Spontaneous abdominal effusion in dogs with presumed anaphylaxis.

OBJECTIVE: To describe patient characteristics of dogs developing spontaneous abdominal effusion in association with anaphylaxis. DESIGN: Retrospective study between 2010 and 2018. SETTING: University teaching hospital and referral specialty private practice emergency departments. ANIMALS: Sixteen dogs presenting to the emergency department for clinical signs suggestive of anaphylaxis with peritoneal effusion documented via ultrasonography. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Dogs presented with clinical signs of anaphylaxis including vomiting 12 of 16 (75%), diarrhea 9 of 16 (56%), and collapse 7 of 16 (44%). Physical examination findings included altered mentation 14 of 16 (88%), erythema 2 of 16 (13%), and urticaria 2 of 16 (13%). Historically, 3 of 16 (19%) had just recently been vaccinated, 1 of 16 (6%) had known contact with an insect, and 8 of 16 (50%) had been outdoors prior to the onset of clinical signs, whereas 5 of 16 (31%) had no known triggering event. At presentation, median systolic arterial pressure was 70 mm Hg (range, 30-210 mm Hg). Venous blood gas revealed an acidemia with a mean pH of 7.24 ± 0.09, a base deficit of 7.15 ± 7.7 mmol/L, and an increased plasma lactate with a mean of 7.35 ± 2.09 mmol/L. Bloodwork abnormalities included an increased alanine aminotransferase activity with a mean of 439.2 ± 404.5 U/L and an increased gamma-glutamyl transferase activity with a mean concentration of 7.29 ± 4.1 U/L. Twelve patients (75%) had gallbladder wall abnormalities on ultrasonography. Eight patients (50%) had abdominocentesis performed. The median PCV of the effusion was 0.29 L/L (29%; range, 4-41) and total plasma protein was 38 g/L (3.8 g/dL; range, 2.4-6.5). Two dogs (12.5%) were euthanized. The remaining 14 dogs (87.5%) survived to discharge, with a mean hospitalization time of 23.7 ± 16.7 hours. CONCLUSIONS: Abdominal effusion should be considered a potential sequela of anaphylaxis in dogs. Therefore, serial monitoring for presence or development of spontaneous abdominal effusion should be considered.

Retrospective evaluation of the use of hydrocortisone for treatment of suspected critical illness-related corticosteroid insufficiency (CIRCI) in dogs with septic shock (2010-2017): 47 cases.

OBJECTIVE: To evaluate characteristics of septic shock patients treated with hydrocortisone (HC) due to suspicion of critical illness-related corticosteroid insufficiency (CIRCI) as compared to septic shock patients without suspicion of CIRCI. DESIGN: Retrospective study between February 2010 and October 2017. SETTING: University teaching hospital ICU. ANIMALS: Data were collected for 47 dogs with septic shock. Twenty-one dogs were treated with HC (HC-treated) due to suspicion of CIRCI. Twenty-six dogs did not receive HC (non-HC-treated). INTERVENTIONS: HC was administered either as an intermittent IV bolus or as a constant rate infusion (CRI) to those patients with suspected CIRCI. MEASUREMENTS AND MAIN RESULTS: Significantly higher baseline APPLEfull scores and predicted mortality were detected in the HC-treated patients compared to non-HC-treated patients (0.87 vs 0.44 for predicted mortality, P = 0.039). Patients in the HC-treated group were on more vasopressors and cardiotonics than those in the non-HC-treated group (2.5 vs 1.5, P <0 .001). All patients initially responded to vasopressor administration, with average time to resolution of hypotension being 90 minutes for the HC-treated group compared to 60 minutes for the non-HC-treated group (P = 0.640). However, HC-treated patients took significantly longer to have a sustained resolution (a systolic blood pressure > 90 mm Hg or a mean blood pressure > 65 mm Hg for at least 4 h) of their hypotension after starting vasopressors, as compared to their non-HC-treated counterparts (8.5 vs 4 h, P = 0.001). Three (14.3%) HC-treated patients survived to discharge compared to 9 (34.6%) non-HC-treated patients, but this was not statistically significant. CONCLUSIONS: HC-treated patients had a higher baseline risk of mortality than non-HC-treated patients. There was no significant difference in survival between the HC-treated and non-HC-treated septic shock patients. Further studies are needed to evaluate the use of HC in patients with suspected CIRCI.

Clinical features and outcome of septic shock in dogs: 37 Cases (2008-2015).

OBJECTIVES: To describe patient characteristics of dogs with septic shock, investigate markers of disease severity, and assess treatment impact on outcome. DESIGN: Retrospective study. SETTING: Single center, university veterinary teaching intensive care unit. ANIMALS: Thirty-seven dogs with septic shock. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Mean number of organ dysfunction was 3.24 ± 1.0, and included cardiovascular (100%), respiratory (73%), hematologic (68%), renal (49%), and hepatic (32%) dysfunction. The gastrointestinal tract was the most common source of sepsis. Mean blood pressure prior to resuscitation was 50 ± 8 mm Hg. All dogs were given IV fluids before vasopressor therapy with a mean rate of 12.1 ± 11.0 mL/kg/h. All dogs were given antimicrobials, administered within a mean of 4.3 ± 5.7 hours after diagnosis. Dopamine or norepinephrine was administered IV, respectively in 51.3% and 37.8% of dogs, with a mean duration of hypotension of 2.6 ± 3.0 hours. Mortality rate was 81.1%. Survivors were more likely to have a feeding tube (P = 0.007) and to have gastrointestinal sepsis (P = 0.012), and less likely to have respiratory dysfunction (P < 0.001). APPLEFull scores (P = 0.014) and time to antimicrobial therapy (P = 0.047) were identified as predictors of mortality. Treatment bundles consisting of 7 interventions that may improve outcomes in people with septic shock were evaluated. Survivors received 4.1 ± 1.3 interventions, whereas nonsurvivors received 2.4 ± 1.4 (P = 0.003). CONCLUSIONS: Septic shock in dogs confers a guarded prognosis. Early antimicrobial therapy and the utilization of treatment bundles may increase survivability in dogs with septic shock. More research is warranted to investigate the impact of specific interventions on survival.