Retrospective evaluation of the clinical course and outcome of zinc toxicosis due to metallic foreign bodies in dogs (2005-2021): 55 cases.

OBJECTIVE: To describe the overall clinical course of zinc toxicosis in dogs including source, time to source control, incidence of hemolytic anemia, acute liver injury (ALI), acute kidney injury (AKI), and pancreatitis. DESIGN: Retrospective case series from 2005 to 2021. SETTING: Six university veterinary teaching hospitals. ANIMALS: Fifty-five client-owned dogs with known zinc toxicosis due to metallic foreign body (MFB) ingestion. MEASUREMENTS AND MAIN RESULTS: The most common source of zinc was US pennies minted after 1982 (67.3%). Forty-five of 55 (81.8%) dogs survived and 10 of 55 (18.2%) died or were euthanized. Median length of hospitalization for survivors and nonsurvivors was 3 days. The most common clinical sequelae of zinc toxicosis were anemia (87%), ALI (82%), coagulopathy (71%), thrombocytopenia (30.5%), AKI (26.9%), and acute pancreatitis (5.5%). Most dogs (67.3%) required blood products and 83% of dogs achieved a stable HCT or PCV in a median of 24 hours after MFB removal. The median duration of illness prior to presentation was 48 hours for both survivors and nonsurvivors and there was no impact of time to presentation on the incidence of ALI, AKI, or pancreatitis. CONCLUSIONS: Zinc toxicosis secondary to MFB ingestion should be considered a differential diagnosis for dogs with gastrointestinal signs, hemolytic anemia, ALI, hemostatic abnormalities, AKI, and pancreatitis. AKI may be a more common sequela of zinc toxicosis than previously suspected. Acute pancreatitis is a rare but potentially serious sequela to zinc toxicosis.

Retrospective analysis of immunosuppressive and anti-thrombotic protocols in nonassociative immune mediated hemolytic anemia in dogs.

BACKGROUND: Evidence supporting the effectiveness of therapeutic protocols for nonassociative immune-mediated hemolytic anemia (na-IMHA) is weak. HYPOTHESIS/OBJECTIVES: Investigate the efficacy of various drugs in na-IMHA. ANIMALS: Two hundred forty-two dogs. METHODS: Multi-institutional retrospective study (2015-2020). Immunosuppressive effectiveness was determined by time to packed cell volume (PCV) stabilization and duration of hospitalization through analysis by mixed model linear regression. Occurrence of disease relapse, death, and antithrombotic effectiveness, were analyzed using mixed model logistic regression. RESULTS: Use of corticosteroids vs a multi-agent protocol had no effect on time to PCV stabilization (P = .55), duration of hospitalization (P = .13), or case fatality (P = .06). A higher rate of relapse (P = .04; odds ratio: 3.97; 95% confidence interval [CI]: 1.06-14.8) was detected in dogs receiving corticosteroids (11.3%) during follow-up (median: 28.5 days, range: 0-1631 days) compared to multiple agents (3.1%) during follow up (median: 47.0 days, range: 0-1992 days). When comparing drug protocols, there was no effect on time to PCV stabilization (P = .31), relapse (P = .44), or case fatality (P = .08). Duration of hospitalization was longer, by 1.8 days (95% CI: 0.39-3.28 days), for the corticosteroid with mycophenolate mofetil group (P = .01) compared to corticosteroids alone. Use of clopidogrel vs multiple agents had no effect on development of thromboses (P ≥ .36). CONCLUSIONS AND CLINICAL IMPORTANCE: Addition of a second immunosuppressive agent did not alter immediate outcome measures but might be associated with a reduction in relapse. Use of multiple antithrombotic agents did not reduce incidence of thrombosis.

Peripheral biomarkers of oxidative stress in dogs with acute pancreatitis.

BACKGROUND: Oxidative stress is considered a pathomechanism of acute pancreatitis (AP), but no studies have extensively characterized oxidant status in dogs with naturally-occurring AP. HYPOTHESIS OR OBJECTIVES: Evaluate measures of oxidant status in dogs with AP and explore whether these measures correlate with AP severity. ANIMALS: Fifteen dogs with AP and 9 control dogs. METHODS: Prospective, controlled observational study. Plasma reactive metabolite (RM) concentrations, antioxidant potential (AOP), and urinary F2 isoprostane concentrations were measured in AP dogs and healthy controls. Severity of AP was assessed by length of hospitalization and 3 disease severity indices: canine acute pancreatitis severity (CAPS), modified canine activity index (M-CAI), and the acute patient physiologic and laboratory evaluation score (APPLEfull ). RESULTS: Reactive metabolite (RM) concentrations (median, 65 relative fluorescent units [RFU]/µL; range, 20-331 RFU/µL) and RM:AOP (median, 7; range, 4-109) were higher in AP dogs than healthy controls (median RM, 25 RFU/µL; range, 16-41 RFU/µL; median RM:AOP, 4; range, 2-7; P < .001 for both comparisons). Reactive metabolite (rS  = 0.603, P = .08) and RM:AOP (rS  = 0.491, P = .06) were not correlated with the duration of hospitalization or disease severity indices evaluated. However, disease severity indices did not predict mortality in our study. Normalized urine 2,3-dinor-8-iso-prostaglandin F2α concentrations were correlated with C-reactive protein (CRP; rS  = 0.491, P = .03), canine specific pancreatic lipase (Spec cPL; rS  = 0.746, P = .002), and CAPS (rS  = 0.603, P = .02). CONCLUSIONS AND CLINICAL IMPORTANCE: Oxidant status is altered in dogs with naturally occurring AP, but the clinical relevance of this finding is unknown.

Evaluation of resuscitative endovascular balloon occlusion of the aorta catheter placement and comparison to resuscitative thoracotomy with aortic clamping in cadaver dogs.

OBJECTIVE: To describe placement of an aortic occlusion catheter in aortic zone 1 (Z1) and aortic zone 3 (Z3) in dogs and to compare time to placement in these zones with and without external chest compressions (ECC). Additional evaluations of time to placement in Z1 with time for resuscitative thoracotomy with aortic clamping (RT-AC) were performed. DESIGN: Prospective ex vivo study. SETTING: University teaching hospital. ANIMALS: Ten canine cadavers. INTERVENTIONS: Ten cadaver dogs were obtained from client donation after euthanasia. Cadavers were randomized to have balloon catheter placement into the right or left femoral artery via cutdown, with or without ECC. The xiphoid was used as an external anatomical landmark for Z1, and the spinous process of the 5th lumbar vertebra was used for Z3. Balloon placement was confirmed with radiography. Time to balloon placement in Z1 and Z3 and time to RT-AC were recorded. MEASUREMENTS AND MAIN RESULTS: Median body weight was 23.5 kg (9-40 kg). Median time to Z1 placement was 6.6 minutes (4.6-12.4 minutes) with ECC and 6.9 minutes (3.3-13.1 minutes) without ECC and was not statistically different (P = 0.5). Median time to RT-AC was 1 minute (0.6-1.4 minutes), which was significantly faster than time to balloon placement in Z1 with or without ECC (P = 0.004 and P = 0.002, respectively). CONCLUSIONS: Endovascular balloon occlusion of the aorta can be achieved by cutdown with and without ECC, but RT-AC is faster. Successful balloon position in Z1 could be achieved with knowledge of external anatomical landmarks, but landmarks for Z3 need further study.

Gastric or duodenal perforation and secondary septic peritonitis following therapeutic nonsteroidal anti-inflammatory drug administration.

OBJECTIVE: To report which nonsteroidal anti-inflammatory drugs (NSAIDs) were associated with gastric or duodenal perforation (GDP) in dogs presented to a university teaching hospital and to report the frequency of prescription of NSAIDs by the corresponding referring veterinary community during the same time period. DESIGN: Retrospective cohort study of dogs from January 2007 to March 2020. SETTING: Single university teaching hospital. ANIMALS: A total of 30 dogs met inclusion criteria. MEASUREMENTS AND MAIN RESULTS: Four dogs were administered more than 1 NSAID within 7 days of GDP, 3 dogs received a combination of an NSAID and a corticosteroid, and 1 dog received 2 NSAIDs and a corticosteroid. Four dogs received an overdose of an NSAID. One dog received an overdose of 1 NSAID and received an additional NSAID at the labeled dose within 7 days of GDP. Eighteen dogs received only 1 NSAID at the labeled dose. In these 18 dogs, meloxicam was administered in 44.4% (8/18), firocoxib in 27.8% (5/18), deracoxib in 16.7% (3/18), and piroxicam in 11.1% (2/18). One hundred and sixty surveys on NSAID prescribing practice were returned. Carprofen was the most commonly prescribed NSAID (70.6%), followed by meloxicam (10.6%), deracoxib (8.4%), firocoxib (7.8%), aspirin (1.5%), and other (0.9%). CONCLUSIONS: NSAID administration, even at labeled doses, appears to be a precipitating factor for GDP. Despite carprofen being the most frequently prescribed NSAID over the study period, no case of GDP received it as a single therapeutic agent. Further prospective evaluation is needed to verify these findings.

Evaluation of Veterinary Medical Student Retention of Pre-clinical Concepts with Various Experiential Learning Methods.

Many veterinary medical colleges have undergone curricular changes that have moved away from traditional lecture-based teaching in favor of evidence-based, experiential methods of instruction. Such a curricular reinvention occurred in 2018 at Michigan State University's College of Veterinary Medicine, with individual courses using numerous instructional and learning methods. In the present study, three courses were assessed, two of which used a method of experiential learning, and the other utilizing a traditional lecture approach. The purpose of this study was to determine if the method of instruction impacted exam grades, content retention, and student perspective. Methods of teaching and learning were quantified for each course using the Classroom Observation Protocol for Undergraduate STEM. Following completion of each course, participants (n = 27) retook the same final examination and participated in a survey to evaluate their perspective 5 weeks later. Mean scores on the initial examinations in the experiential learning courses were significantly higher than the mean score of the traditional lecture course (p = .01). However, mean retake examination scores were similar for all courses (p = .76). Students reported more confidence with course materials and examinations in courses that incorporated active learning strategies. Although true retention is difficult to assess in veterinary medicine, evaluation of student perspectives suggests the use of experiential learning methods primarily or in combination with lecture-based material to support student learning of pre-clinical concepts. Future controlled studies are needed to evaluate veterinary students' short- and long-term learning and retention.

Retrospective evaluation of the prognostic utility of quick sequential organ failure assessment scores in dogs with surgically treated sepsis (2011-2018): 204 cases.

OBJECTIVE: To assess the prognostic utility of admission quick Sequential Organ Failure Assessment (qSOFA) scores for in-hospital mortality in a population of dogs with surgically treated sepsis. DESIGN: Retrospective cohort study of dogs from January 2011 to January 2018. SETTING: University teaching hospital. ANIMALS: One thousand three hundred nine cases were identified with a clinical diagnosis of sepsis requiring surgical source control. Two hundred and four dogs with surgically treated sepsis met inclusion criteria, defined as: meeting 2 or more systemic inflammatory response syndrome (SIRS) criteria with a documented source of infection. One hundred and forty-three cases of septic peritonitis, 26 cases of septic soft tissue infection, 20 cases of pyometra, and 15 cases of pyothorax were evaluated. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Overall in-hospital mortality was 63 of 204 (30.9%). Patients with a qSOFA ≥ 2 were more likely to die or be euthanized (odds ratio [OR] 7.1, 95% confidence interval [CI] 2.9-16.4; P < 0.0001). Survivor and nonsurvivor qSOFA scores were significantly different in all categories. Dogs with septic peritonitis and a qSOFA ≥ 2 had an increased risk of postoperative complications (OR 3.9; 95% CI 1.3-11.1; P = 0.02). qSOFA scores were correlated with length of hospitalization in survivors of all-cause surgical sepsis (r = 0.28, P = 0.0007), septic peritonitis (r = 0.33, P = 0.001), and septic soft tissue infection (r = 0.59, P = 0.004). CONCLUSIONS: This was the first study to retrospectively evaluate the prognostic utility of qSOFA scores in dogs surgically treated for sepsis. Dogs diagnosed with septic peritonitis and other causes of surgically treated sepsis with a qSOFA ≥ 2 may have a higher risk of in-hospital mortality, although future prospective studies are necessary.

Retrospective evaluation of feline dystocia: clinicopathologic findings and neonatal outcomes in 35 cases (2009-2020).

OBJECTIVES: The aim of this study was to describe the characteristics of cases of feline dystocia presenting to a university emergency service. METHODS: The medical records of queens presenting for dystocia between January 2009 and September 2020 were reviewed. Data collected included queen signalment, presenting complaints, treatments, and maternal and neonatal outcomes. Clinicopathologic data included serum ionized calcium concentration, blood glucose level, packed cell volume and total solids. Owing to the small sample size, descriptive statistics were used and data presented as median (range). RESULTS: Thirty-five cases were reviewed. Dystocia was attributed to maternal factors in 69% (n = 24) and fetal factors in 31% (n = 11). Venous blood gas data from 19 queens in stage 2 labor revealed that no queens were hypocalcemic (median ionized calcium 5.4 mg/dl [range 4.9-5.8]) or hypoglycemic (median glucose 143 mg/dl [range 78-183]). Medical management was attempted in 21/35 queens. Successful medical management was achieved in 29% (n = 6/21). Thirteen queens underwent surgical management, six of these after failing medical management. Seven queens received no treatment. Fifteen queens were discharged and one queen was euthanized while still in labor. The remaining 19 queens delivered all fetuses with medical (n = 6) or surgical management (n = 13). Maternal survival was 94% (n = 33/35). A total of 136 kittens were born to all queens, with 58% (n = 79/136) born prior to initiation of treatment, 16% (n = 22/136) after medical management and 26% (n = 35/136) after surgical management. Overall neonatal survival to discharge was 66% (n = 90/136). CONCLUSIONS AND RELEVANCE: Feline dystocia is an emergent condition that can result in up to 34% neonatal mortality for kittens delivered via both medical and surgical means. Hypoglycemia and hypocalcemia were not precipitating causes of feline dystocia in this population.

Retrospective evaluation of the effects and outcome of bromethalin ingestion: 192 Dogs (2010-2016).

OBJECTIVE: To evaluate the frequency of clinical signs, dose ingested, and outcome in a large group of dogs with bromethalin ingestion. DESIGN: Retrospective cohort study of dogs from 2010 to 2016. SETTING: Three university teaching hospitals and 1 private practice. ANIMALS: A total of 192 dogs with bromethalin ingestion. MEASUREMENTS AND MAIN RESULTS: Total 192 cases were identified, of which 25 dogs developed clinical signs. Five cases initially had severe neurological signs and were euthanized. A sum of 187 dogs survived to discharge. The total ingested dose was recorded in 59 dogs with a median (interquartile range) 0.2 mg/kg (0.28 mg/kg). The remaining 133 dogs had confirmed ingestion reported by owners (witnessed ingestion or colored feces) but the total dose could not be calculated. The median (interquartile range) time to presentation for all dogs was 2 hours (4.8 h). A majority of patients were treated on an outpatient basis (121/192) and 71 of 192 were treated as inpatients with 58 of 71 receiving fluid diuresis. Decontamination was performed in 179 dogs including emesis induction (14), activated charcoal administration (42), and both (123). Emesis was successful in 128 dogs and apomorphine was the most common emetic agent (121). Mild to severe clinical signs at admission were reported in 19 cases including vomiting (6), tremors (5), lethargy (4), ataxia (3), weakness (2), diarrhea (2), collapse (2), and and anorexia (2). One case developed ataxia and tremors within 72 hours of admission. CONCLUSIONS AND CLINICAL RELEVANCE: Symptoms of bromethalin toxicosis are uncommon, and most ingested doses are well below the reported dose expected to cause clinical signs. In this patient population, prognosis was excellent unless severe clinical signs were noted, which carried a high euthanasia rate. Effects of treatment on outcome could not be evaluated due to the low number of patients that developed clinical signs.

Iatrogenic Urethral Trauma During Routine Prescrotal Orchiectomy in a Dog.

A 6-month-old neutered male redbone coonhound was presented for a 2-day history of progressive subcutaneous swelling that began immediately following a routine prescrotal orchiectomy. Severe, fluctuant swelling and bruising of the ventral thorax, abdomen, scrotum, and right pelvic limb was apparent on examination. No evidence of an underlying coagulopathy was detected. Azotemia and hyperkalemia were noted on venous blood gas analysis. Analysis of the serosanguineous fluid obtained from the fluctuant swelling revealed a BUN, creatinine, and potassium that were severely elevated and consistent with urine extravasation. A retrograde contrast urethrogram was performed and revealed leakage of contrast at the level of the prescrotal urethra. The dog was taken to surgery and a 2-cm longitudinal urethral defect was noted at the level of the prescrotal incision. A scrotal ablation and urethrostomy was performed, and the dog recovered uneventfully. This case highlights the diagnostic workup of a case of subcutaneous urine extravasation secondary to a urethral laceration sustained during a routine prescrotal orchiectomy. Iatrogenic urethral trauma should be considered as a differential diagnosis in dogs presenting for subcutaneous swelling with a history of recent orchiectomy surgery.

Salmonella Mesenteric Lymphadenitis Causing Septic Peritonitis in Two Dogs.

This report describes two cases of Salmonella mesenteric lymphadenitis leading to septic peritonitis in two young dogs. The cases were similar in presentation, diagnosis, treatment, and length of hospitalization. Both cases presented with clinical signs of vomiting, abdominal pain, and fever and were treated successfully via surgical debridement, omentalization, and antibiotic therapy. Both cases grew multi-drug resistant Salmonella spp. with resistance to ampicillin sulbactam, which is a common empiric antibiotic choice for cases of canine septic peritonitis. In both cases, the source of Salmonella is proposed to be the raw diet that preceded the septic peritonitis diagnosis. While Salmonella mesenteric lymphadenitis has been reported in humans and pigs, to the authors' knowledge, this is the first report of Salmonella mesenteric lymphadenitis in dogs.

Retrospective evaluation of intravenous premixed amiodarone use and adverse effects in dogs (17 cases: 2011-2014).

OBJECTIVE: The goal of this study was to evaluate the number and frequency of adverse effects in a population of clinical canine patients receiving Nexterone. ANIMALS: Seventeen canine patients receiving Nexterone (five of which were treated during cardiopulmonary arrest). METHODS: An electronic records search for canine patients receiving intravenous Nexterone at the Michigan State University Veterinary Teaching Hospital was performed and retrospectively evaluated for patient demographic information, pre- and post-treatment values for heart rate, blood pressure and rhythm diagnosis, as well as any documented adverse effects (hypotension, anaphylaxis, vomiting, phlebitis, and death). Data including the underlying cardiac or systemic disease, concurrent medications, as well as the final clinical diagnosis and treatment outcome were also recorded. RESULTS: No adverse effects were noted in this population of clinical canine patients receiving Nexterone. The median pre-treatment heart rate and blood pressure values were 160 bpm (range 120-300 bpm) and 105 mmHg (range 60-170 mmHg), respectively. After treatment, the median heart rate was significantly lower (120 bpm; range 68-172 bpm). The median blood pressure similar to the pre-treatment blood pressure (115 mmHg; range 100-150 mmHg). CONCLUSION: In this study of 17 dogs receiving the premixed formulation of injectable Nexterone, no dogs were found to have acute adverse side effects. Nexterone appears to be a safe drug choice for in-hospital treatment of canine arrhythmias. Further studies are needed to assess the efficacy and long-term effects of this medication and the ideal dosing protocol for various arrhythmias.

Salmonella Enteritidis-induced alteration of inflammatory CXCL chemokine messenger-RNA expression and histologic changes in the ceca of infected chicks.

To understand better the events in early avian host immune responses to Salmonella Enteritidis (SE), we examined messenger-RNA (mRNA) expression for eight genes: CXCLi1[K60], CXCLi2 [IL-8/CAF], interferon (IFN)-gamma, interleukin (IL)-1beta, IL-6, IL-12alpha, IL-12beta, and gallinacin (Gal)-2 in the ceca of young chicks 1 wk postinoculation with SE. Cecum tissue sections were stained and evaluated for the presence of macrophages, lymphocytes, heterophils, and apoptotic cells following SE infection. With the use of quantitative reverse transcriptase-polymerase chain reaction (RT-PCR), SE infection was associated with a significant (P < 0.01) upregulation of cecal CXCLi1 and CXCLi2 mRNA expression. Infection with SE was also associated (P < 0.05) with increased staining for macrophages and decreased apoptosis (single-stranded DNA [ssDNA]) in cecal tissue sections when these sections were compared with those of uninfected animals. Changes in chemokine expression and cell population dynamics are a direct result of SE infection, as uninfected animals do not show these alterations. Thus, these SE-induced changes reflect the host immune response to SE in young chickens.