2024 AAHA Fluid Therapy Guidelines for Dogs and Cats.

Fluids are drugs used in veterinary patients capable of producing beneficial therapeutic or inadvertent harmful effects within the body's intravascular, interstitial, and intracellular fluid spaces. The individualized design of a fluid therapy plan requires careful patient assessment and targeted selection of proper fluid types, administration routes, and rates, along with adjustments during therapy tailored specifically as per the individual patient's fluid requirement and therapeutic response. Personalized fluid prescriptions and vigilant patient monitoring help avoid patient morbidity from body fluid deficiencies, fluid excess, and electrolyte derangements and support better patient outcomes. These guidelines provide an overview of fluid dynamics within the fluid spaces of the body, describe various types of fluids and their uses, and outline recommendations for fluid administration for resuscitation, rehydration, and maintenance purposes. The guidelines also outline approaches to fluid therapy for anesthetized patients and reiterate the recommendations of reduced fluid rates in this population of patients. Additionally, the guidelines include practical fluid therapy strategies for patients with various common disorders. The goal of these guidelines is to help veterinary professionals safely and effectively prescribe and administer fluid therapy for canine and feline patients.

Delay of definitive care in cats and dogs with gastrointestinal foreign body obstruction following antiemetic administration: 537 cases (2012-2020).

OBJECTIVE: To determine whether administration of antiemetic medication to dogs and cats with gastrointestinal foreign body obstruction (GIFBO) delays time to definitive care (surgery or endoscopy) and increases the risk of complications. DESIGN: Retrospective study (January 2012-July 2020). SETTING: Private referral center. ANIMALS: Five hundred and thirty-seven (440 dogs and 97 cats). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Medical records of dogs and cats with GIFBO were reviewed for antiemetic administration at the onset of clinical signs, time from onset of clinical signs to first intervention and definitive care, GIFBO-related complications, and length of hospitalization. Antiemetics were prescribed for 200 of 537 patients (158 dogs, 42 cats). Antiemetic administration was associated with an increased time between the onset of clinical signs and definitive care (3.2 days [95% confidence interval, CI, 2.8-3.5] vs. 1.6 days [95% CI, 1.4-2.0]; P < 0.001) but not with GIFBO-associated complications (P = 0.45). Antiemetic administration was associated with an increased length of hospitalization (1.6 days [95% CI, 1.4-1.7] vs. 1.1 days [95% CI, 1.1-1.2]; P < 0.001). A longer duration of clinical signs prior to intervention was associated with GIFBO-related complications (P < 0.001) regardless of antiemetic administration. CONCLUSIONS: Antiemetic administration in patients with GIFBO was associated with increased time to definitive care and length of hospitalization but not GIFBO-associated complications. Antiemetics are not inherently contraindicated in patients for whom GIFBO is a differential, but clients should be counseled to monitor for progression of clinical signs and follow-up accordingly.

Traumatic Brain Injury-A Review of Intravenous Fluid Therapy.

This manuscript will review intravenous fluid therapy in traumatic brain injury. Both human and animal literature will be included. Basic treatment recommendations will also be discussed.

Crystalloid and Colloid Compositions and Their Impact.

This manuscript will review crystalloid (hypo-, iso-, and hyper-tonic) and colloid (synthetic and natural) fluids that are available for intravenous administration with a focus on their electrolyte, acid-base, colligative, and rheological effects as they relate to each solution's efficacy and safety. The goal is for the reader to better understand the differences between each fluid and the influence on plasma composition, key organ systems, and their implications when used therapeutically in animals with critical illness.

Effect of prazosin on feline recurrent urethral obstruction.

OBJECTIVES: The aim of this study was to determine if male cats treated with 7 days of prazosin following relief of urethral obstruction (UO) experienced decreased rates of recurrent urethral obstruction (rUO) within 30 days vs those treated with 7 days of placebo. METHODS: All castrated male cats presenting for the first time with UO from May 2014 to August 2017 were eligible for enrollment. Exclusion criteria included the administration of medications or passage of a urinary catheter prior to referral, the presence of heart disease or hypertension requiring medication, prior treatment with glucocorticoids, non-steroidal anti-inflammatory medications, prazosin or phenoxybenzamine, or radiographic identification of cystoliths. Cats were treated with standardized anesthetic and analgesic protocols, standardized indwelling urinary catheter management, and were hospitalized for care. A random numbers table was generated prior to study initiation and cats were randomized to receive either prazosin (0.5 mg PO q12h for 7 days) or placebo in a blinded fashion. A 30-day follow-up with owners via telephone was performed to identify the rate of rUO. Cats that did not receive the full course of study medication were removed from the analysis. The study was unblinded at the end of data collection. RESULTS: Eighty cats were enrolled and 65 cats completed the study; 12 were excluded because they did not receive the study medication. Sixteen of 65 cats experienced rUO (25%). Of the 16 cats experiencing rUO, five received placebo (n = 5/28 [18%]) and 11 received prazosin (n = 11/37 [30%]). Ten of the cats that experienced rUO reblocked while still hospitalized. There was no significant difference in frequency of rUO in cats treated with prazosin vs placebo (P = 0.27). CONCLUSIONS AND RELEVANCE: Prazosin administered at 0.5 mg PO q12h did not decrease the rate of rUO in this population of obstructed male cats vs placebo. These results further support evidence suggesting that prazosin may not be beneficial in prevention of feline rUO.

Percent recovery of insulin from two different concentrations (3 U/250 mL and 45 U/250 mL) of regular insulin solutions prepared for continuous rate infusion.

OBJECTIVE: To compare the percent recovery of regular insulin prepared for administration as a continuous rate infusion (CRI) using 2 different concentrations, 3 and 45 U in 250 mL 0.9% saline. DESIGN: In vitro experiment SETTING: Privately-owned emergency and referral teaching hospital. ANIMALS: None INTERVENTION: Commercial 250 mL 0.9% sodium chloride IV fluid bags were injected with either 3 U (solution bag A) or 45 U (solution bag B) of regular insulin. The insulin concentration was measured in each bag. A fluid administration and extension set were connected to each bag and 50 mL was drained through the IV tubing. The insulin concentration was then measured from samples post washout. MEASUREMENTS AND MAIN RESULTS: Comparison of the concentration of insulin injected into the bag and concentration of insulin in the bag showed that there was a 29.7 and 37.3% recovery of insulin from solution bag A and solution bag B, respectively. Comparison of the concentration of insulin injected into the bag and concentration of insulin in the post 50-mL washout samples showed that there was an 11.9 and 30.6% recovery of insulin from bags A and B, respectively. CONCLUSIONS: Substantially more insulin was available after a 50-mL washout from solution bag B compared to solution bag A. Insulin binding to the IV bag and fluid administration set is likely the cause of this difference. CLINICAL SIGNIFICANCE: Patients receiving lower concentrations of insulin as a CRI, such as might be prescribed for cats and small dogs may require longer time for resolution of hyperglycemia and ketonemia.

Preliminary evaluation of the efficacy of intravenous magnesium sulfate for the treatment of ventricular arrhythmias in 16 dogs.

OBJECTIVE: To evaluate the efficacy of IV magnesium sulfate in decreasing the number of ventricular ectopic beats or convert ventricular tachyarrhythmia to sinus rhythm in dogs. DESIGN: Prospective, observational feasibility study. SETTING: Private referral center. ANIMALS: Sixteen client-owned dogs exhibiting 1 or more of the following: (1) sustained or paroxysmal ventricular tachycardia (heart rate > 180/min), (2) single or multiform ventricular complexes at > 60 ectopies/min. INTERVENTIONS: Pretreatment (T1) blood creatinine and electrolyte concentrations were measured. A 60-second lead II ECG strip and systolic arterial blood pressure (SABP) were recorded. Magnesium sulfate 0.1 mmol/kg (0.2 mEq/kg) was administered IV over 5 minutes. Five minutes after completion of the magnesium sulfate injection (T2), electrolyte concentrations were measured again. A second 60-second lead II ECG strip and SABP were recorded. The number of ectopic ventricular and supraventricular beats (sinus beats) that occurred in 60 seconds during the T1 and T2 ECG recordings was compared. T1 and T2 electrolytes and SABP were also compared. RESULTS: There was an increase in the ionized magnesium concentration, a decrease in the heart rate and the number of ventricular ectopic beats, and an increase in the number of supraventricular beats at T2. Two dogs converted to a sinus rhythm at T2 that was not sustained. CONCLUSIONS: Intravenous administration of 0.1 mmol/kg (0.2 mEq/kg) magnesium sulfate in dogs with ventricular ectopy decreased the number of ventricular beats and heart rate. However, a specific conclusion regarding the use of magnesium sulfate as a first-line therapy for dogs with ventricular tachyarrhythmias at the investigated dose cannot be made.

Incidence of hypochloremic metabolic alkalosis in dogs and cats with and without nasogastric tubes over a period of up to 36 hours in the intensive care unit.

OBJECTIVE: To evaluate the incidence of hypochloremic metabolic alkalosis (HCMA) in dogs and cats in the ICU that had intermittent nasogastric tube (NGT) aspiration for up to 36 hours. DESIGN: Prospective cohort study (December 2013 to October 2014). SETTING: Privately owned emergency and referral teaching hospital. ANIMALS: Forty-nine client-owned dogs and 16 client-owned cats. INTERVENTIONS: Patients wherein NGT placement was recommended and client consent was obtained were included in the interventional group. Those with an NGT placed (NGT group) had the NGT aspirated every 4 hours. Patients for whom placement of a NGT was declined by the owner served as a reference group (NoNGT). Venous blood gas and electrolyte values were obtained every 12 hours. MEASUREMENTS AND MAIN RESULTS: Thirty-five dogs and cats had an NGT placed. Thirty dogs and cats did not have an NGT placed. The serum venous blood gas and electrolyte changes were compared over time within the NGT group and between the NGT and NoNGT groups. No cases developed HCMA. In the NGT group, blood pH increased over time. There was no significant difference between the NGT and the NoNGT group in the average value of pH, HCO3- , base excess, chloride, or corrected chloride. Serum venous blood gas, chloride, and corrected chloride changes were not associated with the volumes of gastric fluid aspirated over time. CONCLUSIONS: In this small population of dogs and cats, intermittent NGT aspiration was not associated with the development of HCMA over a period of up to 36 hours after NGT placement.

Diabetic ketoacidosis in the cat: Recognition and essential treatment.

Practical relevance: Diabetic ketoacidosis (DKA) is a not uncommon emergency in both newly diagnosed and poorly regulated diabetic cats. When there is a heightened metabolic rate and energy requirement due to concurrent illness, an increase in the release of glucose counter-regulatory hormones causes insulin receptor resistance, lipolysis, free fatty acid release and ketogenesis. This necessitates not only treatment to eliminate the ketosis and control blood glucose, but also investigation of concurrent illnesses. Clinical challenges: A number of metabolic derangements can occur with DKA, requiring a comprehensive diagnostic evaluation, elimination of ketones, careful correction of glucose, electrolyte and acid base abnormalities, and close monitoring. AUDIENCE: Any veterinarian that cares for cats in urgent and emergency situations should understand the pathophysiology of DKA in order to address an individual's clinical signs and metabolic derangements. Evidence base: This review draws evidence from the peer-reviewed literature as well as the author's personal clinical experience.

Utstein-style guidelines on uniform reporting of in-hospital cardiopulmonary resuscitation in dogs and cats. A RECOVER statement.

OBJECTIVE: To provide recommendations for reviewing and reporting clinical in-hospital cardiopulmonary resuscitation (CPR) events in dogs and cats and to establish nonambiguous operational definitions for CPR terminology. DESIGN: Consensus guidelines. SETTING: International, academia, referral practice, general practice, and human medicine. METHODS: An international veterinary Utstein task force was convened in April 2013 in San Francisco to determine the scope of the project, the variables to be reported, their definitions, and a reporting template. Factors that were essential for meaningful data reporting and were amenable to accurate collection (ie, core variables) and additional variables useful for research projects and hypothesis generation (ie, supplemental variables) were defined. Consensus on each item was either achieved during that meeting or during the subsequent online modified Delphi process and dialogue between task force members. RESULTS: Variables were defined and categorized as hospital, animal, event (arrest), and outcome variables. This report recommends a template for standardized reporting of veterinary in-hospital CPR studies involving dogs or cats. Core elements include the suspected cause(s) and location of arrest, first rhythm identified, the occurrence of return of spontaneous circulation (ROSC) of more than 30 seconds (any ROSC) or more than 20 minutes (sustained ROSC), survival to discharge, and functional capacity at discharge. If CPR is discontinued or the patient is euthanized by owner request, a reason is reported. The task force suggests a case report form to be used for individual resuscitation events. CONCLUSIONS: The availability of these veterinary small animal CPR reporting guidelines will encourage and facilitate high-quality veterinary CPR research, improve data comparison between studies and across study sites, and serve as the foundation for veterinary CPR registries.

Autologous blood transfusion in dogs with thoracic or abdominal hemorrhage: 25 cases (2007-2012).

OBJECTIVE: To describe the use and outcome following autologous blood transfusion (ABT) in dogs. DESIGN: Retrospective study (January 2007-July 2012). SETTING: Private veterinary referral center. ANIMALS: Twenty-five dogs that underwent ABT secondary to thoracic or abdominal hemorrhage. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The hospital transaction database was searched using the keyword "autotransfusion" from January 2007 to July 2012. Data collected included signalment, body weight, etiology of hemorrhage, source and method of collection, volumes and method of ABT administration, use of anticoagulant, reported complications, and outcome. Twenty-five dogs were included for a total of 27 ABTs. Causes of hemorrhage included vascular trauma (14/25 dogs, 56%), ruptured tumor (8/25, 32%), and coagulopathy attributed to brodifacoum toxicosis (3/25, 12%). Autologous blood was collected from the abdominal (19/25, 76%), thoracic (5/25, 20%), or abdominal and thoracic cavities (1/25, 4%). Anticoagulant was added to the ABT blood in 13 of 25 (52%) cases. A median ABT volume of 29.3 mL/kg (range 2.9-406.9 mL/kg) was infused through either a 210 µm blood administration filter (21/27, 78%) or an 18 µm hemonate filter (6/27, 22%). Reported complications that may have been associated with ABT included hypocalcemia (4/17, 24%), hemolyzed serum (5/19, 26%), and prolonged coagulation times (4/5, 80%). These complications were considered of minimal clinical significance. Additional blood products were administered in 17 of 25 (68%) dogs. Seventeen (68%) dogs survived to discharge. Cause of death in the remaining cases was euthanasia or cardiac arrest secondary to uncontrollable hemorrhage. CONCLUSIONS: ABT is an adjunct to volume replacement in dogs with thoracic or abdominal hemorrhage secondary to vascular trauma, ruptured tumor, or anticoagulant rodenticide toxicosis. ABT may be used as bridge to definitive hemorrhage control, particularly when other blood products are not available or affordable. Complications may include hypocalcemia, prolonged coagulation times, and hemolysis.

Magnesium physiology and clinical therapy in veterinary critical care.

OBJECTIVE: To review magnesium physiology including absorption, excretion, and function within the body, causes of magnesium abnormalities, and the current applications of magnesium monitoring and therapy in people and animals. ETIOLOGY: Magnesium plays a pivotal role in energy production and specific functions in every cell in the body. Disorders of magnesium can be correlated with severity of disease, length of hospital stay, and recovery of the septic patient. Hypermagnesemia is seen infrequently in people and animals with significant consequences reported. Hypomagnesemia is more common in critically ill people and animals, and can be associated with platelet, immune system, neurological, and cardiovascular dysfunction as well as alterations in insulin responsiveness and electrolyte imbalance. DIAGNOSIS: Measurement of serum ionized magnesium in critically or chronically ill veterinary patients is practical and provides information necessary for stabilization and treatment. Tissue magnesium concentrations may be assessed using nuclear magnetic resonance spectroscopy as well as through the application of fluorescent dye techniques. THERAPY: Magnesium infusions may play a therapeutic role in reperfusion injury, myocardial ischemia, cerebral infarcts, systemic inflammatory response syndromes, tetanus, digitalis toxicity, bronchospasms, hypercoagulable states, and as an adjunct to specific anesthetic or analgesic protocols. Further veterinary studies are needed to establish the frequency and importance of magnesium disorders in animals and the potential benefit of magnesium infusions as a therapeutic adjunct to specific diseases. PROGNOSIS: The prognosis for most patients with magnesium disorders is variable and largely dependent on the underlying cause of the disorder.

Hydroxyethyl starch: a review of pharmacokinetics, pharmacodynamics, current products, and potential clinical risks, benefits, and use.

OBJECTIVE: To review and summarize the pharmacokinetics and pharmacodynamics of hydroxyethyl starch (HES), as well as reported risks and benefits of HES infusion, and to provide administration and monitoring recommendations for HES use in dogs and cats. DATA SOURCES: Veterinary and human peer-reviewed medical literature, including scientific reviews, clinical and laboratory research articles, and authors' clinical experience. SUMMARY: HES solutions are the most frequently used synthetic colloid plasma volume expanders in human and veterinary medicine. The majority of research in human medicine has focused on the adverse effects of HES infusion, with emphasis on acute kidney injury and coagulation derangements. The studies often differ in or fail to report factors, such as the type, amount, interval, and concentration of HES administered; the patient population studied; or concurrent fluids administered. Currently, there is no definitive clinical evidence that the reported adverse effects of HES use in human medicine occur in veterinary species. There is little information available on HES administration techniques or simultaneous administration of additional fluids in human and veterinary medicine. The rationale for HES use in small animals has been largely extrapolated from human medical studies and guidelines. A controlled approach to intravenous fluid resuscitation using crystalloid and HES volumes titrated to reach desired resuscitation end point parameters is outlined for small animal practitioners. CONCLUSION: The extrapolation of data from human studies directly to small animals should be done with the knowledge that there may be species variations and different pharmacokinetics with different HES solutions. Veterinary reports indicate that bolus and continuous rate infusions of 6% hetastarch solutions at moderate doses are well tolerated in feline and canine subjects. Further research in domesticated species is necessary to better define and expand the knowledge regarding use of HES solutions in small animal medicine.

Comparison of Hb-200 and 6% hetastarch 450/0.7 during initial fluid resuscitation of 20 dogs with gastric dilatation-volvulus.

OBJECTIVE: To compare the use of polymerized stroma-free bovine hemoglobin (Hb-200) and 6% hetastarch 450/0.7 (HES 450/0.7) in 0.9% saline during fluid resuscitation of dogs with gastric dilatation-volvulus (GDV). DESIGN: Prospective, randomized clinical case series. SETTING: Private specialty and referral clinic. ANIMALS: Twenty client-owned dogs presenting with GDV. INTERVENTIONS: Dogs presenting with GDV and abnormal perfusion parameters first received rapid IV infusion of a buffered isotonic replacement crystalloid (15 mL/kg) and IV opioids. Patients were then randomized to receive either Hb-200 (N = 10) or HES 450/0.7 (N = 10). Balanced isotonic replacement crystalloids (10-20 mL/kg IV) were rapidly infused along with either Hb-200 or HES in 5 mL/kg IV aliquots to meet resuscitation end points. MEASUREMENTS AND MAIN RESULTS: Resuscitation was defined as meeting at least 2 of 3 criteria: (1) capillary refill time 1-2 seconds, pink mucous membrane color, strong femoral pulse quality; (2) heart rate (HR) ≤ 150/min; or (3) indirect arterial systolic blood pressure (SBP) > 90 mm Hg. HR, SBP, packed cell volume, hemoglobin, glucose, venous pH, bicarbonate, base excess, anion gap, and colloid osmotic pressure were compared at hospital entry and within 30 minutes post-resuscitation. Compared to the HES group, the Hb-200 group required significantly less colloid (4.2 versus 18.4 mL/kg) and crystalloid (31.3 versus 48.1 mL/kg) to reach resuscitation end points (P = 0.001). Time to resuscitation was significantly shorter in the Hb-200 group (12.5 versus 52.5 min). CONCLUSIONS: Dogs with GDV receiving Hb-200 during initial resuscitation required smaller volumes of both crystalloid and colloid fluids and reached resuscitation end points faster than dogs receiving HES 450/0.7 (P = 0.02).

The role of aquaporin 4 in the brain.

Emerging evidence suggests that aquaporin (AQP) 4 water channels play an important role in water homeostasis in the brain. These water channels are most abundant in the cell membrane of astrocytes, but are also present within ependymal cell membranes and in osmosensory areas of the hypothalamus. Water transport through AQP4 depends on concentration gradients across the membrane, but the rate of transport is determined by the capacity of astrocytes to up- and down-regulate AQP4 numbers, their location within the membrane, and the overall permeability of the channel. Other functions of brain AQP4 involve potassium uptake and release by astrocytes, migration of glial cells, glial scarring, and astrocyte-to-astrocyte cell communication. AQP water channels are involved in formation and control of edema in the brain and in multiple disease processes in the brain, such as seizures and tumors. There is abundant scientific literature on AQP4 describing its structure, function, location, and role in water homeostasis and edema in the brain. Investigation of AQP expression in the canine and feline brain should be pursued so that clinically relevant comparisons between findings in mice, rats, and people and animal patients can be made.

Evaluation of the effects of bovine hemoglobin glutamer-200 on systolic arterial blood pressure in hypotensive cats: 44 cases (1997-2008).

OBJECTIVE: To determine effects of bovine hemoglobin glutamer-200 (Hb-200) solution on systolic arterial blood pressure (SAP) in hypotensive cats and describe potential adverse effects associated with this treatment. DESIGN: Retrospective case series. ANIMALS: 44 cats. PROCEDURES: Medical records of hypotensive (Doppler SAP ≤ 80 mm Hg) cats that received Hb-200 treatment were reviewed. Volume and rate of Hb-200 administration, treatments for hypotension given prior to Hb-200 administration, changes in SAP, potential adverse effects, and short-term outcome were evaluated. RESULTS: 44 cats were included in the study. Mean ± SD SAP prior to Hb-200 administration was 52 ± 11 mm Hg, despite other treatments. Forty-three cats received Hb-200 via IV bolus administration (mean ± SD volume, 3.1 ± 2.2 mL/kg [1.41 ± 1.0 mL/lb] over 25.17 ± 17.51 minutes); 1 cat received a continuous rate infusion (CRI) only. The SAP increased to > 80 mm Hg in 33 of 44 (75%) cats. The SAP increased > 20 mm Hg above baseline value in 29 of these 33 cats and in 4 cats in which SAP did not exceed 80 mm Hg. A CRI (mean ± SD rate, 0.8 ± 0.5 mL/kg/h [0.36 ± 0.23 mL/lb/h]) of Hb-200 was administered to 37 cats (after bolus infusion in 36). Mean SAP during the CRI was 92 ± 18 mm Hg. Adverse effects included respiratory changes (n = 8 cats), vomiting (2), and pigmented serum (30). Seventeen (39%) cats survived to discharge from the hospital, 6 died, and 21 were euthanized. CONCLUSIONS AND CLINICAL RELEVANCE: Hb-200 effectively increased SAP in hypotensive cats with few adverse effects.

Evaluation of initial plasma lactate values as a predictor of gastric necrosis and initial and subsequent plasma lactate values as a predictor of survival in dogs with gastric dilatation-volvulus: 84 dogs (2003-2007).

OBJECTIVE: To test whether an initial plasma lactate ≥ 6.0 mmol/L is associated with the presence of macroscopic gastric wall necrosis and overall survival in dogs presenting with gastric dilatation-volvulus (GDV). Additionally, if no association was identified we sought to identify a different predictive initial plasma lactate concentration and to examine whether serial plasma lactate concentrations provide better prediction of survival. DESIGN: Retrospective study over a 5-year period (2003-2007). SETTING: Urban private referral small animal teaching hospital. ANIMALS: Eighty-four client-owned dogs with a diagnosis of GDV and plasma lactate measurements. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: There was no statistically significant relationship found between survival and the presence of macroscopic gastric wall necrosis with the initial plasma lactate ≥ 6 mmol/L. There was a significant relationship between the initial plasma lactate >2.9 mmol/L for predicting necrosis and <4.1 mmol/L for predicting survival to discharge. Forty dogs that had an increased initial plasma lactate (>2.5 mmol/L) also had a subsequent plasma lactate measured within 12 hours of presentation, with 37/40 dogs surviving and 70% of these surviving dogs having the subsequent lactate decrease by ≥ 50% within 12 hours. The 3/40 that died failed to decrease their plasma lactate by ≥ 50% from the initial blood lactate. CONCLUSION: The results of this study indicate that an initial presenting plasma lactate concentration ≥ 6.0 mmol/L is not predictive of macroscopic gastric wall necrosis or survival in dogs presenting with GDV. A decrease in plasma lactate concentrations ≥ 50% within 12 hours may be a good indicator for survival. Limitations to the study include its retrospective nature, the small number of patients, and the number of dogs that were euthanized rather than allowed to progress to a natural outcome.

Airway obstruction in a dog after Dieffenbachia ingestion.

OBJECTIVE: To describe a case of Dieffenbachia ingestion in a dog presented for dysphagia and airway obstruction successfully treated with a temporary tracheostomy and supportive care beyond that reported in the veterinary literature. CASE SUMMARY: An 8-year-old male neutered Labrador Retriever, weighing 30 kg, was presented with the complaint of choking and gagging. Abdominal radiographs showed that he had a distended stomach full of foreign material and a gastrotomy was performed. After receiving preanesthetic medication, the dog developed inspiratory stridor and during anesthetic induction, marked oropharyngeal swelling complicated tracheal intubation. During surgery a large amount of dog bedding and Dieffenbachia plant material was removed. Because of the severity of the oropharyngeal swelling, the dog required a temporary tracheostomy and treatment for an acute allergic reaction related to the Dieffenbachia ingestion. The patient was discharged after 6 days in the hospital and had no significant complications. NEW OR UNIQUE INFORMATION PROVIDED: To our knowledge, this is the first reported case of successful treatment of an airway obstruction related to the toxicity of Dieffenbachia ingestion.

Perfusion versus hydration: impact on the fluid therapy plan.

Creating a fluid therapy plan that is adequate to meet an individual patient's needs depends on identifying whether the animal has poor perfusion, is dehydrated, or both. This article reviews the body's fluid compartments, fluid dynamics, and the clinical parameters used to differentiate perfusion from hydration and create a fluid therapy plan.