Resolution of Canine Acute Bilirubin Encephalopathy and Immune-Mediated Hemolytic Anemia Following Four Plasmapheresis Treatments.

An 8 mo old spayed female mixed-breed dog was presented for pale mucous membranes. The dog was diagnosed with intravascular immune-mediated hemolytic anemia (IMHA) and was started on medical management including corticosteroids, thromboprophylaxis, a packed red blood cell transfusion, and IV immunoglobulin. The dog developed severe hyperbilirubinemia (total bilirubin 48.1 mg/dL) and was referred for centrifugal plasmapheresis. Before treatment, the dog was stuporous to comatose, had intermittent opisthotonos, forelimb extension, and an absent menace consistent with acute bilirubin encephalopathy (ABE). The dog underwent a previously reported protocol of three therapeutic plasma exchange (TPE) treatments 24 hr apart. Moderate improvement was noted in her neurological status, although autoagglutination and hemolysis persisted, and the protocol was deemed inadequate. A fourth TPE treatment was performed on day 6. The following morning, the dog was autoagglutination negative. Her neurological status gradually improved, and she was discharged from the hospital on day 12. The dog remains neurologically normal and continues to do well at home on monotherapy with mycophenolate. Continued plasmapheresis treatments should be offered as a treatment option for severe cases of IMHA in the face of persistent disease, because TPE is able to provide ongoing support and stabilization, particularly in the face of ABE.

Prevalence of acute kidney injury and outcome in cats treated as inpatients versus outpatients following lily exposure.

OBJECTIVE: To investigate the prevalence of acute kidney injury (AKI) and outcome in cats treated for lily exposure as inpatients (IPs) or outpatients (OPs). METHODS: Medical records of cats with lily exposure were retrospectively evaluated; 112 cats were included. Signalment, type of exposure, time from exposure to presentation, decontamination procedures, treatment group (IPs vs OPs), creatinine and International Renal Interest Society AKI grade at specific time points (initial presentation, 0 to 24 hours, 24 to 48 hours, and 48 hours to 2 weeks), whether an AKI developed at any point, whether AKI grade was static or improved when comparing baseline to last documented AKI grade, and outcome (alive or dead/euthanized) were recorded. RESULTS: There were no significant differences in prevalence of AKI between the IP cats (45 of 96 [46.9%]) and OP cats (7 of 16 [43.8%]). Of the AKI cats, 27 IP cats (60%) and 4 OP cats (57.1%) had a static or improved AKI grade. Inpatient cats had a significantly higher survival compared to OP cats (100% vs 86.5%). CONCLUSIONS: Cats exposed to lilies in both groups had a higher prevalence of AKI than previously reported; however, many cats with AKIs had a static or improved AKI grade by the last documented AKI grade. Although the survival was lower in OP cats compared to IP cats, overall survival was excellent. CLINICAL RELEVANCE: Results of our study suggested that IP cats have a superior outcome than OP cats; however, cats treated as OPs may still have favorable outcomes.

Difficult catheterization and previous urethral obstruction are associated with lower urinary tract tears in cats with urethral obstruction.

OBJECTIVE: To retrospectively assess the hospital prevalence and risk factors associated with iatrogenic lower urinary tear in cats with urethral obstruction (UO). ANIMALS: 15 client-owned cats diagnosed with concurrent UO and lower urinary tears and year-matched control population of 45 cats diagnosed with UO. METHODS: University teaching hospital records were reviewed for cats presenting with UO between January 2010 and December 2022. Signalment, anatomic location of tear, experience of the individual passing the urinary catheter, difficulty level of catheter passage, history of previous UO, blood work parameters on presentation, presence of visible grit in urine, and survival to discharge were recorded. In addition, prevalence of lower urinary tears in cats presenting with UO was calculated. RESULTS: The prevalence of lower urinary tears was 0.92% in UO cats. Cats with lower urinary tears were significantly less likely to survive to discharge and had a longer period of hospitalization than cats without tears. In addition, cats with tears were more likely to have a history of previous UO and had more difficult urinary catheter passage than cats in the control group. Cats with tears also had a higher Hct than the control UO cats. CLINICAL RELEVANCE: Cats that develop lower urinary tears are more likely to have a history of previous UO and difficult catheter passage. This group of cats is also more likely to have a longer hospitalization period and lower survival to discharge rates.

Clinical course and radiographic resolution of pneumonia in dogs treated with a shorter versus longer course of antimicrobials: a randomized, double-masked, placebo-controlled study.

OBJECTIVE: To describe clinical and radiographic outcomes in dogs with uncomplicated pneumonia receiving a shorter (2-week) versus longer (4-week) duration of antimicrobial therapy. ANIMALS: 30 client-owned dogs with radiographic evidence of pneumonia. METHODS: Dogs were randomly assigned to either a 2-week course of antimicrobials followed by a 2-week course of placebo medication (2-week group) or a 4-week course of antimicrobials (4-week group). All study investigators and owners were masked to the treatment group. Dogs were reevaluated at 12 ± 2 days and again at 28 ± 2 days for a physical examination and thoracic radiography. Standard documentation at visits included owner-reported clinical signs, nurse-acquired history, the clinician's physical examination, the number of affected lung lobe segments, and the global radiographic severity scores assigned. Outcomes investigated included the persistence of clinical and radiographic signs of pneumonia. RESULTS: 28 dogs (93.3%) experienced complete resolution of clinical signs by the first visit, and no dogs in either group experienced relapse of clinical signs during the study period. Eighteen of 30 dogs (60%) and 25 of 30 dogs (83%) experienced complete resolution of radiographic lesions at the first and second study visits, respectively. The remaining 5 dogs (17%) had either stable (4 dogs) or continued (1 dog) improvement in radiographic lesions. CLINICAL RELEVANCE: Resolution of clinical and radiographic signs followed similar courses in dogs with uncomplicated pneumonia receiving a 2-week course of antimicrobials compared to a 4-week course. Clinical signs may be more useful for guiding discontinuation of antimicrobial therapy for pneumonia than radiographic signs.

Animal Trauma Triage Score, Modified Glasgow Coma Scale, age, and weight were associated with outcome in feline bite wounds (1,065 cases): a VetCOT registry study.

OBJECTIVE: To identify associations between admission variables, Animal Trauma Triage (ATT) score, and Modified Glasgow Coma Scale (MGCS) score with need for transfusion or surgical interventions and survival to discharge in cats with bite wounds. ANIMALS: 1,065 cats with bite wounds. PROCEDURES: Records of cats with bite wounds were obtained from the VetCOT registry from April 2017 to June 2021. Variables included point of care laboratory values, signalment, weight, illness severity scores, and surgical intervention. Associations between admission parameters, terciles of MGCS, quantiles of ATT scores, and death or euthanasia were assessed using univariable and multivariable logistic regression analysis. RESULTS: 872 cats (82%) survived to discharge, while 170 (88%) were euthanized and 23(12%) died. In the multivariable model, age, weight, surgical treatment, ATT and MGCS scores were associated with nonsurvival. For every 1 year of age, odds of nonsurvival increased by 7% (P = .003) and for every 1 kg of body weight, odds of nonsurvival decreased by 14% (P = .005). Odds of dying increased with lower MGCS and higher ATT scores (MGCS: 104% [95% CI, 116% to 267%; P < .001]; ATT: 351% [95% CI, 321% to 632%; P < .001). Odds of dying decreased by 84% (P < .001) in cats that underwent surgery versus those that did not. CLINICAL RELEVANCE: This multicenter study indicated association of higher ATT and lower MGCS with worse outcome. Older age increased the odds of nonsurvival, while each kilogram increase in bodyweight decreased odds of nonsurvival. To our knowledge, this study is the first to describe associations of age and weight with outcome in feline trauma patients.

Increased incidence and shift in the location of gunshot wound injuries in dogs and cats during the COVID-19 pandemic.

OBJECTIVE: To investigate the incidence and patterns of gunshot wound trauma in patients that were presented to an urban level 1 veterinary trauma center before and after the start of the coronavirus disease of 2019 (COVID-19) pandemic. ANIMALS: 24 dogs and 1 cat. METHODS: Medical records were retrospectively reviewed for patients presenting with gunshot wound injuries between March 2018 and February 2020 (prepandemic) and March 2020 and February 2022 (pandemic). The total number of patients presented to the hospital during those same time periods was also obtained. Patient data were collected including species, breed, age, sex, location of injury, trauma score (if available), surgical procedures performed, length of hospitalization, and case outcome. RESULTS: In the prepandemic period, 9 patients were presented for gunshot wound injuries, whereas there were 16 patients evaluated for gunshot wound injuries during the pandemic period. The total number of gunshot wound cases increased by 77.8% in the pandemic period. The total number of hospital patient visits, however, decreased by 12.2% in the pandemic period as compared to the prepandemic period: 65,168 versus 74,262 patients, respectively. Injuries were predominantly localized to the extremities (55%) in the prepandemic period versus maxillofacial (56%) in the pandemic period. CLINICAL RELEVANCE: There was an increased number of gunshot wound injuries in companion animals presenting to an urban level 1 veterinary trauma center during the COVID-19 pandemic. A shift in the predominant location of injury was also identified during the pandemic period. This study highlights the ramifications that societal dynamics can have on animal health and welfare.

Predictors of inflammatory lower airway disease in cats presented to the emergency room in respiratory distress: a case-control study.

OBJECTIVES: The objective of the study was to identify whether venous blood gas (VBG) variables may serve as a predictor of inflammatory lower airway disease (ILAD) in cats presenting with respiratory distress. A secondary objective of this study was to compare the diagnostic utility of patient signalment, history and physical examination findings, as compared with VBG variables. METHODS: The medical records of cats presenting with respiratory distress secondary to ILAD (54 cases) and non-ILAD (121 controls) were retrospectively reviewed. RESULTS: No admission VBG variables were predictive of a final diagnosis of ILAD. Comparatively, multivariable analysis identified a history of a cough (P <0.001), increased respiratory rate (P = 0.001), the presence of an abdominal component to respiration (P = 0.007) and the absence of pleural effusion (P <0.01) to be independently associated with a final diagnosis of ILAD. Cats with a history of a cough and an abdominal component to respiration had 7.86 and 5.81 greater odds of being diagnosed with ILAD, respectively. Cats with pleural effusion had 7.43 lower odds of having this final diagnosis. For every 10 breaths/min increase in respiratory rate, cats had 1.48 greater odds of being diagnosed with ILAD. Cats diagnosed with ILAD had a survival rate of 94% (95% CI 84-99%) vs 61% (95% CI 51-70%) for non-ILAD controls (P <0.001). CONCLUSIONS AND RELEVANCE: The results of this study found patient history and physical examination findings to be more useful predictors of a final diagnosis of ILAD in comparison with VBG variables at presentation. A history of a cough, an abdominal component to respiration and a lack of pleural effusion were found to be significant predictors of this diagnosis. Further investigation into the role of respiratory rate in ILAD is warranted.

Evaluation of coccygeal and radial artery Doppler blood pressure measurements in sick cats with and without abnormalities in tissue perfusion.

OBJECTIVE: To compare systolic blood pressure measured by Doppler (SBP) taken from the coccygeal artery versus common digital branch of the radial artery in cats with normal and poor perfusion parameters. DESIGN: Prospective, observational study. SETTING: University Teaching Hospital. ANIMALS: Eighty-five cats presenting to the emergency service for which prior emergency treatment was not received and a blood pressure was indicated on triage. INTERVENTIONS: Systolic blood pressure was measured by Doppler using the radial and coccygeal arteries. Cats were categorized as having normal or poor tissue perfusion based on physical examination. MEASUREMENTS AND MAIN RESULTS: Agreement was poor between coccygeal and radial SBP overall with absolute and relative bias (95% limits of agreement) of 23 (-51 to 96) mm Hg and 16% (-38% to 69%), respectively. In cats with poor perfusion, the agreement was absolute bias = 28 mm Hg and relative bias = 22% and with normal perfusion absolute bias = 22 mm Hg, and relative bias = 12%. The median (interquartile range) coccygeal SBP was significantly different from the radial SBP 141 (50) mm Hg versus 120 (45) mm Hg, P < 0.001. In multivariate linear regression, heart rate was negatively associated with coccygeal SBP (r2  = 0.088, P = 0.049), and pale mucous membrane color (P = 0.034) and poor pulse quality (P = 0.007) were independently associated with lower radial SBP (r2  = 0.18). CONCLUSIONS: Median coccygeal SBP is significantly greater than radial SBP in sick cats with both normal perfusion and hypoperfusion. Agreement between coccygeal and radial SBP is poor in cats and cannot be used interchangeably. As clinically significant differences exist between sites, the authors recommend obtaining SBP from both sites initially and choosing to monitor and trend changes with the one site that correlates most with physical examination findings.

Multicenter evaluation of decompressive cystocentesis in the treatment of cats with urethral obstruction.

OBJECTIVE: To investigate whether decompressive cystocentesis (DC) safely facilitates urethral catheterization (UC) in cats with urethral obstruction (UO). ANIMALS: 88 male cats with UO. PROCEDURES: Cats were randomly assigned to receive DC prior to UC (ie, DC group cats; n = 44) or UC only (ie, UC group cats; 44). Abdominal effusion was monitored by serial ultrasonographic examination of the urinary bladder before DC and UC or before UC (DC and UC group cats, respectively), immediately after UC, and 4 hours after UC. Total abdominal effusion score at each time point ranged from 0 (no effusion) to 16 (extensive effusion). Ease of UC (score, 0 [easy passage] to 4 [unable to pass]), time to place urinary catheter, and adverse events were recorded. RESULTS: No significant difference was found in median time to place the urinary catheter in UC group cats (132 seconds), compared with DC group cats (120 seconds). Median score for ease of UC was not significantly different between UC group cats (score, 1; range, 0 to 3) and DC group cats (score, 1; range, 0 to 4). Median change in total abdominal effusion score from before UC and DC to immediately after UC was 0 and nonsignificant in UC group cats (range, -5 to 12) and DC group cats (range, -4 to 8). Median change in effusion score from immediately after UC to 4 hours after UC was not significantly different between UC group cats (score, -1; range, -9 to 5) and DC group cats (score, -1; range, -7 to 5). CONCLUSIONS AND CLINICAL RELEVANCE: DC did not improve time to place the urinary catheter or ease of UC in cats with UO.

Evaluation of the rectal-interdigital temperature gradient as a diagnostic marker of shock in dogs.

OBJECTIVE: To evaluate the difference in the rectal-interdigital temperature gradient (RITG) between dogs that were presented to an emergency room with clinical signs of shock compared to those without signs of shock, and if this gradient can be used as a diagnostic marker for shock. DESIGN: Prospective, single center, observational study conducted from 2014 to 2015. SETTING: University veterinary teaching hospital. ANIMALS: Twenty dogs with a clinical diagnosis of shock and 60 dogs without a clinical diagnosis of shock (controls). MEASUREMENTS AND MAIN RESULTS: Upon presentation to the emergency room and prior to intervention, measurements of rectal temperature, interdigital temperature, ambient temperature, systemic markers of perfusion (capillary refill time [CRT], heart rate [HR], respiratory rate [RR], Doppler blood pressure [DBP], and venous plasma lactate concentration), and venous blood gas analytes were recorded. Dogs were initially determined to be in shock by the attending clinician, and post hoc inclusion criteria were applied. Shock was defined as abnormalities in ≥3 of the 6 following criteria: HR > 120/min, RR > 40/min, CRT > 2 seconds, rectal temperature <37.8°C (100.0°F), venous plasma lactate concentration >2.5 mmol/L, or DBP < 90 mm Hg. Animals with circulatory shock had a significantly increased RITG. An increased RITG was also correlated with individual perfusion parameters including prolonged CRT (ρ = .353, P = 0.0013), tachycardia (ρ = .3485, P = 0.0015), decreased DBP (ρ = -0.6162, P = 0.0003), and shock index (ρ = 0.6168, P = 0.0003). Receiver operator curve analysis indicated a RITG cutoff point of 11.6°F had 90% specificity for the diagnosis of shock (area under the curve = 0.7604). CONCLUSIONS: The RITG in this study was associated with a diagnosis of shock and therefore may serve as a diagnostic marker of circulatory shock. Future studies with larger sample sizes to validate the use of temperature gradients and other peripheral perfusion abnormalities as diagnostic and monitoring tools are warranted.

A prospective randomized, double-blinded clinical study evaluating the efficacy and safety of bupivacaine versus morphine-bupivacaine in caudal epidurals in cats with urethral obstruction.

OBJECTIVE: To investigate the efficacy and safety of the caudal epidural technique in cats with urethral obstruction (UO). DESIGN: Prospective, double-blinded, randomized, sham-controlled study. ANIMALS: Eighty-eight male cats with UO. INTERVENTIONS: Thirty cats randomized to bupivacaine epidural (BUP), 28 cats to bupivacaine-morphine epidural (BUP/MOR), and 30 cats to sham epidural (SHAM). MEASUREMENTS AND MAIN RESULTS: Time to perform the epidural and efficacy of the epidural was assessed by evaluation of tail and perineal responses. The amount of propofol for urinary catheterization and time to administration of rescue analgesia (buprenorphine) was recorded. Cats were monitored for epidural complications. The median time to perform the epidural was 2 min (range, 0.2-13 min and range, 0.5-13 min), with an epidural success rate of 70%. The median amount of propofol administered for urinary catheterization was significantly less in the BUP (2.1 mg/kg; range, 0-7.5 mg/kg) and MOR/BUP cats (1.85 mg/kg; range, 0-8.6 mg/kg) as compared to SHAM cats (4 mg/kg; range, 0-12.7 mg/kg) (P = 0.006, P = 0.0008, respectively). The median time to administration of rescue analgesia was also significantly longer in the BUP (10 h; range, 2-32 h) and MOR/BUP cats (10 h; range, 4-45 h) as compared to SHAM cats (4 h; range, 2-36 h) (P = 0.0026, P = 0.0004, respectively). There were no recognized complications related to the epidural. CONCLUSION: Caudal epidural appears to be safe, may reduce the amount of IV anesthesia needed to facilitate urinary catheterization, and can be used to provide long-term analgesia in the hospital.

Focused cardiac ultrasound and point-of-care NT-proBNP assay in the emergency room for differentiation of cardiac and noncardiac causes of respiratory distress in cats.

OBJECTIVE: To assess the accuracy of focused cardiac ultrasound (FOCUS) and point-of-care N-terminal proBNP assay in the emergency setting for differentiation of cardiac from noncardiac causes of respiratory distress in cats. DESIGN: Prospective diagnostic accuracy study between 2014 and 2016. SETTING: Emergency room at an urban university teaching hospital. ANIMALS: Forty-one client-owned cats presenting for evaluation of respiratory distress. INTERVENTIONS: Emergency clinicians made an initial diagnosis of noncardiac or cardiac cause of respiratory distress based on physical examination (PE) findings and history. The diagnoses were updated after performing FOCUS and point-of-care N-terminal B-type natriuretic peptide (POC-BNP). Reference standard diagnosis was determined by agreement of a board-certified cardiologist and critical care specialist with access to subsequent radiographs and echocardiograms. MEASUREMENTS AND MAIN RESULTS: Forty-one cats were enrolled. Three cats with incomplete data and 1 cat with an uncertain reference standard diagnosis were excluded. The remaining 37 cats were used for analysis: 21 cardiac and 16 noncardiac cases. The ratio of left atrial to aortic root diameter (LA:Ao) measured by FOCUS was significantly correlated with LA:Ao measured by echocardiography (R = 0.646, P < 0.0001). Emergency clinicians correctly diagnosed 27 of 37 (73.0%), yielding a PE positive percent agreement = 76.2% (95% CI, 52.8-91.8%) and negative percent agreement = 68.8% (95% CI, 41.3-89.0%). Five noncardiac and 5 cardiac cats were misdiagnosed. Post FOCUS, overall percent agreement improved to 34 of 37 (91.9%), with positive percent agreement = 95.2% (95% CI, 76.2-99.9%) and negative percent agreement = 87.5% (95% CI, 61.7-98.5%). The POC-BNP yielded an overall percent agreement = 32/34 (94.1%), positive percent agreement = 100% (95% CI, 82.4-100.0%), and negative percent agreement = 86.7% (95% CI, 59.5-98.3%) in differentiating cardiac versus noncardiac cases. CONCLUSIONS: FOCUS evaluation of basic cardiac structure and LA:Ao by trained emergency clinicians improved accuracy of diagnosis compared to PE in cats with respiratory distress. FOCUS and POC-BNP are useful diagnostics in the emergent setting.

Investigation of focused cardiac ultrasound in the emergency room for differentiation of respiratory and cardiac causes of respiratory distress in dogs.

OBJECTIVE: To determine whether focused cardiac ultrasound (FOCUS) performed by emergency and critical care (ECC) specialists or residents in training improves differentiation of cardiac (C) versus non-cardiac (NC) causes of respiratory distress in dogs compared to medical history and physical examination alone. DESIGN: Prospective cohort study (May 2014 to February 2016). SETTING: University hospital. ANIMALS: Thirty-eight dogs presenting with respiratory distress. INTERVENTIONS: FOCUS. MEASUREMENTS AND MAIN RESULTS: Medical history, physical examination, and FOCUS were obtained at presentation. Emergency and critical care clinicians, blinded to any radiographic or echocardiographic data, categorized each patient (C vs NC) before and after FOCUS. Thoracic radiography (within 3 h) and echocardiography (within 24 h) were performed. Percent agreement was calculated against a reference diagnosis that relied on agreement of a board-certified cardiologist and ECC specialist with access to all diagnostic test results. Reference diagnosis included 22 dogs with cardiac and 13 dogs with noncardiac causes of respiratory distress. In 3 dogs a reference diagnosis was not established. Prior to FOCUS, positive and negative percent agreement to detect cardiac causes was 90.9% (95% CI, 70.8-98.9) and 53.9% (25.1-80.8), respectively. Overall agreement occurred in 27 of 35 dogs (77.1%). Two C and 6 NC cases were incorrectly categorized. Following FOCUS, positive and negative percent agreement to detect cardiac causes was 95.5% (77.2-99.9) and 69.2% (38.6-90.9), respectively. Overall agreement occurred in 30 of 35 dogs (85.7%). Three dogs with discrepant pre-FOCUS diagnoses were correctly re-categorized post-FOCUS. One C and 4 NC cases remained incorrectly categorized. No correctly categorized dogs were incorrectly re-categorized following FOCUS. The proportions of dogs correctly classified pre- versus post-FOCUS were not significantly different (P = 0.25). CONCLUSIONS: FOCUS did not significantly improve differentiation of C vs NC causes of respiratory distress compared to medical history and physical examination alone.

Evaluation of the relationship between peripheral pulse palpation and Doppler systolic blood pressure in dogs presenting to an emergency service.

OBJECTIVE: To assess the association between peripheral pulse palpation and Doppler-derived systolic blood pressure (SBP) measurement in dogs presenting to an emergency service. DESIGN: Prospective observational study. SETTING: University veterinary teaching hospital. ANIMALS: Ninety-three dogs that were presented to the emergency service. Dogs were eligible for inclusion in the study if a physical examination and a SBP measurement were performed prior to any interventions. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Both the femoral pulse quality and dorsal metatarsal pulse quality were digitally palpated and assessed as either strong, weak, or absent. The mean SBP in all dogs was 139 mm Hg (± 39 mm Hg). Seventeen (17/93; 18%) dogs were hypotensive with a SBP < 90 mm Hg (range, 40-88 mm Hg). The median SBP was not significantly different between dogs in the absent and present femoral pulse groups (P = 0.120) but the median SBP was significantly different between absent and present metatarsal pulse groups (P = 0.002). Dogs with absent metatarsal pulses were 7.6 times more likely to be hypotensive with a SBP < 90 mm Hg (OR, 7.6; 95% CI, 1.8-32) as compared to dogs with palpable metatarsal pulses. The sensitivity of absent metatarsal pulses to diagnose hypotension (SBP < 90 mm Hg) was 33% (95% CI, 10-65%) and the specificity was 94% (95% CI, 86-98%). CONCLUSIONS: Absent metatarsal pulses are highly specific in the diagnosis of hypotension. However, dogs with palpable metatarsal pulses can still be hypotensive. Dorsal metatarsal pulse palpation is useful during triage assessment of dogs presenting to an emergency service, though it should not be used as the only indicator of a dog's cardiovascular stability and should not replace an actual blood pressure measurement.

Retrospective evaluation of and risk factor analysis for presumed fluid overload in cats with urethral obstruction: 11 cases (2002-2012).

OBJECTIVE: To describe patient characteristics, treatment, and outcome in male cats with urethral obstruction (UO) and fluid overload (FO), and to determine risk factors for the development of FO. DESIGN: Retrospective case-control study from 2002-2012. ANIMALS: Eleven client-owned cats with UO that developed respiratory distress secondary to suspected FO and 51 control cats with UO without FO. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Medical records of cats with UO and FO were identified. FO was defined as the development of respiratory distress secondary to pleural effusion or pulmonary edema while receiving IV fluids. To identify risk factors for FO, variables for cats that developed FO were compared with variables from a randomly selected control group of unaffected UO cats during the same time period. Variables analyzed included patient signalment, previous medical history, serum biochemical data, respiratory rate, cardiac auscultation abnormalities, admission systolic blood pressure, intravenous fluid administration, thoracic imaging, treatment, duration and cost of hospitalization, and outcome. Echocardiogram identified heart disease in 5/6 cats with FO. Cost (2.9 times as much) and median duration of hospitalization (4.1 vs 1.8 days) were significantly greater in cats with FO. Cats with FO were more likely to have received a fluid bolus (odds ratio [OR]: 5.1; 95% confidence interval [CI]: 1.3, 20, P = 0.014), developed a heart murmur (OR: 4.5; 95% CI, 1.1-18, P = 0.028) or a gallop sound (OR: 75; 95% CI, 8.1-694, P < 0.0001). CONCLUSIONS: FO is a possible complication of the treatment of UO. The administration of a fluid bolus on presentation, and the development of a heart murmur or gallop sound during treatment were the most clinically useful risk factors identified. The development of FO is associated with significant increases in both the cost and length of hospitalization, but was not associated with increased mortality.

Evaluation of the use of shock index in identifying acute blood loss in healthy blood donor dogs.

OBJECTIVE: To determine if shock index (SI) would increase following blood donation and if it would be a more sensitive assessment of acute blood loss as compared with heart rate (HR), blood pressure, and plasma lactate. DESIGN: Prospective study. SETTING: University teaching hospital. ANIMALS: Twenty client-owned clinically normal dogs. INTERVENTIONS: Peripheral venous blood measurements and blood donation. MEASUREMENTS AND MAIN RESULTS: Data were collected at 3 time points: prior to donation (Tpre ), immediately after donation (T0 ), and 10 minutes following completion of donation (T10 ). HR and systolic blood pressure (SBP) were recorded and used to calculate SI at time points Tpre , T0 , and T10 . Packed cell volume (PCV), total plasma protein (TPP), and plasma lactate were evaluated from a peripheral venous blood sample at Tpre and T10. The mean SI was significantly increased at both time points following blood donation as compared to baseline (SIpre = 0.88 ± 0.19 vs SI0 = 1.17 ± 0.21 vs SI10 = 1.12 ± 0.25 (P = 0.0002 and 0.0003, respectively). Following blood donation, the mean SBP was significantly lower (SBPpre = 149 ± 24 mm Hg, SBP0 = 118 ± 20 mm Hg; P = 0.0001, SBP10 = 133 ± 21 mm Hg; P = 0.011). The mean HR was not significantly different at T0 but was significantly increased at T10 (HRpre = 128 ± 21/min, HR0 = 136 ± 25/min, P = 0.193; HR10 = 146 ± 29/min, P = 0.003). There was no significant difference in mean PCV (PCVpre = 50 ± 4%, PCV10 = 48 ± 4%, P = 0.08). The mean TPP and plasma lactate were significantly different following donation but still within the reference interval (TPPpre = 6.8 ± 0.4 g/dL, TPP10 = 6.4 ± 0.4 g/dL, P = 0.0014; Lacpre = 1.7 ± 0.7mmol/L, Lac10 = 1.9 ± 0.8 mmol/L, P = 0.04). A receiver operating characteristic (ROC) analysis comparing area under the curve (AUC) for SI, HR, and SBP at T0 and T10 compared to Tpre found that SI (AUC at T0 : 0.858, CI: 0.730, 0.984 AUC at T10 : 0.769 CI: 0.617, 0.921) was a better indicator of blood loss than SBP at both T0 (AUC 0.165, CI: 0.0384, 0.292, P < 0.0001) and T10 (AUC 0.288, CI: 0.124, 0.451, P < 0.001) and better than HR at T0 (AUC 0.574, CI: 0.392, 0.756, P < 0.001). An SI cut-off of 1.064 was 80% specific and 85% sensitive at T0 for detecting blood loss. CONCLUSIONS: An SI > 1.0 is a sensitive and specific tool for detecting acute small volume blood loss in healthy dogs.

The effect of prazosin on outcome in feline urethral obstruction.

OBJECTIVE: To determine whether prazosin administration following urethral obstruction (UO) reduces the risk for recurrent urethral obstruction (rUO) or lower urinary tract signs, and to document adverse effects associated with prazosin use in cats. DESIGN: Double-blinded, prospective, interventional study. SETTING: University teaching hospital. ANIMALS: A population of 47 consecutive male cats with UO not associated with urinary tract calculi >2 mm in diameter. INTERVENTIONS: Cats were randomized to receive either prazosin (0.25 mg/cat PO q 12 h, n = 27) or placebo (n = 20) for 1 month following UO. MEASUREMENTS AND MAIN RESULTS: Cats were monitored for rUO, severity of lower urinary tract signs, and medication adverse effects during hospitalization and through weekly conversations with the owner during the 1- month study period and once more at 6 months following discharge. There was no difference in the rUO rate among cats that received prazosin or placebo prior to hospital discharge (2/26 (7%) versus 1/19 (5%), P = 1.00), during the 1- month medication period (4/26 (15%) versus 3/18 (17%), P = 0.776), or at 6 months following treatment for UO (7/19 (37%) versus 4/13 (31%), P = 0.811). There was no difference in the severity of lower urinary tract signs reported by the owners at the 1-, 2-, 3-, or 4-week follow-up periods among the cats in either group (P = 0.62, 0.68, 0.33, 1.00, respectively). Reported adverse effects from prazosin administration included lethargy, ptyalism, diarrhea, anorexia, and malodorous stool. CONCLUSIONS: Although our study results failed to find a difference in the incidence of rUO and severity of lower urinary tract signs among cats receiving prazosin and those receiving placebo, these study results should be interpreted cautiously as our study was underpowered to identify such differences. Larger placebo-controlled, prospective studies are needed to determine the clinical utility of prazosin in prevention of rUO.

Point-of-Care Glucose and Ketone Monitoring.

Early and rapid identification of hypo- and hyperglycemia as well as ketosis is essential for the practicing veterinarian as these conditions can be life threatening and require emergent treatment. Point-of-care testing for both glucose and ketone is available for clinical use and it is important for the veterinarian to understand the limitations and potential sources of error with these tests. This article discusses the devices used to monitor blood glucose including portable blood glucose meters, point-of-care blood gas analyzers and continuous glucose monitoring systems. Ketone monitoring options discussed include the nitroprusside reagent test strips and the 3-ß-hydroxybutyrate ketone meter.

Prediction of systolic blood pressure using peripheral pulse palpation in cats.

OBJECTIVE: To evaluate the ability of peripheral pulse palpation to predict systolic blood pressure (SBP) in cats presenting as emergencies. DESIGN: Prospective observational study performed over an 8-month period. SETTING: University veterinary teaching hospital. ANIMALS: One hundred two cats presenting to the emergency service. Eligibility for inclusion in the study included a physical examination and a SBP via Doppler technique performed prior to treatment. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Femoral and metatarsal pulses were digitally palpated and the quality of the pulses was assessed as either strong, moderate, poor, or absent. A concurrent SBP was also recorded. The median SBP for all cats was 92.5 mm Hg (range, 30-240 mm Hg). Femoral pulse quality was found to strongly correlate with the admission SBP (P < 0.001, rho = 0.6755). The median SBP for each femoral pulse quality category (strong, moderate, poor, or absent) was significantly different (P < 0.05). For metatarsal pulses, the median SBP for cats with either absent or strong pulses was significantly different (P < 0.001). Cats with absent metatarsal and femoral pulses had a median SBP of 30 mm Hg (range, 30-105 mm Hg), whereas cats with strong metatarsal pulses had a median SBP of 135 mm Hg (range, 58-210 mm Hg). Absent metatarsal pulses correctly identified cats with a blood pressure of 75 mm Hg or less 84% the time (area under the curve: 0.89, confidence interval 0.81, 0.97). CONCLUSIONS: In cats, peripheral pulse quality assessment by emergency room veterinarians correlates with SBP. With progressive decreases in blood pressure, metatarsal pulses will disappear and it is only with severe hypotension that femoral pulses are absent. An assessment of both dorsal metatarsal pulse and femoral pulse quality during triage may be useful in identifying abnormalities in blood pressure.

Development of anemia, phlebotomy practices, and blood transfusion requirements in 45 critically ill cats (2009-2011).

OBJECTIVE: To describe the incidence of the development of anemia, the number of phlebotomies performed daily, the approximate volume of blood withdrawn, the transfusion requirements and their association with duration of hospitalization and survival to discharge in critically ill cats. DESIGN: Retrospective study from January 2009 to January 2011. SETTING: University teaching hospital. ANIMALS: Cats hospitalized in the intensive care unit (ICU) for >48 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Medical records of cats hospitalized for >48 hours in the ICU were examined. Of the 45 cats included, 60% (27/45) were not anemic upon admission to the ICU. Of these, 74.1% (20/27) developed anemia during their ICU stay. Development of anemia was associated with a longer duration of hospitalization (P = 0.002) but not with survival (P = 0.46). Fourteen cats (31.1%; 14/45) received one or more packed red blood cell transfusions and had significantly longer ICU stays (P < 0.001). Transfusion requirements were not associated with survival (P = 0.66). The median number of phlebotomies per day for all cats in the ICU was 3 (range 1-6). This was significantly associated with the development of anemia (P = 0.0011) and higher transfusion requirements (P = 0.16) in the 14 cats that received a transfusion. The estimated volume phlebotomized was significantly (P < 0.001) greater in cats that required a transfusion (median volume 3.32 mL/kg/ICU stay) compared to cats that did not require a transfusion (median volume 1.11 mL/kg/ICU stay) but was not associated with survival to discharge (P = 0.84). CONCLUSIONS: Development of anemia necessitating blood transfusions is common in critically ill cats and leads to significantly longer duration of ICU hospitalization. Iatrogenic anemia from frequent phlebotomies is an important cause for increased transfusion requirement. Fewer phlebotomies and other blood conserving strategies in these patients may help reduce the incidence of anemia and decrease transfusion requirements, as well as result in shorter hospital stays.