Medication-induced hypokalemia.

A potassium deficiency can impair metabolic functions, and medications cause hypokalemia through a variety of mechanisms. The authors report on a 58-year-old female suffering from fatigue and weakness after a recent diagnosis of adrenal insufficiency.

Use of a hearing loss grading system and an owner-based hearing questionnaire to assess hearing loss in pet dogs with chronic otitis externa or otitis media.

BACKGROUND: Hearing loss is important when assessing the suitability of dogs with otitis externa/media for medical or surgical therapy. HYPOTHESIS/OBJECTIVES: To assess an owner-completed questionnaire as an indicator of hearing loss and a canine hearing loss scoring system in chronic canine otitis. ANIMALS: One hundred hospital population dogs referred for chronic otitis investigation. METHODS: Owners completed a questionnaire to assess their dog's response to common household noises. The presence of otitis externa or media was determined and brainstem auditory-evoked response measurements were performed on each dog. The minimal hearing threshold (MHT) in decibels normal hearing level (dB NHL) was recorded and categorized according to the human World Health Organization grading system into five grades from 0 to 4 with cut-off values of ≤25 dB NHL, 26-40 dB NHL, 41-60 dB NHL, 60-80 dB NHL and ≥81 dB NHL. RESULTS: The questionnaire correctly determined normal hearing in grade 0 cases, but did not reliably detect unilateral or grade 1 bilateral hearing loss. For dogs with bilateral hearing loss ≥ grade 2, questionnaire sensitivity was 83% [24 of 29, 95% confidence interval, (CI) 64-94%] and specificity was 94% (67 of 71, 95% CI 86-98%). Higher grades of hearing loss were significantly associated with the presence of otitis media (P < 0.01). CONCLUSIONS AND CLINICAL IMPORTANCE: The questionnaire may be a useful in-practice screening tool in chronic canine otitis for moderate to severe bilateral hearing deficits (MHT ≥41 dB NHL). The hearing loss grading system may help clinicians make therapeutic decisions. Chronic otitis media may be associated with higher grades of hearing loss.

Study to assess in vitro antimicrobial activity of nine ear cleaners against 50 Malassezia pachydermatis isolates.

BACKGROUND: Ear cleaning is an important part of the successful therapy of otitis externa. HYPOTHESIS/OBJECTIVES: To evaluate the in vitro activity of nine commercially available ear cleaners (Cerumaural(®), CleanAural Dog(®), Epi-Otic(®), MalAcetic Aural(®), Otoclean(®), Otodine(®), Sancerum(®), Surosolve(®) and TrizUltra™ + Keto) against 50 Malassezia pachydermatis isolates from clinical cases of canine otitis externa. To the authors' knowledge, this is the first study to analyse the in vitro susceptibility of a large number of M. pachydermatis isolates to a variety of ear cleaner products. ANIMALS: Forty-nine hospital population dogs diagnosed with otitis externa with Malassezia spp. present on cytological examination of ear swabs and culture. METHODS: The antimicrobial activity of nine ear cleaners was tested against 50 M. pachydermatis isolates from 49 clinical cases of canine otitis externa using an in vitro agar diffusion test. RESULTS: There were statistically significant differences in activity between ear cleaners, with five showing excellent in vitro anti-Malassezia activity (CleanAural Dog(®), Epi-Otic(®), MalAcetic Aural(®), Sancerum(®) and TrizUltra™ + Keto), two moderate activity (Otodine(®) and Surosolve(®)), one variable activity (Otoclean(®)) and one no activity (Cerumaural(®)). There was a significant overall difference in susceptibility between M. pachydermatis isolates tested (P < 0.001). CONCLUSIONS AND CLINICAL IMPORTANCE: Ear cleaners with activity against Malassezia may help to reduce the unnecessary use of antibiotic-containing polypharmaceutical ear medications. This study shows that the use of a large number of isolates may provide a more accurate account of the in vitro activity of a product.