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

Objective: To characterize the clinical features of the acute respiratory distress syndrome (ARDS), risk factors, and outcome in dogs and cats. The study also aimed to evaluate the current veterinary criteria for the diagnosis of ARDS by comparison of clinical diagnostic criteria with necropsy findings.

Design: Retrospective study.

Animals: Fifty-four client-owned animals, 46 dogs and 8 cats.

Interventions: Medical records were reviewed for patients with the diagnosis of ARDS based on previously published clinical criteria or necropsy diagnosis. Signalment, clinical findings, and outcome were recorded.

Measurements and main results: Animals were grouped according to a clinical or necropsy diagnosis: 43/54 (80%) were diagnosed with ARDS based on clinical criteria (group 1) and 11/54 (20%) were diagnosed with ARDS based on necropsy only (group 2). In group 1, 22/43 (51%) had a necropsy, which confirmed ARDS in 12/22 (54%). Direct (pulmonary) causes of ARDS were more common than indirect causes in dogs, while cats had a similar occurrence of direct and indirect causes. The most common risk factors identified in dogs were aspiration pneumonia (42%), systemic inflammatory response syndrome (SIRS) (29%), and shock (29%). All cats diagnosed clinically with ARDS had SIRS with or without sepsis. Of the animals with a clinical diagnosis of ARDS, 49% received mechanical ventilation and 58% received treatment (with or without mechanical ventilation) for 24 hours or longer. The overall case fatality rate was 84% in dogs and 100% in cats.

Conclusions and clinical relevance: As described in human literature, pneumonia was the most common risk factor in dogs with ARDS, whereas it was SIRS for the cat population. The high mortality rate and discrepancy between the clinical diagnosis and necropsy findings may highlight limitations in the clinical criteria for the diagnosis of ARDS and treatment in dogs and cats.

Objective: To describe computed tomographic (CT) features of intra-abdominal hypertension (IAH) in 3 dogs with abdominal distension.

Case summary: Three dogs with anorexia, distended abdomen, or labored breathing were presented for CT imaging. All 3 dogs were premedicated with IV butorphanol (0.2 mg/kg). A Foley urinary catheter was aseptically placed and the transvesical technique was used to obtain intra-abdominal pressure (IAP). The IAP measurements were obtained with the dogs in a standing position after a stabilization period of 5 minutes. The mean IAP values for each of the 3 dogs were 26.0, 12.0, and 13.0 mm Hg. Anesthesia was induced with IV propofol (2.0-4.0 mg/kg, to effect) in all 3 dogs and maintained with sevoflurane in 2 dogs. Compression of the caudal vena cava and elevation of the diaphragm were observed in all 3 dogs, whereas renal compression and the extension of peritoneal fluid to the vaginal canal and cavity were seen in the dog with the highest IAP.

New or unique information provided: Compression of the caudal vena cava, direct renal compression, and the extension of peritoneal fluid into the vaginal canal and vaginal cavity are consistent with a diagnosis of IAH. Measurement of IAP and detection of these CT features should alert clinicians to the possible presence of IAH in veterinary patients.

Objective: To determine if 3 resuscitative fluid therapy strategies increase N-terminal pro-brain natriuretic peptide (NT proBNP) levels in healthy dogs.

Design: Randomized crossover trial.

Setting: Veterinary teaching hospital.

Animals: Plasma NT proBNP concentrations were measured in 6 healthy purpose-bred dogs that received 3 resuscitative fluid therapy protocols.

Measurements and main results: Crystalloid, synthetic colloid, or hypertonic saline fluids were administered at resuscitative doses. Blood samples were collected via an indwelling catheter before, and at set time points between 0.5 and 36 h after fluid therapy and analyzed for NT-proBNP. A general linear mixed model was used to estimate the differences in NT-proBNP over time and among treatments. None of the resuscitative fluid therapy protocols caused increases of serum NT-proBNP beyond the previously reported cutoff concentration used to differentiate cardiac versus noncardiac causes of respiratory signs. Dogs receiving crystalloid fluid therapy had the most significant and prolonged increase in serum NT-proBNP concentration above baseline compared to dogs receiving either resuscitative doses of colloids or hypertonic saline.

Conclusions: Serum NT-proBNP concentration in normal dogs was not increased beyond concentrations previously established to equate to cardiac disease after receiving resuscitative fluid therapy with either a balanced crystalloid solution, hypertonic saline, or a synthetic colloid solution in this study.

Objective: To report a case of acute barium poisoning in a dog subsequent to ingestion of a common handheld pyrotechnic (sparkler).

Case summary: A 5-year-old female neutered German Shorthaired Pointer presented with acute onset of generalized flaccid muscle paralysis and fasciculations, ptyalism, and an irregular heart rhythm. Marked hypokalemia (1.9 mmol/L [mEq/L]; reference range [3.5-5.8 mmol/L [mEq/L]), acidemia (pH 7.20; reference range 7.38-7.44), and hypoventilation (PvCO₂ 55 mm Hg; reference range 40-50 mm Hg) were present on admission. Treatment consisted of fluid therapy, aggressive IV potassium chloride supplementation, gastric lavage, and oral magnesium sulfate administration. Based on history and clinical presentation, barium intoxication after ingestion of handheld firework (sparklers) was suspected and a serum sample was submitted for barium analysis. The serum barium concentration determined by inductively coupled plasma/mass spectrometry was 2,000 μg/L, a 3 orders of magnitude elevation above previously reported normal values in dogs. Within 18 hours of admission, the clinical signs resolved and the blood potassium concentration normalized. The animal was discharged home 36 hours after admission. On follow-up performed after 1 and 5 years, no health issues were apparent.

New information provided: To the authors' knowledge, this is the first report of acute, life-threatening barium toxicosis characterized by flaccid paralysis, acidemia, and severe hypokalemia occurring in a dog after ingestion of a popular pyrotechnic (sparkler) containing barium nitrate. Clinical signs may resolve within 24 hours with appropriate supportive care including aggressive potassium supplementation and chelation therapy.