. Each cat received 20 mL/kg of balanced isotonic crystalloid (PLA), 3.3 mL/kg of 5% hypertonic saline (HS), and 5 mL/kg of 6% tetrastarch 130/0.4 (HES) over 15 min on separate occasions. Hemoglobin concentration, red blood cell count, hematocrit, heart rate, and blood pressure were measured at baseline, 5, 10, 15, 20, 30, 40, 50, 60, and every 15 min until 180 min. Urine output was estimated every 30 min using point-of-care bladder ultrasonography. Plasma dilution derived from serial hemoglobin concentration and red blood cell count served as input variables for group and individual fluid volume kinetic analyses using a non-linear mixed effects model. In general, the distribution of all IV fluids was rapid, while elimination was slow. The half-lives of PLA, HS, and HES were 49, 319, and 104 min, respectively. The prescribed fluid doses for PLA, HS, and HES resulted in similar peak plasma volume expansion of 27-30%. The potency of HS was 6 times higher than PLA and 1.7 times greater than HES, while HES was 3.5 times more potent than PLA. Simulation of ideal fluid prescriptions to achieve and maintain 15 or 30% plasma volume expansion revealed the importance of a substantial reduction in infusion rates following initial IV fluid bolus. In conclusion, volume kinetic analysis is a feasible research tool that can provide data on IV fluid kinetics and body water physiology in cats. The rapid distribution but slow elimination of IV fluids in healthy conscious cats is consistent with anecdotal reports of fluid overload susceptibility in cats and warrants further investigation.

Understanding Volume Kinetics: The Role of Pharmacokinetic Modeling and Analysis in Fluid Therapy.

Fluid therapy is a rapidly evolving yet imprecise clinical practice based upon broad assumptions, species-to-species extrapolations, obsolete experimental evidence, and individual preferences. Although widely recognized as a mainstay therapy in human and veterinary medicine, fluid therapy is not always benign and can cause significant harm through fluid overload, which increases patient morbidity and mortality. As with other pharmaceutical substances, fluids exert physiological effects when introduced into the body and therefore should be considered as "drugs." In human medicine, an innovative adaptation of pharmacokinetic analysis for intravenous fluids known as volume kinetics using serial hemoglobin dilution and urine output has been developed, refined, and investigated extensively for over two decades. Intravenous fluids can now be studied like pharmaceutical drugs, leading to improved understanding of their distribution, elimination, volume effect, efficacy, and half-life (duration of effect) under various physiologic conditions, making evidence-based approaches to fluid therapy possible. This review article introduces the basic concepts of volume kinetics, its current use in human and animal research, as well as its potential and limitations as a research tool for fluid therapy research in veterinary medicine. With limited evidence to support our current fluid administration practices in veterinary medicine, a greater understanding of volume kinetics and body water physiology in veterinary species would ideally provide some evidence-based support for safer and more effective intravenous fluid prescriptions in veterinary patients.

High-flow nasal cannula oxygen therapy in acute hypoxemic respiratory failure in 22 dogs requiring oxygen support escalation.

OBJECTIVE: To determine the effect of high-flow nasal cannula (HFNC) oxygen therapy on cardiorespiratory variables and outcome in dogs with acute hypoxemic respiratory failure. DESIGN: Prospective, sequential clinical trial. SETTING: University veterinary teaching hospital. ANIMALS: Twenty-two client-owned dogs that failed to respond to traditional oxygen support. INTERVENTIONS: Initiation of HFNC therapy after traditional oxygen supplementation failed to increase Spo2 > 96% and Pao2 > 75 mm Hg or improve respiratory rate/effort. MEASUREMENTS AND MAIN RESULTS: Physiological variables, blood gas analyses, and dyspnea/sedation/tolerance scores were collected prior to HFNC initiation (on traditional oxygen support [time 0 or T0]), and subsequently during HFNC oxygen administration at time 30 minutes, 60 minutes, and 7 ± 1 hours. Relative to T0, use of HFNC resulted in a decreased respiratory rate at 1 hour (P = 0.022) and 7 hours (P = 0.012), a decrease in dyspnea score at all times (P < 0.01), and an increase in Spo2 at all times (P < 0.01). There was no difference in arterial/venous Pco2 relative to T0, although Paco2 was correlated with flow rate. Based on respiratory assessment, 60% of dogs responded to HFNC use by 30 minutes, and 45% ultimately responded to HFNC use and survived. No clinical air-leak syndromes were observed. CONCLUSIONS: HFNC use improved oxygenation and work of breathing relative to traditional oxygen therapies, without impairing ventilation. HFNC use appears to be a beneficial oxygen support modality to bridge the gap between standard oxygen supplementation and mechanical ventilation.

Preliminary evaluation of the use of high-flow nasal cannula oxygen therapy during recovery from general anesthesia in dogs with obstructive upper airway breathing.

BACKGROUND: Brachycephalic airway syndrome can pose a risk of complicated recovery from anesthesia as a result of irritation to the excess pharyngeal andlaryngeal tissue present in affected dogs. High-flow nasal cannula (HFNC) oxygen therapy is a respiratory support modality that offers provision of continuous positive airway pressure via high gas flow rates. The HFNC system actively warms and humidifies inspired gases, which improves comfort and facilitates tolerance of the high flow rates in people and dogs. HFNC oxygen therapy was applied to brachycephalic dogs that developed increased work of breathing or hypoxemia in the recovery phase of anesthesia to determine if this device would be tolerable and effective for relief of upper respiratory difficulty. KEY FINDINGS: The HFNC nasal prong interface is well suited to the brachycephalic facial structure. The application of HFNC was found to reduce dyspnea scores in patients with signs of upper airway obstruction after general anesthesia. Aerophagia and changes in PCO2 were noted. SIGNIFICANCE: Application of HFNC in the recovery period may result in improved airflow during times of somnolent obstructive breathing, not unlike the use of continuous positive airway pressure therapy in sleep-disordered breathing in people.

Comparison of high flow nasal cannula oxygen administration to traditional nasal cannula oxygen therapy in healthy dogs.

OBJECTIVE: To determine the feasibility, degree of respiratory support, and safety of high flow nasal cannula (HFNC) oxygen therapy in sedated and awake healthy dogs, when compared to traditional nasal cannula (TNC) oxygen administration. DESIGN: Randomized experimental crossover study. SETTING: University research facility. ANIMALS: Eight healthy dogs. INTERVENTIONS: Variable flow rates (L/kg/min) were assessed, TNC: 0.1, 0.2, and 0.4 and HFNC: 0.4, 1.0, 2.0, and 2.5. HFNC was assessed in sedated and awake dogs. MEASUREMENTS: Variables measured included: inspiratory/expiratory airway pressures, fraction of inspired oxygen (FiO2 ), end-tidal oxygen (ETO2 ), end-tidal carbon dioxide (ETCO2 ), partial pressure of oxygen (PaO2 ), partial pressure of carbon dioxide (PaCO2 ), temperature, heart/respiratory rate, arterial blood pressure, and pulse oximetry. Sedation status, complications, and predefined tolerance and respiratory scores were recorded. MAIN RESULTS: Using HFNC, continuous positive airway pressure (CPAP) was achieved at 1 and 2 L/kg/min. CPAP was not higher at 2.5 than 2 L/kg/min, with worse tolerance scores. Expiratory airway pressures were increased when sedated (P = 0.006). FiO2 at 0.4 L/kg/min for both methods was 72%. FiO2 with TNC 0.1 L/kg/min was 27% and not different from room air. The FiO2 at all HFNC flow rates ≥1 L/kg/min was 95%. PaO2 for HFNC 0.4 L/kg/min was lower than at other flow rates (P = 0.005). The only noted complication was aerophagia. PaCO2 was increased with sedation and use of HFNC when compared to baseline (P = 0.006; P < 0.01). CONCLUSIONS: Use of HFNC in dogs is feasible and safe, provides predictable oxygen support and provides CPAP, but may cause a mild increase in PaCO2 . Flow rates of 1-2 L/kg/min are recommended. If using TNC, flow rates above 0.1 L/kg/min may attain higher FiO2 .

Evaluation of a transcutaneous blood gas monitoring system in critically ill dogs.

OBJECTIVES: To describe the use of a transcutaneous blood gas monitoring system in critically ill dogs, determine if transcutaneous and arterial blood gas values have good agreement, and verify if clinical or laboratory variables are correlated with differences between transcutaneous and arterial blood gas measurements. DESIGN: Prospective observational study. SETTING: University teaching hospital ICU. ANIMALS: Twenty-three client-owned dogs. INTERVENTIONS: In critically ill dogs undergoing arterial blood gas monitoring, a transcutaneous blood gas monitor was used to measure transcutaneous partial pressure of carbon dioxide (PtcCO2 ) and transcutaneous partial pressure of oxygen (PtcO2 ) values 30 minutes after sensor placement, which were compared to PaCO2 and PaO2 values measured simultaneously. Clinical and laboratory variables were concurrently recorded to determine if they were correlated with the difference between transcutaneous and arterial blood gas measurements. MEASUREMENTS AND MAIN RESULTS: Bland-Altman analysis revealed a mean bias of 4.6 ± 26.3 mm Hg (limits of agreement [LOA]: -46.9/+56.1 mm Hg) between PtcO2 and PaO2 and a mean bias of 9.3 ± 8.5 mm Hg (LOA: -7.5/+26.0 mm Hg) between PtcCO2 and PaCO2 . The difference between PtcCO2 -PaCO2 was strongly negatively correlated with HCO3 (-) (r(2) = 0.52, P < 0.001) and PaCO2 (r(2) = 0.58, P < 0.001) and weakly positively correlated with diastolic blood pressure (r(2) = 0.21, P = 0.044), whereas the difference between PtcCO2 -PaCO2 was moderately negatively correlated with diastolic blood pressure (r(2) = 0.33, P = 0.008). CONCLUSIONS: Agreement between transcutaneous and arterial PO2 and PCO2 measurements in these critically ill dogs was inferior to that reported in similar adult and pediatric human studies. The transcutaneous monitor consistently over-estimated PaO2 and PaCO2 and should not be used to replace arterial blood gas measurements in critically ill dogs requiring blood gas interpretation.

Effect of synthetic colloid administration on hemodynamic and laboratory variables in healthy dogs and dogs with systemic inflammation.

OBJECTIVE: To compare the effects of administering equal volumes of isotonic crystalloids and synthetic colloids on hemodynamic and laboratory variables in healthy dogs and dogs with systemic inflammation. DESIGN: Randomized, placebo-controlled, blinded study. SETTING: Comparative clinical research facility. ANIMALS: Sixteen adult purpose-bred Beagles. INTERVENTIONS: Dogs were first randomized to receive either lipopolysaccharide (LPS; 5 µg/kg, IV) or an equal volume of placebo (0.9% NaCl, IV). Dogs were then randomized into 1 of 2 groups receiving fluid resuscitation with either 40 mL/kg IV isotonic crystalloid (0.9% NaCl) or synthetic colloid (tetrastarch). After a 14-day washout, the study was repeated such that dogs received the opposite treatment (LPS or placebo) and the same resuscitation fluid regimen. Vital signs (heart rate (HR), oscillometric blood pressure) were measured and blood samples were collected for PCV, total plasma protein (TPP), serum lactate concentration, and colloid osmotic pressure (COP) measurements. MEASUREMENTS AND MAIN RESULTS: Healthy (placebo) dogs had similar decreases in PCV and TPP after administration of either fluid. Tetrastarch administration was associated with a larger increase in HR, systolic blood pressure, and mean blood pressure. Dogs with systemic inflammation had similar increases in systolic blood pressure and decreases in PCV, TPP, and lactate after administration of either fluid. Tetrastarch administration caused greater immediate increase in HR and mean blood pressure compared to 0.9% NaCl. In all dogs, 0.9% NaCl administration decreased COP and tetrastarch administration increased COP. CONCLUSIONS: Resuscitation with equal volumes of 0.9% NaCl and tetrastarch caused similar changes in hemodynamic and laboratory variables in dogs with LPS-induced systemic inflammation; however, larger increases in HR and blood pressure were seen within the first 2 hours following tetrastarch administration compared to 0.9% NaCl. Tetrastarch administration increased COP in all dogs, despite a decrease in TPP.

A comparison of 3 anesthetic protocols for 24 hours of mechanical ventilation in cats.

OBJECTIVE: To compare the recovery times, recovery quality, and cardiovascular (CV) effects of 3 anesthetic protocols during 24 hours of mechanical ventilation (MV) in healthy cats. DESIGN: Prospective, randomized, crossover study. SETTING: Research laboratory at a veterinary teaching hospital. ANIMALS: Six healthy intact male purpose-bred cats. INTERVENTIONS: Each cat was randomly assigned to receive 3 anesthetic protocols for 24 hours of MV; Protocol K consisted of ketamine, Protocol P, propofol; and Protocol PK, propofol plus fixed-rate low-dose ketamine. Each infusion drug dose was adjusted using a sedation scoring system. All protocols included fixed doses of fentanyl (10 µg/kg/h) and midazolam (0.5 mg/kg/h). MEASUREMENTS AND MAIN RESULTS: Drug doses and recovery times were recorded. Recovery quality was scored. Blood gas results, CV parameters, and frequency of bradycardia or hypotension requiring interventions were recorded. The mean d dose ± standard error of K was 81.3 ± 3.3 µg/kg/m. The median dose (95% cardiac index) of propofol (µg/kg/m) in PK was 16.0 (13.1, 19.6) and in P was 48.1 (39.3, 58.9). P necessitated significantly more propofol than PK (P < 0.05). Protocol K (35.6 ± 3.2 hours) had significantly longer times to full recovery compared to P (18.2 ± 3.2 hours). Protocol K had significantly longer times to head up, crawling, and standing compared to P and PK. Cats sedated with PK (2.33 ± 0.47) required significantly more interventions for hypotension than K (0.50 ± 0.47). Protocol P (3.2 ± 0.4) and PK (1.4 ± 0.3) required significantly more interventions for bradycardia compared to K (0.8 ± 0.3). When comparing protocol K to P and PK, significant differences in blood pressure, lactate, oxygen delivery, and oxygen consumption were noted. CONCLUSIONS: Cats anesthetized with P had shorter times to full recovery compared to K. Cats anesthetized with K required fewer interventions for bradycardia or hypotension but had longer recovery times compared to P or PK. Protocol PK reduced the propofol dose required to maintain optimal anesthesia.

Detection and characterization of Clostridium perfringens in the feces of healthy and diarrheic dogs.

Clostridium perfringens has been implicated as a cause of diarrhea in dogs. The objectives of this study were to compare 2 culture methods and to evaluate a multiplex polymerase chain reaction (PCR) assay to detect C. perfringens toxin genes alpha (α), beta (ß ), beta 2 (ß2), epsilon (ɛ), iota (ι), and C. perfringens enterotoxin (cpe) from canine isolates. Fecal samples were collected from clinically normal non-diarrheic (ND) dogs, (n = 105) and diarrheic dogs (DD, n = 54). Clostridium perfringens was isolated by directly inoculating stool onto 5% sheep blood agar (SBA) and enrichment in brain-heart infusion (BHI) broth, followed by inoculation onto SBA. Isolates were tested by multiplex PCR for the presence of α, ß, ß2, ɛ, ι, and cpe genes. C. perfringens was isolated from 84% of ND samples using direct culture and from 87.6% with enrichment (P = 0.79). In the DD group, corresponding isolation rates were 90.7% and 93.8% (P = 0.65). All isolates possessed the α toxin gene. Beta (ß), ß2, ɛ, ι, and cpe toxin genes were identified in 4.5%, 1.1%, 3.4%, 1.1%, and 14.8% of ND isolates, respectively. In the DD group, ß and ß2 were identified in 5%, ɛ and ι were not identified, and the cpe gene was identified in 16.9% of isolates. Enrichment with BHI broth did not significantly increase the yield of C. perfringens, but it did increase the time and cost of the procedure. C. perfringens toxin genes were present in equal proportions in both the ND and DD groups (P ≤ 0.15 to 0.6). Within the parameters of this study, culture of C. perfringens and PCR for toxin genes is of limited diagnostic usefulness due to its high prevalence in normal dogs and the lack of apparent difference in the distribution of toxin genes between normal and diarrheic dogs.

Investigation of the use of three electroencephalographic electrodes for long-term electroencephalographic recording in awake and sedated dogs.

OBJECTIVE: To compare electroencephalography (EEG) artifact associated with use of the subdermal wire electrode (SWE), gold cup electrode (GCE), and subdermal needle electrode (SNE) over an 8-hour period in sedated and awake dogs. ANIMALS: 6 healthy dogs. PROCEDURES: 8 EEG channels were recorded during 20-minute video-EEG recording sessions (intermittently at 0.5, 2, 4, 6, and 8 hours) with and without chlorpromazine sedation. Nonphysiologic artifacts were identified. Duration of artifact was summed for each channel. Number of unaffected channels (NUC) was determined. RESULTS: NUC was significantly affected by electrode type and sedation over time; median for SWE (2.80 channels; 95% confidence interval [CI], 0.84 to 5.70 channels) was significantly different from medians for GCE (7.87 channels; 95% CI, 7.44 to 7.94 channels) and SNE (7.60 channels; 95% CI, 6.61 to 7.89 channels). After 4 hours, NUC decreased in awake dogs, regardless of electrode type. In awake dogs, duration of artifact differed significantly between SWE and GCE or SNE; medians at 8 hours were 61.55 seconds (95% CI, 21.81 to 173.65 seconds), 1.33 seconds (95% CI, 0.47 to 3.75 seconds), and 21.01 seconds (95% CI, 6.85 to 64.42 seconds), respectively. CONCLUSIONS AND CLINICAL RELEVANCE: The SWE had a significant duration of artifact during recording periods > 2 hours, compared with results for the GCE and SNE, in awake dogs. The GCE, SNE, and sedation resulted in significantly more channels unaffected by artifact. For longer recordings, caution should be exercised in selecting EEG electrodes and sedation state, although differences among electrodes may not be clinically relevant.

A clinical review of peritoneal dialysis.

OBJECTIVE: To review the principles and practice of peritoneal dialysis in veterinary medicine. DATA SOURCES: Clinical and experimental studies and current guideline recommendations from the human literature; and original case studies, case reports, and previous reviews in the veterinary literature. SUMMARY: Peritoneal dialysis involves the exchange of solutes and fluid between the peritoneal capillary blood and the dialysis solution across the peritoneal membrane. It requires placement of a peritoneal dialysis catheter for repeated dialysate exchange. The ideal catheter provides reliable, rapid dialysate flow rates without leaks or infections. Catheter selection and placement are reviewed along with dialysate selection, exchange prescriptions, and overall patient management. PD does not require specific or complex equipment, and it can achieve effective control of uremia and electrolyte imbalances. CONCLUSIONS: Peritoneal dialysis is a potential life-saving measure for patients with acute renal failure. Peritoneal dialysis results in gradual decline in uremic toxins. Previously low success rates have been reported. Improved success rates have been noted in dogs with acute kidney injury (AKI) secondary to leptospirosis. Cats also have a good success rate when PD is elected in patients with a potentially reversible underlying disease. Overall, PD remains a viable intervention for patients with AKI unresponsive to medical management. In select patients a favorable outcome is attained whereby PD provides temporary support until return of effective renal function is attained.

Noninvasive ventilation in cats.

OBJECTIVE: The primary objective of this study was to assess the feasibility of noninvasive mechanical ventilation (NIV) in cats. The secondary objective was to determine whether cardiovascular parameters and anesthetic drug requirements associated with noninvasive ventilation differ from those associated with invasive ventilation. DESIGN: Randomized, cross-over design. SETTING: A research laboratory in a veterinary teaching hospital. ANIMALS: Eight healthy adult cats, 3 intact females and 5 intact males, weighing between 3 and 6 kg, were used. INTERVENTIONS: Each cat was randomly assigned to NIV via nasal mask, or invasive ventilation using an endotracheal tube. Mechanical ventilation was performed for 6 hours. Anesthesia was provided using continuous infusions of propofol and butorphanol. After a minimum 9-day washout period, the procedure was repeated using the alternate ventilation interface. MEASUREMENTS AND MAIN RESULTS: Cardiovascular parameters (heart rate, rectal temperature, direct arterial blood pressure), arterial blood gases, drug requirements, sedation score, and ventilation parameters, were monitored throughout the procedures. These values were evaluated using ANCOVA for repeated measures. All cats were effectively ventilated using NIV. There were no significant differences in cardiovascular parameters, drug requirements, or sedation scores between groups. Although PaCO(2) values did not differ, PaO(2) values were significantly higher in the invasively ventilated group. Inspiratory tidal volumes were similar between groups, whereas expiratory tidal volumes were significantly lower in the NIV group. Inspiratory pressures were significantly higher in the NIV group. Respiratory frequency was significantly higher in the invasively ventilated group. CONCLUSIONS: NIV of cats is possible. However, currently it does not confer any cardiovascular benefit over invasive ventilation and drug requirements are similar. Use of a correctly fitted mask is essential for successful NIV as air leaks account for the observed discrepancy between inspiratory and expiratory volumes. Further investigation into this modality is warranted.

Cluster of methicillin-resistant Staphylococcus aureus colonization in a small animal intensive care unit.

CASE DESCRIPTION: Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from the tracheostomy tube of an 18-month-old castrated male Golden Retriever in the intensive care unit (ICU) of the Ontario Veterinary College. This prompted an investigation of MRSA colonization in other animals in the ICU. CLINICAL FINDINGS: On day 1 of the investigation, MRSA was isolated from nasal swabs obtained from 2 of 10 animals (2/7 dogs and 0/3 cats), including the index case. Subsequently, MRSA was isolated from 3 of 12 animals on day 9; 3 of 9 animals on day 13; and none of 14, 5, and 6 animals on day 20, 27, and 78, respectively. Overall, MRSA was isolated from 6 of 26 (23%) animals during the outbreak period (4/22 dogs and 2/4 cats). The apparent incidence of MRSA acquisition in the ICU from days 1 through 13 was 20% (5/25 animals). No clinical signs of MRSA infections developed. All isolates were indistinguishable from one another. TREATMENT AND OUTCOME: Infection-control measures including active surveillance of all animals in the ICU, barrier precautions, and hand hygiene were used to control the apparent outbreak. CLINICAL RELEVANCE: Methicillin-resistant S aureus is an emerging problem in veterinary medicine. Intensive care units may be at particular risk for periodic outbreaks of colonization and disease. The outbreak of this report highlights the potential for clinically inapparent transmission of MRSA within a facility; infection-control measures that might facilitate MRSA eradication should be considered in ICU settings.

Effects of ranitidine, famotidine, pantoprazole, and omeprazole on intragastric pH in dogs.

OBJECTIVE: To identify the normal gastric acid secretion profile in dogs and determine the degree of gastric acid suppression associated with 4 gastric acid suppressants. ANIMALS: 12 healthy Beagles. PROCEDURE: Intragastric pH was measured continuously for 24-hour periods with a digital recording system placed via a gastrostomy tube. Baseline measurements were obtained when food was withheld and when dogs were fed a standard diet. Dogs were then treated with ranitidine (2 mg/kg, IV, q 12 h), famotidine (0.5 mg/kg, IV, q 12 h), pantoprazole (1 mg/kg, IV, q 24 h), omeprazole (1 mg/kg, PO, q 24 h), or saline solution for 7 days; intragastric pH was recorded on days 0, 2, and 6. Subsequently, the effects of administering famotidine (0.5 mg/kg, IV, q 8 h; 6 dogs) and omeprazole as a suspension (1 mg/kg, PO, q 12 h; 6 dogs) were evaluated. Median 24-hour intragastric pH, percentage of time pH was > or = 3, and percentage of time pH was > or = 4 were determined. RESULTS: Median pH, percentage of time pH was > or = 3, and percentage of time pH was > or = 4 were all significantly higher when food was withheld than when dogs were fed. Famotidine, pantoprazole, and omeprazole significantly suppressed gastric acid secretion, compared with saline solution, as determined on the basis of median 24-hour pH and percentages of time pH was > or = 3 or > or = 4. However, ranitidine did not. Omeprazole suspension suppressed gastric acid secretion. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that in healthy dogs, famotidine, pantoprazole, and omeprazole significantly suppress gastric acid secretion. Twice daily administration of a suspension of omeprazole, was the only regimen tested that approached the potential therapeutic efficacy for acid-related disease when assessed by criteria used for human patients.