Acute nontraumatic rhabdomyolysis in a Greyhound after albuterol toxicosis.

OBJECTIVE: To describe the clinical features of rhabdomyolysis due to albuterol toxicosis in a Greyhound. CASE SUMMARY: A 4-year-old neutered male Greyhound was presented for albuterol toxicosis leading to severe hypokalemia and respiratory paralysis. After 3 hours of mechanical ventilation, pigmenturia and marked enlargement, firmness, and pain of the left thigh muscles were noted. Severe hyperkalemia and cardiac arrhythmias were identified after turning the patient. After discontinuation of mechanical ventilation, other muscles became involved, and the patient developed acute kidney injury and concern for multiple organ dysfunction syndrome over the next 5 days. On day 6, the patient was euthanized, and necropsy revealed myocardial and skeletal muscle necrosis, myoglobinuria, and acute tubular degeneration. NEW OR UNIQUE INFORMATION PROVIDED: To the authors' knowledge, this is the first case of albuterol toxicosis leading to rhabdomyolysis.

Retrospective evaluation of the clinical course and outcome following grape or raisin ingestion in dogs (2005-2014): 139 cases.

OBJECTIVE: To describe the prevalence of acute kidney injury (AKI), clinical course, decontamination procedures, and outcome in dogs following grape or raisin ingestion. DESIGN: Retrospective case series from 2005 to 2014. SETTING: Three university veterinary teaching hospitals. ANIMALS: One hundred thirty-nine client-owned dogs with known grape or raisin ingestion. MEASUREMENTS AND MAIN RESULTS: Among dogs with biochemical data, the prevalence of AKI was 6.7% (8/120). The prevalence of AKI in the early presentation (3/67) and late (5/53) presentation groups were 4.5% and 9%, respectively. The prevalence of AKI was not significantly different between groups (P = 0.27). Four dogs (3.3%) were azotemic at presentation and 4 dogs (3.3%) had increases in creatinine of ≥26.5 µmol/L (0.3 mg/dL) at recheck (3 from the early and 1 from the late group). Vomiting was the most common clinical sign (18/139). One hundred twenty-two dogs (88%) underwent gastrointestinal decontamination and significantly more dogs in the early group were decontaminated (P < 0.0001). Two dogs received continuous renal replacement therapy. One hundred thirty-eight dogs survived and 1 died. CONCLUSIONS: The prevalence of AKI and mortality was low in dogs with confirmed grape or raisin ingestion. Due to the retrospective nature of the study, conclusions about the utility of gastrointestinal decontamination and other therapies cannot be made.

Evaluation of an intramuscular butorphanol and alfaxalone protocol for feline blood donation: a pilot study.

Objectives The purpose of this pilot study was to evaluate the use of an intramuscular (IM) sedation protocol with butorphanol and alfaxalone in cats undergoing blood donation. We hypothesized that this drug combination would provide sufficient sedation to perform phlebotomy without causing hypotension or significant changes in heart rate. Methods Six purpose-bred, healthy adult cats were sedated using IM butorphanol (0.4 mg/kg) and alfaxalone (2-3 mg/kg). Pulse and Doppler blood pressure (BP) were recorded at baseline, after sedation and immediately following phlebotomy. Once laterally recumbent, 12 ml/kg blood was collected from the jugular vein. Sedation scores, duration of lateral recumbency and the ability to successfully perform phlebotomy were recorded. Results There was no significant change in heart rate post-sedation (median 190 beats per min [bpm], range 160-224 bpm) or post-phlebotomy (median 200 bpm, range 180-220 bpm) compared with baseline values (median 200 bpm, range 180-220 bpm) ( P = 0.395). A statistically significant change in BP was detected ( P = 0.029), attributed to a difference between post-sedation (median 113.3 mmHg, range 110.7-130.0) and baseline (median 133.3 mmHg, range 130.0-183.3) measurements. Hypotension was not observed in any cat. Collection of at least 80% of the target volume was achieved in 5/6 cats, although all were adequately sedated to allow jugular venous phlebotomy. Median recumbency time was 53 mins (range 43-83 mins). Phlebotomy duration lasted a median of 13 mins (range 5-21 mins). Conclusions and relevance The administration of IM alfaxalone and butorphanol provided sufficient restraint for blood donation without causing hypotension or significant changes in heart rate before or after phlebotomy.

Haptic Orientation Guidance Using Two Parallel Double-Gimbal Control Moment Gyroscopes.

This paper presents a system of two double-gimbal control moment gyroscopes (CMGs) for providing ungrounded kinesthetic haptic feedback. By spinning a second flywheel opposite the first, and rotating them through opposite trajectories, undesired gyroscopic effects can be eliminated, isolating a single torque axis. This produces a moment pulse proportional to the flywheel spin speed and rotation speed. Rotating the CMG gimbals quickly in one direction, then resetting them more slowly generates repeated torque pulses indicating a clear direction cue. We present the mathematical model for moments produced by this system and verify that the performance of our device matches this model. Using these asymmetric moment pulses, we provide haptic cues to participants in two studies. In the first study, users simply identify the direction of torque cues. In the second study, we use the torque pulses to guide users to target orientations. Performance in both studies shows that this system has the potential to provide useful guidance for applications where ungrounded haptic feedback is desired.

Acute respiratory distress syndrome and septic shock in a cat with disseminated toxoplasmosis.

OBJECTIVE: To describe acute respiratory distress syndrome (ARDS) and septic shock in a cat with disseminated toxoplasmosis. CASE SUMMARY: A 2-year-old neutered male domestic shorthair cat was presented for acute respiratory distress. At the time of presentation it had been receiving cyclosporine for treatment of eosinophilic dermatitis. Thoracic radiographs revealed severe mixed nodular interstitial and alveolar patterns. An endotracheal wash was performed, which confirmed a diagnosis of pulmonary toxoplasmosis. Despite initial treatment with oxygen supplementation and intravenous clindamycin, the cat developed refractory hypoxemia and hypotension requiring mechanical ventilation and vasopressor support within 24 hours of hospital admission. Cardiac arrest occurred 56 hours after admission. Necropsy was performed and histopathology revealed protozoal organisms disseminated throughout the heart, lungs, liver, and brain. NEW OR UNIQUE INFORMATION PROVIDED: The clinical and necropsy findings presented here are consistent with ARDS secondary to disseminated toxoplasmosis in a cat. This is the first detailed report of ARDS in a cat. Toxoplasma titer testing and antimicrobial prophylaxis should be considered in cats prior to immunosuppressive treatment with cyclosporine.

Comparison of the efficacy of small and large-bore thoracostomy tubes for pleural space evacuation in canine cadavers.

OBJECTIVE: To determine if there is a difference in the amounts of air (A), low-viscosity fluid (LV), or high-viscosity fluid (HV) that can be aspirated from the pleural cavity of canine cadavers using small-bore (SB) or large-bore (LB) thoracostomy tubes. DESIGN: Prospective experimental ex vivo study. SETTING: University teaching hospital. ANIMALS: Thirty-six canine cadavers. INTERVENTIONS: Each cadaver was randomly assigned to 1 of 6 groups (SB-A, LB-A, SB-LV, LB-LV, SB-HV, LB-HV). In each cadaver bilateral thoracostomy tubes (either SB or LB) were placed and 20 mL/kg of air, LV fluid, or HV fluid was instilled via 1 thoracostomy tube. Both tubes were aspirated and the volume aspirated was recorded and analyzed as a percentage of instilled air or fluid volume. The procedure was repeated on the contralateral hemithorax. MEASUREMENTS AND MAIN RESULTS: There was no significant difference in air or fluid recovery when SB and LB groups were compared. Median (range) air recovery volumes in the SB-A and LB-A groups were 101.5% (94.4-115.8%) and 102.8% (94.1-107.8%), respectively (P = 0.898). Recovery of LV fluid was 93.5% (79.2-99.0%) for SB-LV and 85.8% (77.1-101.8%) for LB-LV cadavers (P = 0.305) and recovery percentages of HV fluid were 92.6% (86.1-96.2%) and 91.4% (74.2-96.4%) for SB-HV and LB-HV groups, respectively (P > 0.999). There was no significant difference between SB and LB groups when all substances were combined (94.1% [79.2-115.8%] and 93.5% [74.2-107.8%], respectively, P = 0.557). CONCLUSIONS: SB and LB thoracostomy tubes demonstrated similar efficacy in removing known amounts of air, LV fluid, and HV fluid from the pleural space of canine cadavers. Further study is necessary to determine if SB and LB thoracostomy tubes demonstrate similar efficacy in clinical veterinary patients.

Evaluation of the effects of time, temperature, and specimen storage on in vitro lactate concentrations in healthy dogs.

BACKGROUND: Lactate concentrations increase significantly under certain storage conditions, except for when glycolysis-arresting agents are used. Evaluation of time and storage conditions on heparinized whole blood lactate concentrations without glycolysis-arresting agents have not been evaluated in dogs. OBJECTIVES: The purpose of the study was to determine the effects of preanalytic storage conditions on the in vitro concentration of lactate in heparinized canine venous blood specimens. METHODS: In this prospective study, blood collected from 30 healthy dogs was aliquoted and stored under different conditions: anaerobic refrigerated (3°C), aerobic refrigerated, anaerobic room temperature (RT), and aerobic RT. Whole blood lactate was analyzed at 15-25, 30-40, 60-70, and 120-130 minutes from time 0 (T0) under all storage conditions. Percent increases from the T0 specimen were calculated. RESULTS: There were significantly increased lactate concentrations at all time points within the anaerobic refrigerated specimens compared to T0, and in the anaerobic RT specimens after 15-25 minutes. The aerobic refrigerated specimens did not have significant changes in lactate when compared to anaerobic refrigerated specimens, while the aerobic RT specimens had significant increases at all time points. Anaerobically refrigerated specimens stored < 40 minutes and aerobically refrigerated specimens stored < 25 minutes had in vitro lactate increases of < 20%. CONCLUSIONS: Results support analyzing lactate specimens immediately. If lactate analysis is delayed, anaerobic refrigerated specimens should be analyzed within 40 minutes, and aerobic refrigerated specimens should be analyzed within 25 minutes. Room temperature specimens stored either aerobically or anaerobically should be avoided as lactate concentrations may be falsely increased.

Sarcocystid organisms found in bile from a dog with acute hepatitis: a case report and review of intestinal and hepatobiliary Sarcocystidae infections in dogs and cats.

Sarcocystidae is a family of coccidian protozoa from the phylum Apicomplexa that includes Toxoplasma, Neospora, Sarcocystis, Hammondia, and Besnoitia spp. All species undergo a 2-host sexual and asexual cycle. In the definitive host, replication is enteroepithelial, and infection is typically asymptomatic or less commonly causes mild diarrhea. Clinical disease is most frequently observed in the intermediate host, often as an aberrant infection, and is mostly associated with neurologic, muscular, or hepatic inflammation. Here, we review the literature regarding intestinal Sarcocystidae infections in dogs and cats, with emphasis on the life cycle stages and the available diagnostic assays and their limitations. We also report the diagnostic findings for an 11-year-old dog with acute neutrophilic hepatitis, biliary protozoa, and negative biliary culture. Although Toxoplasma and Neospora IgG titers were both high, PCR for these 2 organisms was negative for bile. The organisms were identified by 18S rDNA PCR as most consistent with Hammondia, either H heydorni or H triffittae. This is the first report of presumed Hammondia organisms being found in canine bile.

Presumptive intraperitoneal envenomation resulting in hemoperitoneum and acute abdominal pain in a dog.

OBJECTIVE: To describe the clinical features, diagnostic findings, treatment, and outcome of a dog with acute abdominal pain and hemoperitoneum secondary to a presumptive intraperitoneal (IP) snakebite. CASE SUMMARY: A 10-month-old castrated male mixed-breed dog was evaluated for suspected snake envenomation. The dog presented recumbent and tachycardic with signs of severe abdominal pain. Two cutaneous puncture wounds and hemoperitoneum were discovered during evaluation. Ultrasonographic examination revealed communication of the wounds with the peritoneal cavity. The dog was treated with supportive care, parenteral analgesia, packed red blood cell and fresh frozen plasma transfusions, crotalid antivenom, and placement of an IP catheter to provide local analgesia. The dog recovered fully and was discharged 5 days after initial presentation. NEW OR UNIQUE INFORMATION PROVIDED: To our knowledge, this is the first report of IP envenomation accompanied by hemorrhage treated with continuous IP analgesia in the veterinary literature.

Tactile Feedback of Object Slip Facilitates Virtual Object Manipulation.

Recent advances in myoelectric prosthetic technology have enabled more complex movements and interactions with objects, but the lack of natural haptic feedback makes object manipulation difficult to perform. Our research effort aims to develop haptic feedback systems for improving user performance in object manipulation. Specifically, in this work, we explore the effectiveness of vibratory tactile feedback of slip information for grasping objects without slipping. A user interacts with a virtual environment to complete a virtual grasp and hold task using a Sensable Phantom. Force feedback simulates contact with objects, and vibratory tactile feedback alerts the user when a virtual object is slipping from the grasp. Using this task, we found that tactile feedback significantly improved a user's ability to detect and respond to slip and to recover the slipping object when visual feedback was not available. This advantage of tactile feedback is especially important in conjunction with force feedback, which tends to reduce a subject's grasping forces and therefore encourage more slips. Our results demonstrate the potential of slip feedback to improve a prosthesis user's ability to interact with objects with less visual attention, aiding in performance of everyday manipulation tasks.

Systematic evaluation of evidence on veterinary viscoelastic testing part 4: Definitions and data reporting.

OBJECTIVE: To systematically examine evidence surrounding definitions and reporting of data for viscoelastic testing in veterinary medicine. DESIGN: Standardized, systematic evaluation of the literature, categorization of relevant articles according to level of evidence and quality, and development of consensus on conclusions for application of the concepts to clinical practice. SETTING: Academic and referral veterinary medical centers. RESULTS: Databases searched included Medline, CAB abstracts, and Google Scholar. CONCLUSIONS: All 4 standard thromboelastography (TEG) and rotational thromboelastometry (ROTEM) variables should be universally reported, and the reporting of shear elastic modulus in addition to maximum amplitude (MA) is encouraged. There is insufficient evidence to support universal usage of the coagulation index at this time. The K value and clot formation time are the most variable of the 4 parameters, with alpha angle, MA, and maximum clot firmness generally the least variable. Individual studies should report sufficient data on patients and institutional controls to enable definitions of hypo- and hypercoagulability to be evaluated post-hoc, and it is recommended that all studies specifically report how these conditions were defined. In reporting data relating to fibrinolysis, the TEG variables LY30, LY60, CL30, CL60, and the ROTEM variables LI30, LI60, ML, LOT, and LT should be documented. Studies should report sufficient data on patients and controls to enable definitions of hyper- and hypofibrinolysis to be evaluated post-hoc, and we suggest that standard TEG/ROTEM assays may be unable to detect hypofibrinolysis in companion animals. We recommend that every center establish reference intervals, which are specific to either TEG or ROTEM. These reference intervals should be established using veterinary clinical pathology guidelines, standardized protocols, and a minimum of 40 healthy animals. There are currently insufficient data in companion animals to suggest a utility for Vcurve variables beyond that of standard TEG variables.

Comparison of venous sampling methods for thromboelastography in clinically normal dogs.

OBJECTIVE: To evaluate effects of blood collection method and site on results of thromboelastography in healthy dogs. ANIMALS: 8 clinically normal purpose-bred dogs. PROCEDURES: Blood was collected from the external jugular vein by syringe aspiration via direct venipuncture with a 20-gauge needle, through a central venous catheter, or into an evacuated tube with a 21-gauge winged needle catheter. Blood was collected from the lateral saphenous vein by syringe aspiration via direct venipuncture with a 20-gauge needle or into an evacuated tube with a 21-gauge winged needle catheter. Kaolin-activated thromboelastographic analyses were performed, and R (reaction time), K (clot formation time), α angle, maximal amplitude, and G (global clot strength) were analyzed. RESULTS: No significant differences were observed with regard to sampling site. Sample collection method had no effect on thromboelastographic results for saphenous vein samples. Blood samples collected from the jugular vein by syringe aspiration had a lower R and K and higher α angle than did blood samples collected from the jugular vein by evacuated tube collection. Significant differences were observed between blood samples collected from the jugular vein by syringe aspiration and samples collected from the saphenous vein by evacuated tube collection and between samples collected from the saphenous vein by evacuated tube collection and samples collected from the jugular vein through a central venous catheter. CONCLUSIONS AND CLINICAL RELEVANCE: Different sampling methods resulted in small but significant differences in thromboelastographic values. Results justify the use of standardized techniques for research purposes, but all of these sampling methods were acceptable for 1-time clinical use.