Comparison of point-of-care NOVA CCX blood gas analyzer to laboratory analyzer in a population of healthy adult cats.

OBJECTIVE: To compare the level of agreement of measurement of analytes (sodium, chloride, potassium, urea nitrogen [UN], creatinine, glucose) in a population of healthy adult cats between the point-of-care (POC) analyzer and laboratory analyzer. To establish reference intervals for the POC analyzer in healthy adult cats. DESIGN: Prospective observational study. SETTING: University teaching hospital. ANIMALS: Fifty-five cats were screened. Seven cats were excluded due to aggression that prohibited phlebotomy, and 1 cat was excluded due to prolonged restraint; 47 cats were enrolled. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: In this patient population, reference intervals for the POC analyzer were calculated: sodium 145-157 mmol/L; chloride 116-124 mmol/L; potassium 3.4-5.5 mmol/L; UN 5.71-13.9 mmol/L (16-39 mg/dl); creatinine 74.3-189.2 mmol/L (0.84-2.14 mg/dl); and glucose 4-11.8 mmol/L (72-213 mg/dl). Comparison between the POC analyzer and laboratory analyzer using the Bland-Altman method was performed. The bias for each analyte is as follows: sodium 1.55 mmol/L; chloride 0.99 mmol/L; potassium 0.21 mmol/L; UN -0.25 mmol/L (-0.7 mg/dl); creatinine 9.73 mmol/L (0.11 mg/dl); and glucose 0.5 mmol/L (9.79 mg/dl). CONCLUSIONS: Reference intervals for each analyte were similar to other chemistry analyzers. There was no significant difference between the POC and laboratory analyzers in analysis of UN, with a statistically significant difference observed with sodium, potassium, chloride, creatinine, and glucose. However, the values are likely not sufficiently different to alter initial clinical decisions regarding patient care.

Prospective investigation of factors associated with success on the American College of Veterinary Emergency and Critical Care certification examination (2016-2018).

OBJECTIVE: To assess the association of candidate attributes and residency training factors with success on the American College of Veterinary Emergency and Critical Care (ACVECC) board certification examination and to develop multivariable models of first-attempt success. DESIGN: Prospective survey-based study. SETTING: Post-assessment ACVECC examination candidates. ANIMALS: None. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Comprehensive surveys were distributed to ACVECC examination candidates in 2016 to 2018 after completion of their assessments, but prior to publication of examination results. Unique anonymous candidate identification numbers were used to match survey responses to outcome data from the office of the ACVECC Executive Secretary. After curation to retain only the first response from each candidate, there were 97 unique candidate responses available for analysis. Univariate analyses identified multiple factors associated with first-attempt success and multiple differences between academic and private practice residency programs. Multivariable logistic regression modeling suggested that 5 factors were independently associated with first-attempt success on the ACVECC examination, specifically younger age, more weeks of study prior to the examination, training at a facility with more ACVECC Diplomates, training at a facility with more ACVECC residents, and having no requirement to manage both Emergency Room (ER) and Critical Care (CC) cases simultaneously. CONCLUSIONS: Numerous resident and training center factors are associated with success in the ACVECC board certification examination. Residents and training centers might be able to use these data to enhance training, but caution must be exercised because these data are associative only.

Factors associated with job satisfaction and engagement among credentialed small animal veterinary technicians in the United States.

OBJECTIVE: To investigate job satisfaction and engagement among credentialed veterinary technicians (CVTs) employed in the United States. SAMPLE: 873 CVTs who responded to an internet-based survey in 2017. PROCEDURES: A survey was conducted to collect information on demographics, individual engagement, and job satisfaction among a convenience sample of CVTs in the United States. Only responses from those employed in small animal practice were included. Demographic and job-related factors were evaluated for associations with individual engagement and job satisfaction. RESULTS: The mean (SD) score for overall individual engagement (7-point Likert scale, with 7 representing strong engagement) was 4.9 (1.0) and for job satisfaction (7 representing extreme satisfaction) was 5.4 (1.5). Factors associated with lower individual engagement and lower job satisfaction included most frequently working overnight shifts and having more veterinarians in the respondent's practice, whereas holding a supervisory role, receiving a higher hourly wage, and having more veterinary technicians in the practice were significantly associated with higher individual engagement and higher job satisfaction, with other variables held constant. Having a veterinary technician specialist designation was not associated with individual engagement or job satisfaction. CONCLUSIONS AND CLINICAL RELEVANCE: To the authors' knowledge, this was the first study to investigate factors associated with individual engagement and job satisfaction among CVTs in the United States. Employers should review these factors and support and enhance those associated with enhanced engagement and increased job satisfaction. Employers should regularly review factors identified as negatively associated with job satisfaction and engagement and do their best to mitigate them.

Comparison of right lateral versus left lateral versus sternal recumbence intra-abdominal pressure measurements in normal dogs.

OBJECTIVE: To determine if there is a difference in intra-abdominal pressure (IAP) among 3 anatomic body positions (right lateral, left lateral, and sternal recumbence) in apparently healthy dogs. DESIGN: Prospective, observational study. SETTING: University Veterinary Medical Teaching Hospital. ANIMALS: Fourteen apparently healthy male dogs. MEASUREMENTS AND MAIN RESULTS: After mild sedation with dexmedetomidine, a water manometer attached to a Foley urinary catheter was used to measure IAP in 3 different body positions in each dog. There was no significant difference in IAP between right lateral (3.87± 3.16 cm H2 O), left lateral (4.45 ± 3.22 cm H2 O), and sternal recumbence (4.04 ± 3.57 cm H2 O). CONCLUSIONS: Based on data from these 14 apparently healthy dogs, these 3 body positions can be used interchangeably for monitoring an individual dog. However, more research in dogs is needed to see if this conclusion holds true when IAP is abnormal.

Organophosphate intoxication in 2 dogs from ingestion of cattle ear tags.

OBJECTIVE: To describe 2 cases of organophosphate intoxication through a previously unreported method of exposure. CASE SERIES: A 2-year-old intact male Australian Cattle Dog (case 1) presented with progressive muscarinic and nicotinic clinical signs, and a 3-year-old neutered male mixed breed dog (case 2) presented after known ingestion of cattle ear tags. The dog in case 1 was discovered to have ingested cattle ear tags after abdominal radiographs. Organophosphate testing of gastric contents confirmed diazinon toxicosis. The dog in case 2 was found to be eating ear tags by the owner. The tags in case 2 contained diazinon and coumaphos. The dog in case 1 was treated with gastric lavage, gastroprotectants, prokinetics, antiemetics, pralidoxime chloride, and atropine. The dog in case 2 was treated with pralidoxime chloride. Both patients received standard supportive and nursing care and recovered completely with no further concerns. NEW OR UNIQUE INFORMATION PROVIDED: This is a novel exposure to organophosphates that has not been reported in small animals. In dogs with relevant clinical signs and potential environmental exposure, cattle ear tag ingestion is an important differential diagnosis to consider.

Analysis of the first-time pass rate of the American College of Veterinary Emergency and Critical Care certifying examination (2010-2015).

OBJECTIVES: To disseminate information regarding the annual pass rates for the American College of Veterinary Emergency and Critical Care (ACVECC) certifying examination. To compare the first-time pass rates (FTPR) of ACVECC residents trained in academic and private practice settings. DESIGN: Retrospective study. SETTING: ACVECC examination. ANIMALS: None. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Anonymized ACVECC examination performance data from 2010-2015 inclusive were analyzed. Overall pass rates and FTPR were calculated for all candidates and categorized by type of residency training program. The overall pass rate for all candidates was 64.3%. The median pass rate for the 6-year period was 63.8% [IQR 59.3-67.3%]. The FTPR for residents trained in academic programs was significantly higher than for residents trained in private practice (77.1% vs 47.2%, P < 0.0001). When residents were subdivided by species-focus of training program, there was no significant difference between academic versus private practice training programs for large-animal candidates (P = 0.2), but there remained a significant difference between residency training programs for small-animal candidates (P < 0.0001). CONCLUSIONS: Between 2010 and 2015 residents trained in academic training programs were significantly more likely to pass the ACVECC certifying examination compared to those trained in private practice training programs. The causes of this difference are uncertain, are likely multifactorial and warrant further investigation.

Pharmacokinetics of minocycline in domestic cats.

OBJECTIVES: Recently, the increased cost and decreased availability of doxycycline has sparked an interest in using minocycline as an alternative. The purpose of this study was to determine the pharmacokinetics of minocycline in domestic cats in order to facilitate dosage decisions. METHODS: Purpose-bred, young adult cats were administered a single dose of either intravenous (IV; n = 4; 5 mg/kg) or oral (n = 6; 50 mg/cat) minocycline. Blood was collected from each at intervals up to 24 h afterwards. Minocycline was measured using high performance liquid chromatography with ultraviolet detection. A one-compartment pharmacokinetic model was fit to the oral data and a two-compartment model to the IV data via a computer program. Plasma protein binding was measured by fortifying blank plasma from untreated healthy cats with minocycline at two concentrations and applying an ultracentrifugation method. RESULTS: Two cats became transiently lethargic and tachypneic during IV drug infusion. One cat vomited 6.0 h after infusion, and two cats vomited either 1.5 h or ~5.0 h after oral drug administration. The mean oral dose administered was 13.9 ± 0.47 mg/kg. Oral bioavailability was approximately 62%. Plasma protein binding was 60% at 5 µg/ml and 46% at 1 µg/ml. After IV administration, elimination half-life (t(½)), apparent volume of distribution at steady-state, and systemic clearance were 6.7 h (coefficient of variation [CV] 14.4%), 1.5 l/kg (CV 34.5%) and 2.9 ml/kg/min (CV 40.8%), respectively. After oral administration the terminal t(½) and peak concentration (Cmax) were 6.3 h (CV 9%) and 4.77 µg/ml (CV 36%), respectively. CONCLUSIONS AND RELEVANCE: Because most bacteria will have a minimum inhibitory concentration of ⩽0.5 µg/ml, an oral dose of 8.8 mg/kg q24h would be adequate to meet pharmacokinetic-pharmacodynamic targets after adjusting for protein binding. Although some gastrointestinal upset may occur, one 50 mg capsule orally q24h would provide appropriate dosing for most cats.

Plasma lactate concentrations and comparison of two point-of-care lactate analyzers to a laboratory analyzer in a population of healthy cats.

OBJECTIVE: To establish a reference interval for plasma lactate in a population of healthy adult cats on a laboratory analyzer (Nova Biomedical Critical Care Xpress [CCX]) and 2 commercially available point-of-care (POC) analyzers (Abbott i-STAT [i-STAT] and Nova Biomedical Lactate Plus [LP]), and to compare the level of agreement of lactate measurement between the laboratory analyzer and POC analyzers. DESIGN: Prospective observational study. SETTING: University veterinary teaching hospital. ANIMALS: Forty-seven healthy adult cats. INTERVENTIONS: Jugular phlebotomy. MEASUREMENTS AND MAIN RESULTS: In this population, plasma lactate reference interval was 0.67-5.44 mmol/L for the CCX, 0.65-5.16 mmol/L for the i-STAT, and 0.68-4.39 mmol/L for the LP. Comparisons were made between lactate measurements on 2 point-of-care analyzers and the laboratory analyzer using the Bland-Altman method. For the comparison of CCX and i-STAT, the bias was -0.10 mmol/L; for the CCX and LP, the bias was -0.24 mmol/L. CONCLUSIONS: Measurements of plasma lactate in cats using the i-STAT showed acceptable agreement with the CCX. The LP showed weaker agreement. However, both POC analyzers are suitable for measurement of lactate in cats, provided results from different POC analyzers are not directly compared. This study identified a larger reference interval for plasma lactate concentration in cats than what has been previously reported.

Comparison of whole blood and plasma colloid osmotic pressure in healthy cats.

OBJECTIVE: To establish reference intervals for whole blood and plasma colloid osmotic pressure (COP) in healthy cats between the ages of 1 and 10 years using a cage-side colloid osmometer. DESIGN: Prospective, observational study. SETTINGS: University veterinary teaching hospital. ANIMALS: Sixty-three healthy cats. INTERVENTIONS: Phlebotomy. MEASUREMENTS AND MAIN RESULTS: Whole blood COP mean was 24.4 (±2.78) mmHg and plasma COP mean was 24.3 (±2.59) mmHg. Reference interval for our study population of feline whole blood COP was 18.9 to 30.4 mmHg, and for our study population of feline plasma COP was 18.3 to 30.8 mmHg. Difference of paired whole blood COP and plasma COP was +0.23 ± 1.68 mmHg (P = 0.32). There was no significant difference when comparing COP from neutered male and neutered female cats. Total protein and albumin were significantly correlated with whole blood COP (total protein to whole blood COP P < 0.0001, r = 0.53; albumin to whole blood COP P <0.0001, r = 0.68) and plasma COP (total protein to plasma COP P = 0.0025, r = 0.41; albumin to plasma COP P < 0.0001, r = 0.66). CONCLUSIONS: No significant difference was found between mean whole blood and plasma COP in this study population of cats. Even though not statistically significant, evaluation of paired whole blood COP and plasma COP did reveal a slight difference; therefore, it seems prudent to maintain sample consistency for serial evaluations in cats.

Comparison of whole blood and plasma colloid osmotic pressure in healthy dogs.

OBJECTIVE: To determine the difference between colloid osmotic pressure (COP) values determined from plasma versus those determined from whole blood. DESIGN: Prospective observational study. SETTINGS: University veterinary teaching hospital. ANIMALS: Fifty-three healthy dogs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Whole blood and plasma COP, CBC, plasma biochemistry. In all dogs, plasma COP values were significantly lower (P=0.02) than whole blood COP, with a mean of difference of 0.5 mm Hg. The mean and median whole blood COP was 21.75 and 21.4 mm Hg, respectively, with a range of 17.9-27.1 mm Hg. The mean and median plasma COP was 21.2 and 20.9 mm Hg with a range of 16.7-28.9 mm Hg. CONCLUSIONS: While significant difference exists between plasma and whole blood COP, the individual values are within expected reference intervals for dogs (21-25 mm Hg). Using either sample appears to provide the same information in clinically healthy dog; however, it is recommended that clinicians utilize the same sample type for comparison in an individual patient.

Characterization of acute kidney injury in hospitalized dogs and evaluation of a veterinary acute kidney injury staging system.

OBJECTIVE: To retrospectively apply standards characterizing acute kidney injury (AKI) used in human medicine to a population of critically ill hospitalized dogs in order to identify dogs with potential AKI based on subtle increases in plasma creatinine concentration. DESIGN: Retrospective study. SETTING: University Veterinary Medical Teaching Hospital. ANIMALS: One hundred and sixty-four client-owned dogs admitted to the intensive care unit. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Medical records of 164 dogs meeting the study inclusion criteria were reviewed to identify age, results of creatinine measurements, discharge status, length of stay, performance of general anesthesia, number of diagnoses, and calculated survival prediction index scores (SPI2). A veterinary AKI (VAKI) staging system was retrospectively applied to classify dogs based on increase in creatinine concentration from baseline as follows: stage 0 (S0; <150%), stage 1 (S1; 150-199% or ≥26.5 µmol/L [≥0.3 mg/dL]), stage 2 (S2; 200-299%), or stage 3 (S3; ≥300%). Of the dogs evaluated, 140/164 were VAKI stage S0, 19/164 were classified as S1, 3/164 as S2, and 2/164 were S3. Mortality rate was greater for S1-3 (13/24; 54.2%) compared to S0 dogs (22/140; 15.7%) (P < 0.0001). Length of stay, general anesthesia, and number of diagnoses were not associated with survival. In a logistic regression model, stage and age were jointly, significantly associated with mortality (P = 0.0002 and P = 0.0330, respectively). Mean SPI2 scores were not different between S0 (0.52) and S1 (0.59) dogs (P = 0.23). Only 4/19 (21%) of S1 dogs had a peak plasma creatinine concentration above the laboratory reference interval. CONCLUSIONS: Dogs meeting VAKI stage 1-3 criteria were less likely to survive to discharge. Small increases in plasma creatinine concentration may be clinically relevant even when absolute values are within reference intervals.

Age-associated changes to pathogen-associated molecular pattern-induced inflammatory mediator production in dogs.

OBJECTIVE: To determine whether older dogs will have a more pronounced pro-inflammatory response and blunted anti-inflammatory response to pathogen-associated molecular patterns (PAMPs) compared with younger dogs. DESIGN: Prospective. SETTING: University teaching hospital. ANIMALS: Thirty-eight privately owned sexually altered dogs of various ages. INTERVENTIONS: Blood was collected for HCT, WBC count, plasma biochemical analysis, and whole blood culture. Whole blood was stimulated with lipopolysaccharide (LPS) or, lipoteichoic acid or, peptidoglycan or, addition of phosphate-buffered saline. Tumor necrosis factor (TNF), interleukin (IL)-6, and IL-10 production from whole blood were compared among young, middle aged, and geriatric dogs. MEASUREMENTS AND MAIN RESULTS: LPS, lipoteichoic acid, and peptidoglycan stimulated significant TNF, IL-6, and IL-10 production from canine whole blood compared with phosphate-buffered saline. Whole blood from geriatric dogs had a blunted IL-10 response to LPS stimulation and middle-aged dogs had increased LPS-induced TNF production compared with the other groups. CONCLUSION: PAMPs from gram-positive and gram-negative bacteria stimulate TNF, IL-6, and IL-10 production from canine whole blood. The inflammatory mediator response to PAMPs from gram-negative bacteria alters with age and may be one factor contributing to mortality in geriatric dogs with sepsis.

Immunomodulatory effects of opioids.

OBJECTIVE: To review the immunomodulatory effects of opioids. DATA SOURCES: Original research publications and review articles using the PubMed search engine with the following keywords--opioids, morphine, immuomodulation, and immunosuppression. VETERINARY AND HUMAN DATA SYNTHESIS: Opioids have been shown to modulate the immune system in animal models by affecting both the acquired and innate arms of the immune system. Natural killer cell activity, T-cell proliferation, antibody production, phagocytic cell function, and cytokine production have all been shown to be affected by opioids. Many of these effects are reversed by opioid antagonists. Opioids have also been shown to induce sepsis in laboratory animals. Opioid administration alters immune parameters in healthy humans at analgesic doses and may increase the risk of infection in some patient populations. CONCLUSIONS: While opioids remain the most powerful and widely used analgesics available, their negative effects on the immune system are well established in the laboratory setting. Thoughtful consideration should be given to the use of certain opioids in critically ill patients, especially those with pre-existing immunocompromise.

A comparison of total calcium, corrected calcium, and ionized calcium concentrations as indicators of calcium homeostasis among hypoalbuminemic dogs requiring intensive care.

OBJECTIVE: (1) To evaluate whether total calcium (tCa) correlates with ionized calcium (iCa) in hypoalbuminemic dogs; (2) to evaluate whether calcium adjusted for albumin (Alb), or total protein (TP), or both accurately predict iCa concentrations and hence can be used to monitor calcium homeostasis in critically ill hypoalbuminemic dogs; and (3) to evaluate factors associated with any potential discrepancy in calcium classification between corrected total and ionized values. DESIGN: Prospective observational clinical study. SETTING: Small animal intensive care unit in a veterinary medical teaching hospital. ANIMALS: Twenty-eight client-owned dogs with hypoalbuminemia. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: iCa was determined using ion-specific electrode methodology, on heparinized plasma. The tCa concentration was adjusted for Alb and TP using published equations. In total 29% (8/28) of the hypoalbuminemic, critically ill dogs in this study were hypocalcemic at intensive care unit admission, as determined by iCa measurement. Corrected calcium values failed to accurately classify calcium status in 67.9% and 64.3% of cases, according to whether the Alb-adjusted or TP-adjusted values, respectively, were used. The sensitivity and specificity of the tCa to evaluate hypocalcemia was 100% and 47%, respectively. The sensitivity and specificity of the correction formulae were 37.5% and 79% for the Alb-adjusted values and 37.5% and 74% for TP-adjusted values. tCa overestimated the presence of hypocalcemia and underestimated the presence of normocalcemia, while corrected calcium values overestimated the presence of normocalcemia and underestimated the presence of hypocalcemia. CONCLUSIONS: Calcium homeostasis in hypoalbuminemic critically ill dogs should be evaluated by iCa concentrations rather than tCa or calcium adjusted for Alb or TP. Given that tCa has 100% sensitivity for detecting hypocalcemia in this population it is recommended that all hypoalbuminemic and critically ill patients with low tCa should be evaluated with an iCa measurement.

Diagnosis and successful treatment of a caudal lingual abscess in a geriatric dog.

A 13-year-old, intact male, golden retriever was presented for glossomegaly. A diagnosis of a caudal lingual abscess was made by fine needle aspiration under general anesthesia. The dog showed marked clinical improvement following abscess drainage. Lingual abscesses should be included as a differential diagnosis in any dog with an unexplained acute glossomegaly.

Response of healthy dogs to infusions of human serum albumin.

OBJECTIVE: To evaluate the clinical and immunologic response in healthy dogs to infusions of human serum albumin (HSA). ANIMALS: 9 healthy purpose-bred mixed-breed dogs. PROCEDURES: Each dog was administered a 25% HSA solution once or twice. Various physical examination and laboratory variables were serially evaluated. Antibody against HSA was assayed before and after infusion by use of an ELISA. Intradermal testing was also conducted. A repeated-measures ANOVA or Friedman repeated-measures ANOVA on ranks was used to compare results for the variables. RESULTS: Adverse clinical reactions were observed after the first or second infusion in 3 dogs. Anaphylactoid reactions were observed in 1 of 9 dogs during the first infusion and in 2 of 2 dogs administered a second infusion. Two dogs developed severe edema and urticaria 6 or 7 days after an initial infusion. All dogs developed anti-HSA antibodies. Positive responses for ID tests were observed in 8 of 9 dogs. Short-term increases were detected in blood protein, total bilirubin, and calcium concentrations after HSA infusion. Serum cholesterol concentrations and platelet counts decreased after HSA infusion. CONCLUSIONS AND CLINICAL RELEVANCE: Administration of HSA resulted in profound reactions in 2 of 9 dogs administered a single infusion and in 2 of 2 dogs administered a second infusion. This indicates that there is risk of life-threatening adverse reactions to HSA infusion in healthy dogs.

Glomerular filtration rate and renal scintigraphy.

Clinical evaluation of early renal dysfunction is problematic in the nonazotemic animal. Measurement of glomerular filtration rate (GFR) provides the most accurate assessment of renal function. However, many methods of determining GFR are not practical for use in routine veterinary practice. This article provides a description and literature review of methods to determine GFR, including benefits and drawbacks of each method for the practicing veterinarian.

Evaluation of a continuous glucose monitoring system for use in veterinary medicine.

BACKGROUND: With the emergence of continuous glucose monitoring systems being used to provide a detailed glucose picture in humans, a commercially available system (CGMS(R), Medtronic Minimed, Northridge, CA) was examined for use in veterinary species. METHODS: Adult, clinically normal horses (n = 7), cats (n = 3), dogs (n = 4), and cows (n = 5) were studied. Cats (n = 4), dogs (n = 5), and one horse with diabetes were included in the study. Several of the normal horses, including the horse with diabetes, and one cow were subjected to an intravenous glucose tolerance test. The CGMS was attached to each animal, and the recorded interstitial glucose concentrations were compared with whole blood glucose concentrations as determined by a point-of-care glucose meter. Events such as insulin administration, feeding, travel, or administration of intravenous glucose were all noted and compared with results from the CGMS. RESULTS: There was a positive correlation between interstitial and whole blood glucose concentrations for all the clinically normal species, those with diabetes mellitus, and those receiving intravenous glucose. Events such as feeding, glucose or insulin administration, and transport to the clinic were noted by the owner or clinician and could be identified on the graph and correlated with time of occurrence. CONCLUSIONS: Our data indicate that the use of the CGMS is valid for use in the species examined. Use of this system alleviated the need for multiple blood samples and the stress associated with obtaining those samples. This system may provide greater monitoring capabilities in patients with diabetes and promote the diagnostic and research potential of serial glucose monitoring in veterinary species.