Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)最新文献

Objective: To describe the clinical presentation, diagnostic investigation, and medical management of a dog on immunosuppressive therapy that developed a severe soft tissue infection attributed to Aeromonas hydrophila/caviae.

Case summary: A 5-year-old female neutered Border Collie dog was presented for investigation of a rapidly growing skin lesion. The dog had been diagnosed with immune-mediated thrombocytopenia and was receiving immunosuppressive therapy for 5 weeks. Physical examination at initial presentation revealed no abnormalities except a 6 cm raised, erythematous, firm, and painful swelling on the ventral abdomen. Within 12 hours of admission, the lesion had expanded to cover much of the ventrum and some areas had begun to slough. The patient had also become obtunded and exhibited pyrexia, tachypnea, tachycardia as well as extreme pain around the lesion. The dog's clinical signs and hematology results were consistent with sepsis. Histopathology showed severe acute suppurative cellulitis and panniculitis and a heavy growth of A. hydrophila/caviae was obtained on tissue culture. The infection was treated with trimethoprim sulphadiazine, based on culture and susceptibility results.

Unique information provided: This is the first reported case of severe panniculitis and cellulitis caused by Aeromonas spp. in a dog. Aeromonas spp. should be considered a differential diagnosis for cases of severe soft tissue infection, especially in immune-compromised animals or those with a history of aquatic exposure.

Objective: To describe the clinical presentation, advanced imaging findings, and short- and long-term outcomes in dogs with intracranial empyema.

Design: Retrospective case series.

Animals: Client-owned dogs diagnosed with intracranial empyema.

Methods: Medical records from 2 referral hospitals were searched for dogs diagnosed with intracranial empyema. To be included in this study, dogs had to fulfill 1 or more of the following 3 inclusion criteria: a magnetic resonance imaging (MRI) scan with space occupying accumulation of extra-axial material suggestive of empyema, a cerebrospinal fluid analysis suggestive of empyema, or direct visualization of purulent material during intracranial surgery.

Results: Nine dogs with intracranial empyema were included, with a median age of 3.5 years (range: 4 mo-12.5 y). All presented as emergencies with 7 of the 9 dogs showing neurological abnormalities and 2 of the 9 with retrobulbar swelling and exophthalmos. Six had surgical intervention, 1 was medically managed, and the remaining 2 dogs were euthanized. Typical MRI findings included extra-axial, T1-weighted hypo- to isointense, T2-weighted hyperintense material compared to gray matter with varying degrees of contrast enhancement, with 6 of 8 showing evidence of contiguous infection from adjacent structures on MRI. For 7 dogs, ≥1 samples were sent for culture and sensitivity, with Enterococcus (surgical swab), Streptococcus pneumonia (from cerebral spinal fluid), and coagulase positive Staphylococcus (ear swab) being cultured. The median antimicrobial course length was 6 weeks (range: 2-28 wk). All dogs for which treatment was attempted survived to discharge, with a median hospitalization time of 7 days (range: 4-10 d). Four of the 7 are still alive at the time of writing (1 lost to follow-up; 2 euthanized for other reasons) with all 4 considered neurologically normal with a successful long-term outcome.

Conclusion: Although intracranial empyema in dogs is a rare condition, excellent outcomes are possible in those cases treated appropriately.

Objectives: A recent study described increased l-lactate concentrations in ponies with gastrointestinal disease compared to horses, but blood glucose (BG) concentrations were not considered. The study tested the hypothesis that BG and l-lactate concentrations are correlated in horses and ponies with gastrointestinal disease and that BG concentrations, not equid type (pony vs horse), are an independent predictor of L-lactate concentrations. It was further hypothesized that equid type was an independent predictor of BG concentrations.

Design: Retrospective study 2008-2016.

Setting: University teaching hospital.

Animals: Admission data from 545 animals (384 horses and 161 ponies) with gastrointestinal disease.

Interventions: None.

Measurements and main results: Data collected included signalment, clinicopathological findings on admission, and nature and location of the gastrointestinal lesion (strangulating vs non-strangulating and large vs small intestinal lesion). The association between admission blood l-lactate concentrations, equid type (pony or horse) and BG concentrations was investigated in a multivariable model. Admission l-lactate and BG concentrations were strongly correlated (n = 522; r = 0.63; P < 0.001). Ponies had significantly higher l-lactate (2.7 mmol/L (0.5-18.0 mmol/L) vs 1.4 mmol/L (0.3-19 mmol/L); P < 0.001) and BG concentrations than horses (8.4 mmol/L (4.2-24.4 mmol/L); 151 mg/dL (76-439 mg/dL) vs 6.9 mmol/L (3.4-26.8 mmol/L); 124 mg/dL (61-482 mg/dL); P < 0.001). In the multivariable analysis, l-lactate concentrations were significantly and positively associated with admission BG concentrations in all animals and also with equid type. For each millimole per liter (18 mg/dL) increase in BG, l-lactate concentrations increased by 7.9% (5.9, 9.9); P < 0.001. In comparison to ponies, l-lactate concentrations were decreased by 27.7% (37.4, 16.5); P < 0.001 in horses. Admission BG concentrations were significantly and positively associated with l-lactate concentrations in all animals. For each millimole per liter increase in l-lactate concentration, BG concentration increased by 6.2% (4.7, 7.6; P < 0.001). Admission BG concentrations were not associated with equid type.

Conclusion: Admission BG concentrations and equid type are independent predictors of blood l-lactate concentrations in equids with gastrointestinal disease, but their relationship requires further investigation.

Objectives: To investigate whether lipopolysaccharide (LPS) is present in plasma of calves with naturally occurring diarrhea. The second objective was to determine whether plasma [LPS] correlates with clinical, hematological, biochemical, and acid-base variables, and whether [LPS] differs between surviving and nonsurviving diarrheic calves.

Design: Prospective observational study (January 2012-May 2014).

Setting: Veterinary teaching hospital.

Animals: Thirty-four calves <28 days old admitted for diagnosis and treatment of diarrhea and 30 healthy control calves.

Measurements and main results: Admission demographics, physical examination, blood gas, biochemistry analysis, and outcome data were recorded. Plasma concentration of LPS was determined using a bovine LPS ELISA assay. Plasma [LPS] was detected in both healthy and diarrheic calves. Plasma [LPS] was significantly higher in diarrheic than healthy calves (median: 0.99 ng/mL; Interquartile range (IQR): 0.068, vs 0.88 ng/mL; 0.065 ng/mL, respectively; P < 0.001). Plasma [LPS] was higher in nonsurviving (1.04 ng/mL; 0.07 ng/mL) than in surviving calves (0.98 ng/mL; 0.022 ng/mL; P < 0.001). Plasma [LPS] was higher in beef (1.07 ng/mL; 0.182 ng/mL) than in dairy diarrheic calves (0.99 ng/mL; 0.022 ng/mL; P < 0.001). In diarrheic calves, plasma [LPS] correlated with [l-lactate] (r² = 0.496; P = 0.002); hypoglycemia (r² = -0.453; P = 0.007); increased unmeasured strong ions (r² = 0.332; P = 0.050), [Mg²⁺ ] (r² = 0.475; P = 0.004), and [phosphate] (r² = 0.468; P = 0.005), and increased aspartate aminotransferase activity (r² = 0.348; P = 0.003).

Conclusions: This study highlights a potential role of LPS in the pathogenesis of metabolic derangements such as hyperlactatemia, hypoglycemia, and increased concentration of unmeasured strong anions in diarrheic calves. Further investigation evaluating the effect of LPS on l-lactate and glucose metabolism in diarrheic calves is warranted.

Objective: To describe the clinical use of a novel, minimally invasive technique for fluoroscopic wire-guided esophagojejunal tube (FEJT) placement in dogs and cats.

Design: Retrospective study (February 2010-September 2013).

Setting: University veterinary teaching hospital.

Animals: Eighteen dogs and 2 cats with intolerance of, or contraindications to, gastric feeding that underwent attempted FEJT placement.

Interventions: All patients underwent attempted FEJT placement using a novel fluoroscopic wire-guided technique.

Measurements and main results: Patient data were collected including information about the FEJT placement and utilization of the tube postplacement. The primary diagnosis in dogs undergoing FEJT placement was pancreatitis in 61% of cases. The ability to achieve postpyloric access with the technique was 95% (19/20). Mean duration of the procedure in dogs where FEJT placement was successful was 63.8 minutes (SD, 28.6; min-max, 30-120 min). Mean fluoroscopy time was 19.4 minutes (SD, 11.5; min-max, 5.2-42.1-min). Esophagostomy site infection was a complication of FEJT placement in 2 dogs. The mean duration the FEJT remained in place in dogs was 3.8 days (SD, 2.2; min-max, 1-7 days), and mean duration of feeding was 3.6 days (SD, 2.2; min-max, 1-7 days). Vomiting was noted in 89% of patients prior to FEJT placement and was significantly reduced to only 24% of patients postplacement (P = 0.0001).

Conclusions: FEJT placement is a viable technique for providing postpyloric nutrition in dogs and cats intolerant of, or with contraindications to, gastric feeding.

Objective: To illustrate the application of the Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE) guidelines to the management of dogs and cats at risk of developing thrombosis using a case-based approach.

Etiology: Dogs and cats become at risk of developing thrombosis from a wide range of conditions. These conditions often involve a specific insult followed by an inflammatory response and when combined with other contributing factors (eg, hypercoagulability, vascular endothelial injury, hemodynamic changes) create favorable conditions for thrombosis.

Diagnosis: Development of thrombosis in small animals remains challenging to demonstrate. Compatible clinical signs, the presence of known risk factors, and supporting diagnostic tests may be highly suggestive of the development of thrombosis.

Therapy: Therapeutic recommendations in accordance with the CURATIVE guidelines for dogs and cats are described in specific case vignettes presented. Discussion is centered on antithrombotic drug choices and dosing protocols, as outlined in Domains 2 and 3 of the CURATIVE guidelines. Where appropriate, guidelines related to therapeutic monitoring (Domain 4) and discontinuation of antithrombotics (Domain 5) were included.

Prognosis: In small animals at risk of developing thrombosis, overall prognosis may be improved by following consensus-based recommendations on the use of antithrombotics as outlined in the CURATIVE guidelines. Whether such interventions have any impact on outcome requires further investigation.

Objective: To report the incidence of adverse events during euthanasia of client-owned dogs administered either intravenous pentobarbital/phenytoin (PP) or PP after propofol delivery.

Design/setting: Prospective, observational, multi-site study.

Animals: Four hundred thirty-six dogs undergoing client-elected euthanasia over a 1-year period.

Interventions: Interventions included placement of an IV catheter and delivery of euthanasia agents (PP for the PP group, propofol followed by PP for the propofol group). Seven pre-determined adverse events were recorded: agonal breaths, urination, defecation, vocalization, muscle activity, dysphoria, and catheter complications. Euthanasia scores for each patient were defined as the sum of all adverse events (0-7) the patient exhibited.

Measurements and main results: Two hundred thirty-six dogs were in the PP group and 200 dogs were in the propofol group. No significant differences were detected in the dose of PP administered (166.9 ± 105.6 mg/kg for PP group, 182.6 ± 109.8 mg/kg for propofol group). Propofol dogs received 4.5 ± 2.9 mg/kg propofol. The incidence of ≥ 1 adverse event was 35.2% in the PP group and 26.5% in the propofol group (P = 0.052). Mean euthanasia scores (0.47 PP group, 0.32 propofol group) were not significantly different (P = 0.08). Propofol significantly reduced the incidence of muscle activity (6% vs. 14%, odds ratio 0.39; P = 0.0079).

Conclusions: There was no difference in the likelihood of the studied adverse events during client-elected euthanasia in dogs when propofol was used prior to PP. There was a significant reduction in perimortem muscle activity if propofol was given prior to PP.

Objective: To investigate the association between synthetic colloids and biomarkers of acute kidney injury (AKI) in dogs with hemorrhagic shock.

Design: Experimental interventional study.

Setting: University.

Animals: Twenty-four healthy ex-racing Greyhounds.

Interventions: Anesthetized Greyhounds subjected to hemorrhage for 60 min were resuscitated with 20 mL/kg of fresh whole blood (FWB), 6% hydroxyethyl starch (HES) 130/0.4, 4% succinylated gelatin (GELO), or 80 mL/kg of isotonic crystalloid (CRYST) over 20 min (n = 6 per treatment). Concentrations of biomarkers of AKI were measured at baseline, end of hemorrhage, and at 40 (T60), 100 (T120), and 160 (T180) min after fluid bolus. Biomarkers included neutrophil gelatinase-associated lipocalin in urine and serum (uNGAL; sNGAL), and urine cystatin C (uCYSC), kidney injury molecule-1 (uKIM), clusterin (uCLUST), osteopontin, gamma-glutamyl transferase, monocyte chemoattractant protein-1 (uMCP), interleukin-6, interleukin-8, protein (uPROT), hyaluronan, and F₂ -isoprostanes. Renal histology was scored for tubular injury and microvesiculation. Biomarker fold-change from baseline was compared between groups using mixed effects models (Bonferroni-Holm corrected P<0.05). Frequencies of histology scores were compared by Fisher's exact test.

Measurements and main results: In dogs treated with GELO, uNGAL fold-change was markedly greater compared with all other groups at T60, T120, and T180 (all P<0.001), and uCYSC was greater at T60 compared with CRYST (P<0.001), and at T120 and T180 compared with all other groups (all P<0.001). Smaller, albeit significant, between-group differences in uKIM, uCLUST, uMCP, and urine protein concentration were observed across the FWB, GELO, and HES groups, compared with CRYST. The GELO group more frequently had marked tubular microvesiculation than the other groups (P = 0.015) although tubular injury scores were comparable.

Conclusion: In dogs with hemorrhagic shock, GELO was associated with greater magnitude increases in urine biomarkers of AKI and more frequent marked tubular microvesiculation, compared with FWB, CRYST, and HES.