Evaluation of Clinicopathological Data, the Specific Feline Pancreatic Lipase Assay, and Abdominal Ultrasound as Severity Determinants in Cats with Pancreatitis.

Limited data exist to predict the severity of pancreatitis in cats. In this retrospective case series, we reviewed the medical records of 45 cats with SP from June 2014 to June 2019. Case definition was based on an internist's review of clinopathologic data, Spec fPL concentration, and AUS findings. Information extracted from the medical records included signalment, history, physical examination findings, selected clinicopathological data (total bilirubin, glucose, ALP, ALT, and total calcium), Spec fPL concentration, AUS images/clips, length of hospitalization, and survival data. Hazard ratios were used to evaluate the association between clinicopathological data, the Spec fPL assay, AUS findings, and the length of hospitalization. Clinicopathological abnormalities, the Spec fPL, and AUS abnormalities were not statistically associated with the length of hospitalization. Despite a lack of statistical significance, the hazard ratios suggest the potential that an elevated total bilirubin (hazard ratio (HR): 1.19), hypocalcemia (HR: 1.49), and an elevated Spec fPL concentration (HR: 1.54) could be associated with prolonged hospitalization, although additional studies would be needed to verify this. Additionally, hazard ratios suggest that AUS evidence of concurrent gallbladder (HR: 1.61) and gastric abnormalities (HR: 1.36) could be associated with prolonged hospitalization.

Effects of leukoreduction on N-methylhistamine concentration in stored units of canine whole blood.

OBJECTIVE: To determine the effects of leukoreduction on N-methylhistamine (NMH; a stable histamine metabolite) concentration in units of canine whole blood during storage and incubation at room temperature (approx 22 °C) to simulate temperature conditions during transfusion. ANIMALS: 8 healthy adult Walker Hounds. PROCEDURES: A standard unit of blood (450 mL) was obtained from each dog twice, with at least 28 days between donations. Blood units collected from 4 dogs during the first donation underwent leukoreduction, whereas the blood units collected from the other 4 dogs did not undergo leukoreduction, prior to storage at 4 °C. The alternate treatment was applied to blood units collected during the second donation. A sample from each unit was obtained for determination of plasma NMH concentration the day of donation (before and after leukoreduction when applicable) and before and after incubation at room temperature for 5 hours on days 14 and 28 of storage. RESULTS: Units that underwent leukoreduction had substantially lower leukocyte and platelet counts than nonleukoreduced units. Plasma NMH concentration increased immediately after leukoreduction but did not change significantly during the subsequent 28 days of storage, nor did it differ between units that did and did not undergo leukoreduction. CONCLUSIONS AND CLINICAL RELEVANCE: Leukoreduction and simulated transfusion temperature did not affect the histamine load in units of canine whole blood during the first 28 days of storage. Further research is necessary to determine whether histamine contributes to the development and severity of blood transfusion reactions in dogs.

Ketoconazole-induced transient hypoadrenocorticism in a dog.

A 6-year-old, spayed female, mixed breed boxer dog was presented for decreased appetite, polyuria and polydipsia, and lethargy 9 days after treatment with ketoconazole for Malassezia pododermatitis. Ketoconazoleinduced hypoadrenocorticism was confirmed with an adrenocorticotropic hormone (ACTH) stimulation test, and ketoconazole was discontinued. Clinical signs resolved 48 hours after initiation of prednisone, and resolution of glucocorticoid insufficiency was confirmed with a repeat ACTH stimulation test 48 hours after a 10-day course of prednisone. Glucocorticoid insufficiency after administration of a commonly used dermatological dose of ketoconazole has not been previously reported in veterinary medicine but should be considered in patients with adverse effects while receiving ketoconazole. Key clinical message: Iatrogenic hypoadrenocorticism may occur in dogs treated with commonly used dermatological doses of ketoconazole. The disease is likely transient, but steroid supplementation may be required in some patients to resolve clinical signs, especially in the presence of concurrent illness or stress.

Hypoadrénocorticisme transitoire induit par le kétoconazole chez un chien. Une femelle Boxer mélangée stérilisée et âgée de 6 ans fut présentée pour une diminution d'appétit, de la polyurie et de la polydipsie, ainsi que de la léthargie 9 jours après un traitement avec du kétoconazole pour une pododermatite à Malassezia. L'hypoadrénocorticisme induit par le kétoconazole fut confirmé par un test de stimulation avec une hormone adrénocorticotropique (ACTH), et le kétoconaxole fut arrêté. Les signes cliniques ont cessé 48 heures après le début d'un traitement à la prednisone, et la résolution de l'insuffisance de glucocorticoïdes fut confirmée par une répétition du test de stimulation à l'ACTH 48 heures après 10 jours de traitement à la prednisone. L'insuffisance de glucocorticoïdes après l'administration d'une dose de kétoconazole fréquemment utilisée en dermatologie n'a pas été préalablement rapportée en médecine vétérinaire mais devrait être considérée chez des patients présentant des réactions adverses lorsqu'ils reçoivent du kétoconazole.Message clinique clé:De l'hypoadrénocorticisme iatrogénique peut survenir chez des chiens traités avec du kétoconazole avec des doses fréquemment utilisées en dermatologie. La maladie est probablement transitoire, mais une supplémentation en stéroïde pourrait être requise chez certains patients afin de résoudre les signes cliniques, spécialement en présence de maladie concomitante ou de stress.(Traduit par Dr Serge Messier).

Association between abdominal ultrasound findings, the specific canine pancreatic lipase assay, clinical severity indices, and clinical diagnosis in dogs with pancreatitis.

BACKGROUND: A clinical diagnosis (CDx) of pancreatitis includes evaluation of clinical signs, abdominal ultrasound (AUS), and pancreatic lipase. However, practitioners are using AUS to diagnose pancreatitis and are using AUS severity to guide decisions. The validity of this is unknown. OBJECTIVES: To determine whether (1) there is a correlation between AUS, specific canine pancreatic lipase (Spec cPL) assay, and CDx; (2) individual AUS abnormalities correlate more closely with CDx than others; (3) AUS severity mirrors clinical severity indices; (4) changes in AUS can be used as a marker for changes in Spec cPL or CDx; and (5) the sensitivity and specificity of AUS for pancreatitis. ANIMALS: One hundred fifty-seven dogs. METHODS: In this retrospective case study, inclusion criteria were signs of gastrointestinal, pancreatic disease, or both, in addition to having a Spec cPL and AUS performed within 30 hours. Information extracted from the records included bloodwork, Spec cPL, AUS images/clips, and severity of ultrasonographic findings. RESULTS: AUS was weakly correlated with Spec cPL (rs = .0178, P = .03) and moderately correlated with CDx (rs = .379, P = <.001). Pancreatic size (rs = .285, P = <.001), echogenicity (rs = .365, P = <.001), and mesenteric echogenicity (rs = .343, P = <.001) were correlated with CDx. Change in AUS was not correlated with Spec cPL or CDx changes. When pancreatic enlargement, echogenicity, or altered mesenteric echogenicity were required for a diagnosis, the sensitivity and specificity were 89% (95% confidence interval [CI] 71.8, 97.7) and 43% (95% CI 34.0, 51.6). When all 3 criteria were required, the sensitivity and specificity were 43% (95% CI 24.5, 62.8) and 92% (95% CI 85.3, 95.7). CONCLUSIONS: AUS should not be used in isolation to diagnose pancreatitis and is a poor indicator of severity.

Strategies to Improve Case Outcome When Referral Is Not Affordable.

We conducted a survey-based study to determine whether on-site consultations and cost-effective protocols are beneficial to general practitioners handling challenging small animal internal medicine patients when owners cannot afford referral and whether fourth-year veterinary students benefit from training in this area. Fifteen general practices were visited over 12 months by a board-certified internist and students. On-site consultations for patients belonging to owners who could not afford referral were conducted by the internist. Students and general practitioners completed pre- and post-participation surveys. Students' surveys contained questions about comfort level with complicated cases on a budget and knowledge gained from, and perception of, the on-site consultations and protocol development. Practitioners' surveys contained questions about comfort level and experience with complicated internal medicine cases, the benefit of the consultations, and the cost-effective protocols, which were compiled into a booklet for practitioners. All students and practices completed the pre-survey, and 56 of 60 (93.3%) of the students and 13 of 15 (86.7%) of the practices completed the post-survey. Approximately 68% of students believed their comfort level with budget-limited cases improved and that they benefited from participation in the consultations and protocol development. Similarly, most general practitioners believed these strategies were highly beneficial. The cost of veterinary care, especially referral medicine, is unaffordable for many owners. Veterinary students should be exposed to these challenges and trained in cost-effective approaches. Similarly, general practitioners may be able to more successfully and efficiently diagnose and treat challenging internal medicine cases using the proposed strategies when owners decline referral.

Evaluation of a structured individualised protocol as a potential cost-effective diagnostic and therapeutic approach to chronic diarrhoea in the dog.

Diagnostic investigation and management of chronic diarrhoea in dogs can be cost-prohibitive to many owners. The objectives of this study were to evaluate evidence-based, individualised diagnostic and therapeutic protocols for management of dogs with chronic diarrhoea, where financial constraints dictate a budget-limited approach and where more expensive approaches are deferred until simple affordable protocols are unsuccessful. Twenty-two client-owned dogs with chronic (minimum 2 weeks duration) untreated small, large or mixed small/large bowel diarrhoea were enrolled in a budget-limited step-wise management protocol (maximum expenditure $300 over 6 weeks), with diagnostic testing and therapeutic trials managed in an individualised and evidence-based fashion. Success was defined as complete resolution of diarrhoea for a minimum of 1 month. Dogs that failed to respond to a budget-limited protocol were then enrolled for complete, referral-level management. Four dogs exited the project early (one death due to caval syndrome, three lost to follow-up). Thirteen out of the remaining 18 dogs had complete resolution of diarrhoea utilising a budget-limited approach (success rate 72.2%, confidence intervals 46.5-90.3%) and five dogs were moved on to a referral-level investigation, with complete resolution of diarrhoea in four out of five. Seventeen out of the 18 dogs therefore responded to a protocol based on a budget-limited approach followed by extensive investigation only if needed, for an overall success rate of 94.4% (CI 72.7-99.9%). Comprehensive investigation of chronic diarrhoea can be deferred while simple affordable diagnostics and therapeutic trials are conducted in stable canine patients and, often, an extensive management approach will be unnecessary.