Occurrence and clinical relevance of postoperative hypernatremia in dogs undergoing cholecystectomy.

BACKGROUND: Patients undergoing cholecystectomy have not been reported previously to develop clinically relevant postoperative hypernatremia. OBJECTIVES: Describe the frequency of postoperative hypernatremia in dogs undergoing cholecystectomy and its clinical relevance (duration of hospitalization and survival). ANIMALS: Thirty-seven dogs undergoing cholecystectomy at 2 private referral hospitals. METHODS: Retrospective study of dogs undergoing cholecystectomy with available preoperative and postoperative serum sodium concentrations. RESULTS: Postoperative hypernatremia (>150 mEq/L) was common (56%; 95% confidence interval [CI], 40%-70%) and was associated with significantly higher mortality compared to nonhypernatremic patients (52%; 95% CI, 30%-70% vs 12.5%; 95% CI, 2%-40%; P = .02). Nonsurvivors had higher mean postoperative peak serum sodium concentrations (155 mEq/L; range, 146-172) than survivors (150 mEq/L; range, 142-156; P = .01). Dogs developing hypernatremia within 6 hours after surgery had 7.7 higher odds of nonsurvival (odds ratio [OR], 7.7; 95% CI, 5.9-9.4). A delta value (serum sodium concentration on admission [T0] - serum sodium concentration 6 hours postoperatively [T2]) of ≥10 mEq/L carried 3.3 higher odds of mortality (OR, 3.3; 95% CI, 1.6-5.1). All dogs with a postoperative peak sodium concentration >160 mEq/L did not survive. Admission acute patient physiologic laboratory evaluation fast (APPLEfast ) scores were not different between survivors and nonsurvivors or between postoperative hypernatremic and normonatremic patients. Hospitalization time was no different between hypernatremic and normonatremic patients (6 days vs 4.5 days; P = .15). Dogs with gallbladder mucocele were more likely to develop postoperative hypernatremia and have poorer outcomes. CONCLUSIONS: Hypernatremia was a common and clinically relevant postoperative complication in dogs after cholecystectomy. Detection of hypernatremia within 6 hours after surgery may be associated with poorer outcomes.

Emergency treatment with intravenous infusion of methylene blue followed by oral administration in a cat presented with severe recurrent methemoglobinemia.

OBJECTIVE: To describe the use of IV infusion followed by oral administration of methylene blue (MB) to successfully treat recurrent methemoglobinemia (MetHb) in a young cat. CASE SUMMARY: A 6-month-old male Ragdoll cat presented with recurrent episodes of severe MetHb and was successfully managed with IV infusion of MB followed by a course of oral MB. Although the definitive cause of the patient's MetHb remains unknown, the cat made a full recovery following treatment without developing any significant side effects secondary to therapy and at the time of writing not had any further recurrences. Follow-up at 6 months found the patient in good health and without any long-term consequences. NEW INFORMATION PROVIDED: To the authors' knowledge, this is the first report of a cat presented with severe MetHb quantitatively assessed via co-oximetry and successfully treated with both IV and oral administration of MB.

Indications for use and complications associated with canine plasma products in 170 patients.

OBJECTIVES: To describe a population of dogs receiving canine plasma products (PP), report the incidence of transfusion reactions (TR), and to identify whether this is higher when non-type-matched plasma is administered. DESIGN: Retrospective study conducted on dogs receiving canine PP between March 2016 and January 2018. SETTING: Private referral hospital with first opinion emergency clinic. ANIMALS: One hundred and ninety-four privately owned dogs identified from the clinic electronic medical record system that received at least 1 unit of canine PP during the study period; 25 patients were excluded due to incomplete records. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A search of computerized records was performed, identifying any patients that received canine PP between 2016 and 2018; clinical notes were examined to identify the number and type of TR associated. One hundred and sixty-nine cases were included in the study, receiving a total of 412 PP transfusions. Reactions were noted in 4% (17/412) of transfusions administered, with the vast majority being mild in nature. Of the TR identified, a greater proportion were in type-matched PP transfusions than non-type-matched, although this difference was not statistically significant (P = 0.7989). The number of dogs suffering a TR was higher (13%) when multiple units of plasma were administered than if only 1 unit was transfused (5%), but this was not statistically significant (P = 0.1161). Transfusion reactions were more likely to occur when packed red blood cells were also administered, although this was also not statistically significant (P = 0.07). CONCLUSION: Administration of canine plasma products appears to be a safe procedure that carries a low risk of transfusion reactions. Type-matching of canine PP appears unnecessary and does not reduce incidence of TR in dogs.