Treatment and outcome following substantial ketamine overdose in a dog.

A 9-year-old, 3.7 kg (8.14 lb) neutered male Yorkshire terrier mix was treated following a ketamine overdose after subcutaneous ureteral bypass surgery. Due to an error in communication and misinterpretation of an electronic treatment sheet, the dog was inadvertently placed on a continuous rate infusion (CRI) of ketamine at 67.6 mg/kg per hour, rather than the intended 0.2 mg/kg per hour rate. Four hours after initiation of the ketamine CRI, the dog developed signs indicative of a ketamine overdose including tachycardia, hyperthermia, anisocoria, and hypoglycemia. It was determined the dog had received an iatrogenic overdose of ketamine; the infusion had been running at 67.6 mg/kg per hour, resulting in 270 mg/kg of ketamine over 4 h. Aggressive supportive measures were undertaken, and the dog gradually recovered over an 18-hour period, without lasting consequences of the overdose. To the authors' knowledge, there are no current published reports of a ketamine overdose of this magnitude in a dog. This case report documents an iatrogenic 338 times intravenous ketamine overdose in a dog, which was successfully managed with supportive care. In addition, it highlights the importance of doctor-technician communication and the potential errors in using electronic treatment sheets.

Traitement et résultat à la suite d'une surdose importante de kétamine chez un chien. Un Yorkshire terrier mélangé mâle de 9 ans et pesant 3,7 kg (8,14 lb) a été traité à la suite d'une surdose de kétamine après un pontage urétéral sous-cutané. En raison d'une erreur de communication et d'une mauvaise interprétation d'une feuille de traitement électronique, le chien a été placé par inadvertance sous une perfusion à débit continu (IRC) de kétamine à 67,6 mg/kg par heure, au lieu du débit prévu de 0,2 mg/kg par heure. Quatre heures après le début de l'IRC de kétamine, le chien a développé des signes indiquant une surdose de kétamine, notamment de la tachycardie, de l'hyperthermie, de l'anisocorie et de l'hypoglycémie. Il a été déterminé que le chien avait reçu une surdose iatrogène de kétamine; la perfusion fonctionnait à 67,6 mg/kg par heure, entraînant 270 mg/kg de kétamine en 4 h. Des mesures de soutien agressives ont été mises en place et le chien s'est progressivement rétabli sur une période de 18 heures, sans conséquences durables du surdosage.À la connaissance des auteurs, il n'existe actuellement aucun rapport publié sur une surdose de kétamine de cette ampleur chez un chien. Ce rapport de cas documente une surdose iatrogène de kétamine de 338 fois par voie intraveineuse chez un chien, qui a été gérée avec succès avec des soins de soutien. De plus, il met en évidence l'importance de la communication médecin-technicien et les erreurs potentielles dans l'utilisation des fiches de traitement électroniques.(Traduit par Dr Serge Messier).

Successful resuscitation and neurological monitoring of a dog with out-of-hospital cardiopulmonary arrest due to pentobarbital overdose.

OBJECTIVE: To describe the clinical signs, electroencephalographic (EEG) findings, treatment, and outcome in a dog after successful resuscitation from out-of-hospital cardiopulmonary arrest (OHCA) induced by pentobarbital intoxication. CASE SUMMARY: A 10-year-old, male intact Jack Russell Terrier was referred for management of refractory status epilepticus and presented dead on arrival. After 7 minutes of cardiopulmonary resuscitation, return of spontaneous circulation was achieved, but the dog remained comatose, apneic, and lacked brainstem reflexes on neurological examination 6 hours following resuscitation. Magnetic resonance imaging showed polioencephalomalacia consistent with prolonged epileptiform activity, and EEG was initially concerning for electrocerebral inactivity. Following supportive care that included short-term mechanical ventilation, the dog made a full recovery and was discharged from the hospital alive 7 days postresuscitation. It was later revealed that the dog had been administered an unknown amount of pentobarbital during transportation, which likely contributed to the OHCA, clinical, and EEG findings. NEW INFORMATION PROVIDED: This is the first report to describe the full recovery and hospital discharge of a dog suffering OHCA and the first description of EEG findings in a clinical veterinary patient following cardiopulmonary arrest and successful resuscitation. Factors likely contributing to successful patient outcome and potential benefits and limitations of EEG in monitoring postcardiac arrest patients are discussed.

Outcomes of nonsteroidal anti-inflammatory drug toxicosis treated with therapeutic plasma exchange in 62 dogs.

BACKGROUND: Therapeutic plasma exchange (TPE) is gaining popularity for the management of nonsteroidal anti-inflammatory drug (NSAID) overdose in dogs. HYPOTHESIS/OBJECTIVES: Describe a population of dogs treated with TPE for NSAID overdose. ANIMALS: Sixty-two dogs with NSAID overdose treated with TPE. METHODS: Multicenter retrospective study of dogs treated with TPE for ibuprofen, carprofen, or naproxen overdose. RESULTS: The median dose of ibuprofen, carprofen or naproxen ingested was 533 mg/kg (range, 36-4857 mg/kg), 217 mg/kg (range, 88-625 mg/kg) and 138 mg/kg (range, 26-3000 mg/kg), respectively. Based on previously established toxic ranges for each NSAID, 2 (3.2%), 14 (22.6%), and 46 (74.2%) dogs ingested a gastrointestinal, renal, and neurological toxic dose, respectively. The median time between ingestion and presentation was 4 hours (range, 1-20 hours). The median number of plasma volumes processed was 1.6 (range, 0.4-2.2). The median TPE session duration was 2 hours (range, 1-4.5 hours). Circuit clotting developed during 8 (12.9%) sessions. Patient adverse events reported during 21 (33.8%) sessions consisted of urticaria (12.9%), asymptomatic hypocalcemia (9.6%), and hypotension (9.6%). The median duration of hospitalization was 2.25 days (range, 1-11 days). Sixty-one (98.4%) dogs survived to discharge, and none were rehospitalized. Thirty-one (91.1%) of the 34 dogs with at least 1 follow-up visit were not azotemic at the time of reevaluation. CONCLUSIONS AND CLINICAL IMPORTANCE: This population of dogs managed with TPE had excellent outcomes, even in cases of high NSAID dose ingestion. When TPE is available and the time frame is appropriate, this extracorporeal modality should be considered for the management of NSAID overdose.

Successful treatment of ivermectin overdose in a bearded dragon (Pogona vitticeps) using gastric lavage and intravenous lipid emulsion.

OBJECTIVE: To describe the clinical signs and outcome following ivermectin overdose in a bearded dragon. This case also describes the novel use of intravenous lipid emulsion (ILE) as a rescue therapy in reptiles, as well as the use of aggressive gastrointestinal decontamination. CASE SUMMARY: A 4-year-old female intact bearded dragon (Pogona vitticeps) (0.6 kg) was admitted to the ICU at a specialty hospital following accidental overdose of 40 mg (66.7 mg/kg) of ivermectin enterally. The patient was physically inverted to allow passive reflux of the medication, then sedated for gastric lavage. A 20% ILE was administered intravenously due to the high risk for fatality. Additional treatments included 2 doses of activated charcoal, as well as SC fluids, enteral nutrition, and sucralfate. The patient was profoundly sedate until day 4 when mild improvements in mentation were noted. The patient started ambulating on its own on day 6 and was discharged from the hospital on day 13. The patient was alive 720 days postdischarge. NEW OR UNIQUE INFORMATION PROVIDED: This is the first case report describing the events following ivermectin overdose and the use of ILE therapy and activated charcoal in a bearded dragon. These therapies were tolerated with no adverse effects noted in this patient. This report provides evidence that complete recovery from ivermectin overdose is possible.

Successful management and recovery of a dog with immune-mediated thrombocytopenia following vincristine overdose.

OBJECTIVE: To describe the management and outcome of a dog following a 10-fold dosing error of vincristine. CASE SUMMARY: A 2-year-old neutered female Toy Fox Terrier presenting for immune-mediated thrombocytopenia was administered an accidental overdose of vincristine (0.2 mg/kg [2.71 mg/m2 ]). The dog was managed for severe gastrointestinal signs, neutropenia, and neurological consequences secondary to the overdose. Neurological signs included diffuse muscle tremors, limb hyperextension, and myalgia during the dog's hospitalization. Medical management consisted of aggressive supportive care in addition to novel strategies, including folinic acid, glutamic acid, and Tbo-filgrastim. The dog was discharged from the hospital after 12 days of hospitalization and recovered completely within a month of the overdose with no lasting consequences. NEW OR UNIQUE INFORMATION PROVIDED: This is the first report of the successful management of severe vincristine overdose in a dog. Therapy included the use of Tbo-filgrastim, folinic acid, and glutamic acid along with aggressive supportive care.

The first responder exposure to contaminating powder on dog fur during intranasal and intramuscular naloxone administration.

OBJECTIVE: To determine whether first responders delivering naloxone by either the IM or intranasal (IN) route were at risk of contamination with inert powder simulating canine opioid exposure. DESIGN: Prospective, crossover design. SETTING: Research study (university setting). ANIMALS: Ten clinically normal working dogs ranging from 9 to 44 months were enrolled based on training to detect odor and ability to be restrained with minimal stress. All enrolled dogs completed both arms of the study without adverse effects. INTERVENTIONS: Dogs were randomly assigned to fentanyl reversal with either IM or IN naloxone and then the alternate treatment after a 7-day washout period. Prior to reversal, dogs' heads were brushed with an inert glow-in-the-dark powder. First responders (the same 2 individuals for all dogs) performing the reversal were photographed under ultraviolet light prior to and 5 min after administering the medication. Digital photographs were scored by body region for presence of glowing powder by observers blinded to timing of photograph (pre- or postreversal) and route of reversal (IM vs IN). MEASUREMENTS AND MAIN RESULTS: Compared to pretreatment, the inert powder scores were higher after treatment regardless of route of naloxone administration (P < 0.001). IN administration led to higher contamination than IM naloxone, particularly in the chest area (P = 0.012). CONCLUSIONS: Both IN and IM naloxone administration to dogs with clinical signs of opioid exposure result in a risk of first responders becoming contaminated with powder, which could include opioids. Awareness, proper personal protective equipment, and appropriate posttreatment decontamination are important to reduce risk of inadvertent exposure of mucous membranes to these contaminating powders.

Emergency treatment with intermittent hemodialysis for amikacin overdose in a cat.

OBJECTIVE: To describe the safety and use of intermittent hemodialysis (IHD) for the emergency treatment of a cat with an amikacin overdose. CASE SUMMARY: A cat was accidentally administered 400 mg (97.5 mg/kg, IV) of amikacin. Four hours after the time of the overdose, a single emergency IHD session to remove amikacin was performed. The 4-hour IHD treatment allowed for the active removal of approximately 110 mg of amikacin. The plasma concentration of amikacin from the beginning to the end of the session decreased from approximately 160 µg/mL to a nontoxic concentration of 10 µg/mL. Following IHD treatment, the cat developed an International Renal Interest Society (IRIS) grade IV acute kidney injury (AKI) with a peak creatinine of 486 µmol/L (5.5 mg/dL) and was hospitalized for 4 days for supportive management of AKI. At the time of discharge, 4 days following the overdose, the AKI had resolved. NEW OR UNIQUE INFORMATION PROVIDED: This is the first report describing the use and safety of using IHD for emergency removal of amikacin overdose in a cat.

Clinical outcomes and prognostic factors associated with nonsteroidal anti-inflammatory drug overdose in dogs presented to an emergency room.

OBJECTIVE: To describe case presentations, clinical signs, and outcomes following nonsteroidal anti-inflammatory drug (NSAID) overdose in a clinical population of dogs and to identify factors associated with various outcomes including death or euthanasia, acute kidney injury, and suspected gastrointestinal ulceration (GIU). DESIGN: Retrospective study. SETTING: University teaching hospital. ANIMALS: One hundred twenty-five client-owned dogs presenting to an emergency room for NSAID overdose between January 2006 and December 2017. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Vomiting was the most common clinical sign, seen in 46 of 125 dogs (36.8%). Acute kidney injury and suspected GIU were seen in 17 (13.6%) and 16 dogs (12.8%), respectively. Thirty-two dogs (25.6%) ingested veterinary-formulated NSAIDs and 93 (74.4%) ingested human-formulated NSAIDs. No difference in any outcomes was seen between these two groups. One hundred twenty dogs (96%) survived to discharge. In multivariable analysis, the only significant finding was of the number of days of anorexia increased the risk of death or euthanasia with an odds ratio of 2.7 (95% confidence interval [1.14-6.5], P = 0.02). CONCLUSIONS: Acute kidney injury and suspected GIU were seen less frequently than vomiting. Similar outcomes were seen for dogs ingesting veterinary- versus human-formulated NSAIDs. Owners presenting dogs with a longer duration of anorexia may be more apt to euthanize. As this was a clinical population of dogs presenting to an emergency room, findings may be more broadly applicable to the general population than prior studies utilizing poison control center data.

Therapeutic plasma exchange to mitigate flunixin meglumine overdose in a cria.

OBJECTIVE: To describe the use of therapeutic plasma exchange (TPE) in the treatment of flunixin meglumine overdose in a cria. CASE SUMMARY: A 3-day-old alpaca cria was diagnosed with ureteral obstruction and agenesis resulting in severe bilateral hydronephrosis. During hospitalization, the cria inadvertently received a flunixin meglumine overdose of >65 mg/kg. Here, we report the use of lipid emulsion and TPE to mitigate flunixin meglumine toxicosis. TPE appeared to prevent any flunixin-induced kidney or gastrointestinal injury, even in a patient with congenital defects of the urinary tract. NEW INFORMATION PROVIDED: This is the first report of the use of TPE in a cria.

The successful treatment of multiple organ dysfunction syndrome and severe hypernatremia, secondary to joint supplement toxicity in a dog.

OBJECTIVE: To describe a case of the successful management of hypernatremia and multiple organ dysfunction syndrome secondary to joint supplement toxicity in a dog. CASE SUMMARY: A 6-year-old neutered male Dachshund was presented for severe hypernatremia and neurological abnormalities after ingestion of a large quantity of joint supplements. The patient developed evidence of multiple organ dysfunction in the form of increased hepatocellular enzymes, prolongation of prothrombin and partial thromboplastin times, azotemia, and thrombocytopenia. Treatment was successful at correcting the hypernatremia and restoring neurological function, and organ dysfunction was successfully managed. Following multiple days of hospitalization and aggressive supportive care, the patient survived to discharge. NEW OR UNIQUE INFORMATION PROVIDED: This case report describes the successful management and survival of multiple organ dysfunction associated with joint supplement toxicity. It also serves to highlight the potential for joint supplement overdose in veterinary patients, which is currently believed to be underrecognized.

The identification of risk factors contributing to accidental opioid poisonings in companion dogs using data from a North American poison control center (2006-2014).

In the last decade, there has been a marked increase in opioid-related human deaths in the U.S. However, the effects of the growth in opioid use on vulnerable populations, such as pet dogs, are largely unknown. The objective of this study was to investigate potential risk factors at the dog, county, and state-levels that contributed to accidental dog opioid poisonings. Dog demographic information was collected during calls to the Animal Poison Control Center (APCC), operated by the American Society for the Prevention of Cruelty to Animals, about pet dog exposures to poisons from 2006-2014. Data concerning state-level opioid-related human death rates and county-level human opioid prescription rates were collected from databases accessed from the Centers for Disease Control and Prevention. A multilevel logistic regression model with random intercepts for county and state was fitted to explore associations between the odds of a call to the APCC being related to dog opioid poisonings with the following independent variables: sex, weight, age, reproductive status, breed class, year, source of calls, county-level human opioid prescription rate, and state-level opioid human death rate. There was a significant non-linear positive association between accidental opioid dog poisoning calls and county-level human opioid prescription rates. Similarly, the odds of a call being related to an opioid poisoning significantly declined over the study period. Depending on the breed class, the odds of a call being related to an opioid poisoning event were generally lower for older and heavier dogs. The odds of a call being related to an opioid poisoning were significantly higher for intact compared to neutered dogs, and if the call was made by a veterinarian compared to a member of the public. Veterinarians responding to poisonings may benefit from knowledge of trends in the use and abuse of both legal and illegal drugs in human populations.

Survival of a dog with accidental colchicine overdose.

OBJECTIVE: To describe the treatment and clinical course of a dog accidentally prescribed 10 times the recommended dose of colchicine (0.3 mg/kg/d instead of 0.03 mg/kg/d). CASE SUMMARY: After glaucoma surgery, a 1-year-old male neutered Pomeranian weighing 6.8 kg was prescribed 1,000 µg colchicine twice a day per os. The dog presented to the emergency department after the first dose with vomiting and was treated as an outpatient. Two colchicine doses later, the dog represented with vomiting, ocular pain, and increased intraocular pressure. The dog's vital signs were normal, and the dog was admitted for rehydration, analgesia, and revision glaucoma surgery the next day. Two hours after revision surgery, the dog developed vomiting and diarrhea. Postoperatively, the dog was hypothermic (36.3°C), persistently hypertensive (227 mm Hg), and bradycardic (60/min). Biochemistry revealed metabolic acidosis and increased hepatic enzyme activities. Mannitol was administered for presumed cerebral edema. Later, the dog developed bradycardia due to second-degree atrioventricular heart block, which responded to atropine. Total hospitalization was 9 days. Treatment included IV fluids, IV lipid emulsion, N-acetylcysteine, activated charcoal, gastroprotectants, antiemetics, opioids, antimicrobials, and barrier nursing due to transient neutropenia. NEW OR UNIQUE INFORMATION PROVIDED: This is the first report to describe the successful treatment of a dog with colchicine overdose. The systemic effects were presumed to be secondary to colchicine toxicosis rather than diet, infection, or other drug reaction, and may have been compounded by a second anesthetic episode. Gastrointestinal signs, symptoms of cerebral edema, cardiac arrhythmias, and neutropenia were documented. One other report of colchicine overdose in a dog exists, and that patient was euthanized. This report demonstrates that complete recovery with intensive care is possible; however, the prognosis remains guarded.

Use of therapeutic plasma exchange to treat nonsteroidal anti-inflammatory drug overdose in dogs.

BACKGROUND: Therapeutic plasma exchange (TPE) may be an effective technique for treatment of accidental nonsteroidal anti-inflammatory drug (NSAID) overdose, but information regarding the use of this technique in veterinary medicine is currently limited. OBJECTIVES: To evaluate the overall outcome for dogs with NSAID overdose treated with TPE and to determine if any presenting factors can predict or influence overall outcome. Secondary objectives included investigating TPE complications as well as the utility of other adjunctive treatments. ANIMALS: Eleven client-owned dogs presented for NSAID overdose that received TPE. All patients also received additional supportive treatment including IV lipid infusion. METHODS: Retrospective review of medical records. RESULTS: Eleven cases were included in the study. Of these, the NSAID ingested was ibuprofen in 6 (54.5%), naproxen in 4 (36.4%), and deracoxib in 1 (9.1%). All dogs survived to discharge with 3 (27.3%) developing acute kidney injury during hospitalization. A larger initial dose of NSAID ingested was associated with a higher maximum serum creatinine concentration during hospitalization (P = .04) and larger change in serum creatinine concentration from baseline (P = .02). Six dogs (54.5%) developed complications associated with TPE. The use of other treatments did not affect the overall outcome. CONCLUSIONS AND CLINICAL IMPORTANCE: We identified TPE as an effective treatment for NSAID overdose with good outcomes despite high doses of NSAID ingestion in dogs treated with a single TPE treatment. Complications were common but did not affect the final outcome. Therapeutic plasma exchange should be considered in patients presenting for high-dose NSAID ingestion.

Successful management of doxorubicin overdose and extravasation in a dog with lymphoma.

A dog was hospitalized after accidental overdose and extravasation of doxorubicin. With supportive care and dexrazoxane, systemic toxicity resolved by Day 9 and extravasation injury by Day 36. This case demonstrates that, with treatment, dogs can survive doxorubicin overdose and extravasation. The report also highlights the importance of checking the dose of chemotherapeutic agents and preventing extravasation.

Gestion réussie d'une surdose à la doxorubicine et de l'extravasation chez un chien atteint d'un lymphome. Un chien a été hospitalisé après une surdose accidentelle et l'extravasation de doxorubicine. Avec des soins de soutien et de la dexrazoxane, la toxicité systémique s'est résorbée au Jour 9 et la blessure d'extravasation au Jour 36. Ce cas démontre que, avec un traitement, les chiens peuvent survivre à une surdose de doxorubicine et à l'extravasation. Ce rapport souligne aussi l'importance de la vérification de la dose d'agents chimiothérapeutiques et de la prévention de l'extravasation.(Traduit par Isabelle Vallières).

Treatment of carprofen overdose with therapeutic plasma exchange in a dog.

OBJECTIVE: To report the use of therapeutic plasma exchange (TPE) in a dog with carprofen toxicosis. SUMMARY: A 6-year-old female neutered Bichon Frise weighing 6.9 kg was examined after it had ingested 72 mg/kg carprofen. Mild dehydration without azotemia and with a urine specific gravity of 1.050 was noted at presentation. Treatment consisted of induction of emesis, symptomatic medical therapy, and TPE. The TPE achieved 1.5 plasma volume exchanges over 3 hours. Blood samples and effluent samples were collected every 30 minutes during TPE and additional blood samples were collected 11 and 35 hours after treatment. Carprofen concentrations in these samples were determined by high-pressure liquid chromatography. A 51% reduction in serum carprofen concentration was achieved following TPE. NEW OR UNIQUE INFORMATION PROVIDED: This report describes the successful reduction of plasma carprofen concentration in a dog using TPE. Although recent studies suggest that this particular dog may not have received a toxic dose, a 51% reduction of plasma carprofen concentration was achieved over 180 minutes, and TPE may be beneficial for treatment of dogs that have ingested higher doses.

SUSPECTED HYPERVITAMINOSIS D IN RED-RUMPED AGOUTI ( DASYPROCTA LEPORINA) RECEIVING A COMMERCIAL RODENT DIET.

An 8 yr, intact male red-rumped agouti ( Dasyprocta leporina) was evaluated for weight loss. Examination revealed poor body condition, hypercalcemia, elevated serum 25-hydroxyvitamin D, metastatic calcification of soft tissues, and hyperechoic kidneys. The diet, formulated for laboratory rodents, contained elevated levels of vitamin D3. Histopathology from a female conspecific that died 5 mo prior identified dystrophic mineralization and nephrosclerosis, suggestive of a vitamin D3 toxicity. The male agouti responded well to a dietary reduction in vitamin D3 and calcium. Six months into therapy, progressive renal failure was identified and was further managed with enalapril, phosphorus binders, and dietary manipulation. Suspected vitamin D3 toxicity has been reported in pacas ( Cuniculus paca) and agouti and has been linked to exposure to New World primate diets. In this brief communication, an agouti developed suspected hypervitaminosis D after receiving a commercial rodent diet commonly fed to this species in captivity.

Treatment of acute kidney injury associated with cyclosporine overdose in a dog using hemodialysis and charcoal hemoperfusion.

OBJECTIVE: To describe the management of cyclosporine overdose using hemodialysis and hemoperfusion in a dog. CASE SUMMARY: A 6-year-old, spayed female Australian Shepherd was presented for treatment of cyclosporine overdose and acute kidney injury. Five days prior to presentation, the dog had been diagnosed by its referring veterinarian with immune-mediated thrombocytopenia. Treatment was initiated with prednisone, but since no response was noted, azathioprine (50 mg PO q 24 h) and cyclosporine (6 mg/kg IV q 24 h) were added. On day 4, an overdose of cyclosporine (33 mg/kg IV) was administered accidentally. Upon presentation, serum biochemistry panel revealed azotemia [creatinine, 521.6 µmol/L (5.9 mg/dL); BUN, 59.3 mmol/L (166 mg/dL)], increased activities of liver enzymes, and hyperbilirubinemia. Due to the presumed diagnosis cyclosporine overdose and acute kidney injury, a combined hemodialysis and charcoal hemoperfusion treatment was planned. Hemosorba CH-350 charcoal hemoperfusion cartridge was placed in series upstream in the extracorporeal circuit from the hemodialyzer. A 3-hour treatment was performed and a total of 0.74 L/kg of blood was processed. Pretreatment blood cyclosporine concentration was 960 nmol/L (1154 ng/mL) and decreased to 440 nmol/L (529 ng/mL) posttreatment (54% fractional reduction, 18% per hour). Thirty-one hours following treatment, blood cyclosporine concentration was 220 nmol/L (265 ng/mL; 1.5% decrease per hour). Twelve days following presentation to our hospital, the dog was euthanized due to lack of response to medical management. NEW OR UNIQUE INFORMATION PROVIDED: Combined hemodialysis and charcoal hemoperfusion treatment can significantly reduce blood cyclosporine concentrations following acute intoxication or overdosage, and should be considered as an option for decontamination in such cases.

Clinical Update: The Risk of Opioid Toxicity and Naloxone Use in Operational K9s.

The increasing use of opioids (e.g., fentanyl, carfentanil) for illicit drug manufacturing poses a potential life-threatening hazard to law enforcement officers and first responders (e.g., EMS, fire and rescue) who may unknowingly come into contact with these drugs during the course of their daily activities. Similarly, Operational canines (OpK9s) of all disciplines-detection (drug, explosive, accelerant), patrol, tracking, search and rescue, and others-are at risk for accidental illicit opioid exposure. The most serious adverse effect of opioid exposure is respiratory depression leading to slow, shallow breathing or complete cessation of voluntary breathing (respiratory arrest). Naloxone, an opioid antagonist, is the antidote for reversing the effects of an opioid overdose in both humans and OpK9s. This clinical update describes the potential risks associated with opioid exposure as well as the use of naloxone as it pertains to the OpK9.

Recovery from Cyclophosphamide Overdose in a Dog.

An adult female spayed dog was evaluated after inadvertently receiving a total dose of 1,750 mg oral cyclophosphamide, equivalent to 2,303 mg/m2, over 21 days (days -21 to 0). Nine days after the last dose of cyclophosphamide (day +9), the dog was evaluated at Perth Veterinary Specialists. Physical examination revealed mucosal pallor, a grade 2/6 systolic heart murmur, and severe hemorrhagic cystitis. Severe nonregenerative pancytopenia was detected on hematology. Broad spectrum antibiotics, two fresh whole blood transfusions, granulocyte colony stimulating factor, and tranexamic acid were administered. Five days after presentation (day +14), the peripheral neutrophil count had recovered, and by 12 days (day +21) the complete blood count was near normal. A second episode of thrombocytopenia (day +51) was managed with vincristine, prednisolone, and melatonin. The dog made a complete recovery with no long-term complications at the time of writing. To the author's knowledge, this is the highest inadvertently administered dose of cyclophosphamide to result in complete recovery.