Our quest for creating a space that is welcoming to all: A commentary from the American College of Veterinary Emergency and Critical Care Diversity, Equity, and Inclusion Committee.

Diversity, equity, and inclusion (DEI) are crucial elements of successful veterinary emergency and critical care practices across the world. Embracing the elements of DEI creates a work environment that is safe and welcoming for all the members of the team. The American College of Veterinary Emergency and Critical Care DEI committee was formed to enhance and support efforts to increase racial diversity in veterinary emergency and critical care, as well as provide resources that will generate DEI practices across the country. This article provides an overview of the vision of the committee and some of the steps that have been taken to create a welcoming space for all represented in veterinary emergency and critical care.

The use of high-dose insulin therapy and intravenous lipid emulsion to treat severe, refractory diltiazem toxicosis in a dog.

OBJECTIVE: To describe the novel use of high-dose insulin (HDI) therapy and intravenous lipid emulsion (ILE) to treat refractory, severe diltiazem toxicosis in a dog. CASE SUMMARY: A 4-year-old Pomeranian was presented for treatment 2.5 hours following ingestion of a diltiazem extended-release capsule. Toxic ingestion was calculated at a maximum exposure of 79 mg/kg, with a reported canine LD50 of 50 mg/kg. Clinical signs of progressive hypotension and severe bradycardia with atrial standstill were observed, which persisted despite treatment with atropine, calcium, glucagon, and dopamine. The novel use of HDI and ILE as part of therapy for diltiazem toxicosis resulted in clinical resolution of life-threatening signs. Within 1 hour of initiating HDI therapy, the clinical signs improved, and with continued treatment, the patient remained normotensive and survived to discharge. NEW OR UNIQUE INFORMATION PROVIDED: To the authors' knowledge, this is the first reported clinical case describing the use of both HDI and ILE therapy in the treatment of severe refractory diltiazem toxicosis in veterinary medicine. No significant adverse effects were observed from the treatment. In veterinary patients with severe refractory calcium channel blocker toxicosis, the use of HDI and ILE should be considered for life-threatening clinical signs.

Magnesium sulfate as an adjunct therapy in the management of severe generalized tetanus in a dog.

OBJECTIVE: To describe the use of magnesium sulfate in a case of generalized tetanus in a dog. CASE SUMMARY: A 1.5-year-old golden retriever was presented for a digital wound on the right thoracic limb and clinical signs associated with generalized tetanus. Initial case management consisted of wound debridement, treatment with metronidazole, tetanus immunoglobulin, methocarbamol, airway management via tracheostomy, and nursing care. Sedation to control severe muscle spasms became insufficient despite increasing doses of benzodiazepine, methocarbamol, and barbiturate continuous rate infusions. A magnesium sulfate continuous rate infusion was instituted on day 7 and muscle rigidity improved within 16 hours allowing discontinuation of sedative infusions over the subsequent 2 days. Clinical improvement continued and the dog was discharged on day 14. NEW OR UNIQUE INFORMATION PROVIDED: This case demonstrates the use of supraphysiologic magnesium in the treatment of severe generalized tetanus with a positive outcome. No clinical signs associated with magnesium toxicity were noted during the course of therapy. Magnesium sulfate should be considered as a potential adjunct therapy in the management of spastic paralysis caused by severe tetanus in dogs.

Anticoagulant effects of low-molecular-weight heparins in healthy cats.

BACKGROUND: Low-molecular-weight heparin (LMWH) has potential benefit in cats at risk for thromboembolic disease. However, LMWH pharmacokinetics has not been characterized in the cat. Drug effect with LMWH may be evaluated with analysis of factor Xa inhibition (anti-Xa) or thromboelastography (TEG). HYPOTHESIS: Administration of LMWH at previously recommended dosages and schedules to healthy cats will result in inhibition of factor Xa and hypocoagulable TEG. ANIMALS: In vivo research with heparin was performed in 5 purpose-bred cats. METHODS: In a prospective study with randomized crossover design, heparin or placebo was administered. Treatments were unfractionated heparin (UFH), 250 IU/kg q6h; dalteparin, 100 IU/kg q12h; enoxaparin, 1 mg/kg q12h; or 0.9% saline, 0.25 mL/kg q6h. Each drug was administered for 5 consecutive days followed by a minimum washout of 14 days. Baseline and post-treatment analyses included anti-Xa, TEG, and prothrombin time/activated partial thromboplastin time. RESULTS: Mean anti-Xa activity 4 hours after enoxaparin (0.48 U/mL) approached the human therapeutic target (0.5-1.0 U/mL); however, mean trough anti-Xa activity was below detection limits. Mean anti-Xa activity 4 hours after dalteparin was lower, and only 1 cat attained therapeutic target at a single time point. Cats receiving UFH attained target anti-Xa activity and changes in TEG at trough and 4 hours. CONCLUSIONS: Cats have rapid absorption and elimination kinetics with LMWH therapy. On the basis of pharmacokinetic modeling, cats will require higher dosages and more frequent administration of LMWH to achieve human therapeutic anti-factor Xa activity of 0.5-1 U/mL. Peak anti-Xa activity is predicted at 2 hours after administration of LMWH.