Retrospective evaluation of transportation and outcome of dogs on a mechanical ventilator: 9 cases

OBJECTIVE

To describe the transportation and clinical outcome of 9 dogs transported to a referral hospital on mechanical ventilation (MV).

DESIGN

Retrospective case series (2015-2020).

SETTING

University teaching hospital.

ANIMALS

Nine dogs transported to a referral center on MV.

INTERVENTIONS

All dogs underwent MV during vehicular transport.

MEASUREMENT AND MAIN RESULTS

The medical records of 9 dogs transported on a MV to a university teaching hospital were reviewed. Data collected included signalment, reason for MV, ventilator settings, sedation protocol, monitoring in transit, distance traveled, complications, clinical outcome, and cost. All dogs transported survived transport to the referral hospital and 8 of 9 were successfully weaned from the ventilator and discharged home.

CONCLUSIONS

MV during transport in this setting was practical and safe. Dogs in this study had a high survival rate compared to previous studies of dogs undergoing MV, likely due to selection of cases assessed to have a correctable underlying disease.

Retrospective study of gross and histopathologic lesions associated with closed chest cardiopulmonary resuscitation in dogs

OBJECTIVES

To investigate and characterise the incidence of iatrogenic complications secondary to closed chest cardiopulmonary resuscitation in dogs.

MATERIALS AND METHODS

Necropsy reports and histologic sections of tissues were retrospectively examined from 180 dogs that had received closed chest cardiopulmonary resuscitation to determine lesions associated with resuscitation.

RESULTS

The most common complication was pulmonary haemorrhage (81/163, 49.7%, 95% confidence interval: 42.1 to 57.3), although only nine dogs had pulmonary haemorrhage of at least moderate severity. Liver fractures occurred in 16 of 180 cases (8.9%, 95% confidence interval: 5.5 to 14.0). Blood loss of >15% of blood volume into the abdomen and/or thorax occurred in 13 of 180 cases (7.2%, 95% confidence interval: 4.2 to 12.1).

CLINICAL SIGNIFICANCE

Significant haemorrhage secondary to cardiopulmonary resuscitation may decrease the chances of achieving the return of spontaneous circulation or may cause or compound ischemic damage to critical organs if the return of spontaneous circulation is achieved. Following successful cardiopulmonary resuscitation, animals should be screened for cavitary or pulmonary haemorrhage, as significant haemorrhage could be a factor in recurrence of cardiac arrest.

Treatment of a massive naproxen overdose with therapeutic plasma exchange in a dog

In comparison with other over-the-counter anti-inflammatory drugs, naproxen has a longer half-life in dogs and can lead to severe morbidity and mortality. This report describes the successful use of membrane-based therapeutic plasma exchange after a massive ingestion of naproxen by a dog resulting in 86% reduction in plasma concentration.

A Randomized Double Blinded Placebo-Controlled Clinical Trial of a Probiotic or Metronidazole for Acute Canine Diarrhea

Acute diarrhea is a common, often self-limiting, cause of presentation for veterinary care, yet there is a paucity of data on frequently-prescribed treatments. The purpose of this randomized, double blinded placebo-controlled clinical trial was to compare two anecdotally-recommended treatments: a probiotic combination and metronidazole. Sixty dogs without concurrent comorbidities were randomized into three treatment groups. The time to resolution of diarrheal signs was evaluated using owner surveys and fecal scoring charts. Dogs presenting with acute diarrhea achieved acceptable fecal consistency after 3.5 ± 2.2 days when receiving probiotic, 4.6 ± 2.4 days with oral metronidazole, and 4.8 ± 2.9 days with placebo; statistically significant differences were not identified between treatment groups (p = 0.17). These findings failed to provide evidence for the common use of metronidazole in this cohort of dogs with acute canine diarrhea, and a larger study population would be required to identify a statistically significant effect of probiotics.

Antiepileptic Drug Use Patterns in Suspect Epileptic Dogs Among Neurology and Emergency Specialists

This study used a cross-sectional survey designed to inquire about antiepileptic drug (AED) use in newly diagnosed idiopathic epileptic dogs among board-certified emergency and neurology specialists. Results were obtained from 300 completed surveys by 128 board-certified neurologists and 172 board-certified emergency and critical care (ECC) specialists. Case volume was slightly different between groups, with 36% of neurologists and 18% of ECC specialists managing >50 cases of first-time canine seizure patients yearly. The initial AED of choice was similar between the groups, with 66% of neurologists and 64% of ECC specialists using phenobarbital and 16% of neurologists and 26% of ECC specialists using levetiracetam. Although most respondents gave a loading dose of phenobarbital, roughly one-fourth of neurologists did not load the drug versus 6% of ECC specialists. The total loading dose was similar between respondents (16 mg/kg) but varied in administration protocol. Approximately half of neurologists and nearly two-thirds of ECC specialists gave a higher initial dose of levetiracetam than recommended. Almost all the respondents who gave a higher initial dose of levetiracetam used 60 mg/kg IV once. Understanding the common practices in AED use may promote future discussions regarding best practices in the management of canine idiopathic epilepsy.

Clearance of plasma ivermectin with single pass lipid dialysis in 2 dogs

OBJECTIVE

To describe the use of single pass lipid dialysis (SPLD) for treatment of ivermectin toxicosis in 2 Australian Shepherd dogs with the ABCB1-1Δ gene mutation.

CASE SERIES SUMMARY

Two Australian Shepherd dogs were presented for treatment of ivermectin toxicosis. Dogs were initially treated with intravenous lipid emulsion and supportive care, without improvement of clinical signs. They both developed respiratory paralysis and required mechanical ventilation. In order to increase the clearance of circulating ivermectin, SPLD was performed using dialysate containing 5% lipid. Blood samples were obtained immediately before and after dialysis and analyzed for serum ivermectin concentration. Ivermectin reduction ratio was calculated at 29% and 39% for each dog, respectively. When compared to intrinsic total body ivermectin clearance, only the second dog had a relative improvement of plasma clearance following SPLD. Both dogs were confirmed to be homozygous for ABCB1-1Δ gene mutations. Both dogs remained ventilator dependent for several days and ultimately made a full recovery.

NEW OR UNIQUE INFORMATION PROVIDED

SPLD may be an adjunctive detoxification strategy for highly lipophilic toxins such as ivermectin.

Temporary percutaneous T-fastener gastropexy and continuous decompressive gastrostomy in dogs with experimentally induced gastric dilatation

OBJECTIVE To evaluate a percutaneous, continuous gastric decompression technique for dogs involving a temporary T-fastener gastropexy and self-retaining decompression catheter. ANIMALS 6 healthy male large-breed dogs. PROCEDURES Dogs were anesthetized and positioned in dorsal recumbency with slight left-lateral obliquity. The gastric lumen was insufflated endoscopically until tympany was evident. Three T-fasteners were placed percutaneously into the gastric lumen via the right lateral aspect of the abdomen, caudal to the 13th rib and lateral to the rectus abdominis muscle. Through the center of the T-fasteners, a 5F locking pigtail catheter was inserted into the gastric lumen and attached to a device measuring gas outflow and intragastric pressure. The stomach was insufflated to 23 mm Hg, air was allowed to passively drain from the catheter until intraluminal pressure reached 5 mm Hg for 3 cycles, and the catheter was removed. Dogs were hospitalized and monitored for 72 hours. RESULTS Mean ± SD catheter placement time was 3.3 ± 0.5 minutes. Mean intervals from catheter placement to a ≥ 50% decrease in intragastric pressure and to ≤ 6 mm Hg were 2.1 ± 1.3 minutes and 8.4 ± 5.1 minutes, respectively. After catheter removal, no gas or fluid leakage at the catheter site was visible laparoscopically or endoscopically. All dogs were clinically normal 72 hours after surgery. CONCLUSIONS AND CLINICAL RELEVANCE The described technique was performed rapidly and provided continuous gastric decompression with no evidence of postoperative leakage in healthy dogs. Investigation is warranted to evaluate its effectiveness in dogs with gastric dilatation-volvulus.

Successful treatment of severe hypokalemia in a dog with acute kidney injury caused by leptospirosis

OBJECTIVE

To report the case management of a patient with severe hypokalemia resulting in cardiopulmonary arrest caused by infection with leptospirosis.

CASE SUMMARY

A 3-year-old intact female Dachshund presented for polyuria, polydipsia, and refractory hypokalemia, which progressed to flaccid paralysis and cardiorespiratory arrest. Following successful resuscitation, the dog was apneic and managed with mechanical ventilation while volume status and electrolytes were corrected. The dog showed rapid improvement allowing for weaning from the ventilator within the first day. The dog was identified as having leptospirosis causing severe kaliuresis (fractional excretion of potassium 31%). Following discharge from hospital, the dog was managed with doxycycline, oral potassium supplementation, and spironolactone and made a full clinical recovery.

NEW OR UNIQUE INFORMATION PROVIDED

This report identifies an unusually severe presentation of leptospirosis in a dog from a region where the disease is not considered common, which was successfully treated despite cardiopulmonary arrest on initial presentation.

Severe Pit Viper Envenomation with Extended Clinical Signs and Treatment Complications in a Dog

This manuscript describes the extended clinical abnormalities that can occur in severe snake envenomation and the clinical signs associated with antivenom hypersensitivity in a 3 yr old dog. Treatment consisted of IV fluid therapy, analgesics, a vasopressor, cardiac antiarrhythmia drugs, and polyvalent pit viper antivenom. Following initial response to treatment, relapse of clinical signs occurred. Most interesting was the recrudescence of clinical signs on day 7 that may have been caused by the release of deposited venom during surgical debridement of necrotic skin. The resulting extensive clinical signs required multiple vials of antivenom (22 vials over a 7 day period). Both F(ab′)2 antivenom and antivenin (Crotalidae) polyvalent were used in this dog because of availability logistics. It is thought that this large amount of antivenom resulted in type I (anaphylaxis) and type III hypersensitivity (serum sickness) reactions. The dog made a complete clinical recovery. This description of extended, fluctuating clinical abnormalities that were associated with envenomation together with the development of hypersensitivity reactions that were presumably secondary to antivenom administration is information that can be useful for the management of patients afflicted with severe pit viper envenomation.

Use of IV Lipid Emulsion for Treatment of Ivermectin Toxicosis in a Cat

Ivermectin toxicosis in cats is infrequently reported. IV lipid emulsion (ILE) is a novel treatment in veterinary medicine that has been used for amelioration of adverse effects seen with multiple lipid soluble compounds. Previously, ILE has been investigated in experimental models with rats, rabbits, pigs, and dogs, mainly for resuscitation of cardiopulmonary arrest and treatment of hypotension due to local anesthetic drug overdose. There are few case reports in veterinary medicine of using ILE for drug toxicity. Only one feline case has been reported, with IV lipids used for treatment of lidocaine toxicity. This report describes a case of ivermectin toxicosis in a 1 yr old domestic shorthair that was safely and successfully treated using ILE.

Cardiopulmonary effects of a new inspiratory impedance threshold device in acute hemorrhagic shock in dogs

OBJECTIVE

To compare cardiovascular and respiratory effects of an inspiratory impedance threshold device (ITD) in dogs before and after induction of acute hemorrhagic shock.

STUDY DESIGN

Prospective experimental randomized study.

ANIMALS

Eight healthy adult dogs.

METHODS

Dogs were anesthetized and maintained on spontaneous ventilation. Tidal volume (V(T)), systolic, mean and diastolic arterial blood pressure (SAP, MAP, DAP), central venous pressure (CVP), gastric P(CO2) (GBF) as an indicator of gastric perfusion, cardiac index (CI), systemic vascular resistance (SVR), oxygen delivery (DO(2)), and plasma lactate were monitored. To monitor respiratory compliance (RC) and respiratory resistance (ResR), animals were briefly placed on mechanical ventilation. Dogs were studied under 4 different conditions: (1) baseline (euvolemic state) (MAP > 60 mm Hg) with and without the ITD and (2) acute hemorrhagic shock (hypovolemic state) (target MAP of 40 mm Hg) with and without ITD. These 4 conditions were performed during one anesthetic period, allowing time for stabilization of parameters for each condition. Data were analyzed by ANOVA for repeated measure mixed models.

RESULTS

No cardiovascular changes were detected between groups with and without use of ITD during euvolemic states. During acute hemorrhagic hypovolemic state, CI and DO(2) were higher with the ITD (2.9 ± 0.6 L/min/m(2)) and (326.5 ± 86.8 mL/min) compared with no ITD (1.8 ± 0.6 L/min/m(2)) and (191.3 ± 58.1 mL/min), respectively. The use of ITD during hypovolemia also increased SAP and MAP. There was an increase in ResR and decreased RC with the ITD in both euvolemic and hypovolemic states.

CONCLUSION AND CLINICAL RELEVANCE

The use of an ITD in dogs during acute hemorrhagic hypovolemic shock improved cardiovascular parameters but had negative effects on RC and ResR.

Acute hyperammonemia after L-asparaginase administration in a dog

OBJECTIVE

To describe a previously unreported and potentially fatal complication of L-asparaginase (L-asp) administration in a dog.

CASE SUMMARY

A 7-year-old, 6.6 kg, female spayed Beagle presented with a 1-week history of progressive inappetance and lethargy. Diagnostic tests identified the presence of stage Vb lymphoma and liver dysfunction. The dog was treated with L-asp at 400 IU/kg, corticosteroids, and IV fluids. Within 12 hours the dog became depressed, vomited, and developed abdominal pain. Within 24 hours, the dog's mentation progressed from obtunded to comatose; subsequently the dog developed a "decerebrate posture." Blood ammonia concentrations exceeded 1,000 μmol/L (1,700 μg/dL). Treatment with broad-spectrum antimicrobials, lactulose enemas, and continuous renal replacement therapy were initiated without response and the dog suffered cardiopulmonary arrest.

NEW OR UNIQUE INFORMATION PROVIDED

The purpose of this report is to describe the development of severe hyperammonemia after L-asp therapy in a dog, which has not been previously reported in the literature. Given the rapid progression and fatal outcome observed in this case, early recognition may be crucial for management and treatment of this complication.

The continuing dental education (CDE) activities of a regional cohort of Irish dentists--a baseline study

The need for continuing dental education (CDE) throughout one's career is becoming increasingly accepted by the modern practitioner. The current paper is part of a longitudinal investigation of the various conceptual, practical and attitudinal aspects of CDE. (Based on the responses of a representative sample of 146 dentists, it documents the level of participation in CDE among practitioners in the South and Mid-West regions of Ireland, at a baseline examination). Only 41% of respondents belonged to more than one professional association, while 55% subscribed to more than one journal. The Irish Dental Association and the present journal dominated these statistics. There was a generally low level of involvement in elements of CDE, such as attendance at scientific conferences, professional courses and occasional meetings. There was a high degree of consistency in the respondents' participation in CDE-related activities. Thus dentists who belonged to a number of organisations and subscribed to various journals, also tended to more frequently attend relevant conferences, courses and meetings. With some exceptions, specialist and hospital-based dentists were more likely to be involved in CDE activities.

Blood loss and haematological consequences related to nasal surgery

A prospective study was carried out to compare blood loss from various types of nasal surgery, to investigate how accurately this loss was estimated during surgery and to find out how soon any losses were replenished. Blood loss during surgery was estimated, and by serial blood tests actual blood loss and continuing changes in haematological parameters were recorded. It was found that blood loss was highest when a nasal polypectomy and submucous resection were performed together and over the whole range of nasal surgery studied the actual blood loss was more than double the estimate during surgery. Although the blood volume recovers soon after surgery it was found that even after 6 weeks many patients had still not made up their loss of haemoglobin.