To report a case of delayed death after initial successful treatment of severe bromethalin intoxication in a cat.
Case Summary
A 2-year-old neutered male domestic shorthair cat presented as a referral for bromethalin toxicosis and progressive neurological decline. At the time of referral, the cat was nonambulatory tetraparetic with minimal motor function in all 4 limbs and exhibited a dull mentation. Within the first 4 hours of hospitalization, the cat's neurological status continued to rapidly decline, and osmotherapy, corticosteroids, and intralipids were administered. The treatment regimen also included levetiracetam, thiamine, cholestyramine, vitamin E, and gingko biloba. Six days after bromethalin ingestion, the cat displayed marked neurological improvement with near normal mentation and mild tetraparesis and was discharged. The cat continued to do well at home with improving neurological status and function. Nine days after discharge, the cat was presented dead on arrival. Postmortem examination revealed transforaminal brain herniation secondary to spongy degeneration of the white matter and increased intracranial pressure as the cause of death.
New Information Provided
To the authors’ knowledge, this is the first report of a cat that suffered delayed death despite initial neurological improvement after being treated for severe bromethalin toxicosis.
目的：报告一例严重溴甲烷中毒的猫在初步成功治疗后延迟死亡的病例：病例摘要：一只两岁大的阉割雄性家养短毛猫因溴甲烷中毒和神经系统功能逐渐衰退而转诊。转诊时，这只猫四肢瘫痪，不能行走，四肢运动功能极弱，神志呆滞。在住院的最初 4 小时内，猫咪的神经状况持续迅速恶化，医生为其注射了渗透疗法、皮质类固醇和体内类脂。治疗方案还包括左乙拉西坦、硫胺素、胆碱、维生素 E 和银杏叶。摄入溴甲烷六天后，猫咪的神经系统明显好转，精神状态接近正常，四肢轻度瘫痪，并已出院。猫咪在家中的表现依然良好，神经状况和功能都有所改善。出院九天后，这只猫突然死亡。尸检显示，死因是继发性脑白质海绵状变性和颅内压增高引起的跨椎间孔脑疝：据作者所知，这是第一份关于猫咪在接受严重溴甲烷中毒治疗后，尽管最初神经系统症状有所改善，但却延迟死亡的报告。
{"title":"Delayed transforaminal brain herniation in a cat following bromethalin intoxication","authors":"Erica Matula VMD, DACVECC, Alicia Mastrocco DVM, DACVECC, Jennifer Prittie DVM, DACVIM, DACVECC, Taryn Donovan DVM, DACVP","doi":"10.1111/vec.13413","DOIUrl":"10.1111/vec.13413","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To report a case of delayed death after initial successful treatment of severe bromethalin intoxication in a cat.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Summary</h3>\u0000 \u0000 <p>A 2-year-old neutered male domestic shorthair cat presented as a referral for bromethalin toxicosis and progressive neurological decline. At the time of referral, the cat was nonambulatory tetraparetic with minimal motor function in all 4 limbs and exhibited a dull mentation. Within the first 4 hours of hospitalization, the cat's neurological status continued to rapidly decline, and osmotherapy, corticosteroids, and intralipids were administered. The treatment regimen also included levetiracetam, thiamine, cholestyramine, vitamin E, and gingko biloba. Six days after bromethalin ingestion, the cat displayed marked neurological improvement with near normal mentation and mild tetraparesis and was discharged. The cat continued to do well at home with improving neurological status and function. Nine days after discharge, the cat was presented dead on arrival. Postmortem examination revealed transforaminal brain herniation secondary to spongy degeneration of the white matter and increased intracranial pressure as the cause of death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> New Information Provided</h3>\u0000 \u0000 <p>To the authors’ knowledge, this is the first report of a cat that suffered delayed death despite initial neurological improvement after being treated for severe bromethalin toxicosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 5","pages":"502-508"},"PeriodicalIF":1.1,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141891178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To investigate the utility of the neutrophil-to-lymphocyte ratio (NLR) as a prognostic marker in cats with blunt trauma.
Design
Retrospective study from January 2018 to December 2021.
Setting
University teaching hospital.
Animals
Medical records of 177 cats admitted with blunt trauma were evaluated. History, clinical findings, blood cell count-based ratios, thoracic radiographs on presentation, and outcome were reviewed. The Animal Trauma Triage (ATT) score was assessed in each cat and classified as mild (1–3), moderate (4–7), and severe trauma (≥8). Forty-eight healthy blood donor cats served as the control population. NLR, neutrophil counts, and lymphocyte counts were compared between cats with blunt trauma and controls, and among trauma patients.
Interventions
None
Measurements and Main Results
NLR, neutrophil counts, and lymphocyte counts significantly differ in cats with blunt trauma compared to controls (p < 0.001), and NLR was higher in patients with thoracic trauma (p = 0.044). Nonsurvivors had lower lymphocyte counts (p = 0.041), although those values do not appear to be clinically relevant. A significant increase in NLR was observed with increasing severity of trauma (p < 0.001). The NLR was not associated with the length of hospitalization, intensive care assistance, or mortality.
Conclusion
NLR is a widely available diagnostic tool, which can be used in addition to ATT to assess trauma severity, although in our study it was not predictive of the outcome.
{"title":"Retrospective evaluation of the neutrophil-to-lymphocyte ratio as a prognostic marker in cats with blunt trauma (2018–2021): 177 cases","authors":"Pavlos G. Doulidis DVM, Yasamin Vali DVM, Caroline Frizzo Ramos DVM, Abigail Guija-de-Arespacochaga DVM, DECVCP","doi":"10.1111/vec.13414","DOIUrl":"10.1111/vec.13414","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate the utility of the neutrophil-to-lymphocyte ratio (NLR) as a prognostic marker in cats with blunt trauma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective study from January 2018 to December 2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>University teaching hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Animals</h3>\u0000 \u0000 <p>Medical records of 177 cats admitted with blunt trauma were evaluated. History, clinical findings, blood cell count-based ratios, thoracic radiographs on presentation, and outcome were reviewed. The Animal Trauma Triage (ATT) score was assessed in each cat and classified as mild (1–3), moderate (4–7), and severe trauma (≥8). Forty-eight healthy blood donor cats served as the control population. NLR, neutrophil counts, and lymphocyte counts were compared between cats with blunt trauma and controls, and among trauma patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interventions</h3>\u0000 \u0000 <p>None</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements and Main Results</h3>\u0000 \u0000 <p>NLR, neutrophil counts, and lymphocyte counts significantly differ in cats with blunt trauma compared to controls (<i>p</i> < 0.001), and NLR was higher in patients with thoracic trauma (<i>p</i> = 0.044). Nonsurvivors had lower lymphocyte counts (<i>p</i> = 0.041), although those values do not appear to be clinically relevant. A significant increase in NLR was observed with increasing severity of trauma (<i>p</i> < 0.001). The NLR was not associated with the length of hospitalization, intensive care assistance, or mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>NLR is a widely available diagnostic tool, which can be used in addition to ATT to assess trauma severity, although in our study it was not predictive of the outcome.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 5","pages":"478-486"},"PeriodicalIF":1.1,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/vec.13414","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141794196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To describe the short-term response, early prognostic markers, and survival after treatment of canine immune-mediated thrombocytopenia (ITP) with human intravenous immunoglobulin (hIVIG) and methylprednisolone.
Design
Retrospective cohort study.
Settings
Private referral veterinary medical center.
Animals
Twenty-seven client-owned dogs with primary or secondary ITP.
Interventions
All dogs received 2 mg/kg IV methylprednisolone once daily and a single infusion of 5% hIVIG administered over 6–12 hours.
Measurements and Main Results
A substantial increase in platelet count within 60 ± 12 hours post-hIVIG infusion (T60) was observed in 19 of the 27 (70%) dogs with ITP (responders). Thirty-four variables, including serum immunoglobulin (Ig) G concentration 24 ± 12 hours post-hIVIG infusion (T24IgG) and increase in serum IgG concentration 24 ± 12 hours post-hIVIG infusion (T24ΔIgG), were compared between responders and nonresponders at 5 different time points. Mortality rates of responders and nonresponders were evaluated 14 days post-hIVIG infusion. Serum T24IgG and serum T24ΔIgG were both significantly higher at T60 in responders. All responders were alive 14 days post-hIVIG infusion, and their mortality rate was significantly lower compared with nonresponders.
Conclusions
Responder dogs had an excellent 14-day survival rate. Serum T24IgG and serum T24ΔIgG concentrations accurately predicted response status at 60 hours post-hIVIG infusion.
{"title":"Retrospective evaluation of the short-term response of human intravenous immunoglobulin therapy in the management of canine immune-mediated thrombocytopenia (2010–2015): 27 cases","authors":"Andrea Zoia DVM, MSc, PhD, DECVIM, Francesca Busato DVM, DECVIM, Michele Drigo DVM, PhD","doi":"10.1111/vec.13408","DOIUrl":"10.1111/vec.13408","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To describe the short-term response, early prognostic markers, and survival after treatment of canine immune-mediated thrombocytopenia (ITP) with human intravenous immunoglobulin (hIVIG) and methylprednisolone.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective cohort study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Settings</h3>\u0000 \u0000 <p>Private referral veterinary medical center.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Animals</h3>\u0000 \u0000 <p>Twenty-seven client-owned dogs with primary or secondary ITP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interventions</h3>\u0000 \u0000 <p>All dogs received 2 mg/kg IV methylprednisolone once daily and a single infusion of 5% hIVIG administered over 6–12 hours.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements and Main Results</h3>\u0000 \u0000 <p>A substantial increase in platelet count within 60 ± 12 hours post-hIVIG infusion (T<sub>60</sub>) was observed in 19 of the 27 (70%) dogs with ITP (responders). Thirty-four variables, including serum immunoglobulin (Ig) G concentration 24 ± 12 hours post-hIVIG infusion (T<sub>24</sub>IgG) and increase in serum IgG concentration 24 ± 12 hours post-hIVIG infusion (T<sub>24</sub>Δ<sub>IgG</sub>), were compared between responders and nonresponders at 5 different time points. Mortality rates of responders and nonresponders were evaluated 14 days post-hIVIG infusion. Serum T<sub>24</sub>IgG and serum T<sub>24</sub>Δ<sub>IgG</sub> were both significantly higher at T<sub>60</sub> in responders. All responders were alive 14 days post-hIVIG infusion, and their mortality rate was significantly lower compared with nonresponders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Responder dogs had an excellent 14-day survival rate. Serum T<sub>24</sub>IgG and serum T<sub>24</sub>Δ<sub>IgG</sub> concentrations accurately predicted response status at 60 hours post-hIVIG infusion.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 5","pages":"465-477"},"PeriodicalIF":1.1,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To determine the prevalence of veterinary emergency service pause systems (VESPSs) and describe aspects of implementation and perceived impact.
Design
Electronic questionnaire
Setting
Membership of the Veterinary Emergency and Critical Care Society (VECCS).
Animals
None.
Interventions
None.
Measurement and Main Results
A questionnaire was distributed to 6176 VECCS members with 1168 responses. Seventy-six percent of the respondents were veterinarians. Ninety-one percent of respondents practice in the United States, with 74% of them working at 24/7 multispecialty practices. Eighty-seven percent of respondents indicated patient volume had increased, and 75% reported that a VESPS had been implemented between September 2020 and December 2021. Sixty-two percent reported that their emergency service had been paused or closed once per week or more. The top reasons for implementing a VESPS included excessive caseload and staffing shortages. A variety of methods were utilized to implement a pause. Sixty-nine percent reported their VESPS was less than ideal for effectiveness. Pause systems were reported to be highly supported by medical staff. Seventy-seven percent reported increased client frustration and complaints, and 57% reported staff were stressed from denying care. Of those who do not currently have a VESPS in place, 74% would prefer to have one.
Conclusions
VESPSs were in widespread use at the time of this survey, and most have been implemented between September 2020 and December 2021. The majority of VESPSs were employed to mitigate increased caseload and staffing shortages. Although VESPSs are largely supported by medical staff, drawbacks may include staff stress and client frustrations, and improvements are warranted.
{"title":"Evaluation of the implementation, frequency of use, type, and impact of veterinary emergency service pause systems","authors":"Andrew Linklater DVM, DACVECC","doi":"10.1111/vec.13410","DOIUrl":"10.1111/vec.13410","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine the prevalence of veterinary emergency service pause systems (VESPSs) and describe aspects of implementation and perceived impact.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Electronic questionnaire</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Membership of the Veterinary Emergency and Critical Care Society (VECCS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Animals</h3>\u0000 \u0000 <p>None.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interventions</h3>\u0000 \u0000 <p>None.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurement and Main Results</h3>\u0000 \u0000 <p>A questionnaire was distributed to 6176 VECCS members with 1168 responses. Seventy-six percent of the respondents were veterinarians. Ninety-one percent of respondents practice in the United States, with 74% of them working at 24/7 multispecialty practices. Eighty-seven percent of respondents indicated patient volume had increased, and 75% reported that a VESPS had been implemented between September 2020 and December 2021. Sixty-two percent reported that their emergency service had been paused or closed once per week or more. The top reasons for implementing a VESPS included excessive caseload and staffing shortages. A variety of methods were utilized to implement a pause. Sixty-nine percent reported their VESPS was less than ideal for effectiveness. Pause systems were reported to be highly supported by medical staff. Seventy-seven percent reported increased client frustration and complaints, and 57% reported staff were stressed from denying care. Of those who do not currently have a VESPS in place, 74% would prefer to have one.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>VESPSs were in widespread use at the time of this survey, and most have been implemented between September 2020 and December 2021. The majority of VESPSs were employed to mitigate increased caseload and staffing shortages. Although VESPSs are largely supported by medical staff, drawbacks may include staff stress and client frustrations, and improvements are warranted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 5","pages":"455-464"},"PeriodicalIF":1.1,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mallory V. Horridge DVM, Bridget M. Lyons VMD, DACVECC, Darko Stefanovski BS, MS, PhD, Deborah C. Silverstein BS, DVM, DACVECC
Objectives
To develop a novel illness severity scoring system to identify canine patients with infection that are at higher risk of mortality.
Key Findings
Mentation (Modified Glasgow Coma Scale and the Acute Patient Physiologic and Laboratory Evaluation mentation score), heart rate, pH, Pvco2, potassium, and total plasma protein were found to be associated with mortality on univariate analysis. Logistic regression found that mentation, heart rate, and Pvco2 combined to form the following score: [(100 × mentation score) + (3 × heart rate) + (10 × Pvco2], which was predictive of mortality (area under the receiver operating characteristic curve: 0.88). A cutoff of 900 provided a sensitivity of 80% and a specificity of 80%. If the cutoff was changed to 800, the sensitivity was 100% and the specificity was 50%.
Significance
A novel scoring system was developed to predict mortality in hospitalized dogs with confirmed or suspected infection. Further prospective evaluation in a larger patient cohort is necessary to validate this score.
{"title":"Development of a novel scoring system to predict mortality in canine patients with infection","authors":"Mallory V. Horridge DVM, Bridget M. Lyons VMD, DACVECC, Darko Stefanovski BS, MS, PhD, Deborah C. Silverstein BS, DVM, DACVECC","doi":"10.1111/vec.13405","DOIUrl":"10.1111/vec.13405","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To develop a novel illness severity scoring system to identify canine patients with infection that are at higher risk of mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Key Findings</h3>\u0000 \u0000 <p>Mentation (Modified Glasgow Coma Scale and the Acute Patient Physiologic and Laboratory Evaluation mentation score), heart rate, pH, P<sub>v</sub><span>co</span><sub>2</sub>, potassium, and total plasma protein were found to be associated with mortality on univariate analysis. Logistic regression found that mentation, heart rate, and P<sub>v</sub><span>co</span><sub>2</sub> combined to form the following score: [(100 × mentation score) + (3 × heart rate) + (10 × P<sub>v</sub><span>co</span><sub>2</sub>], which was predictive of mortality (area under the receiver operating characteristic curve: 0.88). A cutoff of 900 provided a sensitivity of 80% and a specificity of 80%. If the cutoff was changed to 800, the sensitivity was 100% and the specificity was 50%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance</h3>\u0000 \u0000 <p>A novel scoring system was developed to predict mortality in hospitalized dogs with confirmed or suspected infection. Further prospective evaluation in a larger patient cohort is necessary to validate this score.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 4","pages":"412-416"},"PeriodicalIF":1.1,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141636043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Manju Gauri Kunchur BVSc, MS, Teri Jo Mauch MD, PhD, FAAP, FASN, Max Parkanzky DVM, MS, DACVIM, Louisa J. Rahilly DVM, DACVECC
Objective
To review the current scientific literature on renal tubular acidosis (RTA) in people and small animals, focusing on diseases in veterinary medicine that result in secondary RTA.
Data Sources
Scientific reviews and original research publications on people and small animals focusing on RTA.
Summary
RTA is characterized by defective renal acid–base regulation that results in normal anion gap hyperchloremic metabolic acidosis. Renal acid–base regulation includes the reabsorption and regeneration of bicarbonate in the renal proximal tubule and collecting ducts and the process of ammoniagenesis. RTA occurs as a primary genetic disorder or secondary to disease conditions. Based on pathophysiology, RTA is classified as distal or type 1 RTA, proximal or type 2 RTA, type 3 RTA or carbonic anhydrase II mutation, and type 4 or hyperkalemic RTA. Fanconi syndrome comprises proximal RTA with additional defects in proximal tubular function. Extensive research elucidating the genetic basis of RTA in people exists. RTA is a genetic disorder in the Basenji breed of dogs, where the mutation is known. Secondary RTA in human and veterinary medicine is the sequela of diseases that include immune-mediated, toxic, and infectious causes. Diagnosis and characterization of RTA include the measurement of urine pH and the evaluation of renal handling of substances that should affect acid or bicarbonate excretion.
Conclusions
Commonality exists between human and veterinary medicine among the types of RTA. Many genetic defects causing primary RTA are identified in people, but those in companion animals other than in the Basenji are unknown. Critically ill veterinary patients are often admitted to the ICU for diseases associated with secondary RTA, or they may develop RTA while hospitalized. Recognition and treatment of RTA may reverse tubular dysfunction and promote recovery by correcting metabolic acidosis.
{"title":"A review of renal tubular acidosis","authors":"Manju Gauri Kunchur BVSc, MS, Teri Jo Mauch MD, PhD, FAAP, FASN, Max Parkanzky DVM, MS, DACVIM, Louisa J. Rahilly DVM, DACVECC","doi":"10.1111/vec.13407","DOIUrl":"10.1111/vec.13407","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To review the current scientific literature on renal tubular acidosis (RTA) in people and small animals, focusing on diseases in veterinary medicine that result in secondary RTA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Sources</h3>\u0000 \u0000 <p>Scientific reviews and original research publications on people and small animals focusing on RTA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Summary</h3>\u0000 \u0000 <p>RTA is characterized by defective renal acid–base regulation that results in normal anion gap hyperchloremic metabolic acidosis. Renal acid–base regulation includes the reabsorption and regeneration of bicarbonate in the renal proximal tubule and collecting ducts and the process of ammoniagenesis. RTA occurs as a primary genetic disorder or secondary to disease conditions. Based on pathophysiology, RTA is classified as distal or type 1 RTA, proximal or type 2 RTA, type 3 RTA or carbonic anhydrase II mutation, and type 4 or hyperkalemic RTA. Fanconi syndrome comprises proximal RTA with additional defects in proximal tubular function. Extensive research elucidating the genetic basis of RTA in people exists. RTA is a genetic disorder in the Basenji breed of dogs, where the mutation is known. Secondary RTA in human and veterinary medicine is the sequela of diseases that include immune-mediated, toxic, and infectious causes. Diagnosis and characterization of RTA include the measurement of urine pH and the evaluation of renal handling of substances that should affect acid or bicarbonate excretion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Commonality exists between human and veterinary medicine among the types of RTA. Many genetic defects causing primary RTA are identified in people, but those in companion animals other than in the Basenji are unknown. Critically ill veterinary patients are often admitted to the ICU for diseases associated with secondary RTA, or they may develop RTA while hospitalized. Recognition and treatment of RTA may reverse tubular dysfunction and promote recovery by correcting metabolic acidosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 4","pages":"325-355"},"PeriodicalIF":1.1,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141636042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Briana M. McConnell DVM, Yonaira Cortes DVM, DACVECC, Dennis Bailey DVM, DACVIM
Objective
To assess the relationship between shock index (SI) and mortality in dogs with head trauma (HT). A secondary objective was to compare SI with the animal trauma triage (ATT) score and Modified Glasgow Coma Scale (MCGS) score in HT cases. A tertiary aim was to assess if SI is predictive of survival to discharge or improvement in presenting neurologic signs.
Design
Retrospective study from January 2015 to December 2020.
Setting
Tertiary referral level II veterinary trauma center.
Animals
Eighty-six dogs with evidence of HT presenting through emergency for various traumas compared to 60 healthy control dogs.
Measurements and Main Results
SI was calculated using the quotient of heart rate over systolic blood pressure measured on presentation. SI was significantly higher in HT patients than healthy controls (P = 0.0019). SI was not significantly different between traumatic brain injury dogs that died or were euthanized and HT dogs that lived until the time of discharge (P = 0.98). SI was not significantly different between HT dogs that were neurologically normal at the time of discharge and HT dogs that were static or improved but not normal neurologically at the time of discharge (P = 0.84). In HT dogs, SI did not correlate with ATT score (P = 0.16) or MGCS score (P = 0.75). There was no significant difference in SI and length of hospitalization until death or discharge (P = 0.78).
Conclusions
SI was significantly higher in HT patients compared to control patients. Interestingly, SI was not correlated with ATT score or MGCS score. The use of SI in HT patients warrants further investigation to assess the efficacy in predicting mortality.
目的：评估休克指数（SI）与头部外伤（HT）犬死亡率之间的关系：评估休克指数（SI）与犬头部外伤（HT）死亡率之间的关系。次要目的是将休克指数与动物创伤分流（ATT）评分和改良格拉斯哥昏迷量表（MCGS）评分进行比较。第三个目的是评估 SI 是否可预测出院后的存活率或出现的神经体征是否有所改善：设计：2015 年 1 月至 2020 年 12 月的回顾性研究：三级转诊二级兽医创伤中心：86只因各种创伤急诊就诊的有HT证据的狗与60只健康对照狗进行比较：SI用发病时测量的心率与收缩压之商计算。HT 患者的 SI 明显高于健康对照组（P = 0.0019）。死亡或安乐死的脑外伤犬与存活至出院的 HT 犬之间的 SI 无明显差异（P = 0.98）。出院时神经系统正常的 HT 狗与出院时静止或有所改善但神经系统不正常的 HT 狗之间的 SI 没有明显差异（P = 0.84）。在 HT 狗中，SI 与 ATT 评分（P = 0.16）或 MGCS 评分（P = 0.75）不相关。SI与死亡或出院前的住院时间没有明显差异（P = 0.78）：结论：与对照组患者相比，高血压患者的 SI 明显更高。有趣的是，SI 与 ATT 评分或 MGCS 评分无关。在高血压患者中使用 SI 值得进一步研究，以评估其在预测死亡率方面的功效。
{"title":"Retrospective evaluation of shock index and mortality in dogs with head trauma (2015–2020): 86 cases","authors":"Briana M. McConnell DVM, Yonaira Cortes DVM, DACVECC, Dennis Bailey DVM, DACVIM","doi":"10.1111/vec.13411","DOIUrl":"10.1111/vec.13411","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess the relationship between shock index (SI) and mortality in dogs with head trauma (HT). A secondary objective was to compare SI with the animal trauma triage (ATT) score and Modified Glasgow Coma Scale (MCGS) score in HT cases. A tertiary aim was to assess if SI is predictive of survival to discharge or improvement in presenting neurologic signs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Retrospective study from January 2015 to December 2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Tertiary referral level II veterinary trauma center.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Animals</h3>\u0000 \u0000 <p>Eighty-six dogs with evidence of HT presenting through emergency for various traumas compared to 60 healthy control dogs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements and Main Results</h3>\u0000 \u0000 <p>SI was calculated using the quotient of heart rate over systolic blood pressure measured on presentation. SI was significantly higher in HT patients than healthy controls (<i>P</i> = 0.0019). SI was not significantly different between traumatic brain injury dogs that died or were euthanized and HT dogs that lived until the time of discharge (<i>P</i> = 0.98). SI was not significantly different between HT dogs that were neurologically normal at the time of discharge and HT dogs that were static or improved but not normal neurologically at the time of discharge (<i>P</i> = 0.84). In HT dogs, SI did not correlate with ATT score (<i>P</i> = 0.16) or MGCS score (<i>P</i> = 0.75). There was no significant difference in SI and length of hospitalization until death or discharge (<i>P</i> = 0.78).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>SI was significantly higher in HT patients compared to control patients. Interestingly, SI was not correlated with ATT score or MGCS score. The use of SI in HT patients warrants further investigation to assess the efficacy in predicting mortality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 4","pages":"387-392"},"PeriodicalIF":1.1,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141636044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To determine the number of homologous blood transfusions received by canine surgical patients after introducing a cell salvage device (CSD), trends in surgeries requiring blood transfusion, and the incidence of transfusion reactions.
Study Design
Retrospective study.
Setting
Single referral hospital.
Animals
All dogs having surgery at a single center (November 2015 to February 2021).
Interventions
Medical records of dogs having surgical treatment, including those that received either an autologous or homologous blood transfusion, were reviewed. The surgical patients were the baseline population, and the 2 transfusion groups were compared within this population to analyze the trends.
Main Results
A total of 37 and 86 dogs received autologous and homologous blood transfusions, respectively. There was an upward trend in the number of total monthly blood transfusions. No significant increase in the monthly number of homologous transfusions was observed before or after acquisition of the CSD. There was also an upward trend in total monthly surgeries, including those with higher risks of hemorrhage. Dogs receiving homologous blood transfusions had a higher incidence of clinical signs consistent with transfusion reactions (6.98%).
Conclusions
An upward trend in autologous blood transfusions was seen with the introduction of a CSD. Hospitals with large surgical caseloads at high risk of hemorrhage may see a decreased need for outsourced blood products with the use of the CSD. The device can lead to a more responsible use of an increasingly scarce resource and decrease the risk of a blood transfusion reaction in dogs.
{"title":"Impact of a cell salvage device on blood transfusions to dogs undergoing surgery at a referral veterinary hospital","authors":"Núria Comas Collgros LV, Vasilis Zapridis DVM, Janet Diana Godolphin BSc, PhD, Nicholas Bacon MA, VetMB, DECVS, DACVS","doi":"10.1111/vec.13403","DOIUrl":"10.1111/vec.13403","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To determine the number of homologous blood transfusions received by canine surgical patients after introducing a cell salvage device (CSD), trends in surgeries requiring blood transfusion, and the incidence of transfusion reactions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design</h3>\u0000 \u0000 <p>Retrospective study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Single referral hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Animals</h3>\u0000 \u0000 <p>All dogs having surgery at a single center (November 2015 to February 2021).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interventions</h3>\u0000 \u0000 <p>Medical records of dogs having surgical treatment, including those that received either an autologous or homologous blood transfusion, were reviewed. The surgical patients were the baseline population, and the 2 transfusion groups were compared within this population to analyze the trends.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Results</h3>\u0000 \u0000 <p>A total of 37 and 86 dogs received autologous and homologous blood transfusions, respectively. There was an upward trend in the number of total monthly blood transfusions. No significant increase in the monthly number of homologous transfusions was observed before or after acquisition of the CSD. There was also an upward trend in total monthly surgeries, including those with higher risks of hemorrhage. Dogs receiving homologous blood transfusions had a higher incidence of clinical signs consistent with transfusion reactions (6.98%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>An upward trend in autologous blood transfusions was seen with the introduction of a CSD. Hospitals with large surgical caseloads at high risk of hemorrhage may see a decreased need for outsourced blood products with the use of the CSD. The device can lead to a more responsible use of an increasingly scarce resource and decrease the risk of a blood transfusion reaction in dogs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 4","pages":"376-386"},"PeriodicalIF":1.1,"publicationDate":"2024-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daniel S. Gordon DVM, MS, DACVECC, Cathy E. Langston DVM, DACVIM
Objective
To describe the use of intermittent hemodialysis (IHD) to remove gadolinium (28.1 mg/kg dose) in a dog with severe kidney disease.
Case Summary
A 12-year-old neutered female Yorkshire Terrier presented with severe acute-on-chronic kidney injury and concurrent neurological signs. The dog received extracorporeal therapy as part of management. Uremia improved after hemodialysis, but central nervous system signs persisted; therefore, a contrast-enhanced magnetic resonance imaging was performed, immediately followed by IHD. Two IHD treatments with a low-flux dialyzer were performed 1.5 and 25.75 hours after administration of gadolinium, with almost complete removal of gadolinium. More than 96% of gadolinium was removed with a single treatment.
New or Unique Information Provided
Extracorporeal therapy is effective at removing gadolinium-based chelated contrast agents and could be considered if magnetic resonance imaging is indicated in a patient with substantial kidney impairment. Alternatively, newer contrast agents that have been deemed safer in this patient population could be used.
{"title":"Effective removal of gadolinium with hemodialysis in a dog with severe acute on chronic kidney injury","authors":"Daniel S. Gordon DVM, MS, DACVECC, Cathy E. Langston DVM, DACVIM","doi":"10.1111/vec.13404","DOIUrl":"10.1111/vec.13404","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To describe the use of intermittent hemodialysis (IHD) to remove gadolinium (28.1 mg/kg dose) in a dog with severe kidney disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Summary</h3>\u0000 \u0000 <p>A 12-year-old neutered female Yorkshire Terrier presented with severe acute-on-chronic kidney injury and concurrent neurological signs. The dog received extracorporeal therapy as part of management. Uremia improved after hemodialysis, but central nervous system signs persisted; therefore, a contrast-enhanced magnetic resonance imaging was performed, immediately followed by IHD. Two IHD treatments with a low-flux dialyzer were performed 1.5 and 25.75 hours after administration of gadolinium, with almost complete removal of gadolinium. More than 96% of gadolinium was removed with a single treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> New or Unique Information Provided</h3>\u0000 \u0000 <p>Extracorporeal therapy is effective at removing gadolinium-based chelated contrast agents and could be considered if magnetic resonance imaging is indicated in a patient with substantial kidney impairment. Alternatively, newer contrast agents that have been deemed safer in this patient population could be used.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 4","pages":"406-411"},"PeriodicalIF":1.1,"publicationDate":"2024-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sabrina N. Hoehne Dr med vet, DACVECC, DECVECC, Kate Hopper BVSc, PhD, DACVECC, Marlis L. Rezende DVM, PhD, DACVAA, Angela Borchers Dr med vet, DVM, DACVIM, DACVECC, Steven E. Epstein DVM, DACVECC
<div> <section> <h3> Objective</h3> <p>To evaluate differences in point-of-care (POC) variables obtained from arterial and jugular venous blood in dogs undergoing manual basic life support (BLS) and report changes over time.</p> </section> <section> <h3> Design</h3> <p>Experimental study.</p> </section> <section> <h3> Setting</h3> <p>Small animal research facility.</p> </section> <section> <h3> Animals</h3> <p>Twenty-four purpose-bred research dogs.</p> </section> <section> <h3> Interventions</h3> <p>Dogs were anesthetized, and arterial catheters were placed before euthanasia. One minute after cardiopulmonary arrest, BLS consisting of manual chest compressions and ventilation delivered via endotracheal intubation, face mask, mouth-to-nose, or no ventilation was initiated. Paired arterial and jugular venous blood samples were obtained for POC testing before euthanasia (<i>T</i><sub>0</sub>), at 3 minutes (<i>T</i><sub>3</sub>), and at 6 minutes (<i>T</i><sub>6</sub>) into BLS.</p> </section> <section> <h3> Measurements and Main Results</h3> <p>The association of POC variables with arterial or venous sample type while controlling for type of ventilation and sampling timepoint was determined using a generalized linear mixed model. Variables obtained from arterial and venous blood samples were compared over time using repeated measures ANOVA or Friedman test. Pa<span>o</span><sub>2</sub>, anion gap, potassium, chloride, glucose concentration, and PCV were significantly higher in arterial blood samples compared with venous samples (<i>P</i> < 0.03). By <i>T</i><sub>6</sub>, arterial glucose concentration, arterial and venous base excess, venous pH, and plasma lactate, potassium, creatinine, bicarbonate, and sodium concentrations were significantly increased, and arterial and venous P<span>o</span><sub>2</sub>, ionized calcium concentration, PCV, and total plasma protein concentration were significantly decreased from <i>T</i><sub>0</sub> (<i>P</i> < 0.05).</p> </section> <section> <h3> Conclusions</h3> <p>Although statistically significant, arteriovenous differences and changes in POC blood variables during BLS were small and not clinically relevant over time. Given the challenges of arterial blood sampling, it may be reasonable to pursue venous blood sampling during CPR. Further studies in dogs undergoing BLS and advanced life support are needed to better understand the potential clinical r
{"title":"Serial paired arterial and jugular venous point-of-care values in dogs undergoing manual basic life support","authors":"Sabrina N. Hoehne Dr med vet, DACVECC, DECVECC, Kate Hopper BVSc, PhD, DACVECC, Marlis L. Rezende DVM, PhD, DACVAA, Angela Borchers Dr med vet, DVM, DACVIM, DACVECC, Steven E. Epstein DVM, DACVECC","doi":"10.1111/vec.13406","DOIUrl":"10.1111/vec.13406","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate differences in point-of-care (POC) variables obtained from arterial and jugular venous blood in dogs undergoing manual basic life support (BLS) and report changes over time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Experimental study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Small animal research facility.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Animals</h3>\u0000 \u0000 <p>Twenty-four purpose-bred research dogs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interventions</h3>\u0000 \u0000 <p>Dogs were anesthetized, and arterial catheters were placed before euthanasia. One minute after cardiopulmonary arrest, BLS consisting of manual chest compressions and ventilation delivered via endotracheal intubation, face mask, mouth-to-nose, or no ventilation was initiated. Paired arterial and jugular venous blood samples were obtained for POC testing before euthanasia (<i>T</i><sub>0</sub>), at 3 minutes (<i>T</i><sub>3</sub>), and at 6 minutes (<i>T</i><sub>6</sub>) into BLS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Measurements and Main Results</h3>\u0000 \u0000 <p>The association of POC variables with arterial or venous sample type while controlling for type of ventilation and sampling timepoint was determined using a generalized linear mixed model. Variables obtained from arterial and venous blood samples were compared over time using repeated measures ANOVA or Friedman test. Pa<span>o</span><sub>2</sub>, anion gap, potassium, chloride, glucose concentration, and PCV were significantly higher in arterial blood samples compared with venous samples (<i>P</i> < 0.03). By <i>T</i><sub>6</sub>, arterial glucose concentration, arterial and venous base excess, venous pH, and plasma lactate, potassium, creatinine, bicarbonate, and sodium concentrations were significantly increased, and arterial and venous P<span>o</span><sub>2</sub>, ionized calcium concentration, PCV, and total plasma protein concentration were significantly decreased from <i>T</i><sub>0</sub> (<i>P</i> < 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although statistically significant, arteriovenous differences and changes in POC blood variables during BLS were small and not clinically relevant over time. Given the challenges of arterial blood sampling, it may be reasonable to pursue venous blood sampling during CPR. Further studies in dogs undergoing BLS and advanced life support are needed to better understand the potential clinical r","PeriodicalId":17603,"journal":{"name":"Journal of veterinary emergency and critical care","volume":"34 4","pages":"368-375"},"PeriodicalIF":1.1,"publicationDate":"2024-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"农林科学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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