Plasma Symmetric Dimethylarginine Concentration in Dogs with Acute Kidney Injury and Chronic Kidney Disease.

BACKGROUND: Symmetric dimethylarginine (SDMA) is considered a biomarker for early detection of renal dysfunction in human patients with acute kidney injury (AKI). At present, no studies exist analyzing the relevance of SDMA in dogs with AKI. HYPOTHESIS/OBJECTIVES: SDMA would correctly identify dogs with renal disease but would not be able to differentiate between AKI and CKD. ANIMALS: Eighteen healthy control dogs, 48 dogs with AKI, and 29 dogs with CKD. METHODS: Prospective study. Dogs with kidney disease were categorized as having AKI or CKD according to the history, clinical signs, laboratory findings, and results of diagnostic imaging. Plasma SDMA concentration was measured by IDEXX Laboratories. SDMA/creatinine ratio was calculated in dogs with AKI or CKD. RESULTS: Median SDMA concentrations were 8.5 µg/dL (6-12 µg/dL), 39.5 µg/dL (8->100 µg/dL), and 35 µg/dL (12->100 µg/dL), in healthy, AKI, and CKD, respectively. SDMA concentrations were significantly higher in dogs with AKI (P < .0001) or CKD (P < .0001) in comparison with healthy dogs. Median SDMA/creatinine ratio in dogs with AKI and CKD was 6.5 (1.7-20.9) and 10 (2.4-33.9) (P = .0004), respectively. Although there was overlap of the SDMA/creatinine ratio in dogs with AKI or CKD, it was significantly higher in dogs with CKD compared to dogs with AKI (P = .0004). CONCLUSIONS AND CLINICAL IMPORTANCE: In this population, SDMA was suitable for identifying dogs affected by AKI or CKD, but could not differentiate between them.

Applicability of 99m Tc-Labeled Human Serum Albumin Scintigraphy in Dogs With Protein-Losing Enteropathy.

BACKGROUND: Diagnosis of protein loss into the gastrointestinal tract using noninvasive techniques is challenging. In people, scintigraphy not only is a sensitive tool to confirm protein-losing enteropathy (PLE), but it also allows for localization of protein loss. HYPOTHESIS/OBJECTIVES: To investigate the feasibility of 99m Tc-labeled human serum albumin (HSA) scintigraphy in dogs with PLE in comparison with control dogs. ANIMALS: A total of 8 clinically healthy control research dogs and 7 client-owned dogs with gastrointestinal clinical signs and hypoalbuminemia (serum albumin concentration <2.0 g/dL). METHODS: Prospective case-control study. After IV injection of 400 MBq freshly prepared 99m Tc HSA (30 mg/dog), images of the abdomen were obtained 10, 60, 120, and 240 minutes postinjection. Additional images of the salivary and thyroid glands were obtained to rule out free 99m Tc. A scan was considered positive for PLE when radiopharmaceutical exudation was detectable in the intestinal tract. RESULTS: Only 1 control dog showed exudation of the radiopharmaceutical into the intestinal tract. No free 99m Tc was detected in any dog. In dogs with PLE, focal small intestinal and diffuse small intestinal radiopharmaceutical exudation into the bowel was detected in 2 and 3 dogs, respectively, whereas in 2 dogs, there was disagreement about whether radiopharmaceutical exudation was focal or diffuse. CONCLUSION AND CLINICAL IMPORTANCE: 99m Tc-labeled HSA scintigraphy was feasible to diagnose PLE in dogs.

Comparison of a CHOP-LAsp-based protocol with and without maintenance for canine multicentric lymphoma.

The recommendation to treat canine lymphoma with a discontinuous protocol is based on small case numbers and mostly historic controls. This study compares duration of first remission (DFR) and overall survival time (ST) with a discontinuous protocol to the same protocol with maintenance phase. 408 dogs were treated with a CHOP-LAsp (C=cyclophosphamide; H=hydroxydaunorubicin; O=Oncovin; P=prednisolone; LAsp=l-asparaginase)-based 28-week induction protocol. In 75 dogs (cohort 1), this was followed by a maintenance phase consisting of vincristine, chlorambucil and actinomycin-D with a total treatment duration of two years. In the subsequent 333 dogs, therapy was discontinued after induction (cohort 2). Median DFR and ST in cohort 1 were 216 and 375 days and 184 and 304 days in cohort 2. 6-Month, 1-year and 2-year survival rates in cohort 1 were 73 per cent, 50 per cent, 24 per cent and 67 per cent, 39 per cent, 21 per cent in cohort 2. There was no significant difference between the two protocols (P=0.291 for ST, P=0.071 for DFR). On multivariate analysis, corticosteroid pretreatment (P=0.005), thrombocytopenia at diagnosis (P=0.019), stage (P=0.009), substage b at relapse (P<0.001), age (P=0.002) and incomplete or unstable remission necessitating intensification of therapy (P=0.004) were negatively correlated with ST in both groups. This study supports the use of a discontinuous protocol for canine multicentric lymphoma.

[Transient, secondary hypoadrenocorticism after treatment with delmadinone acetate (Tardastrex®) in a two year old male dog]. / Transienter, sekundärer Hypoadrenokortizismus nach Behandlung mit Delmadinonacetat (Tardastrex®) bei einem zwei Jahre alten Rüden.

INTRODUCTION: A two year old male Labrador Retriever was treated with delmadinone acetate because of benign prostatic hyperplasia. Four days after the injection the dog showed gastrointestinal signs and a progressive lethargy. In the hospital for small animals of the Justus-Liebig-University of Gießen an ACTH stimulation test was done and a secondary hypoadrenocorticism was diagnosed. The dog was treated with prednisolone in physiological dose for 14 weeks after the injection. The clinical symptoms stopped immediately. A new ACTH stimulation test some weeks later showed a completely normal adrenal function.

[Detection of bocavirus in 4-week-old puppies with acute diarrhea]. / Bocavirus-Nachweis bei 4 Wochen alten Welpen mit akutem Durchfall.

Two 4-month-old female Doberman puppies were presented with clinical signs of acute diarrhea and emesis. They also showed sneezing and nasal discharge. The clinical presentation and neutropenia were suggestive of a parvovirus infection. The puppies were hospitalized for several days and treated symptomatically. Fecal samples tested negative for parasites. Virological examination of feces using polymerase chain reaction (PCR) and immune electron microscopy failed to confirm a parvovirus infection. With a recently developed PCR, bocavirus could be identified, thus making an infection with this virus a possible diagnosis. This case report presents a less well-known viral puppy disease and its successful therapy.

Age determination in dogs using ocular light reflection, dental abrasion and tartar.

OBJECTIVE: The knowledge of an animal's age is important for disease probability, prognoses, or epidemiological questions, but unfortunately, it is often unknown for dogs in animal shelters. A simple estimating procedure is preferable being quick and easy to perform, even for non-veterinarians. MATERIAL AND METHODS: In 295 dogs the dimension of light reflection (diameter in millimetres), visible on the posterior lens capsule using a penlight, the grade of dental abrasion and dental tartar were documented photographically and the exact weight and age in days were obtained. These photographs were evaluated blinded. The dogs were divided randomly into two groups. The first group was used to establish a model for age determination using linear and logistic regression models considering the documented parameters, which was then validated with the data of the second group. RESULTS: The size of ocular light reflection and age correlated significantly (r = 0.781; p < 0.001; sy,x = 2.45 years [SD of y for given x]). The linear regression model gave the final equation: Estimated age [months] = 13.954 + 33.400 × lens reflection [mm] + 8.406 × dental abrasion [grade] + 8.871 × tartar [grade] with a standard error of estimation of 2.26 years. CONCLUSION AND CLINICAL RELEVANCE: Age determination, even based on three parameters results in a large standard deviation making age estimation in dogs very crude.

[Usefulness of lactate dehydrogenase concentration in thoracic and abdominal fluid of dogs]. / Interpretation des Laktatdehydrogenasespiegels in Thoraxerguss und Aszites beim Hund.

The aims of this study were to investigate the usefulness of LDH measurement in effusions in dogs to classify the fluid as exudate or transudate and to classify the fluid based on the pathophysiological mechanism. In thoracic (n = 107) and abdominal (n = 199) fluid of dogs cell count, protein and LDH concentrations were measured. The fluid was retrospectively categorized into exudate (group A), protein-poor (B) or protein-rich transudate (C) as well as based on pathophysiology into the following five groups (group 1 - 5): hemorrhagic, chylous, inflammatory, oncotic and congestive. In thoracic and abdominal fluid LDH concentrations were significantly higher in group A compared to group B and C. There was a significant difference of LDH concentration between the groups 1 to 5 in both thoracic and abdominal fluid, however there was a large overlap between the five groups. While fluid LDH measurement in dogs is helpful to distinguish exudate from transudate it is only of little help to elucidate the pathophysiological cause.

Dans ce travail, on étudie la signification de la lactatedéshydrogénase (LDH) dans des épanchements pour les classifier en exsudat ou en transsudat ainsi que pour en différencier la pathophysiologie. On a relevé, dans 306 épanchements thoraciques (n = 107) et abdominaux (n = 199), la numération cellulaire, les protéines totales et la LDH et on les a classé rétrospectivement en exsudats (groupe A), transsudats pauvres en protéines (groupe B) ou transsudats riches en protéines (groupe C) ; on les a également différenciés selon leur origine en hémorragiques, chyleux, inflammatoires, tumoraux ou de stase (groupes 1 à 5). Les valeurs de LDH du groupe A étaient significativement plus élevées que celles des groupes B et C, aussi bien dans les épanchements thoraciques qu'abdominaux. Ces valeurs étaient aussi significativement différentes entre les groupes 1 à 5, mais avec une forte superposition des valeurs entre les divers groupes. Alors que la détermination de la LDH dans un épanchement permet de bien différencier entre exsudat et transsudat, elle n'aide que de façon limitée pour différencier la cause de l'épanchement.

Stimulation of duodenal biopsies and whole blood from dogs with food-responsive chronic enteropathy and healthy dogs with Toll-like receptor ligands and probiotic Enterococcus faecium.

The composition of the microbiome plays a significant role in the pathogenesis of inflammatory bowel disease (IBD) in humans and chronic enteropathies (CE) in dogs. The administration of probiotic micro-organisms is one way of modulating the microbiome, but experiments elucidating mechanisms of action of probiotics in the intestine of healthy and CE dogs are lacking. The aim of our study was to investigate the effects of different Toll-like receptor (TLR) ligands and Enterococcus faecium (EF) on ex vivo cultured duodenal samples and whole blood (WB) from dogs with food-responsive chronic enteropathy (FRE) when compared to healthy dogs. Biopsy stimulation was performed in 17 FRE and 11 healthy dogs; WB stimulation was performed in 16 FRE and 16 healthy dogs. Expression of TLR2, 4, 5 and 9, IL-17A, IL-22, IFNy, TNFα, IL-4, IL-10, TGFß and PPARy was determined in biopsies by quantitative polymerase chain reaction (PCR). In addition, production of TNFα, IL-10, IFNy and IL-17A protein in WB and biopsy supernatants was assessed by ELISA. Treatment with individual TLR ligands or EF induced a variety of changes in the expression of different TLRs and cytokines, but not necessarily a consistent change with a single stimulating agent. Even though cytokine protein could not be detected in supernatants from ex vivo stimulated biopsies, we found TNFα protein responses in blood to be opposite of the transcriptional responses seen in the biopsies. Stimulation of canine duodenal biopsies with TLR ligands can potentially induce anti-inflammatory gene expression, especially in healthy tissue, whereas the effects of EF were limited.

Plasma and urine neutrophil gelatinase-associated lipocalin (NGAL) in dogs with acute kidney injury or chronic kidney disease.

BACKGROUND: Neutrophil gelatinase-associated lipocalin (NGAL) is a protein that is used in human medicine as a real-time indicator of acute kidney injury (AKI). HYPOTHESIS: Dogs with AKI have significantly higher plasma NGAL concentration and urine NGAL-to-creatinine ratio (UNCR) compared with healthy dogs and dogs with chronic kidney disease (CKD). ANIMALS: 18 healthy control dogs, 17 dogs with CKD, and 48 dogs with AKI. METHODS: Over a period of 1 year, all dogs with renal azotemia were prospectively included. Urine and plasma samples were collected during the first 24 hours after presentation or after development of renal azotemia. Plasma and urine NGAL concentrations were measured with a commercially available canine NGAL Elisa Kit (Bioporto® Diagnostic) and UNCR was calculated. A single-injection plasma inulin clearance was performed in the healthy dogs. RESULTS: Median (range) NGAL plasma concentration in healthy dogs, dogs with CKD, and AKI were 10.7 ng/mL (2.5-21.2), 22.0 ng/mL (7.7-62.3), and 48.3 ng/mL (5.7-469.0), respectively. UNCR was 2 × 10(-8) (0-46), 1,424 × 10(-8) (385-18,347), and 2,366 × 10(-8) (36-994,669), respectively. Dogs with renal azotemia had significantly higher NGAL concentrations and UNCR than did healthy dogs (P < .0001 for both). Plasma NGAL concentration was significantly higher in dogs with AKI compared with dogs with CKD (P = .027). CONCLUSIONS AND CLINICAL IMPORTANCE: Plasma NGAL could be helpful to differentiate AKI from CKD in dogs with renal azotemia.

Effect of trilostane on hormone and serum electrolyte concentrations in dogs with pituitary-dependent hyperadrenocorticism.

BACKGROUND: The effects of trilostane on key hormones and electrolytes over 24 hours in dogs with pituitary-dependent hyperadrenocorticism (PDH) are unknown. OBJECTIVES: To determine the plasma concentration of cortisol, endogenous adrenocorticotropic hormone (ACTH), aldosterone, sodium, potassium, and ionized calcium concentrations, and plasma renin activity over a 24-hour period after administration of trilostane to dogs with well-controlled PDH. ANIMALS: Nine dogs (mean age 9.3 ± 0.67 years, mean weight 31.9 ± 6.4 kg) with confirmed PDH. METHODS: Prospective study. Thirty days after the first administration of trilostane, blood samples were taken at -30, 0 (baseline), 15, 30, 60, and 90 minutes, and 2, 3, 4, 6, 8, 12, 16, 20, and 24 hours after administration of trilostane and plasma concentration of cortisol, endogenous ACTH, aldosterone, sodium, potassium, ionized calcium, and renin activity were determined. RESULTS: Cortisol concentrations decreased significantly (P < .001) 2-4 hours after trilostane administration. From baseline, there was a significant (P < .001) increase in endogenous ACTH concentrations between hours 3-12, a significant increase (P < .001) in aldosterone concentration between hours 16-20, and a significant (P < .001) increase in renin activity between hours 6-20. Potassium concentration decreased significantly (P < .05) between hours 0.5-2. CONCLUSION AND CLINICAL IMPORTANCE: Treatment with trilostane did not cause clinically relevant alterations in plasma aldosterone and potassium concentration. Results suggest that in dogs with PDH, the optimal time point for an ACTH-stimulation test to be performed is 2-4 hours after trilostane dosing. Future studies are necessary to establish interpretation criteria for a 2- to 4-hour postpill ACTH-stimulation test.

Best practice for the pharmacological management of hyperthyroid cats with antithyroid drugs.

Pharmacological management of feline hyperthyroidism offers a practical treatment option for many hyperthyroid cats. Two drugs have been licensed for cats in the last decade: methimazole and its pro-drug carbimazole. On the basis of current evidence and available tablet sizes, starting doses of 2·5 mg methimazole twice a day and 10 to 15 mg once a day for the sustained release formulation of carbimazole are recommended. These doses should then be titrated to effect in order to obtain circulating total thyroxine (TT4) concentrations in the lower half of the reference interval. Treated cases should be monitored for side-effects, especially during the first months of treatment. Some side-effects may require discontinuation of treatment. At each monitoring visit, clinical condition and quality of life should also be evaluated, with special attention to possible development of azotaemia, hypertension and iatrogenic hypothyroidism. When euthyroidism has been achieved, monitoring visits are recommended after 1 month, 3 months and biannually thereafter. Cats with pre-existing azotaemia have shorter survival times. However, development of mild azotaemia during the initial course of treatment, unless associated with hypothyroidism, does not appear to decrease survival time. The long-term effects of chronic medical management require further study.

13C-sodium acetate breath test for evaluation of gastric emptying times in dogs with gastric dilatation-volvulus.

OBJECTIVE: The aim of the study was to assess solid phase gastric emptying via non-invasive 13C-sodium acetate breath test in large breed dogs with or without gastric dilatation-volvulus (GDV). MATERIAL AND METHODS: Dogs were recruited into one of the following groups: group 1 = healthy large breed dogs with no history of GDV, group 2 = dogs that underwent elective abdominal surgery for reasons unrelated to the gastrointestinal tract, and group 3 = dogs that underwent laparotomy and gastropexy to correct GDV. The dogs were fed a test meal containing 100 mg 13C-sodium acetate (for group 2 and 3, this was < 48 hours post-operatively). Breath samples were obtained at baseline and every 30 minutes for 3 hours, then every hour for a total of 7 hours. 12CO2/13CO2 ratio was measured for each breath sample via non-dispersive infrared spectroscopy and 25%, 50% and 75% gastric emptying times were calculated and compared between groups. RESULTS: Gastric emptying times were significantly prolonged in dogs undergoing surgery (group 2) compared to group 1 and 3. Also, gastric emptying times of dogs with GDV were significantly prolonged compared to controls, but not to the same extent as dogs in group 2. CONCLUSION AND CLINICAL SIGNIFICANCE: There was a significant effect of abdominal surgery on gastric emptying times. Surprisingly, dogs after GDV surgery and gastropexy had shorter gastric emptying times than dogs undergoing laparotomy for reasons other than GDV, but still prolonged compared to healthy controls. The reason for these differences requires further study.

Causes of vomiting in dogs and usefulness of clinical investigations.

OBJECTIVE: To find the most common diagnoses of dogs where vomiting was the main reason for referral and to determine the usefulness of various diagnostic investigations. MATERIAL AND METHODS: 213 dogs referred for vomiting as main or one of the main causes were analysed retrospectively. Diagnosis was reassessed and categorized into six groups, namely gastrointestinal, systemic, non-gastrointestinal abdominal, neurological, miscellaneous or no diagnosis. All diagnostic investigations were reviewed to assess their usefulness to reach a diagnosis. The usefulness of a diagnostic investigation was scored into the following four groups: enabled a diagnosis; assisted a diagnosis; no assistance, diagnosis reached by another procedure; no assistance, no final diagnosis made. RESULTS: In 203 dogs (95.3%) a diagnosis was reached and was categorised as gastrointestinal (43.7%), systemic (27.7%), non-gastrointestinal abdominal (16.4%), neurological (1.4%) and miscellaneous (6.1%). Laboratory tests enabling or assisting a diagnosis as blood tests in 12.2%; 26.8%, as faecal analysis in 6.6%; 1.4%, as ultrasound in 5.2%; 17%, as cytology in 3.3%; 4.2%, as urinalysis in 2.3%; 9.9% and as radiographs in 1.9%; 8.5% of all cases. CONCLUSION: Overall, there was a high incidence of dogs referred for vomiting with non-gastrointestinal diseases. Amongst them, renal problems were most commonly seen, which emphasises the need to perform a urinalysis in most dogs with vomiting as major complaint. However, vomiting can be due to a large variety of underlying pathophysiological mechanisms and no single problem seems to be much more common compared to other problems in a referral institution. CLINICAL RELEVANCE: Based on this investigation it is not possible to clearly state a most useful single diagnostic test in dogs with emesis, however, it could clearly been shown that more than one test is often needed to reach a final diagnosis. This is important for owners to understand but also for referring veterinarians.

A comparison of once and twice daily administration of trilostane to dogs with hyperadrenocorticism.

OBJECTIVE: This retrospective study describes the use of trilostane given once versus twice daily in dogs with hyperadrenocorticism (SID vs. BID-group) in separate clinical trials. MATERIAL AND METHODS: The groups were compared over a six month period using laboratory findings, dose required to suppress post-ACTH cortisol, and clinical scores from owner and clinician questionnaires. RESULTS: Ninety-three dogs enrolled the trials but for analysis of the final visit results only 56 dogs filled the inclusion criteria: 30 dogs in the SID-group and 26 dogs in the BID-group. Both treatment groups showed an improvement in clinical scores with time and no significant difference between them. In the BID-group post-ACTH cortisol concentrations went below 250 nmol/l sooner and in a higher proportion of dogs than in the SID-group. Twice-daily administration of trilostane also achieved a faster and more effective control for comparable daily doses. A higher individual tolerability (based on clinical scores) was found in the SID-group but there were no supporting laboratory findings. No dogs developed serious side-effects. CONCLUSION: This study reveals only small practical differences between once and twice daily trilostane administrations in treating hyperadrenocorticism. And the overall benefits of twice daily dosing have to be considered against the effect on the owners and their compliance with treatment.

Dietary hyperthyroidism in dogs.

OBJECTIVES: Evaluation of dogs with elevated plasma thyroxine concentration fed raw food before and after changing the diet. METHOD: Between 2006 and 2011 all dogs presented with an elevated plasma thyroxine concentration and a dietary history of feeding raw food were included. Thyroxine (reference interval: 19·3 to 51·5 nmol/L) and in many cases also thyroid-stimulating hormone concentrations (reference interval: <0·30 ng/mL) were measured initially and after changing the diet. RESULTS: Twelve dogs were presented with a median age of five years. The median plasma thyroxine concentration was 156·1 (range of 79·7 to 391·9) nmol/L; in six dogs, thyroid-stimulating hormone concentration was measured and was <0·03 ng/mL in five dogs and 0·05 ng/mL in one dog. Six dogs showed clinical signs such as weight loss, aggressiveness, tachycardia, panting and restlessness while six dogs had no clinical signs. After changing the diet eight dogs were examined: thyroxine concentration normalised in all dogs and clinical signs resolved. CLINICAL SIGNIFICANCE: Dietary hyperthyroidism can be seen in dogs on a raw meat diet or fed fresh or dried gullets. Increased plasma thyroxine concentration in a dog, either with or without signs of hyperthyroidism, should prompt the veterinarian to obtain a thorough dietary history.

[Epidemiological data of urinary stones in cats between 1981 and 2008]. / Epidemiologische Daten zur Harnsteinerkrankung bei Katzen im Zeitraum 1981-2008.

OBJECTIVE: Evaluation of urinary stones analysed between 1981 and 2008 in cats and comparison with data submitted, such as breed, age, sex and body weight. MATERIAL AND METHODS: Over the given years 5173 feline uroliths from cats in Germany and some neighbouring countries were analysed. From the forms submitted the following data was obtained for most cats: breed, age, sex, body weight, obesity status and location of the urinary stone(s). All uroliths were analysed by infrared spectroscopy. Uroliths containing at least 70% of a single mineral were classified as being of that type. RESULTS: The cats with urolithiasis belonged to 25 different breeds. The most common breed was the European shorthair (64.3%) followed by Persian (15.2%), British shorthair (3.9%), Chartreux (1.7%), Maine Coon (1.5%) and Siamese (1.1%). Most animals were neutered or castrated (81.8%). Tom cats were significantly more frequently affected than female cats. The mean age (7 years) was virtually identical between both sexes, but varied between different stone types. Cats with struvite stones were significantly younger than cats with calcium oxalate stones (6.6 versus 7.6 years). Most urinary stones were retrieved from the bladder and/or urethra (93%). Over the entire time period (1981-2008) struvite (51.2%) and calcium oxalate (38.7%) stones were the two most common urolith types. Percent calcium oxalate stones increased significantly over time and were seen more often in 2008 than struvite stones (48.6% versus 43.4%). Amongst other urinary stones, ammonium urate (1.7%), carbonate apatite (1.7%), cystine (0.5%) and xanthine (0.3%) uroliths were analysed. CONCLUSION AND CLINICAL RELEVANCE: While struvite and calcium oxalate stones are presently found at approximately equal frequency in cats, various different urinary stones types can also occur in this species. Epidemiological knowledge of urinary stones is crucial as a basis for adequate therapy and prevention.

[Hypoadrenocorticism without classic electrolyte abnormalities in seven dogs]. / Hypoadrenokortizismus ohne klassische elektrolytveränderungen bei sieben hunden.

OBJECTIVE: Evaluation of all dogs with hypoadrenocorticism (hAC) without classic electrolyte abnormalities that had been admitted during the previous 3.75 years. MATERIAL AND METHODS: Criteria for inclusion in this study were a confirmed diagnosis of hypoadrenocorticism (cortisol concentration before and after ACTH application <2 µg/dl) accompanied by a normal sodium:potassium ratio (≥ 27). Hyperkalaemic animals or those with a history of glucocorticoid, trilostane or mitotane administration were excluded. Information including signalement, history, physical examination, results of complete blood count, serum biochemical analysis, ACTH stimulation test, other laboratory tests and diagnostic imaging findings as well as information on the therapy were evaluated. Outcome, management and development of electrolyte shifts were assessed by owner telephone contact. RESULTS: Seven dogs (among those two poodles) fulfilled the inclusion criteria. The median age was 3.6 years. The most common clinical signs observed were diarrhoea, vomiting, inappetence and lethargy. The median sodium-potassium ratio was 38 (27-41). One dog developed electrolyte abnormalities after 5 months. Prednisolone was given to five dogs while one dog received fludrocortisone. In one dog repeating of the ACTH stimulation test was recommended before the initiation of therapy. One dog was euthanized because of other problems 21 months after diagnosis. The other patients responded well to therapy and are in a good general condition at present. Two of them occasionally have diarrhoea. CONCLUSION AND CLINICAL RELEVANCE: Atypical hAC is an important disease in dogs with recurrent chronic gastrointestinal signs seen mainly in young animals with non-specific historical and physical findings. Therefore, an ACTH stimulation test should be considered before invasive diagnostic tests like endoscopy are performed in these patients. Since some dogs with primary hAC eventually develop classical electrolyte abnormalities serum electrolyte concentrations should be monitored regularly.

Emesis in dogs: a review.

Emesis is a common presenting sign in small animal practice. It requires a rational approach to management that is based upon a sound understanding of pathophysiology combined with logical decision making. This review, which assesses the weight of available evidence, outlines the physiology of the vomiting reflex, causes of emesis, the consequences of emesis and the approach to clinical management of the vomiting dog. The applicability of diagnostic testing modalities and the merit of traditional approaches to management, such as dietary changes, are discussed. The role and usefulness of both traditional and novel anti-emetic drugs is examined, including in specific circumstances such as following cytotoxic drug treatment. The review also examines areas in which common clinical practice is not necessarily supported by objective evidence and, as such, highlights questions worthy of further clinical research.