2023 AAHA Selected Endocrinopathies of Dogs and Cats Guidelines.

Canine and feline endocrinopathies reflect an endocrine gland disease or dysfunction with resulting hormonal abnormali ties that can variably affect the patient's wellbeing, quality of life, and life expectancy. These guidelines provide consensus recommendations for diagnosis and treatment of four canine and feline endocrinopathies commonly encountered in clini cal practice: canine hypothyroidism, canine hypercortisolism (Cushing's syndrome), canine hypoadrenocorticism (Addi son's disease), and feline hyperthyroidism. To aid the general practitioner in navigating these common diseases, a stepwise diagnosis and treatment algorithm and relevant background information is provided for managing each of these diseases. The guidelines also describe, in lesser detail, the diagnosis and treatment of three relatively less common endo crinopathies of cats: feline hyperaldosteronism, feline hypothyroidism, and feline hyperadrenocorticism. Additionally, the guidelines present tips on effective veterinary team utilization and client communication when discussing endocrine cases.

Laboratory Diagnosis of Thyroid and Adrenal Disease.

Diagnosis of thyroid and adrenal disease can be confusing. Whereas the definitive diagnosis of hyperthyroidism and hypoadrenocorticism are relatively straightforward, hypothyroidism and naturally occurring Cushing's syndrome (NOCS) are more complicated. In a patient with compatible clinical signs, a single increased tT4 is enough to confirm hyperthyroidism, but a low tT4 alone is never enough to confirm hypothyroidism. A flatline result (post-stimulation cortisol <2 ug/dL) on an ACTH stimulation test (ACTHst) confirms hypoadrenocorticism, but not all dogs with NOCS have increased ACTHst results. This article explains which diagnostics should be pursued for these endocrinopathies, and how to interpret them.

Effects of desmopressin acetate administration in healthy dogs receiving prednisolone.

BACKGROUND: Glucocorticoids are used for a variety of purposes in veterinary medicine but often are associated with clinically important adverse effects. Polyuria and polydipsia are the most frustrating adverse effects noted by owners. OBJECTIVE: To determine whether administration of desmopressin ameliorates polyuria and polydipsia associated with prednisolone administration. ANIMALS: Seven healthy adult Walker Hounds. METHODS: Prospective hypothesis testing study. Daily water intake and urine specific gravity (USG) were measured in dogs under 4 separate sequential conditions: no medications (C), prednisolone only (P), prednisolone and desmopressin (PD), and prednisolone after discontinuation of desmopressin (PAD). RESULTS: When compared to baseline, 6 of 7 dogs became polydipsic after administration of prednisolone (0.5 mg/kg PO q12h). When desmopressin (5 µg/dog SC q12h) was administered to dogs receiving prednisolone, significant decreases in water intake and serum sodium concentration occurred, and USG increased significantly. CONCLUSIONS AND CLINICAL IMPORTANCE: Administration of desmopressin to dogs receiving prednisolone significantly decreased water intake and serum sodium concentration, and increased USG. Our results suggest that, in some dogs, desmopressin ameliorates the most important adverse effect of prednisolone noted by owners, but that hyponatremia is an important complication associated with desmopressin use.

Ketoconazole-induced transient hypoadrenocorticism in a dog.

A 6-year-old, spayed female, mixed breed boxer dog was presented for decreased appetite, polyuria and polydipsia, and lethargy 9 days after treatment with ketoconazole for Malassezia pododermatitis. Ketoconazoleinduced hypoadrenocorticism was confirmed with an adrenocorticotropic hormone (ACTH) stimulation test, and ketoconazole was discontinued. Clinical signs resolved 48 hours after initiation of prednisone, and resolution of glucocorticoid insufficiency was confirmed with a repeat ACTH stimulation test 48 hours after a 10-day course of prednisone. Glucocorticoid insufficiency after administration of a commonly used dermatological dose of ketoconazole has not been previously reported in veterinary medicine but should be considered in patients with adverse effects while receiving ketoconazole. Key clinical message: Iatrogenic hypoadrenocorticism may occur in dogs treated with commonly used dermatological doses of ketoconazole. The disease is likely transient, but steroid supplementation may be required in some patients to resolve clinical signs, especially in the presence of concurrent illness or stress.

Hypoadrénocorticisme transitoire induit par le kétoconazole chez un chien. Une femelle Boxer mélangée stérilisée et âgée de 6 ans fut présentée pour une diminution d'appétit, de la polyurie et de la polydipsie, ainsi que de la léthargie 9 jours après un traitement avec du kétoconazole pour une pododermatite à Malassezia. L'hypoadrénocorticisme induit par le kétoconazole fut confirmé par un test de stimulation avec une hormone adrénocorticotropique (ACTH), et le kétoconaxole fut arrêté. Les signes cliniques ont cessé 48 heures après le début d'un traitement à la prednisone, et la résolution de l'insuffisance de glucocorticoïdes fut confirmée par une répétition du test de stimulation à l'ACTH 48 heures après 10 jours de traitement à la prednisone. L'insuffisance de glucocorticoïdes après l'administration d'une dose de kétoconazole fréquemment utilisée en dermatologie n'a pas été préalablement rapportée en médecine vétérinaire mais devrait être considérée chez des patients présentant des réactions adverses lorsqu'ils reçoivent du kétoconazole.Message clinique clé:De l'hypoadrénocorticisme iatrogénique peut survenir chez des chiens traités avec du kétoconazole avec des doses fréquemment utilisées en dermatologie. La maladie est probablement transitoire, mais une supplémentation en stéroïde pourrait être requise chez certains patients afin de résoudre les signes cliniques, spécialement en présence de maladie concomitante ou de stress.(Traduit par Dr Serge Messier).

Extraction and Analysis of Xylitol in Sugar-Free Gum Samples by GC-MS with Direct Aqueous Injection.

Xylitol, a sugar substitute frequently used in sugar-free gum, is generally considered harmless to humans but it can be extremely toxic to dogs. Dog-owning customers are becoming increasingly aware of the risks associated with xylitol-containing chewing gums. However, there remains some uncertainty if these chewing gums are still dangerous to dogs after they have been partially consumed. In this work, a reliable low-cost analytical method has been developed to quantify the xylitol in sugar-free gum samples. Xylitol was extracted from gum samples using water as a solvent. Extractions were analyzed by GC-MS with direct aqueous injection (DAI). This method was successfully applied to over 120 samples including fresh gum and 5 min, 15 min, and 30 min chewed gum samples.

Mucous Membrane Color Assessment Variability of Veterinary Students Using Either Colorimetric or Word-Based Scales.

A colorimetric scale has the potential to be very useful as a training tool for students in veterinary training programs. The authors of this report hypothesized that clinically active, graduate level veterinary students would assess mucous membrane color with greater consistency using an image-based system than with traditional word-based techniques. Third- and fourth-year veterinary students were asked to evaluate 10 canine gingival mucosa images and rate them with either an image-based scale designed by the authors or a word-based system. Although the mean absolute deviations from the median values were greater for the word scale (0.22) than for the image scale (0.20) indicating increased variation, mixed model analysis did not demonstrate these differences were significant ( p = .120). Based on this data it is possible that prior image and word-based instruction made it easier for the students to differentiate mucous membrane colors, or that the majority of the students were multimodal learners rather than single-type learners, making previous instruction techniques effective regardless of whether they were visual or read/write based. The authors recommend that future investigators both evaluate previous student instruction and consider administering visual, auditory, read/write, kinesthetic (VARK) tests when investigating potential learning aids in veterinary medicine.

Management of hypoadrenocorticism (Addison's disease) in dogs.

Hypoadrenocorticism (HOAC; Addison's disease) is an endocrine condition seen in small animal practice. Dogs with this disease can present in a variety of ways from acute hypovolemic collapse to vague, chronic, waxing, and waning clinical signs. In the most common form of this disease, animals have both mineralocorticoid and glucocorticoid deficiency, resulting in hyponatremia and hyperkalemia, and signs of cortisol deficiency. The etiology may be immune-mediated destruction of the adrenal cortex, drug-induced adrenocortical necrosis (mitotane), enzyme inhibition (trilostane), or infiltrative processes such as neoplastic or fungal disease. Much less commonly, dogs have signs of cortisol deficiency, but no electrolyte changes. This is referred to as atypical HOAC. The veterinarian needs to have a clinical suspicion for HOAC to make a diagnosis in a timely manner. Treatment of dogs with an acute presentation prioritizes correcting the hypovolemia, hyperkalemia, acidosis, and hypoglycemia. Fluid therapy addresses most of these issues, but other directed therapies may be required in the most severe cases. For chronic management, all patients with Addison's disease will require replacement of glucocorticoids (usually prednisone), and most patients require replacement of mineralocorticoids with either desoxycorticosterone pivalate or fludrocortisone. Atypical Addisonians do not require mineralocorticoid supplementation, but electrolytes should be monitored in case the need arises in the future. The prognosis for dogs treated for HOAC promptly and appropriately is excellent; most patients die from other diseases. However, if the diagnosis is missed, patients may die as a consequence of HOAC. Thus, knowledge of the hallmarks of Addison's disease is imperative.

Correlation between urine color and urine specific gravity in dogs: Can urine color be used to identify concentrated urine?

This combined retrospective-prospective study evaluated the correlation between canine urine color (UC) and urine specific gravity (USG). Urine color was positively correlated with USG, but the relationship was not significantly improved by use of a UC chart. Urine color as an indicator of USG is limited as 20% of dark-yellow samples had a USG < 1.030.

Corrélation entre la couleur de l'urine et la gravité spécifique à l'urine chez les chiens: la couleur de l'urine peut-elle servir à identifier l'urine concentrée? Cette étude combinée rétrospective-prospective a évalué la corrélation entre la couleur de l'urine canine (UC) et la gravité spécifique à l'urine (USG). On a établi une corrélation positive d'UC avec USG, mais la relation n'a pas été significativement améliorée par l'utilisation d'un tableau d'UC. L'UC à titre d'indicateur d'USG est limité car 20 % des prélèvements jaune foncé présentaient un USG < 1,030.(Traduit par Isabelle Vallières).

2018 AAHA Diabetes Management Guidelines for Dogs and Cats.

Diabetes mellitus (DM) is a common disease encountered in canine and feline medicine. The 2018 AAHA Diabetes Management Guidelines for Dogs and Cats revise and update earlier guidelines published in 2010. The 2018 guidelines retain much of the information in the earlier guidelines that continues to be applicable in clinical practice, along with new information that represents current expert opinion on controlling DM. An essential aspect of successful DM management is to ensure that the owner of a diabetic dog or cat is capable of administering insulin, recognizing the clinical signs of inadequately managed DM, and monitoring blood glucose levels at home, although this is ideal but not mandatory; all topics that are reviewed in the guidelines. Insulin therapy is the mainstay of treatment for clinical DM. The guidelines provide recommendations for using each insulin formulation currently available for use in dogs and cats, the choice of which is generally based on efficacy and duration of effect in the respective species. Also discussed are non-insulin therapeutic medications and dietary management. These treatment modalities, along with insulin therapy, give the practitioner an assortment of options for decreasing the clinical signs of DM while avoiding hypoglycemia, the two conditions that represent the definition of a controlled diabetic. The guidelines review identifying and monitoring patients at risk for developing DM, which are important for avoiding unnecessary insulin therapy in patients with transient hyperglycemia or mildly elevated blood glucose.

Update on insulin treatment for dogs and cats: insulin dosing pens and more.

Insulin therapy is still the primary therapy for all diabetic dogs and cats. Several insulin options are available for each species, including veterinary registered products and human insulin preparations. The insulin chosen depends on the individual patient's requirements. Intermediate-acting insulin is usually the first choice for dogs, and longer-acting insulin is the first choice for cats. Once the insulin type is chosen, the best method of insulin administration should be considered. Traditionally, insulin vials and syringes have been used, but insulin pen devices have recently entered the veterinary market. Pens have different handling requirements when compared with standard insulin vials including: storage out of the refrigerator for some insulin preparations once pen cartridges are in use; priming of the pen to ensure a full dose of insulin is administered; and holding the pen device in place for several seconds during the injection. Many different types of pen devices are available, with features such as half-unit dosing, large dials for visually impaired people, and memory that can display the last time and dose of insulin administered. Insulin pens come in both reusable and disposable options. Pens have several benefits over syringes, including improved dose accuracy, especially for low insulin doses.

Novel extraction of volatile biomarkers from canine breath for gas chromatography-mass spectrometry.

Here we describe an effective, reproducible, non-invasive volatile organic compound collection and analysis method for exhaled breath gas samples designed specifically for use with dogs. Conditions of the method were optimized, using a range of standard chemicals. This method utilizes a canine mask, two-way non-re-breathing valve, teflon connector, tubing and bag for sample collection. Collection is followed by condensation and headspace solid phase microextraction for sample concentration and gas chromatography-mass spectrometry for analysis. Custom-made glassware, designed to hold the SPME fiber assembly, was cooled to -10 °C and used for the collection of the condensate followed by 2 h of headspace extraction at 37 °C. Standards show LOD of 0.6-16.8 ppbv, LOQ between 2.1-55.8 ppbv, and good linearity with R(2) between 0.996-0.999 (RSD% 10-19). The method was verified with preliminary results from three dogs demonstrating that this technique is capable of collecting, identifying and quantifying volatile organic chemical constituents in different breath samples.

Seroprevalence of Ehrlichia canis, Ehrlichia chaffeensis and Ehrlichia ewingii in dogs in North America.

BACKGROUND: This study evaluated the exposure of dogs to three different Ehrlichia spp. in the south and central regions of the United States where vector-borne disease prevalence has been previously difficult to ascertain, particularly beyond the metropolitan areas. METHODS: Dog blood samples (n = 8,662) were submitted from 14 veterinary colleges, 6 private veterinary practices and 4 diagnostic laboratories across this region. Samples were tested for E. canis, E. chaffeensis and E. ewingii specific antibodies using peptide microtiter ELISAs. RESULTS: Overall, E. canis, E. chaffeensis and E. ewingii seroprevalence was 0.8%, 2.8%, and 5.1%, respectively. The highest E. canis seroprevalence (2.3%) was found in a region encompassing Arkansas, Louisiana, Oklahoma, Tennessee and Texas. E. chaffeensis seroreactivity was 6.6% in the central region (Arkansas, Kansas, Missouri, and Oklahoma) and 4.6% in the southeast region (Georgia, Maryland, North Carolina, South Carolina, Tennessee and Virginia). Seroreactivity to E. ewingii was also highest in the central region (14.6%) followed by the southeast region (5.9%). The geospatial pattern derived from E. chaffeensis and E. ewingii seropositive samples was similar to previous reports based on E. chaffeensis seroreactivity in white-tailed deer and the distribution of human monocytic ehrlichiosis (HME) cases reported by the CDC. CONCLUSIONS: The results of this study provide the first large scale regional documentation of exposure to E. canis, E. chaffeensis and E. ewingii in pet dogs, highlighting regional differences in seroprevalence and providing the basis for heightened awareness of these emerging vector-borne pathogens by veterinarians and public health agencies.