Case report: Manual carbon hemoperfusion for the treatment of meloxicam toxicity in a cat and suspected ibuprofen toxicity in a dog.

Extracorporeal blood purification (ECBP) has become a popular treatment option for non-steroidal anti-inflammatory drug (NSAID) toxicity in small animals. However, challenges arise when using ECBP for small dogs and cats because the priming volume required by most machine-based ECBP platforms might be excessive, leading to cardiovascular instability if a blood prime is not used. This report describes the successful use of manual carbon hemoperfusion (MCHP) to reduce plasma meloxicam levels in a cat following an inadvertent overdose and its use in a dog following suspected ibuprofen ingestion. In both animals, MCHP reduced the circuit volume needed for ECBP from 125 mL with a machine-based therapeutic plasma exchange or 104 mL with an in-series carbon hemoperfusion on an intermittent hemodialysis platform to just 40-50 mL. In the cat, MCHP reduced plasma meloxicam levels by 44%, and in both animals, the use of MCHP in these pets was well-tolerated and safe. Due to pre-existing anemia, the cat required a blood transfusion but the dog did not. MCHP is technically simple and can be performed at any hospital with access to carbon filters and blood bank resources. This technique may represent a reasonable alternative to treat NSAID toxicities in animals that are too small for conventional extracorporeal decontamination methods using either machine-based platforms without using a blood prime or in locations where these machines are unavailable.

Pet owners provide a more reliable weight estimate for dogs compared to veterinary professionals in an emergency setting.

OBJECTIVE: To determine the accuracy of pet owners, veterinary technicians, house officers (interns and residents), and attending clinicians at estimating dog weights in a veterinary emergency room. ANIMALS: 272 dogs weighing over 2 kg presenting to the emergency room between June 1 and July 29, 2022. METHODS: Pet owners, veterinary technicians, house officers, and attending clinicians recorded the dogs' weight estimations on individual data collection cards. Pet owners were also asked to estimate their dogs' weight during the triage period. The dogs' actual weights were then obtained and recorded. RESULTS: Pet owners were more accurate than veterinary professionals at providing weight estimates for dogs. Weight estimates were accurate to within 10% of the dogs' actual weights for 67.9% (181/267) of pet owners. Forty-one percent (112/270) of attending clinicians, 35.3% (95/269) of house officers, and 35.4% (96/271) of veterinary technicians' weight estimates were within 10% of the dog's actual weight. There was no difference noted in the length of veterinary experience and ability to closely estimate the patient's weight. Overall, veterinary professionals were more likely to closely estimate the weight of large dogs compared to small dogs. CLINICAL RELEVANCE: The pet owner is most likely to provide an accurate weight for dogs and questions about the dog's weight should be directed to the client for situations in which a weight cannot be rapidly obtained.

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.

Comparison of pentobarbital-phenytoin alone vs propofol prior to pentobarbital-phenytoin for euthanasia in 436 client-owned dogs.

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.

Interpretation of canine and feline blood smears by emergency room personnel.

BACKGROUND: Interpretation of blood smears is commonly used to provide rapid laboratory evaluation of animals in veterinary emergency practice, but the accuracy of results of blood smear interpretation by emergency room personnel (ERP) compared with evaluation by trained veterinary clinical pathology personnel is unknown. OBJECTIVE: The goal of this study was to compare blood smear evaluation by ERP with that of clinical pathology personnel. METHODS: All animals that had a CBC determined by a diagnostic laboratory and had blood smears evaluated by personnel at the Foster Hospital for Small Animals Emergency Room between September 2008 and July 2009 were eligible for study inclusion. ERP who evaluated blood smears completed standardized forms with estimates of the WBC and platelet counts and evaluation of RBC and WBC morphology. Results from point-of-care assessment were compared with automated or manual results reported by the veterinary diagnostic laboratory. RESULTS: One hundred and fifty-five blood smears were evaluated. There was moderate agreement (κ value, 0.63; 95% confidence interval [CI]: 0.52, 0.74) between estimated platelet counts by ERP and automated counts. Poor agreement was found between estimated WBC counts by ERP and automated counts (κ value, 0.48; 95% CI: 0.37, 0.60). Specific abnormalities with a high likelihood of clinical significance, eg, toxic change, nucleated RBCs, spherocytes, hemoparasites, and lymphoblasts, were not predictably identified by ERP. CONCLUSIONS: ERP interpretation of canine and feline blood smears should be used cautiously and should not replace evaluation by a veterinary diagnostic laboratory.