Successful use of lipid emulsion to resuscitate a foal after intravenous lidocaine induced cardiovascular collapse

The use of prolonged administration of low-dose intravenous lipid emulsion to treat ivermectin toxicosis in goats

CASE DESCRIPTION

2 Nigerian Dwarf goats (a doe [goat 1] and a wether [goat 2]) with coughing and nasal discharge since they were purchased at an auction 6 days prior were empirically treated for suspected pneumonia and intestinal parasitism. An ivermectin dosing error (intended dose, 0.4 mg/kg, PO; administered dose, 10 mg/kg, PO) was retrospectively discovered, and the owner was urged to return the goats for hospitalization and treatment.

CLINICAL FINDINGS

On admission 19 hours after iatrogenic ivermectin overdose, both goats had tachycardia, tachypnea, and absent menace responses. Goat 1 also had vomited in transit, was lethargic and febrile, had slow pupillary light reflexes, and walked into walls and obstacles. Goat 2 was quiet but responsive, not ataxic or febrile, and had pale mucous membranes and a prolonged capillary refill time.

TREATMENT AND OUTCOME

Each goat received 20% IV lipid emulsion (2 mL/kg, IV bolus over 15 minutes, followed by 0.008 mL/kg/min, IV) and immediately improved. Activated charcoal was administered by orogastric tube, and 6 hours later, mineral oil was similarly administered. Goat 1 had complete resolution of signs and was discharged by 48 and 72 hours, respectively, after admission. Goat 2 improved but developed progressive respiratory distress after the second orogastric intubation and was euthanized. Necropsy findings were consistent with acute renal tubular necrosis, acute respiratory distress syndrome of unknown cause, ruminal tympany, and mesenteric caseous lymphadenitis.

CLINICAL RELEVANCE

Results indicated that IV lipid emulsion could be used to successfully treat ivermectin toxicosis in goats. Treatment early in the course of ivermectin toxicosis is advisable to avoid severe clinical signs and secondary complications.

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.

Conventional treatment of a metaldehyde-intoxicated cat with additional use of low-dose intravenous lipid emulsion

Case summary

An adult male intact domestic shorthair cat was presented for acute onset of generalised tremors, stupor, horizontal nystagmus, anisocoria and bilateral absence of pupillary light and palpebral reflexes. Response to intravenous (IV) administration of benzodiazepines was minimal; thus, the induction of general anaesthesia with propofol, midazolam and dexmedetomidine was necessary to control clinical signs. Following a clinical suspicion of neurotoxicosis, a low-dose constant rate infusion (CRI) of IV lipid emulsion (ILE) was started. Phenobarbital and a low-dose CRI of ketamine were also used for neuroprotective purposes. Metaldehyde intoxication was confirmed by qualitative faecal toxicological analysis after discharge. Anaesthetic drugs were progressively tapered and stopped after 28 h and extubation was possible after 44 h. The cat was discharged 8 days after admission with a complete recovery of the clinical signs.

Relevance and novel information

To the authors’ knowledge, this is the first report to describe a case of metaldehyde toxicosis in a cat treated with intensive supportive care and an additional low-dose CRI of ILE.

Ventricular arrhythmias in horses: Diagnosis, prognosis and treatment

Ventricular arrhythmias (VAs) are often incidental or coincidental with systemic disease. Ventricular arrhythmias are also the most likely cause of many sudden cardiac deaths in horses. This dichotomy creates challenges in the management of horses with VAs. This review presents current knowledge of diagnosis, prognosis and treatment of VAs in horses.

A review of recent developments in the pharmacological prevention and treatment of endocrinopathic laminitis

Despite the prevalence of endocrinopathic laminitis, the pharmacologic options for preventing and treating the disease are severely limited. The present review aims to discuss the spectrum of potential therapeutic agents for the condition, ranging from early experimental compounds to agents nearing registration. There are different pharmacologic targets for, and approaches to, managing laminitis. Reducing hyperinsulinaemia is central to diminishing endocrinopathic laminitis risk, and a detailed understanding of the pathophysiology of insulin dysregulation is necessary to identify pathways that can be targeted to minimise post-prandial insulin secretion and action. This area of research is advancing rapidly, with several exciting prospects, such as sodium-dependent glucose co-transporter-2 inhibitors, on the horizon for the treatment of equine metabolic dysfunction. Drugs that directly target the lamellae and aim to reduce the damage inflicted on the lamellae as part of this condition, are not yet available. Although progress in this area of laminitis therapy is slower, improved understanding of the events that lead to lamellar failure has enabled the investigation of novel drugs that aim to prevent laminitis at the site of the lesion. Finally, a brief review is included of the directions being taken in the management of the chronic and acute pain that accompanies laminitis. Medications for relieving the pain associated with laminitis are currently the most-prescribed drugs for the disease, and range from simple, affordable and thoroughly tested options, such as phenylbutazone, to newer, less-understood applications such as paracetamol and gabapentin. In the future, endocrinopathic laminitis management plans will likely take a multi-faceted approach that still hinge on effective dietary management and exercise, but also include drugs that address foot pathology, pain and underlying endocrine disturbances.

Cardiac Therapeutics in Horses

Many cardiac therapeutics lack significant evidence of benefit in the horse, and in many cases their use is based on extrapolation of evidence from other species. In recent years there has been a push to develop a better understanding of both the pharmacodynamics and pharmacokinetics of these drugs. Recent data have described the use of antiarrhythmic agents including sotalol, flecainide, and amiodarone. Data about the use of ACE inhibitors in the management of congestive heart failure are encouraging and support their use in certain cases, wheras evidence for other medicines, such as pimobendan, remain speculative.