Successful treatment of a severe 5-hydroxytrytophan intoxication using carbon hemoperfusion, hemodiafiltration, and mechanical ventilation in a dog.

OBJECTIVE: To describe the successful use of carbon hemoperfusion and hemodiafiltration in combination with mechanical ventilation (MV) to treat a severe intoxication of 5-hydroxytryptophan (5-HTP) in a dog. CASE SUMMARY: A dog ingested a minimum of 550 mg/kg of extended-release 5-HTP, resulting in serotonin syndrome that progressed to a comatose state and severe hypoventilation requiring MV. Extracorporeal carbon hemoperfusion coupled with hemodiafiltration was performed to remove 5-HTP from this patient. A carbon hemoperfusion cartridge was placed in series upstream in the extracorporeal circuit from the hemodialyzer. A total of 46.5 L of blood (4.89 L/kg) was processed during a 4.85-hour treatment. Serial plasma samples were obtained at 0, 60, 90, and 150 minutes during the session and 14 hours after the session. These samples were later analyzed for 5-HTP and serotonin concentrations. The extraction ratio of 5-HTP was 93.6%-98.9% through the carbon filter. The dog was weaned from MV within 8 hours after extracorporeal therapy and, after a full recovery, was successfully discharged. NEW OR UNIQUE INFORMATION PROVIDED: Despite an extensive review of the available literature, this appears to be the first reported case of using a carbon hemoperfusion, hemodiafiltration, and MV to treat severe serotonin syndrome secondary to 5-HTP intoxication in a dog. The combination of carbon hemoperfusion and hemodiafiltration can significantly reduce plasma 5-HTP concentrations after acute intoxication and may serve to decrease morbidity and mortality in patients with severe intoxication.

Possible development and resolution of dilated cardiomyopathy phenotype secondary to atypical hypoadrenocorticism in a dog.

OBJECTIVE: To report the possible occurrence of dilated cardiomyopathy phenotype associated with atypical hypoadrenocorticism and subsequent marked improvement with treatment in a mixed breed dog. CASE SUMMARY: A 4.5-year-old, neutered male mixed breed dog was evaluated for a history and clinicopathological changes consistent with atypical hypoadrenocorticism. The dog was being fed a grain-free diet. While hospitalized for supportive care and diagnostics, the patient developed and was diagnosed with biventricular congestive heart failure secondary to dilated cardiomyopathy phenotype and IV fluid administration. The left-sided congestive heart failure resolved with discontinuation of IV fluid therapy and short-term administration of diuretics. After treatment of atypical hypoadrenocorticism with glucocorticoid supplementation, and while continuing to be fed varying grain-free diets, the patient's dilated cardiomyopathy phenotype largely resolved. The patient fully recovered and did not require any long-term cardiac medications. NEW OR UNIQUE INFORMATION PROVIDED: Development of dilated cardiomyopathy phenotype has not been described in dogs as a sequela of untreated hypoadrenocorticism but has been reported in human literature. Given the fact that standard management of hypoadrenocorticism typically involves aggressive fluid resuscitation, awareness of this potential sequela is important for patients that fail to respond or develop signs consistent with volume overload.

Self-Reported Anxiety and Perception of Safety Following School Lockdown Drills among Adolescent Youth.

BACKGROUND: Lockdown drills are mandated within many educational settings in the US; they may contribute to adverse mental health and there is little to suggest their effectiveness. We describe factors associated with post-drill anxiety and perceived effectiveness of drills. METHODS: We surveyed youth-caregiver dyads presenting to the pediatric emergency department. Nonparametric tests compared factors across groups of child anxiety and caregiver perceived effectiveness of drills. Kappa statistics (κ) measured child-caregiver agreement on post-drill anxiety and depression symptoms. RESULTS: 108 child-caregiver dyads were included. Post-lockdown drill anxiety was reported by 27% of children; those reporting anxiety were more likely to have histories of bullying or skipping school for safety (p = 0.0004). Of caregivers, 47% believed drills effectively prevent firearm injury. There was a significant disparity between child and caregiver report of post-drill mental health symptomatology (κ anxiety = 0.19; κ depression = 0.30). Implications for School Health, Policy, Practice, and Equity: Understanding factors contributing to anxiety surrounding lockdown drills and perception of drill effectiveness may aid policy decisions and resource allocation. CONCLUSIONS: Lockdown drills may increase mental health symptoms in children, while caregivers may not recognize this occurrence. Studies to identify risk factors of acute and chronic post-lockdown drill anxiety will help determine how to better serve youth.

Oculo-skeletal dysplasia in five Labrador Retrievers.

OBJECTIVE: To describe the clinical features and diagnostic findings of Labrador Retrievers with oculo-skeletal dysplasia (OSD). ANIMAL STUDIED: Five privately owned dogs. PROCEDURES: Medical records of dogs diagnosed with OSD from 2008 through 2018 were reviewed. Patients were excluded if lacking disease confirmation through genetic testing (Optigen RD/OSD). Information collected included signalment, physical and ophthalmic examination findings, results of ocular ultrasound and electroretinogram, and digital radiographs of forelimbs and pelvis. RESULTS: All five dogs were Labrador Retrievers, confirmed to be homozygote for the OSD mutation. The main physical abnormalities were vision deficits (5 dogs), short-limbed dwarfism (5), carpal valgus (4), and color dilution alopecia (4). The main ophthalmic anomalies were cataracts (10 eyes), vitreous syneresis (10), retinal separation (6), persistent hyperplastic primary vitreous (2), lens coloboma (2), microphakia (2), and persistent tunica vasculosa lentis (1). Ocular ultrasound and electroretinogram confirmed the diagnoses of retinal separations and persistent hyperplastic primary vitreous. Radiographic changes included shortening of ulna and curved radius (5 dogs), elbow incongruity and osteoarthritis (4 dogs), hip dysplasia (3), and coxofemoral osteoarthritis (2). Available follow-up information (2 dogs) showed progression of cataract from incipient to mature in one dog, necessitating cataract surgery, and progression of cataract and lameness in another dog. CONCLUSIONS: The clinical findings of OSD are described in five Labrador Retrievers. DNA testing is critical to diagnose OSD and help eradicate this condition from the breed. Progression of cataracts and osteoarthritis in dogs with OSD warrants yearly monitoring.