Hemolysis associated with water administration using a nipple bottle for human infants in juvenile pygmy goats

Case Report: Severe Anemia Associated With an Abomasal Fibrosarcoma in a Goat

A 10-year-old female goat was presented to the clinic with lethargy, emaciation, and pale mucous membranes. Laboratory diagnosis revealed severe anemia with regenerative character as well as melena. Blood transfusions were administered, but the animal's condition continued to deteriorate, so it was euthanized. The main finding in the necropsy was an abomasal neoplasia with two metastases in the mesenterium which was positive for vimentin, but negative for smooth muscle actin and c-kit using immunohistochemistry, indicating a fibrosarcoma that might have contributed to gastrointestinal blood loss. Further pathological findings consisted of changes in the liver cells as well as a cervical leiomyoma. These findings illustrate that intestinal blood loss due to neoplasia should also be considered in older goats with anemia.

Hematologic Conditions of Small Ruminants

Anemia is a clinically important syndrome in small ruminants. Anemia can be divided into regenerative and nonregenerative forms. Differentials for regenerative anemia include hemorrhage owing to gastrointestinal or external parasitism or hemostatic disorders, and hemolysis owing to infectious, osmotic, toxic, and nutritional causes. Differentials for nonregenerative anemia include inflammatory and chronic diseases, renal failure, pancytopenia, copper deficiency, and heavy metal toxicosis. Iron deficiency anemia can be caused by chronic gastrointestinal and external hemorrhage or nutritional deficiency and may be mildly regenerative or nonregenerative. Appropriate diagnostic tests are described along with treatments, including blood transfusion, parasite control, and prevention.

Iatrogenic water intoxication in two cats

OBJECTIVE

To describe 2 cats that developed acute iatrogenic water intoxication, one associated with a continuous infusion of water provided via an esophagostomy tube and one following SC administration of 5% dextrose in water (D5W).

CASE OR SERIES SUMMARY

A 10-year-old cat with squamous cell carcinoma was hospitalized for treatment of dehydration. Rehydration was provided with water via an esophagostomy tube at 5.7 mL/kg/h. After 30 hours of therapy, the cat was found dull and weak. Serum sodium was markedly decreased at 116 mmol/L (116 mEq/L). Supplemental water was stopped, and IV furosemide and mannitol were provided to eliminate free water. Hypertonic saline (1.5%) was administered IV to rapidly restore the sodium concentration. The serum sodium concentration corrected over 17 hours, and the cat was discharged without neurological complications. The second cat had previously received 300 mL D5W subcutaneously and represented 8 hours later with lethargy and paresis with a serum sodium level of 126 mmol/L (126 mEq/L). Intravenous fluid therapy was provided using 0.9% NaCl. Over the following day, the cat's mentation and paresis resolved and sodium concentrations normalized.

NEW OR UNIQUE INFORMATION PROVIDED

These 2 cases describe a presumed uncommon iatrogenic complication of severe hyponatremia due to water provided either via an esophagostomy tube or subcutaneously. While oral rehydration is often considered ideal, it may result in signs of water intoxication if not carefully monitored; additionally, D5W is never considered an acceptable fluid choice as a SC bolus. If promptly recognized, acute hyponatremia may be corrected rapidly with no lasting consequences.