Safety and efficacy of high-dose fomepizole compared with ethanol as therapy for ethylene glycol intoxication in cats.

OBJECTIVE: To determine the safety and efficacy of high-dose fomepizole compared with ethanol (EtOH) in cats with ethylene glycol (EG) toxicosis. DESIGN: Prospective study. SETTING: University veterinary research laboratory. ANIMALS: Thirteen cats. INTERVENTIONS: Two cats received injections of high-dose fomepizole (Study 1). Three cats received lethal doses of EG and fomepizole treatment was initiated 1, 2, or 3 hours later (Study 2). Eight cats received a lethal dose of EG and were treated with fomepizole or EtOH (Study 3). Cats treated with fomepizole received 125 mg/kg IV initially, then 31.25 mg/kg at 12, 24, and 36 hours. Cats treated with EtOH received 5 mL of 20% EtOH/kg IV initially, then every 6 hours for 5 treatments, then every 8 hours for 4 treatments. Cats also received fluids and supportive therapy as needed. MEASUREMENTS AND MAIN RESULTS: Clinical signs were monitored and serial blood analyses performed. Cats receiving fomepizole experienced mild sedation but no biochemical evidence of toxicity. Cats receiving fomepizole for EG intoxication survived if therapy was initiated within 3 hours of EG ingestion. One of the 6 developed acute renal failure (ARF) but survived. Only 1 of the 3 cats treated with EtOH 3 hours following EG ingestion survived; 2 developed ARF and were euthanized. Cats treated 4 hours following EG ingestion developed ARF, whether treated with EtOH or fomepizole. CONCLUSIONS: Fomepizole is safe when administered to cats in high doses, prevents EG-induced fatal ARF when therapy is instituted within 3 hours of EG ingestion, and is more effective than treatment with EtOH.

Cytology and fluid analysis of the acute abdomen.

In patients with acute abdominal pain, abdominal paracentesis and diagnostic peritoneal lavage often yield fluid samples for cytologic and biochemical evaluation. Cytology of the effusion from a patient with acute abdominal disease can be a crucial tool for the rapid diagnosis necessary for initiation of timely and appropriate therapy. Appropriate sample collection, handling, and preparation are essential to obtain an accurate diagnosis. Analysis of the fluid sample should include gross examination of the effusion, measurement of total nucleated cell count, packed red blood cell volume, and protein concentration, as well as examination for the presence of other cells, bacteria, food particles, or plant material. Biochemical evaluation should proceed based on the clinician's index of suspicion for a particular disease process. Abdominal effusions are generally classified as transudate, modified transudate, or exudate, depending on the total nucleated cell count and protein concentration. Cytology of all fluids collected should be performed systematically, utilizing progressively higher magnifications with a microscope. Specific diseases with associated abdominal effusions include septic peritonitis, nonseptic peritonitis, hemoabdomen, uroabdomen, pancreatitis, bile peritonitis, chylous effusion, and neoplasia. A complete description of sample preparation and evaluation is reviewed.

Critical care monitoring considerations for the diabetic patient.

Diabetes mellitus (DM) is a common endocrine disease encountered in the emergency and critical care setting. The diabetic Ketoacidotic (DKA) animal represents an extreme of the DM patient with regard to hyperglycemia and acid-base and electrolyte derangements. Prompt diagnosis of DKA in a critical patient and rapid initiation of appropriate therapy are necessary for a positive outcome. The steps of treatment, in order of importance, include initiation of intravenous fluid therapy, insulin therapy, electrolyte replacement, and reversal of the metabolic acidosis. The main goals of therapy--including correction of dehydration, electrolyte abnormalities and acidosis via aggressive fluid therapy with electrolyte supplementation and correction of ketoacidosis and hyperglycemia via initiation of insulin therapy--can be achieved if these steps are followed. Because of the severity of metabolic alterations in the DKA animal, frequent and careful monitoring are paramount because they will allow the clinician to tailor treatment to each case.