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

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.

Objective: To evaluate the safety and tolerability of rivaroxaban (RIV), an oral direct factor Xa inhibitory drug, in dogs with presumed primary immune-mediated hemolytic anemia (pIMHA).

Design: Prospective, multicenter, positive-controlled, unblinded clinical trial. Client-owned dogs were enrolled between October 2012 and March 2014.

Setting: Private referral centers.

Animals: Twenty-four client-owned dogs with pIMHA. Enrolled dogs were randomized in 2 treatment groups to receive by mouth RIV or clopidogrel (CL) and low-dose aspirin (LDA). All dogs were monitored for 90 days from the enrollment in the study.

Interventions: Enrolled dogs were given a standardized immunosuppressive protocol and RIV or CL and LDA.

Measurements and main results: There was no identifiable adverse drug reaction, evidence of hemorrhage, significant prolongation of prothrombin time or activated partial thromboplastin time, or increase in transfusion requirements associated with RIV therapy compared to CL and LDA in dogs with pIMHA. There was no significant difference between treatment groups with respect to thrombotic events, survival rates to discharge, at 1 month and 3 months from diagnosis.

Conclusions: This study suggests that RIV at a median dose of 0.89 mg/kg by mouth once daily was safe and well tolerated in a small group of dogs with presumed pIMHA able to tolerate oral medications and treated with a standardized immunosuppressive treatment protocol. Conclusions regarding the relative efficacy of RIV as compared to CL and LDA cannot be made due to the small size of the treatment groups and because pharmacodynamic effects were not assessed.

Objective: To evaluate the effect of hemodialysis, hemoperfusion, and a combined approach on the removal of metaldehyde from canine plasma.

Design: In vitro study.

Setting: University veterinary teaching hospital laboratory.

Animals: None.

Interventions: None.

Measurements and main results: Metaldehyde-fortified canine plasma was prepared. Hemodialysis (HD), charcoal hemoperfusion (HP), and in-series hemodialysis and charcoal hemoperfusion (HD/HP) were applied in triplicate to eliminate metaldehyde from plasma. Plasma samples were obtained before starting the procedure and subsequently after every processed total plasma volume until plasma had been processed 10 times. Plasma metaldehyde concentration was quantitatively assayed by gas chromatography-mass spectrometry. Statistical analysis was performed using one-way ANOVA, repeated measures ANOVA, and Bonferroni post hoc test, and by calculating the coefficient of variation from duplicate measurements, binomial distribution, and by Bland-Altman analysis. Statistically significant reduction in metaldehyde concentration was reached by all 3 techniques. Reduction of metaldehyde concentration of more than 95% was achieved after processing the plasma volume 4 times applying HD, 8 times applying HP, and 2 times applying HD/HP. Efficacy in reduction of metaldehyde concentration differed significantly between the 3 procedures (P < 0.001). In-series hemodialysis and charcoal hemoperfusion was more effective in metaldehyde removal than HD (P = 0.003) and HP (P < 0.001), and HD was more effective than HP (P = 0.002).

Conclusions: Metaldehyde was effectively removed by all applied extracorporeal blood purification techniques in vitro. However, the combination of both techniques was more effective than HD or HP alone. Further clinical studies are warranted to confirm therapeutic benefits in patients.