Chemical pneumonitis secondary to accidental pulmonary polyethylene glycol-electrolyte solution infusion in a cat.

OBJECTIVE: To describe the successful conservative management of chemical pneumonitis and presumed acute respiratory distress syndrome in a cat secondary to inadvertent pulmonary polyethylene glycol-electrolyte solution (PEG-ELS) instillation. CASE SUMMARY: PEG-ELS is commonly used in small animals for bowel cleansing and to treat constipation. There have been several instances of aspiration or accidental instillation of this solution into the lungs of both people and dogs. PEG-ELS was inadvertently infused into the lungs of the cat in the current report. After 10 days in the ICU, during which time treatment with oxygen therapy, antibiosis, diuretics, and corticosteroids was provided, the cat was successfully discharged. NEW OR UNIQUE INFORMATION PROVIDED: To the authors' knowledge, this is the first report of instillation of PEG-ELS in a cat resulting in chemical pneumonitis and lung injury. We describe the successful management of this condition with conservative management and without the need for invasive interventions such as bronchoscopy and lavage or mechanical ventilation.

A review of the pharmacology and clinical applications of levetiracetam in dogs and cats.

OBJECTIVE: To review and summarize the pharmacology of the antiepileptic drug (AED), levetiracetam (LEV), and to discuss its clinical utility in dogs and cats. DATA SOURCES: Veterinary and human peer-reviewed medical literature and the authors' clinical experience. SUMMARY: LEV is an AED with mechanisms of action distinct from those of other AEDs. In people and small animals, LEV exhibits linear kinetics, excellent oral bioavailability, and minimal drug-drug interactions. Serious side effects are rarely reported in any species. LEV use is gaining favor for treating epilepsy in small animals and may have wider clinical applications in patients with portosystemic shunts, neuroglycopenia, and traumatic brain injury. In people, LEV may improve cognitive function in patients with dementia. CONCLUSION: LEV is a well-tolerated AED with well-documented efficacy in human patients. Although its use is becoming more common in veterinary medicine, its role as a first-line monotherapy in small animal epileptics remains to be determined. This review of the human and animal literature regarding LEV describes its role in epileptic people and animals as well as in other disease states and provides recommendations for clinical usage.

Comparison of Aural and Rectal Temperature in Dogs Presenting to an Emergency Room.

Purpose: To compare rectal and aural temperatures in canines presenting to a small animal emergency room. Patients and Methods: We performed a prospective cohort study conducted between June 2022 and October 2022. One hundred and fifty-two dogs were evaluated that were presented to a private practice emergency room. Temperatures were obtained on presentation using both an aural Braun ExacTemp and a rectal Vet-Temp Rapid Digital Thermometer. The order of temperature measurement was randomized and recorded. Dogs were classified into three groups based on recorded temperature; normothermic (n = 105), hypothermic (n = 24), and hyperthermic (n = 23). Additional recorded parameters included: patient signalment, heart rate, respiratory rate, presence or absence of aural debris, coat length (classified as short, medium or long), body weight, body condition score, pain score, as well as venous lactate and non-invasive blood pressure, if performed. Results: The overall aural temperatures were significantly lower than rectal temperatures. The average rectal and aural temperatures were 38.7°C (range 36.6-40.7°C) and 38.3°C (range 35.7°C-40.4°C), respectively. Among all canines, there was a moderate, statistically significant relationship between rectal and aural temperatures (r = 0.636; p < 0.001) and this relationship remained significant with a weaker relationship for normothermic dogs (r = 0.411; p < 0.001). For hyperthermic and hypothermic dogs, there was not a statistically significant relationship between rectal and aural temperatures. Hyperthermic dogs had a significantly higher respiratory rate than other groups and hypothermic dogs were more likely to have a short haircoat. Lastly, ambient temperature, but not humidity, influenced patient temperature. Conclusion: Our study found aural temperatures were consistently lower than rectal temperatures in dogs with both normal and abnormal rectal temperatures. Aural thermometry may not be an acceptable method of temperature measurement in the emergency patient cohort.

Microorganism colonization of peripheral venous catheters in a small animal clinical setting.

OBJECTIVE: To compare the incidence of microorganism colonization of peripheral venous catheters (PVCs) placed in the Emergency Department (ED) to those placed in a routine preoperative setting. The relationship between catheter tip colonization and patient urgency (as assessed by triage priority) was also evaluated. DESIGN: Prospective, observational study from January 2021 to October 2021. SETTING: Emergency room and clinical areas of a large, urban, tertiary referral center. ANIMALS: Three hundred dogs and 94 cats with a PVC in place for a minimum of 24 hours were enrolled in the study. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Two hundred and eighty-eight PVCs were placed in the ED and 106 were placed preoperatively. The overall colonization rate was 10.4% (41/394). Sixteen bacterial and 1 fungal genera were cultured. Eight of these bacterial genera (25/51 [49%] bacterial isolates) were resistant to at least 1 antimicrobial class. Twenty-nine of 288 (10.1%) catheters positive for colonization were placed in the ED, whereas 12 of 106 (11.3%) were placed preoperatively. There was no association between microorganism growth on catheters and clinical area of catheter placement. There was also no association between ED patient urgency and positive catheter tip culture. No significant risk factors were identified predisposing to colonization of PVCs. CONCLUSIONS: The overall incidence of microorganism colonization of PVCs in this study population was equivalent to, or lower than, previously reported in veterinary literature. There was no statistical difference between the catheters placed in the ED and those placed for routine surgical procedures. Patient urgency did not affect the incidence of positivity of peripheral catheter tip cultures.

Phenibut toxicosis in a dog.

OBJECTIVE: To describe the successful treatment of severe neurological and cardiovascular abnormalities in a dog following ingestion of the neuropsychotropic drug, phenibut. CASE SUMMARY: A 2-year-old neutered male Weimaraner was found unresponsive and laterally recumbent in his urine after ingesting approximately 1600 mg/kg of phenibut. On presentation to an emergency clinic, the dog was neurologically inappropriate, tachycardic, hypertensive, and exhibiting a profoundly decreased respiratory rate. Because of progressive clinical signs, electrolyte abnormalities, increased hepatic enzyme activity and bilirubin concentrations, and the development of pigmenturia, referral to specialist care was sought. On presentation, the dog was intermittently somnolent and then maniacal. Sinus tachycardia persisted, and hyperthermia was documented. Hospitalization for supportive care was undertaken, and the dog was administered IV fluids, flumazenil, antiepileptics, and IV lipid emulsion therapy. The dog developed hypoglycemia and treated with dextrose supplementation. Progressive increases in liver enzyme activities as well as pronounced increase in creatine kinase activity, consistent with rhabdomyolysis, were noted. Over the course of 48 hours, the hypoglycemia resolved, and clinical signs significantly improved. Ultimately, the dog was discharged with improved clinical signs, with the owner reporting that 1 week after discharge, a full recovery had been made, and no residual clinical signs persisted. NEW INFORMATION PROVIDED: To the authors' knowledge, there are no previous reports of phenibut intoxication in small animals. The growing availability and use of this drug by people in the past several years highlight the need for a greater understanding of its effects in companion animals.

Fatal exposure to quaternary ammonium disinfectant in 2 dogs.

OBJECTIVE: To describe the clinical course and necropsy findings of 2 dogs after exposure to quaternary ammonium disinfectants. CASE SERIES SUMMARY: Two dogs were treated after accidental exposure to quaternary ammonium disinfectants in kennel settings. Both dogs developed ulcerative upper gastrointestinal lesions, severe pulmonary disease, and skin lesions. In the second case, the skin lesions were severe and became necrotizing. Both patients were ultimately euthanized due to severity of illness and lack of response to therapy. NEW OR UNIQUE INFORMATION PROVIDED: Quaternary ammonium compounds are commonly used as disinfectants in veterinary hospitals and boarding facilities. This is the first report detailing presentation, clinical picture, case management, and necropsy findings in dogs exposed to these chemicals. Awareness of the severity of these poisonings and the potential for fatal outcome is imperative.

Retrospective analysis of the use of canine-specific albumin in 125 critically ill dogs.

OBJECTIVE: To describe the clinical use of canine-specific albumin (CSA) in critically ill dogs, report adverse events, and evaluate measurable clinical effects of CSA administration. DESIGN: Retrospective case series from 2019 to 2020. SETTING: Large, urban, private-practice referral and emergency center. ANIMALS: Consecutive sample of 125 client-owned dogs administered CSA transfusions. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The conditions most commonly associated with the use of CSA were surgical (32/125) and nonsurgical (20/125) gastrointestinal disease. Both serum albumin and total plasma protein concentrations were significantly increased posttransfusion (P < 0.001), and 16% albumin transfusions produced the greatest magnitude increase in serum albumin (P = 0.0015). Concurrent crystalloid administration did not affect change in albumin. While there was no significant improvement in blood pressure seen in those patients that received albumin, a significant improvement in shock index was identified (P = 0.02). Adverse events were uncommon; however, 8 critically ill dogs died during CSA administration. CONCLUSIONS: CSA appears to be a relatively safe alternative to synthetic colloids and complementary to crystalloids in critically ill patients. More concentrated solutions may be more effective in raising serum albumin concentration. Further investigation into the indications for and efficacy of CSA will continue to improve our knowledge of this blood product.

High-rise syndrome in cats and dogs.

OBJECTIVE: To review the current literature pertaining to the pathophysiology, diagnosis, and treatment of injuries sustained from high-rise syndrome in cats and dogs. ETIOLOGY: High-rise syndrome is defined as a fall from a height of 2 or more stories that results in a constellation of injuries, including thoracic, abdominal, orthopedic, and orofacial trauma. Animals often fall after slipping from windowsills, engaging in mating behavior, or chasing prey. Cats suffer less severe injuries than dogs due to their "righting reflex" and smaller body mass. Affected animals are younger, and the frequency of falls is higher in warmer months. DIAGNOSIS: Physical examination coupled with radiographs, ultrasound, and computed tomography can diagnose a myriad of injuries that include pneumothorax, pleural or abdominal effusion, orthopedic fractures, and orofacial injuries. Bloodwork may identify anemia, thrombocytopenia, or increases in hepatic, renal, or pancreatic values consistent with trauma to these organs. Serial venous or arterial blood gas can help determine the severity of respiratory compromise and influence resuscitative efforts. Traditional coagulation tests and thromboelastography can assess trauma-induced coagulopathy and guide transfusion therapy. THERAPY: Animals presenting in shock require hemodynamic stabilization. Initial resuscitation may incorporate crystalloids, colloids, blood products, and analgesics. Thoracic injuries may require oxygen, thoracocentesis, chest tube placement, and mechanical ventilation. Fractures and wounds are decontaminated and splinted/bandaged, with definitive fixation pursued after stabilization. Abdominal injuries are managed medically unless there is severe ongoing bleeding, sepsis, or injury to the urinary tract. PROGNOSIS: In feline high-rise syndrome, the prognosis is generally excellent following treatment, with survival exceeding 90%. Canine literature is sparse. The largest retrospective study reported a >90% survival to discharge and a greater need for surgical stabilization in this species. There are no prognostic factors identified that are associated with survival for either species.

Comparing diagnostic findings and cost of whole body computed tomography to traditional diagnostic imaging in polytrauma patients.

OBJECTIVE: To compare the diagnostic utility of traditional diagnostic tests (ie, radiographs and focused assessment using sonography for trauma [FAST] scans) to whole-body computed tomography (WBCT) for characterizing injuries in polytrauma patients. A secondary objective was to compare costs of traditional diagnostic tests to WBCT. DESIGN: Prospective, observational study. SETTING: Private, level 1 veterinary trauma center. ANIMALS: Convenience sample of 21 client-owned cats and dogs presenting with polytrauma. INTERVENTIONS: Abdominal and thoracic FAST were performed by the primary clinician, if indicated. Radiographs were performed on areas concerning for trauma at the primary clinician's discretion. A WBCT was performed on each patient within 24 h of presentation and was blindly interpreted by a board-certified radiologist. Patients were only placed under anesthesia if further procedures were planned. IV contrast administration was employed at the discretion of the primary clinician and radiologist. MEASUREMENTS AND MAIN RESULTS: Twenty-one patients (14 dogs and 7 cats) were enrolled. Sources of trauma included blunt force (80%), penetrating wounds (10%), and unknown sources (10%). Twelve injuries were missed on traditional diagnostics tests. Injuries missed on traditional diagnostic workup included pneumothorax, pneumomediastinum, pulmonary contusions, pleural effusion, traumatic bulla, peritoneal effusion, and an appendicular skeleton fracture. A distal metacarpal fracture was missed on WBCT. Traditional diagnostic tests misdiagnosed a diaphragmatic hernia and a ruptured urinary bladder, whereas WBCT was able to rule out these injuries. There were no adverse outcomes associated with missed injuries. The median cost of traditional diagnostic tests was significantly less than the cost of WBCT (P < 0.001). CONCLUSIONS: Although cost is higher, WBCT is a single test that can provide more comprehensive information and may help decrease the risk of missed injuries compared to traditional diagnostic tests. WBCT may be considered as a first-line diagnostic in severely traumatized patients.

Red cell distribution width, illness severity, and all-cause mortality in dogs admitted to the ICU.

OBJECTIVE: To determine whether red cell distribution width (RDW) can predict illness severity and mortality risk in a heterogenous population of dogs admitted to the ICU. DESIGN: Prospective observational study. SETTING: Large, urban, private teaching hospital. ANIMALS: One hundred eleven dogs consecutively admitted to the ICU between September 2017 and December 2018. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Abbreviated Acute Patient Physiologic and Laboratory Evaluation (APPLEfast ) score and RDW were measured within 6 h of ICU admission. This study did not demonstrate a significant difference in illness severity across patients stratified by RDW. There was no difference in RDW between survivors and nonsurvivors at hospital discharge or at 30 days. CONCLUSIONS: In this study population, RDW did not correspond with illness severity as measured by APPLEfast . Moreover, RDW did not predict in-hospital or 30-day mortality.

Hypoglycemia and presumptive rhabdomyolysis secondary to lisdexamfetamine toxicosis in 3 cats.

OBJECTIVE: To describe the clinical course and novel biochemical changes in 3 cats with lisdexamfetamine (LDX) toxicosis. SERIES SUMMARY: Three cats presented with LDX exposure and initially displayed typical clinical signs of amphetamine toxicosis. However, over the course of hospitalization, hypoglycemia and markedly elevated creatine kinase levels consistent with rhabdomyolysis ensued. All cats were treated with sedatives including phenothiazines and dexmedetomidine. Two cats were hospitalized for 4 days and 1 for 5 days. All cats survived. NEW OR UNIQUE INFORMATION PROVIDED: This is the first case series in cats that reports the novel biochemical changes of delayed hypoglycemia and elevated creatine kinase several days into hospitalization for the treatment of LDX toxicity. The development of delayed clinical signs suggests reconsideration of established hospitalization guidelines for amphetamine ingestion in cats.

Electrolyte Derangements, Hyperlactatemia, and Cardiac Abnormalities Secondary to Refeeding in Three Dogs: Case Report.

Three dogs that presented to the emergency service in severely emaciated body conditions were admitted to the hospital for monitoring and refeeding. During their hospitalization, all three dogs developed electrolyte derangements or required supplementation to prevent hypophosphatemia and hypomagnesemia. Additionally, all dogs developed hyperlactatemia, which was suspected to be secondary to thiamine deficiency. Two dogs were reported to have cardiac abnormalities, including cardiac arrhythmias, systolic dysfunction, and spontaneous echogenic contrast. These cases highlight the complexity of refeeding syndrome and its associated complications that extend beyond electrolyte deficiencies.

The influence of a fast-track service on case flow and client satisfaction in a high-volume veterinary emergency department.

OBJECTIVE: To assess the benefit of a fast-track service in the emergency department of a large, high-volume veterinary hospital. DESIGN: Prospective, observational, clinical study. SETTING: Emergency department of an urban, tertiary referral veterinary hospital. ANIMALS: All animals presented to the emergency department between April 1 and April 30 in 2017 and 2018 were eligible for inclusion. Only patients seen on days in 2017 corresponding to those days of 2018 during which the fast-track service was available were studied. MEASUREMENT AND MAIN RESULTS: Triage case logs were collected and reviewed for April 2017 (prefast-track) and 2018 (fast-track). The fast-track service was launched as a pilot program in April 2018 to provide expedited care to low acuity patients presented to the emergency department. The median number of daily emergency department cases did not differ between 2017 (45, range 26-64) and 2018 (47, range 38-64; P = 0.3). The median time from presentation until first discussion with a doctor for low acuity cases was lower in April 2017 (29 min, range 1-163) than in April 2018 (24 min, range 1-100; P < 0.001). This reduction in wait time was observed despite a 40% increase in low acuity case presentations in 2018. Wait times for high acuity patients did not differ between study periods. The number of cases that left without being seen was higher in April 2017 compared to April 2018 (77 and 45 cases, respectively P < 0.001). CONCLUSIONS: Implementation of a fast-track service reduced wait time for low acuity cases without adversely impacting wait times for sicker patients and led to a reduction in clients leaving without being seen. By introducing the fast-track service in a large volume veterinary hospital, limited resources can be distributed to improve speed of care, case flow, and client satisfaction in the emergency department.

The effect of storage at 4°C on canine-specific albumin on product sterility and albumin concentration.

OBJECTIVES: To determine if lyophilized canine-specific albumin (CSA) can be stored beyond the manufacturer recommended 6 hours post-reconstitution without significant concern for bacterial growth. DESIGN: Laboratory research. SETTING: Large private teaching hospital. INTERVENTIONS: Six bottles of lyophilized CSA were retrieved from a medical grade (4°C) refrigerator and were reconstituted with 0.9% NaCl to a 5% solution. Time to complete dissolution of all bottles at room temperature without agitation was recorded in minutes. A 1.5-mL sample was collected from each bottle at the following time points: time 0 (at the time of complete dissolution), and then 6, 12, and 24 hours after removal from 4°C. Each aliquot was inoculated into a blood culture tube and was immediately submitted for aerobic and anaerobic bacterial culture. A positive and negative control were cultured at the 24-hour time point. At each time point, an additional 0.5-mL aliquot from each albumin bottle was collected, and these were combined to determine the average albumin concentration (g/L, g/dL) as measured by an in-house analyzer. The albumin was stored at 4°C between sample collection. MEASUREMENTS AND MAIN RESULTS: The reconstitution of CSA and storage at 4°C for up to 24 hours did not result in anaerobic or aerobic bacterial growth in any of the 24 cultured samples. Storage did not have a clinically significant effect on the albumin concentration of the solution. The average albumin concentration of all samples was 42 g/L (4.2 g/dL). No growth was noted in the negative control, and the positive control grew 4 strains of bacteria. CONCLUSIONS: It appears safe to use lyophilized CSA up to 24 hours post-reconstitution without significant risk of bacterial growth or change in albumin concentration.

The role of cryoprecipitate in human and canine transfusion medicine.

OBJECTIVE: To evaluate the current role of cryoprecipitate in human and canine transfusion medicine. DATA SOURCES: Human and veterinary scientific reviews and original studies found using PubMed and CAB Abstract search engines were reviewed. HUMAN DATA SYNTHESIS: In the human critical care setting, cryoprecipitate is predominantly used for fibrinogen replenishment in bleeding patients with acute traumatic coagulopathy. Other coagulopathic patient cohorts for whom cryoprecipitate is recommended include those undergoing cardiovascular or obstetric procedures or patients bleeding from advanced liver disease. Preferential selection of cryoprecipitate versus fibrinogen concentrate (when available) is currently being investigated. Also a matter of ongoing debate is whether to administer this product as part of a fixed-dose massive hemorrhage protocol or to incorporate it into a goal-directed transfusion algorithm applied to the individual bleeding patient. VETERINARY DATA SYNTHESIS: Although there are sporadic reports of the use of cryoprecipitate in dogs with heritable coagulopathies, there are few to no data pertaining to its use in acquired hypofibrinogenemic states. Low fibrinogen in dogs (as in people) has been documented with acute traumatic coagulopathy, advanced liver disease, and disseminated intravascular coagulation. Bleeding secondary to these hypocoagulable states may be amenable to cryoprecipitate therapy. Indications for preferential selection of cryoprecipitate (versus fresh frozen plasma) remain to be determined. CONCLUSIONS: In the United States, cryoprecipitate remains the standard of care for fibrinogen replenishment in the bleeding human trauma patient. Its preferential selection for this purpose is the subject of several ongoing human clinical trials. Timely incorporation of cryoprecipitate into the transfusion protocol of the individual bleeding patient with hypofibrinogenemia may conserve blood products, mitigate adverse transfusion-related events, and improve patient outcomes. Cryoprecipitate is readily available, effective, and safe for use in dogs. The role of this blood product in clinical canine patients with acquired coagulopathy remains unknown.

Prospective evaluation of plasma lactate parameters for prognosticating dogs with shock.

OBJECTIVE: To determine whether admission venous plasma lactate concentration, serially calculated lactate variables, or the Acute Patient Physiologic and Laboratory Evaluation (APPLEfast ) score could discriminate hospital survivors from non-survivors in dogs presenting to the emergency department with clinical signs of shock. DESIGN: Prospective case series performed over a 24-month period. SETTING: Large urban private teaching hospital. ANIMALS: Seventy-one dogs admitted to the ICU with initial peripheral venous plasma lactate concentration > 2.5 mmol/L and clinical and hemodynamic parameters consistent with shock. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Heart rate, systolic blood pressure, temperature, initial venous plasma lactate, and APPLEfast score were recorded at admission. Lactate concentrations were serially recorded at predefined time points and used to calculate lactate variables, including lactime (time lactate > 2.5 mmol/L), lactate clearance ([lactateinitial - lactatedelayed ]/ lactateinitial × 100), and LACAREA (area under the lactate concentration versus time curve). Primary outcome was survival to discharge. Overall survival rate was 61%. Admission plasma lactate did not differ between groups (P = 0.28). Lactime was shorter in survivors vs non-survivors (P = 0.03). Lactate clearance at hours (h) 1, 4, 10, and 16 was greater in survivors vs non-survivors (P < 0.05). Final plasma lactate clearance differed between groups (P < 0.05). LACAREA at time intervals 1 to 4 hours, 4 to 10 hours, 10 to 16 hours, and 16 to 24 hours was larger in non-survivors vs survivors (P < 0.05). Total LACAREA did not differ between groups (P = 0.51). Admission APPLEfast was not different between survivors and non-survivors (P = 0.16). CONCLUSIONS: While neither single APPLEfast nor admission plasma lactate concentration could discriminate between hospital survivors and non-survivors, measures of lactate clearance can prognosticate survival in dogs with shock.

Early and aggressive surgical debridement and negative pressure wound therapy to treat necrotizing fasciitis in three dogs.

OBJECTIVE: To report the management and outcomes of dogs with necrotizing fasciitis (NF) treated with early, aggressive surgical debridement and negative pressure wound therapy (NPWT). STUDY DESIGN: Short case series. ANIMALS: Three dogs surgically treated for NF. METHODS: Clinical signs in the three dogs included an identified wound, severe pain, fever, and progressive erythema. A tentative diagnosis of NF was based on the presence of suppurative inflammation and intracellular bacteria seen in fine needle aspirates and clinical progression in each case. Each dog was treated with surgical debridement within 6 hours of clinical suspicion for NF. Necrosis affected multiple tissue layers was noted surgical exploration. Systemic supportive care and antibiotherapy were also provided for 3 to 4 weeks postoperatively. RESULTS: Three surgical debridements were required in two dogs, and four surgical debridements were required in one dog. All of the surgical sites were managed with NPWT until final primary closure was possible at 4, 5, and 6 days after initial surgery. Results of histopathology and culture of the surgical sites were consistent with NF as described in each case. All dogs survived to discharge and long-term follow up. CONCLUSION: Management with early surgery, multiple debridements, and the use of NPWT led to resolution of NF in three dogs.

Use of injectable lipid emulsion and sodium bicarbonate to treat severe cardiovascular collapse secondary to lamotrigine toxicosis in a dog.

CASE DESCRIPTION: A 2-year-old 5.1-kg (11.2-lb) sexually intact male Maltese was admitted because of vomiting and seizures after a known ingestion of up to 206 mg/kg (93.6 mg/lb) of lamotrigine (a commonly prescribed human antiepileptic medication) approximately 3 hours earlier. CLINICAL FINDINGS: On presentation, the dog was having a seizure; however, the seizure stopped before interventional treatment, and the dog was obtunded, tachycardic, and hypertensive. Fluid therapy was initiated, and a bolus of injectable lipid emulsion (ILE) was administered. The dog's cardiovascular and mentation signs improved, and the dog was hospitalized for supportive care and monitoring. Hours later, the dog developed ventricular tachycardia that progressed to ventricular fibrillation, then cardiac arrest. TREATMENT AND OUTCOME: Cardiopulmonary resuscitation, including defibrillation, was initiated. With no response after several minutes of resuscitation efforts, another bolus of ILE was administered, and the dog's heartbeat returned shortly thereafter, albeit with severe ventricular arrhythmias that were treated medically, including with sodium bicarbonate. The dog was discharged 48 hours later with no neurologic or cardiovascular abnormalities. Six months later, the owner reported that the dog was doing well and had no abnormalities. CLINICAL RELEVANCE: To our knowledge, there are no previous case reports in veterinary medicine regarding the successful use of ILE to treat cardiac arrest secondary to lipophilic drug toxicoses nor the use of and physiologic response to sodium bicarbonate during treatment of lamotrigine toxicoses in dogs; therefore, findings in the dog of the present report may help other veterinarians treating similarly affected dogs in the future.

Use of Human Intravenous Immunoglobulin in Veterinary Clinical Practice.

Therapy with human intravenous immunoglobulin (hIVIG) as an immunomodulator in veterinary patients results in effective but transient immunosuppression, and may be viable as part of a multidrug strategy against immune-mediated thrombocytopenia and autoimmune cutaneous disease. Efficacy of hIVIG against other veterinary autoimmune diseases is questionable. Veterinary patients tolerate hIVIG therapy well, with few infusion reactions documented. Veterinary clinical trials of hIVIG are limited, and more work is needed to determine the true efficacy and risk of hIVIG administration in companion animals.

A Preliminary Investigation into the Association of Chloride Concentration on Morbidity and Mortality in Hospitalized Canine Patients.

PURPOSE: To evaluate whole blood chloride concentration and hospital-acquired AKI in hospitalized canine patients. Secondary outcome measures included the volume-adjusted chloride load, in-hospital mortality and length of ICU stay. PATIENTS AND METHODS: This is a prospective, observational study. Sixty dogs admitted to the ICU and receiving IV fluid therapy for >24 hours from February 2018 to July 2019. Corrected chloride and creatinine concentrations were obtained twice daily. Total volume of IV fluid and total chloride load were recorded. Volume-adjusted chloride load (VACL) was calculated by dividing the chloride administered by the volume of fluid administered. Hospital-acquired AKI was defined as an increase in creatinine of ≥26.5 µmol/L (0.3 mg/dL) or 150% from baseline to maximum. Survival to hospital discharge or non-survival and ICU length of stay were also recorded. RESULTS: Fifteen out of 60 patients developed hospital-acquired AKI. Maximum corrected chloride was significantly different in AKI group (median 122.3 mmol/L) vs non-AKI group (median 118.1 mmol/L; p=0.0002). Six out of 60 patients developed hyperchloremia. Hyperchloremic patients were significantly more likely to develop in-hospital AKI (p=0.03). Patients hospitalized ≥2 days had a significantly higher [Cl-]max compared to those with shorter ICU stay (121.8 ± 5.9 mmol/L vs 117.5 ± 4.3 mmol/L; p=0.002). Eight out of 60 patients were non-survivors. Maximum corrected chloride and creatinine concentrations were not significantly different between survivors and non-survivors. VACL was not significantly different between AKI or mortality groups. CONCLUSION: Maximum corrected chloride concentration was significantly higher in dogs with hospital-acquired AKI, even amongst dogs without hyperchloremia. Additionally, maximum corrected chloride concentrations were significantly higher in dogs hospitalized in the ICU longer compared to those hospitalized for fewer than two days. There was no significant difference in VACL in any of the outcome groups. Results from this study suggest alterations in chloride may be observed alongside the development of acute kidney injuries. Future studies in critically ill dogs are warranted.