Use of feeding tubes in 112 cats in an internal medicine referral service (2015-2020).

OBJECTIVES: The aims of this study were to describe diseases, complications and outcomes associated with the use of feeding tubes in a population of sick cats with appetite disturbance managed at an internal medicine referral service. METHODS: Clinicopathological data from cats receiving nasoenteral (NE) or oesophagostomy (O) tubes were studied. Cats were categorised according to their underlying disease and divided into subgroups (NE or O tube). The following factors associated with survival were analysed: disease category, type of tube and return to appetite. RESULTS: Included in the study were 112 cats, representing 118 cases. Of the 118 cases, 98 (83%) and 20 (17%) received NE or O tubes, respectively. The most common underlying conditions were digestive (13.5%), hepatobiliary (11%) and upper urinary tract (11%) disorders. Hepatobiliary (50%) and upper respiratory tract (30%) conditions were predominant in the O tube group. Digestive (15%) and upper urinary tract (12%) diseases were more common in the NE tube group. Complications following tube placement occurred in 22/118 cases (18.6%). The global survival rate was 73% and did not differ between NE (71.4%) and O tube (80%) groups (P = 1.00) or disease categories (P = 0.61). Return of appetite before feeding tube removal occurred in 56 cases (47%), within a median of 3 days (range 1-30) and was not associated with mirtazapine administration (P = 1.00). Appetite returned earlier for cats with NE tubes (3 days, range 1-17) than for those with O tubes (33 days, range 5-60; P <0.05). Voluntary food intake was positively associated with survival (odds ratio 15.17). After discharge and feeding tube retrieval, return of appetite was observed in 67% of cases. CONCLUSIONS AND RELEVANCE: Feeding tubes were predominantly placed for the management of appetite disturbance in cats with digestive, hepatobiliary and upper urinary tract diseases. While complications were frequent, they were mostly mild, easily managed and did not preclude feeding tube use. Return to appetite occurred in a large proportion of cats during or after assisted enteral feeding and was associated with survival.

Formula for the estimation of urine osmolality in healthy cats.

A simple and intuitive formula for the estimation of urine osmolality (Uosm) using the measured concentrations of major active urine osmolytes over a wide range of urine dilutions was proposed in healthy cats. Sixty-three urine samples were retrieved using ultrasound-guided cystocentesis from sixteen healthy cats under 5 years of age receiving intravenous infusion over a period of 24 h. Samples were collected at baseline (T0), T2, T6, T12, and T24. Urine osmolality was measured using a freezing-point osmometer, and the concentrations of osmolytes (urea, sodium, glucose, and potassium) were evaluated. A simple linear regression model for a clinical use was selected, and the agreement between the calculated and actual urine osmolalities was assessed. Urinary concentrations of urea, sodium and glucose were the three variables included in the model with the lowest AICC. Urine osmolality can be predicted accurately and precisely using urine urea, sodium and glucose with the following equation: Uosm = 1.25 × urea (mmol/l) or 20.87 × urea (g/l) + 1.1 × sodium (mmol/l) + 67 × glucose (mmol/l) or 3.72 × glucose (mg/dl). The concordance correlation coefficient for repeated measures between the actual and the calculated urine osmolality was extremely close to 1, which supported a high agreement: 0.996 (CI 95%: [0.993; 0.998]). In a population of healthy cats, urine osmolality can be predicted accurately and precisely using urinary urea, sodium and glucose concentrations. Similar formulae could potentially be established to help the clinician in pathological situations.

Case report of unilateral retrobulbar hematoma associated with von Willebrand disease in a Doberman Pinscher dog.

A 5-year-old Doberman Pinscher dog was presented with sudden onset left-sided periocular bleeding following third eyelid gland replacement surgery. Left-sided exophthalmos and 360-degrees subconjunctival hemorrhage were present. The ophthalmic examination revealed blindness with absent direct and consensual pupillary light reflexes. A superficial exposure ulcerative keratitis due to exophthalmos was also present. Computed tomography (CT) revealed a large left-sided retrobulbar mass lesion surrounding the optic nerve, compatible with a retrobulbar hematoma. Due to absence of orbital fractures and no history of trauma, a coagulopathy was strongly suspected. The buccal mucosal bleeding time (BMBT) was prolonged (>4 minutes) consistent with a primary hemostatic defect in the absence of thrombocytopenia. Von Willebrand factor antigens levels were decreased (24%- Normal Range: 50%-150%). Surgical drainage of the retrobulbar hematoma was performed uneventfully thirty minutes after subcutaneous injection of desmopressine acetate, Minirin® (1 µg/kg, SC). Von Willebrand disease type I gene mutation was confirmed by PCR amplification of the DNA encoding von Willebrand factor. This case report demonstrates that hemostatic disorders, including von Willebrand Disease (vWD), are a risk factor for orbital bleeding following surgical trauma. Retrobulbar hematoma should be considered as a differential diagnosis in any dog with exophthalmos.

Clinical and laboratory features of canine Anaplasma platys infection in 32 naturally infected dogs in the Mediterranean basin.

Since the first description of Anaplasma platys Infection (ApI), the disease has been sporadically reported worldwide. Whereas it is considered a subclinical disease in the United States or in Australia, severe cases are reported in Europe. Thus far, little information is available regarding the clinical and laboratory findings associated with the disease and the implication of co-infections with other vector-borne pathogens (VBPs) in Southern Europe. The purpose of the study was to describe clinical and laboratory findings in PCR-confirmed naturally infected dogs in the Mediterranean Basin, and to assess the potential impact of co-infections with other VBPs. This is a retrospective analysis of medical records from 32 client-owned dogs diagnosed with ApI using PCR-based assays. Anorexia (62.5%) and weight loss (43.8%) were the major changes, whereas lethargy was less frequent (34.4%). Lymphadenomegaly (43.8%), hyperthermia (40.6%) and hemorrhage (37.5%) were frequent clinical abnormalities, whereas cutaneous signs (31.3%), musculoskeletal disorders (21.9%), splenomegaly (15.6%), dehydration and ocular inflammation (12.5%) were less common. Hematological abnormalities included thrombocytopenia (81.0%), anemia (81.0%), leukocytosis (33.3%) and leucopenia (23.8%). Seven dogs (33.3%) were severely thrombocytopenic. Among the 28 dogs with complete testing, 15 and 13 were mono- and co-infected, respectively. Co-infections included Ehrlichia canis (3 dogs), Leishmania infantum (4), Babesia vogeli (2) and Hepatozoon canis (5). One dog was infected concurrently with Anaplasma platys, Ehrlichia canis and Babesia vogeli. The 1-month mortality rate was 23.9% and only 38.1% improved. In the univariate analysis the 15 mono- and the 13 co-infected dogs did not differ regarding the relative frequencies of clinical and laboratory findings. Sequencing and phylogenetic analyses suggested the existence of 2 different groups of strains: one of them might have higher pathogenicity. In all, ApI was associated with a wide variety of non-specific clinical findings. The most common laboratory findings were thrombocytopenia and anemia. Co-infections were frequent but appeared of limited clinical impact. The absence of improvement despite appropriate treatment, high frequency of hemorrhagic disorders, and case fatalities, suggested the existence of pathogenic European strains supported by subsequent molecular analyses.