Vitamin E and exertional rhabdomyolysis during endurance sled dog racing

Clinical Diagnosis of Rhabdomyolysis without Myoglobinuria or Electromyographic Abnormalities in a Dog

A 2-year-old female neutered Old German Shepherd was presented for acute non-ambulatory tetraparesis. Upon presentation to the emergency department, hematology and biochemical blood tests revealed no abnormalities aside from mildly elevated C-reactive protein levels (22.5 mg/L, reference range 0.0-10.0) and immeasurable creatine kinase (CK) activity. Neurological evaluation the next day revealed ambulatory tetraparesis, general proprioceptive deficits, mild ataxia and dubious diffuse myalgia. Withdrawal reflexes were weak on both thoracic and pelvic limbs. The CK was determined to be significantly elevated at that point (32.856 U/L, ref. range 10.0-200.0). Urinalysis revealed no abnormalities. An electromyographic (EMG) study of thoracic limb, paraspinal and pelvic limb muscles revealed no abnormalities. A magnetic resonance imaging (MRI) study of the cervicothoracic spinal cord was performed and revealed no abnormalities. A presumptive clinical diagnosis of rhabdomyolysis without myoglobinuria or EMG abnormalities was formed. Muscular biopsies were declined due to the rapid clinical improvement of the dog. A follow-up showed the progressive decline of CK activity to normal values and clinical remission of signs. A diagnosis of rhabdomyolysis was concluded based on clinical signs, consistent CK activity elevations and the response to supportive treatment for rhabdomyolysis, despite the absence of myoglobinuria and EMG abnormalities. Rhabdomyolysis should not be excluded based on the lack of EMG abnormalities or myoglobinuria in dogs.

The Effect of Two Acute Bouts of Exercise on Oxidative Stress, Hematological, and Biochemical Parameters, and Rectal Temperature in Trained Canicross Dogs

Canicross is a sport discipline that connects human and canine athletes in running. Changes in physiological, hematological, and biochemical parameters, and exercise-induced oxidative stress have not been thoroughly characterized in canicross dogs. The aim of our study was the assessment of the health status of trained canicross dogs that were subjected to two acute bouts of exercise with their owners during the training season. Health status was assessed by measuring the rectal temperature, hematological and biochemical parameters, as well as blood oxidative stress parameters (plasma malondialdehyde, lipid peroxidation marker; whole blood glutathione peroxidase and erythrocyte superoxide dismutase1, antioxidant enzymes) before and during a two-day canicross training session and after a 24-h rest period. Seven trained canicross dogs (three females/four males) aged 12–120 months were included in the study. Blood samples were collected before and immediately after the first acute bout of exercise (day 1), after the second acute bout of exercise (day 2), and after 24 h of rest (day 3). Rectal temperature was measured at the same time as blood sample collection. The majority of hematological and biochemical parameters remained within reference ranges at all sampling times. Rectal temperature was significantly higher after training on days 1 and 2 compared to resting temperature on day 3. Hematological parameters did not change significantly; however, there were significant differences in urea, creatinine, creatine kinase, and triglycerides between specific sampling times. Despite significant changes, these biochemical parameters remained within reference ranges. Significant changes in biochemical parameters seem to reflect the dogs' physiological response to each acute bout of exercise, considering all biochemical parameters and rectal temperature returned to pre-exercise values after a 24-h rest period (day 3). No significant differences in oxidative stress parameters were found between any sampling times. Relatively high erythrocyte superoxide dismutase1 activity at all sampling times may indicate that the canicross dogs are adapted to training by an increased expression of antioxidant enzymes. Based on our results, we can conclude that the trained canicross dogs included in our study were healthy, in good physical condition, and fit for the two acute bouts of field exercise.

Acute nontraumatic rhabdomyolysis in a Greyhound after albuterol toxicosis

OBJECTIVE

To describe the clinical features of rhabdomyolysis due to albuterol toxicosis in a Greyhound.

CASE SUMMARY

A 4-year-old neutered male Greyhound was presented for albuterol toxicosis leading to severe hypokalemia and respiratory paralysis. After 3 hours of mechanical ventilation, pigmenturia and marked enlargement, firmness, and pain of the left thigh muscles were noted. Severe hyperkalemia and cardiac arrhythmias were identified after turning the patient. After discontinuation of mechanical ventilation, other muscles became involved, and the patient developed acute kidney injury and concern for multiple organ dysfunction syndrome over the next 5 days. On day 6, the patient was euthanized, and necropsy revealed myocardial and skeletal muscle necrosis, myoglobinuria, and acute tubular degeneration.

NEW OR UNIQUE INFORMATION PROVIDED

To the authors' knowledge, this is the first case of albuterol toxicosis leading to rhabdomyolysis.

Subclinical hypernatraemia in a population of endurance racing sled dogs

Electrolyte disturbances occur in both human and veterinary endurance athletes; however, hypernatraemia is poorly documented in dogs. To further explore electrolyte changes in canine endurance athletes, we collected blood from two teams of dogs (n=16) participating in the mid-distance (336 km) CanAm race. Serum samples were collected 36 hours before the start and within 20 minutes of race completion. Serum was similarly collected from 18 dogs withdrawn after completing 264 km. Biochemical profiles and aldosterone assays were performed. Mean serum sodium (>155 mEq/l) and corrected chloride concentrations were significantly increased (P<0.01) from baseline in finishing and withdrawn dogs; however, unlike sodium, corrected chloride concentrations remained within the reference interval. Serum phosphorous, hepatic enzymes, cholesterol, creatinine kinase, blood urea nitrogen, globulin, glucose, and iron concentrations were also significantly increased (P<0.01) compared to baseline in both finishing and withdrawn dogs. Both mean serum aldosterone and urea nitrogen concentrations were significantly increased (P<0.01) from baseline in finishing and withdrawn dogs, with finishers having greater concentrations than withdrawn dogs (P<0.01). Pre-race and matched finishing dog populations were then used for correlation analysis. Serum sodium concentrations were significantly (P<0.01) and strongly correlated with chloride (r=0.92), albumin (r=0.88), total protein (r=0.87), globulin (r=0.81), and potassium (r=0.86). Serum sodium concentrations were not significantly correlated with serum aldosterone concentrations (r=0.04, P=0.87). This study uniquely described subclinical hypernatraemia in the canine endurance athlete. The data lend support of dehydration through free water loss as a cause of hypernatraemia likely compounded by insufficient replenishment by drinking. Elevations in aldosterone concentrations in the face of hypernatraemia may be attributed to concurrent extra-renal hypotonic water losses, counter regulatory hormone influences, or physiological hyperthermia. Such findings demonstrate a degree of clinical tolerance for euvolemic driven hypernatraemia in endurance sled dogs, while highlighting the need for appropriate water supplementation.

Effects of Short-Distance Recreational Mushing on Oxytocin, Gastrin, and Creatinine Kinase in Sled Dogs

A considerable increase in creatinine kinase (CK) activity and gastrin hormone due to exercise has been observed in sled dogs during endurance mushing races; however, there have been no studies on sled dogs during recreational mushing. Although oxytocin hormone is involved in social behaviors and empathy, it has not been studied in sled dogs. This study aimed to assess changes in plasma CK activity, and gastrin and oxytocin concentrations in adult sled dogs used in touristic mushing in North Patagonia, Argentina. Blood samples were collected before, during, and after the winter season of 2017. Creatinine kinase activity measurement was done using an enzymatic assay. Hormone analyses were performed using commercial Enzyme-Linked InmunoSorbent Assay kits. Results showed an expected two-fold increase in CK activity during the winter, with recovering basal values after winter (< 400 UI/L), low and stable levels of gastrin (9.4 ± 8.8 pg/mL), and a slight increase in oxytocin (23%) after mushing activities. No evidence indicated gastrin alterations or muscular damage from touristic mushing, but an oxytocin increase would indicate a stimulation of the brain reward system.

Serum Biochemistry and Inflammatory Cytokines in Racing Endurance Sled Dogs With and Without Rhabdomyolysis

Serum muscle enzymes in endurance sled dogs peak within 2–4 days of racing. The object of this study was to compare mid-race serum chemistry profiles, select hormones, markers of inflammation, and the acute phase response in dogs that successfully completed half of the 2015 Yukon Quest sled dog race to their pre-racing samples (n = 14), as well as mid-race samples of successful dogs to those who developed clinical exertional rhabdomyolysis (ER) (n = 5). Concentrations of serum phosphorus in ER dogs were significantly elevated compared to healthy dogs (median 5.5 vs. 4.25 mg/dL, P < 0.01) at mid race. ALT, AST, and CK show a significant increase from pre-race baseline to mid-race chemistries (P < 0.01), with more pronounced increases in dogs with ER compared to healthy racing dogs (CK- median 46,125 vs. 1,743 U/L; P < 0.01). Potassium concentrations were significantly decreased from pre-race baselines in all dogs (median 5.1 vs. 4.5 mEq/L; P < 0.01), and even lower in dogs with ER (median 3.5 mEq/L; P < 0.01) mid-race. No changes in serum pro-inflammatory cytokine concentrations were noted in any groups of dogs. C-reactive protein was elevated in both groups of dogs, but significantly higher in those with ER compared with healthy dogs mid-race (median 308 vs. 164 ug/mL; P < 0.01). Healthy dogs may have CK elevations over 10,000 U/L, and dogs with ER were over 30,000 U/L. Although potassium decreases in healthy endurance sled dogs during racing, it remains in the normal laboratory reference range; however ER dog potassium levels drop further to the point of hypokalemia. Lastly increases in CRP may be reflective of a physiological response to exercise over the course of a race; however high CRP in ER dogs may be capturing an early acute phase response.

Serum myoglobin, creatine kinase, and cell-free DNA in endurance sled dogs and sled dogs with clinical rhabdomyolysis

OBJECTIVE

To evaluate whether cell-free DNA (cfDNA) concentrations are increased in dogs with exertional rhabdomyolysis and whether concentrations are correlated with serum myoglobin concentration and creatine kinase activity.

DESIGN

Observational cohort study.

SETTING

Yukon Quest 1,000-mile International Sled Dog Race 2015.

ANIMALS

Twelve normal competitive sled dogs; 5 dogs with rhabdomyolysis.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Blood was collected from all confirmed cases of exertional rhabdomyolysis and compared to the winning team at the midrace point. Results indicate that median cfDNA did not increase, but decreased by the race finish (prerace = 314.2 ng/mL versus midrace = 283.7 ng/mL versus postrace = 249.5 ng/mL). There were no rises in median cfDNA in dogs with rhabdomyolysis (255 ng/mL) negating its potential utility as a measure of acute skeletal muscle compromise. In contrast, myoglobin concentration and creatine kinase activity at the midrace point for normal dogs were significantly lower than dogs with rhabdomyolysis. Values for myoglobin and creatine kinase were strongly positively correlated (R = 0.91).

CONCLUSIONS

cfDNA is not a useful biomarker for exertional rhabdomyolysis in contrast to myoglobin and creatine kinase. Further evaluation of timing and clinical signs suggests that exertional rhabdomyolysis occurs early in endurance activities. Among the dogs with rhabdomyolysis, the dog that demonstrated clinical signs had the highest serum creatine kinase activity and myoglobin concentration.

Evaluation of Three Hydration Strategies in Detection Dogs Working in a Hot Environment

Physical activity in hot environments can increase the risk of heat stress or heat stroke in dogs. Heat tolerance is influenced by acclimatization to the environment, physical fitness, and hydration state. Three common strategies to promote hydration in working dogs are free access to water (W), oral electrolyte solutions (OESs), and administration of subcutaneous fluids (SQs). None of these methods have been compared for safety or efficacy in a working environment. In a cross-over design, seven vehicle-screening canines were randomly assigned to each of the three hydration strategies during working shifts at the Sarita, TX checkpoint. Physical, behavioral, and biochemical parameters were collected before, during, and after a work shift (mean 5.7 ± 0.8 h). Dogs were given 10 mL/kg oral W, 10 mL/kg chicken flavored OES, or 15 mL/kg of SQs initially followed by controlled access to W or OES. The dogs drank 15.61 ± 4.47 mL/kg/h of W and OES when in the OES group, compared to 7.04 ± 3.42 and 5.56 ± 4.40 mL of W, for the W and SQ groups, respectively. The median environmental temperature was 84.8°F (29.3°C). The median humidity was 70%. Based on mixed effects linear modeling, dogs in the OES and SQ groups had significantly higher total CO₂, and lower packed cell volume and total plasma protein at the end of the day. Creatinine increased a small but significant amount in the SQ group and decreased in the OES group. Searching behaviors were independent of hydration strategy but highly related to the dog specific factors of sex, breed, and activity level. Under conditions of controlled activity in moderate heat and humidity, dogs accustomed to the work and the environment were more likely to increase fluid consumption and hydration when provided a flavored OES. Potential benefits of OES and SQ were indirect and no adverse effects were documented for any of the hydration strategies tested.

Influence of the Environment on Body Temperature of Racing Greyhounds

Heat strain is a potential risk factor for racing greyhounds in hot climates. However, there have been limited studies into the incidence of heat strain (when excess heat causes physiological or pathological effects) in racing greyhounds. The aim of this study was to determine if heat strain occurs in racing greyhounds, and, if so, whether environmental factors (e.g., ambient temperature and relative humidity) or dog-related factors (e.g., sex, bodyweight, color) are associated with the risk of heat strain. A total of 229 greyhounds were included in over 46 race meetings and seven different race venues in South Australia, Australia. Rectal temperatures of dogs were measured pre- and postrace and urine samples collected for analysis of myoglobinuria. Ambient temperature at race times ranged between 11.0 and 40.8°C and relative humidity ranged from 17 to 92%. There was a mean increase in greyhound rectal temperature of 2.1°C (range 1.1-3.1°C). A small but significant association was present between ambient temperature and increase in rectal temperature (r (2) = 0.033, P = 0.007). The mean ambient temperature at race time, of dogs with postrace rectal temperature of or exceeding 41.5°C, was significantly greater than at race time of dogs with a postrace rectal temperature ≤41.5°C (31.2 vs. 27.3°C, respectively, P = 0.004). When the ambient temperature reached 38(o)C, over one-third (39%) of dogs had a rectal temperature >41.5°C. Over half of postrace urine samples were positive by Dipstick reading for hemoglobin/myoglobin, and of 77 urine samples positive for Dipstick readings, 95% were positive for myoglobin. However, urinary myoglobin levels were not associated with ambient temperature or postrace rectal temperatures. The mean increase in rectal temperature was greater in dark (black, blue, brindle) than light (fawn and white) colored greyhounds. The results suggest heat strain occurs in racing greyhounds, evidenced by postrace rectal temperatures over 41.5°C and postrace myoglobinuria. Risk of heat strain may be increased in higher ambient temperatures and in darker colored greyhounds. Further research into the incidence of heat strain in racing greyhounds, and longer term physiological responses to heat strain, are warranted.

Superoxide Dismutase Expression and Oxidative Damage in a Case of Myopathy in Brown Pelicans (Pelecanus Occidentalis)

Four brown pelicans ( Pelecanus occidentalis) housed at a rehabilitation facility were found dead after a 3-day history of muscle weakness and after being fed for about 2 weeks from a recent shipment of fish. The birds had pale streaking of the skeletal and heart muscles. Microscopically, the skeletal muscle, and to a lesser extent the cardiac muscle, had severe myocyte degeneration and necrosis characterized by microvacuolation with loss of cross-striations, condensation of cytoplasm, fragmentation, mineralization, and inflammatory cell infiltrates consisting of multinucleated cells, macrophages, and few heterophils. The findings were consistent with myopathy, and a nutritional myopathy caused by eating rancid fish was suspected. Immunohistochemical staining revealed abundant immunoreactive copper zinc superoxide dismutase and manganese superoxide dismutase either as diffuse homogeneous precipitates or granular aggregates in the cytoplasm of affected cells. Immunoreactivity was directly related to degree of cellular damage as estimated by light microscopic examination. We suggest that the lack of protection, despite upregulation of superoxide dismutase, is most likely attributable to supersaturation of oxidants beyond the capacity of superoxide dismutases to scavenge.

Plasma chemistry before and after two consecutive days of racing in sled dogs: associations between muscle damage and electrolyte status

Exercising long distance endurance sled dogs display plasma biochemistry changes characterised by elevations in creatine kinase (CK) and aspartate aminotransferase (AST), hypoproteinemia, hypoglobulinemia and decreases in sodium and potassium. The aim of this study was to compare resting to day 2 racing plasma biochemistry and associations between electrolytes and markers of muscle damage in well-conditioned sled dogs during a stage-stop race. Blood samples were obtained from 23 dogs prior to the start and on day 2, immediately after racing. Results showed significant decreases in potassium (day 0 – 4.7±0.3 and day 2 – 4.2±0.3 mEq/l), total protein (day 0 – 6.0±0.3 and day 2 – 5.5±0.4 g/dl) and albumin concentrations (day 0 – 3.9±0.2 and day 2 – 3.6±0.3 g/dl). Increases in AST (day 0 – 24±7 and day 2 – 137±97 U/l) and CK activities (day 0 – 129±39 and day 2 – 2,047±2,021 U/l) were also observed. Plasma sodium concentrations were not significantly different after day 2 of racing (day 0 – 153±5.2 and day 2 – 151±4.1). Alterations in plasma electrolytes, and increases in AST, CK, alanine aminotransferase and urea nitrogen were similar to those observed in long distance endurance sled dogs. A strong negative association was observed between plasma potassium and increases in plasma CK activity on day 2 (R2=0.69). The maintenance of sodium concentrations with a concurrent potassium decline, suggests sodium conservation via the renin-angiotensin-aldosterone pathway as previously shown in endurance sled dogs. The negative correlation between muscle damage and plasma potassium warrants further investigation regarding its relationship to rhabdomyolysis.

Serum biochemical, blood gas and antioxidant status in search and rescue dogs before and after simulated fieldwork

The aim of the study was to assess the physiological and antioxidant status before and after a 4 h search and rescue field exercise, with handlers, under warm-weather conditions performing activities compared to a control group of similarly trained dogs at rest. Serum chemistry demonstrated a decrease in serum sodium (Na) and potassium (K) in both exercising and control groups, however only Na was decreased significantly (P < 0.05) after exercise and hematocrits (HCTs) remained unchanged. The exercise group demonstrated significantly decreased serum phosphorus (P) and magnesium (Mg) compared to pre-exercise values, as did the control group (P < 0.025). There was also a significant increase in creatinine kinase concentrations in the exercise groups (P < 0.025). Serum non-esterified fatty acids were increased only in the exercise group after exercise, suggesting fat mobilization to produce energy. The mean total serum antioxidant potential in searching dogs was no different from the pre- and post-exercise values in the control dogs. Serum vitamin E concentrations did not differ between the two groups, with a decreasing trend in both groups. There was a modest decrease in serum uric acid in the control group, while there was a significant rise after exercise in the searching group (P < 0.01). Multiple changes in serum chemistry, HCTs and blood gases were documented in this study, and were similar to those observed after other endurance activities. The lack of hemoconcentration in this field search exercise suggested that even in extreme environmental conditions (heat and humidity), dogs with access to water do not experience significant dehydration or diminished antioxidant status.

Nutrition for working and service dogs

Conformation, genetics, and behavioral drive are the major determinants of success in canine athletes, although controllable variables, such as training and nutrition, play an important role. The scope and breadth of canine athletic events has expanded dramatically in the past 30 years, but with limited research on performance nutrition. There are considerable data examining nutritional physiology in endurance dogs and in sprinting dogs; however, nutritional studies for agility, field trial, and detection are rare. This article highlights basic nutritional physiology and interventions for exercise, and reviews newer investigations regarding aging working and service dogs, and canine detection activities.

Exertional rhabdomyolysis: a clinical review with a focus on genetic influences

In this review, the clinical and laboratory features of exertional rhabdomyolysis (ER) are discussed in detail, emphasizing the full clinical spectrum from physiological elevations of serum creatine kinase after exertion to life-threatening rhabdomyolysis with acute kidney injury and associated systemic complications. Laboratory markers used to diagnose both ER and rhabdomyolysis are very sensitive, but not very specific, and imperfectly distinguish "subclinical" or asymptomatic from severe, life-threatening illness. However, genetic factors, both recognized and yet to be discovered, likely influence this diverse clinical spectrum of disease and response to exercise. Genetic mutations causative for McArdle disease, carnitine palmitoyl transferase deficiency 2, myoadenylate deaminase deficiency, and malignant hyperthermia have all been associated with ER. Polymorphic variations in the myosin light chain kinase, α-actin 3, creatine kinase-muscle isoform, angiotensin I-converting enzyme, heat shock protein, and interleukin-6 genes have also been associated with either ER or exercise-induced serum creatine kinase elevations typical of ER. The prognosis for ER is significantly better than that for other etiologies of rhabdomyolysis, but the risk of recurrence after an initial episode is unknown. Guidelines for management are provided.

The oxidant/antioxidant equilibrium in horses

Since "free radical research" started in 1954, understanding the role of oxidants and antioxidants in physiological and pathological conditions has increased continuously. Oxidants are essentially generated by metabolic enzymes, inflammatory cells and mitochondrial electron leakage; they are indispensable for the cellular redox regulation and may, under certain conditions, have a pro-inflammatory stimulatory role. Endogenous and exogenous antioxidants counterbalance the oxidative processes and so maintain the oxidant/antioxidant equilibrium. Excessive oxidant generation or antioxidant insufficiency can lead to oxidative stress. The aims of this review are: (1) to provide an insight into the concept of the oxidant/antioxidant equilibrium by briefly introducing the oxidant and the antioxidant systems; (2) to describe how the oxidant/antioxidant equilibrium or oxidative stress can be evaluated in horses, and (3) to summarise current knowledge about oxidative stress in equine medicine and equine exercise physiology.

Muscle injury and antioxidant status in sled dogs competing in a long-distance sled dog race

Exercise is associated with an increase in the production of oxidants that may be instrumental in the development of exertional rhabdomyolysis. We speculated that participation in a long-distance sled race would alter antioxidant capacity of dogs, in conjunction with increases in indices of rhabdomyolysis. The objective was to determine the effect of participation in a long-distance sled dog race on antioxidant capacity and plasma creatine kinase (CK) activity in sled dogs. This was a prospective, longitudinal study on a convenience sample of 57 Alaskan sled dogs participating in a 1600 km sled dog race. Blood samples were collected before racing (31 dogs) and after racing (39 dogs) for measurement of plasma vitamin E concentration; CK, aspartate aminotransferase (AST) and caeruloplasmin (CER) activity; and red-blood-cell (RBC) glutathione peroxidase (GPX) and superoxide dismutase (SOD) activity. CER and GPX activities after the race were 26% and 14% lower, respectively, than before racing whereas CK and AST were 300% and 170% greater. There was no change in plasma vitamin E concentration or RBC SOD activity. We conclude that completion of a long-distance sled dog race involving prolonged and repeated submaximal exercise results in a reduction in enzymatic antioxidant activity in the blood of sled dogs.