Limited fluid volume resuscitation (LFVR) in severe shock unresponsive to initial fluid challenge: A pilot study in 10 cats.

OBJECTIVE: To evaluate the effect of limited fluid volume resuscitation (LFVR) administration in cats with severe shock that was unresponsive to initial conventional resuscitation (CR) with isotonic crystalloids. STUDY DESIGN: Clinical pilot study. ANIMALS: Ten client-owned cats with non-cardiogenic shock, unresponsive to CR. METHODS: After an initial ineffective CR with isotonic crystalloids (15-20 mL kg-1 in 15 minutes), LFVR was started. The animals were randomly assigned to one of two treatments: hypertonic saline alone (group HTS) or HTS and hydroxyethyl starch (HES) (group HTS/HES). A first bolus of HTS (2 mL kg-1) was administered to both groups, immediately followed by HES (2 mL kg-1) to group HTS/HES over 5-10 minutes and vital signs were re-evaluated. Additional boluses were administered, every 5-10 minutes, until stabilization (vital parameters, such as temperature, heart rate, respiratory frequency, quality of the pulse and sensorium within the physiological ranges). The time until stabilization (minutes), the volume of HTS and colloid administered and the effect of LFVR on vital parameters were determined. RESULTS: A mean ± standard deviation (range) volume of 3 ± 2 (2-6) mL kg-1 of hypertonic saline in group HTS and 4 ± 2 (2-6) mL kg-1 of both hypertonic and colloidal solutions in group HTS/HES was administered. In six cats (60%), a single bolus of HTS alone (group HTS; n = 3/4) or in combination with HES (group HTS/HES; n = 3/6) was sufficient for stabilization. In the remaining four cases (40%), a second bolus was required. Stabilization occurred in 33 ± 13 minutes (15-60 minutes). Of the 10 cats, six had a positive outcome (6-24 months follow-up) and the others died during hospitalization. CONCLUSIONS AND CLINICAL RELEVANCE: LFVR appears to be an efficacious treatment for feline shock and may be an alternative therapy for cats unresponsive to CR. Larger cross-sectional and prospective studies are needed to confirm these findings.

Retrospective evaluation of shock index and mortality in dogs with head trauma (2015-2020): 86 cases.

OBJECTIVE: To assess the relationship between shock index (SI) and mortality in dogs with head trauma (HT). A secondary objective was to compare SI with the animal trauma triage (ATT) score and Modified Glasgow Coma Scale (MCGS) score in HT cases. A tertiary aim was to assess if SI is predictive of survival to discharge or improvement in presenting neurologic signs. DESIGN: Retrospective study from January 2015 to December 2020. SETTING: Tertiary referral level II veterinary trauma center. ANIMALS: Eighty-six dogs with evidence of HT presenting through emergency for various traumas compared to 60 healthy control dogs. MEASUREMENTS AND MAIN RESULTS: SI was calculated using the quotient of heart rate over systolic blood pressure measured on presentation. SI was significantly higher in HT patients than healthy controls (P = 0.0019). SI was not significantly different between traumatic brain injury dogs that died or were euthanized and HT dogs that lived until the time of discharge (P = 0.98). SI was not significantly different between HT dogs that were neurologically normal at the time of discharge and HT dogs that were static or improved but not normal neurologically at the time of discharge (P = 0.84). In HT dogs, SI did not correlate with ATT score (P = 0.16) or MGCS score (P = 0.75). There was no significant difference in SI and length of hospitalization until death or discharge (P = 0.78). CONCLUSIONS: SI was significantly higher in HT patients compared to control patients. Interestingly, SI was not correlated with ATT score or MGCS score. The use of SI in HT patients warrants further investigation to assess the efficacy in predicting mortality.

Rapid resolution of hyperfibrinolysis in dogs with spontaneous hemoperitoneum following surgical control of hemorrhage.

OBJECTIVE: To estimate the point prevalence and duration of hyperfibrinolysis (HF) in dogs undergoing surgical control of spontaneous hemoperitoneum (SHP). DESIGN: Prospective observational study. SETTING: Single veterinary teaching hospital. ANIMALS: Forty-five client-owned dogs with SHP were screened for HF. Eighteen HF dogs treated surgically were studied. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Dogs with SHP and evidence of shock admitted for surgical control of hemorrhage were screened for HF. Blood samples were collected for PCV, total plasma protein, platelet count, and thromboelastography with 50 U/mL of tissue plasminogen activator at presentation and every 8 hours postoperatively until 72 hours, discharge, or death. HF was defined as a tissue plasminogen activator-activated thromboelastography lysis percentage measured 30 minutes after maximum amplitude (LY30) of ≥20%. LY30 values were compared to a cohort of samples obtained from healthy dogs (n = 22). The point prevalence of HF in all dogs screened was 40% (18/45 dogs), and the mean LY30 at baseline for HF dogs was 48.9% (±24.2%), which was significantly higher than that of control dogs (4.8% ± 7.1%, P < 0.001) and non-HF dogs (1.9% ± 5.7%, P < 0.001). In HF dogs, there was a significant decrease in LY30 between baseline and 8 hours (P < 0.0001) and between 8 and 16 hours (P = 0.035) but no significant change thereafter. LY30 at 8 hours (4%, range: 0%-23.4%) was not statistically different from control dogs (6.5%, range: 1.2%-32.8%, P = 0.664) suggesting early resolution of HF in this population. Only 2 of 18 dogs were persistently hyperfibrinolytic at 24 hours. Malignancy was diagnosed in 12 of 18 dogs (66.6%), while a benign etiology occurred in 6 of 18 dogs (33.3%). All HF dogs survived to discharge. CONCLUSIONS: HF occurs in some dogs with hypovolemic shock due to hemoperitoneum but resolves rapidly following surgical control of bleeding without antifibrinolytic medications. Routine postoperative use of antifibrinolytics in dogs with hemoperitoneum in dogs undergoing surgical control of bleeding may not be warranted.

Erythrocyte damage of crucian carp (Carassius auratus) caused by microcystin-LR: in vitro study.

Fish suffer from anemia and hypovolemic hypotensive shock after in vivo exposure with microcystins.However, except for in vivo causes for anemia and hypotension, an in vitro study of fish erythrocytes exposed to MC is necessary. For a better understanding of hematology toxicity of MC, the main aim of the present study was to investigate the toxic effects of microcystin on fish erythrocytes in vitro. Crucian carp erythrocytes were incubated in vitro with microcystin-LR (MC-LR) at doses of 0, 1, 10, 100 and 1,000 nM.The level of lipid peroxidate significantly increased in MC-LR treatment groups. Glutathione decreased after exposure to MC-LR. The activities of antioxidative enzymes, including superoxide dismutase, catalase,glutathione peroxidase and glutathione-S-transferase,were significantly increased after exposure with MC-LR.The hemolysis was significantly increased, while the activities of acetylcholinesterase, Na?­K?-ATPase and Ca2?­Mg2?-ATPase were significantly decreased. In addition, pathological alterations in agglomerated and jagged erythrocytes were observed in blood smears. The findings indicate that damages to erythrocytes should also be responsible for anemia and hypotensive shock or even death.

Spontaneous abdominal effusion in dogs with presumed anaphylaxis.

OBJECTIVE: To describe patient characteristics of dogs developing spontaneous abdominal effusion in association with anaphylaxis. DESIGN: Retrospective study between 2010 and 2018. SETTING: University teaching hospital and referral specialty private practice emergency departments. ANIMALS: Sixteen dogs presenting to the emergency department for clinical signs suggestive of anaphylaxis with peritoneal effusion documented via ultrasonography. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Dogs presented with clinical signs of anaphylaxis including vomiting 12 of 16 (75%), diarrhea 9 of 16 (56%), and collapse 7 of 16 (44%). Physical examination findings included altered mentation 14 of 16 (88%), erythema 2 of 16 (13%), and urticaria 2 of 16 (13%). Historically, 3 of 16 (19%) had just recently been vaccinated, 1 of 16 (6%) had known contact with an insect, and 8 of 16 (50%) had been outdoors prior to the onset of clinical signs, whereas 5 of 16 (31%) had no known triggering event. At presentation, median systolic arterial pressure was 70 mm Hg (range, 30-210 mm Hg). Venous blood gas revealed an acidemia with a mean pH of 7.24 ± 0.09, a base deficit of 7.15 ± 7.7 mmol/L, and an increased plasma lactate with a mean of 7.35 ± 2.09 mmol/L. Bloodwork abnormalities included an increased alanine aminotransferase activity with a mean of 439.2 ± 404.5 U/L and an increased gamma-glutamyl transferase activity with a mean concentration of 7.29 ± 4.1 U/L. Twelve patients (75%) had gallbladder wall abnormalities on ultrasonography. Eight patients (50%) had abdominocentesis performed. The median PCV of the effusion was 0.29 L/L (29%; range, 4-41) and total plasma protein was 38 g/L (3.8 g/dL; range, 2.4-6.5). Two dogs (12.5%) were euthanized. The remaining 14 dogs (87.5%) survived to discharge, with a mean hospitalization time of 23.7 ± 16.7 hours. CONCLUSIONS: Abdominal effusion should be considered a potential sequela of anaphylaxis in dogs. Therefore, serial monitoring for presence or development of spontaneous abdominal effusion should be considered.

Prospective evaluation of plasma lactate parameters for prognosticating dogs with shock.

OBJECTIVE: To determine whether admission venous plasma lactate concentration, serially calculated lactate variables, or the Acute Patient Physiologic and Laboratory Evaluation (APPLEfast ) score could discriminate hospital survivors from non-survivors in dogs presenting to the emergency department with clinical signs of shock. DESIGN: Prospective case series performed over a 24-month period. SETTING: Large urban private teaching hospital. ANIMALS: Seventy-one dogs admitted to the ICU with initial peripheral venous plasma lactate concentration > 2.5 mmol/L and clinical and hemodynamic parameters consistent with shock. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Heart rate, systolic blood pressure, temperature, initial venous plasma lactate, and APPLEfast score were recorded at admission. Lactate concentrations were serially recorded at predefined time points and used to calculate lactate variables, including lactime (time lactate > 2.5 mmol/L), lactate clearance ([lactateinitial - lactatedelayed ]/ lactateinitial × 100), and LACAREA (area under the lactate concentration versus time curve). Primary outcome was survival to discharge. Overall survival rate was 61%. Admission plasma lactate did not differ between groups (P = 0.28). Lactime was shorter in survivors vs non-survivors (P = 0.03). Lactate clearance at hours (h) 1, 4, 10, and 16 was greater in survivors vs non-survivors (P < 0.05). Final plasma lactate clearance differed between groups (P < 0.05). LACAREA at time intervals 1 to 4 hours, 4 to 10 hours, 10 to 16 hours, and 16 to 24 hours was larger in non-survivors vs survivors (P < 0.05). Total LACAREA did not differ between groups (P = 0.51). Admission APPLEfast was not different between survivors and non-survivors (P = 0.16). CONCLUSIONS: While neither single APPLEfast nor admission plasma lactate concentration could discriminate between hospital survivors and non-survivors, measures of lactate clearance can prognosticate survival in dogs with shock.

Canine hypoadrenocorticism: part II.

Dogs with chronic, vague gastrointestinal signs and those with signs and laboratory abnormalities suggestive of an Addisonian crisis should be tested for hypoadrenocorticism. A previous article (Part I; Can Vet J 2009;50:63-69) discussed the etiology, pathophysiology, clinical signs, and diagnostic abnormalities found in these patients. The present article discusses definitive diagnosis and treatment for both the acute and the chronic Addisonian patient. Expedient treatment remains the cornerstone of management for these patients, particularly those in the former category. The long-term prognosis is excellent for these patients, given well-educated, committed, and vigilant owners.

Shock index is associated with mortality in canine vehicular trauma patients.

OBJECTIVE: To calculate and compare shock index (SI) in healthy dogs and vehicular trauma dogs (VT), determine the prognostic value of SI in VT dogs, and to assess the correlation between SI and the animal trauma triage score, modified Glasgow Coma Scale score, and lactate in VT dogs. DESIGN: Retrospective study from April 2016 to February 2018. SETTING: Twenty-four-hour tertiary referral level II trauma center. ANIMALS: One hundred twenty-one dogs presented to the emergency service for VT and 60 healthy control dogs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Heart rate and systolic blood pressure were measured on each patient and used to calculate SI. SI was significantly higher in VT dogs compared to healthy control dogs (median SI, 1.0 vs 0.75; P < 0.0001). SI was significantly higher in those that died versus those that survived to discharge (median, 1.27 vs 0.96; P = 0.017). SI positively correlated with animal trauma triage score (95% confidence interval, 0.039-0.49; P = 0.019; r = 0.26) but did not with plasma lactate level at presentation (P = 0.068; r = 0.22) or modified Glasgow Coma Scale (P = 0.85; r = -0.021, 95% confidence interval, -0.24 to 0.20). CONCLUSIONS: SI is easy to calculate during triage of a trauma patient. Given its significant relationship with mortality, higher SIs should prompt the clinician to pursue additional monitoring, diagnostics, and intervention.

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.

Recognition, Treatment, and Monitoring of Canine Hypovolemic Shock in First Opinion Practice in the United Kingdom.

The aim of this study was to gain a greater understanding of the detection, treatment, and monitoring of hypovolemic shock (HVS) in dogs by general practitioners in the United Kingdom (UK). An online survey was devised and distributed by email to first opinion practices in the UK. All veterinarians working in first opinion practice treating small animals were eligible to complete the survey. Most respondents (n = 164, 93%) were confident with HVS diagnosis. Isotonic crystalloid fluids were the most common fluid type for first-line treatment and administered as a 10-30 mL/kg bolus over 10-30 minutes by 57% respondents. Initial intravenous isotonic crystalloid fluid rates for HVS management ranged from maintenance fluid requirements to 90 mL/kg/hr for an undefined time period. A synthetic colloid was the most popular second-line fluid choice, typically considered after a total administered volume of 60-90 mL/kg of isotonic crystalloid fluids. Only 72 respondents (40.7%) were able to measure blood lactate in-house, which was used routinely by 36 respondents (20.3%) for initial treatment decision making. Respondents treating HVS most frequently were more likely to use lactate for initial decision making (P = .008). This study highlighted variabilities in the initial approach, fluid management strategies and monitoring instituted by UK general practitioners when faced with canine patients in HVS. This suggests that there is a discrepancy in what is determined to be the most optimal diagnostic and treatment plan for canine HVS patients.

Caudal vena cava collapsibility index as a tool to predict fluid responsiveness in dogs.

OBJECTIVE: To evaluate the use of the caudal vena cava collapsibility index (CVCCI) as a predictor of fluid responsiveness in hospitalized, critically ill dogs with hemodynamic or tissue perfusion abnormalities. DESIGN: Retrospective observational study. SETTING: Private referral center. ANIMALS: Twenty-seven critically ill, spontaneously breathing dogs with compromised hemodynamics or tissue hypoperfusion. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The electronic medical records were searched for dogs admitted for any cause, from August 2016 to December 2017. We included dogs with ultrasound measurements of: CVCCI, performed at baseline; and velocity time integral (VTI) of the subaortic blood flow, carried out before and after a fluid load. CVCCI was estimated as: (maximum diameter-minimum diameter/maximum diameter) × 100. Dogs in which VTI increased ≥15% were considered fluid responders. The CVCCI accurately predicted fluid responsiveness with an area under the receiver operating characteristic curve of 0.96 (95% CI, 0.88 to 1.00). The optimal cut-off of CVCCI that better discriminated between fluid responders and nonresponders was 27%, with 100.0% sensitivity and 83.3% specificity. At baseline, fluid responders had lower VTI (5.48 [4.26 to 7.40] vs 10.61 [7.38 to 13.23] cm, P = 0.004) than nonresponders. The basal maximum diameter of the caudal vena cava adjusted to body weight was not different between responders and nonresponders (0.050 [0.030 to 0.100] vs 0.079 [0.067 to 0.140] cm/kg, P = 0.339). The increase in VTI was related to basal CVCCI (R = 0.60, P = 0.001). Bland-Altman analysis showed narrow 95% limits of agreement between measurements of CVCCI and VTI performed by different observers or by the same observer. CONCLUSIONS: The results of this small cohort study suggest that CVCCI can accurately predict fluid responsiveness in critically ill dogs with perfusion abnormalities. Further research is necessary to extrapolate these results to larger populations of hospitalized dogs.

[Therapy of canine parvovirus infection - review and current insights]. / Therapie der kaninen Parvovirose ­ Übersicht und aktuelle Erkenntnisse.

Canine parvovirus infection remains to represent a worldwide and commonly occurring infectious disease leading to severe morbidity especially in puppies. The main therapeutic approach is primarily based on symptomatic treatment, especially addressing acute gastrointestinal signs as well as treating and preventing potential sepsis due to bacterial translocation. Besides antibiotic and essential fluid therapy, the use of efficient antiemetic and pain medication is required. In addition, early enteral nutrition should be attempted as this has been shown to be associated with a shorter time to recovery. Modulation of the intestinal microbiome could improve clinical signs and possibly aide in avoiding long-term sequelae such as chronic gastrointestinal disease. Treatment with recombinant feline interferon-omega resulted in a lower mortality and a more rapid improvement of clinical signs in several experimental and clinical studies and thus is considered to be effective.

Hypothalamic-pituitary-adrenal axis dysfunction in hospitalized neonatal foals.

BACKGROUND: Transient hypothalamic-pituitary-adrenal (HPA) axis dysfunction occurs frequently in critically ill humans and impacts survival. The prevalence and impact of HPA axis dysfunction in critically ill neonatal foals are not well characterized. HYPOTHESES: (1) HPA axis dysfunction occurs in hospitalized neonatal foals, and is characterized by inappropriately low basal serum cortisol concentration or inadequate cortisol response to exogenous adrenocorticotropic hormone (ACTH); (2) hospitalized foals with HPA axis dysfunction have more severe disease and are less likely to survive than hospitalized foals with normal HPA axis function. ANIMALS: Seventy-two hospitalized foals and 23 healthy age-matched foals. METHODS: Basal ACTH and cortisol concentrations were measured and a paired low-dose (10 microg)/high-dose (100 microg) cosyntropin stimulation test was performed at admission in hospitalized foals. HPA axis dysfunction was defined as (1) an inappropriately low basal cortisol concentration or (2) an inadequate increase in cortisol concentration (delta cortisol) after administration of cosyntropin, with cut-off values for appropriate basal and delta cortisol concentrations determined from results obtained in healthy age-matched foals. RESULTS: Forty-six percent of hospitalized foals had an inappropriately low basal cortisol concentration and 52% had an inadequate delta cortisol concentration after administration of the 100 microg dose of cosyntropin. An inadequate delta cortisol response to the high (100 microg) dose of cosyntropin was significantly correlated with shock and multiple organ dysfunction syndrome in hospitalized foals, and with decreased survival in a subgroup of septic foals. CONCLUSIONS AND CLINICAL IMPORTANCE: HPA axis dysfunction occurs frequently in hospitalized neonatal foals, and negatively impacts disease severity and survival.

Clinical and histologic outcome in a dog surviving massive hepatic necrosis.

This report describes the clinical and histologic recovery of a 2-year-old mixed-breed dog presented with hypovolemic shock, markedly increased serum alanine amino transferase activity, and hemoabdomen. Emergency exploratory surgery revealed a friable liver with multiple capsule hemorrhages necessitating removal of the left lateral lobe. Histologic evaluation showed acute massive hepatic necrosis with centrilobular and midzonal distribution. The dog survived, and all monitored laboratory values normalized within 7 weeks. A liver biopsy taken 8 weeks after presentation revealed normal hepatic architecture with a few, randomly distributed neutrophilic foci. Follow-up included intermittent determination of liver variables including liver function tests for a period of 7 years. The dog's health status, and all test results remained normal during this time. Complete recovery and good long-term quality of life after life-threatening acute liver failure secondary to massive hepatic necrosis is possible in dogs.

Fluid resuscitation and the trauma patient.

Traumatic shock can result from one or more of the following: hypovolemia, increased capillary permeability and vasodilatation, impaired myocardial contractility or dysfunction, blood loss, and cardiovascular obstruction. Animals with traumatic injuries are less tolerant of sudden increases in hydrostatic pressure, which can exacerbate fluid leakage into damaged tissues and disrupt blood clots. Pain amplifies the shock response, and analgesic therapy is always recommended in the trauma patient. Therapy must be individualized and monitored closely.

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.

Assessment of the relationships among coagulopathy, hyperfibrinolysis, plasma lactate, and protein C in dogs with spontaneous hemoperitoneum.

OBJECTIVE: To relate coagulation and fibrinolysis derangements to shock severity as reflected by plasma lactate concentrations in dogs with spontaneous hemoperitoneum (SHP) and determine the impact on transfusions. DESIGN: Prospective, observational, case-control study. SETTING: Three veterinary teaching hospitals. ANIMALS: Twenty-eight client-owned dogs with SHP and 28 breed- and age-matched control dogs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Blood samples for platelet counts, coagulation, and anticoagulant assays (prothrombin time, activated partial thromboplastin time, fibrinogen, antithrombin, and protein C, thromboelastography [TEG]), fibrinolysis testing (d-dimer and TEG lysis parameters with and without the addition of 50 U/mL of tissue plasminogen activator [TEG LY30 measured with the addition of 50 U/mL of tPA to the blood sample, LY3050 and TEG LY60 measured with the addition of 50 U/mL of tPA to the blood sample, LY6050 ; LY30 and LY60]), and plasma lactate as an indicator of severity of shock were collected from SHP dogs at the time of diagnosis. SHP dogs were hypocoagulable (prolonged prothrombin time and activated partial thromboplastin time, decreased TEG maximum amplitude) and hyperfibrinolytic (increased LY3050 and TEG LY6050 ) compared to controls. The severity of hypocoagulability was related to protein C activity, while the severity of hyperfibrinolysis was related to plasma lactate concentration. Among the 18 dogs discharged from the hospital, LY3050 was significantly associated with the dose of fresh frozen plasma administered, but none of the parameters were associated with the dose of red blood cells administered. CONCLUSIONS: Dogs with SHP have evidence of hypocoagulability, protein C deficiency, and hyperfibrinolysis. Parameters of hyperfibrinolysis were related to plasma lactate concentrations and volume of plasma transfused during hospitalization. These derangements resemble those found in people with acute coagulopathy of trauma and shock, and activation of protein C may be a common feature to both syndromes.