Hospital-acquired Anemia in Critically Ill Dogs and Cats: A Multi-Institutional Study

Retrospective evaluation of the prevalence and risk factors associated with red blood cell transfusions in cats with urethral obstruction (2009-2019): 575 cases

OBJECTIVE

To evaluate the prevalence of red blood cell (RBC) transfusions and factors associated with the need for transfusion in cases of feline urethral obstruction (FUO). Secondarily, to compare survival to discharge in cats receiving an RBC transfusion versus those that did not.

DESIGN

Retrospective, multi-institutional study from 2009 to 2019.

SETTING

Four university teaching hospitals.

ANIMALS

Six hundred twenty-two total occurrences of FUO in 575 cats.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Medical records were retrospectively reviewed for pertinent information. The overall prevalence of severe anemia (PCV < 0.20 L/L [<20%]) at presentation was 1.0% (6/622). The prevalence of RBC transfusions during hospitalization was 2.1% (13/622). Cats that received an RBC transfusion weighed significantly less than those that did not (4.9 vs 5.8 kg; P = 0.034) and had a lower PCV at presentation (0.30 L/L [30%] vs 0.41 L/L [41%]; P < 0.001). Hospitalization time (240 vs 72 h) and indwelling urinary catheter time (168 vs 48 h) were significantly longer in cats receiving a transfusion compared with those that did not (P < 0.001). Creatinine concentrations were not significantly associated with transfusion administration, while BUN was higher in cats receiving a transfusion (15.35 mmol/L [43 mg/dL] vs. 11.78 mmol/L [33 mg/dL]; P = 0.043). Transfusion rates were significantly higher in cats undergoing perineal urethrostomy (5.5%) compared with those that did not undergo surgery (0.97%; P < 0.001). The overall survival to discharge rate was 96%. Cats not receiving an RBC transfusion were significantly more likely to survive to discharge than those that did (odds ratio: 14.7, 95% confidence interval: 1.8-37; P < 0.001).

CONCLUSIONS

FUO is rarely associated with severe anemia and the need for RBC transfusions. In this study, cats receiving an RBC transfusion were less likely to survive to discharge; therefore, requiring a blood transfusion may be associated with a worse prognosis. In addition, the need for surgical intervention was associated with a higher prevalence of RBC transfusions.

Evaluation of a long-acting injectable formulation of omeprazole in healthy dogs

BACKGROUND

To evaluate the efficacy of a single intramuscular adminsitration of long-acting omeprazole (LA-OMEP) in increasing gastric pH in dogs.

HYPOTHESIS

We hypothesized that LA-OMEP would meet in healthy dogs the clinical goals defined for human patients for treatment of gastroduodenal ulceration.

ANIMALS

Nine healthy research dogs.

METHODS

Prospective experimental study. Dogs were given a 4 mg/kg intramuscular injection of LA-OMEP. Intragastric pH was continuously recorded on treatment days 0 to 7. Daily mean pH and mean percentage time (MPT) intragastric pH was ≥3 or ≥4 were determined.

RESULTS

The mean onset of action for the LA-OMEP was 98.11 min (SD 46.39). The mean number of days the dogs' pH met established goals for MPT pH ≥3 was 5.5 days (range, 3-7) and 5.25 days for MPT pH ≥4 (range, 3-7). Long-acting omeprazole met the human clinical goals pH ≥3 for 72 hours in 8/8 of the dogs and MPT pH ≥4 for 96 hours in 7/8 of dogs.

CONCLUSIONS AND CLINICAL IMPORTANCE

The LA-OMEP formulation produced gastric acid suppression in healthy dogs for an average of 5 days and up to 7 days, after a single intramuscular injection. No major adverse effects were observed.

Therapy of Pyothorax in Cats via Small-Bore Thoracostomy Tube in Terms of Efficacy, Complications and Outcomes

Simple Summary

With this study we present our therapeutic strategy for cats with purulent fluid accumulation in the thorax. In addition to the systemic administration of antibiotics, the aim of the therapy is always the drainage of the purulent fluid from the thorax. For this purpose, we use a particular small-bore chest drain. The first aim of our study is to assess the efficacy and complication rate of our drainage. The second objective is to evaluate two treatment groups regarding their disease outcomes. We were able to show that our small-bore chest drain is similarly effective to the traditionally used large-bore drains. At the same time, we had a very low drain-associated complication rate. We detected no difference between the treatment groups and, thus, no effect on survival by early placement of bilateral drains into the thoracic cavity or lavage of the thoracic cavity with a heparinised solution. Our study supports the theory that drainage of purulent fluid from the thoracic cavity in cats can be performed with small-bore drains with good results and minimal risk of complications.

Abstract

First-line therapy for cats with pyothorax consists of intravenous antibiotics, drainage of the septic pleural effusion and closed-chest lavage. Large-bore thoracostomy tubes are traditionally used for drainage, but case series indicate a comparable efficacy using small-bore tubes. In this retrospective study, we describe a new technique of sheath-guided small-bore (6 F) thoracostomy tubes in cats with pyothorax and evaluate their efficacy and complications. Additionally, we compare outcomes between two treatment groups. Placement and use of the small-bore thoracostomy tubes described here has a low complication rate of 4% (3/67 tubes), and 53% (24/45) of the cats could be treated with thoracostomy tubes and closed-chest lavage according to the protocol. The success rate is reduced by 18% (8/45) due to deaths caused mainly by sepsis, 16% (7/45) due to structural diseases requiring surgery and a further 14% (6/43) due to lavage failures that could only be cured after additive therapy (thoracotomy or fibrinolysis). The long-term prognosis was very good, with a survival rate one year after discharge of 94% (30/32). We detected no effect on survival by early placement of bilateral thoracostomy tubes or closed-chest lavage with a heparinised solution. In conclusion, therapy of pyothorax with small-bore thoracostomy tubes is as successful as therapy with large- or medium-bore tubes.

Effects of potential confounding variables on accuracy of a commercially available veterinary point-of-care hematocrit meter in the evaluation of blood samples from dogs and cats

OBJECTIVE

To assess the agreement in measurements of Hct values and hemoglobin (Hgb) concentrations in blood samples from dogs and cats between a commercially available veterinary point-of-care (POC) Hct meter and a laboratory-based (LAB) analyzer and to determine the effects of various conditions (ie, lipemia, hyperbilirubinemia, hemolysis, autoagglutination, and reticulocytosis) on the accuracy of the POC meter.

SAMPLES

Blood samples from 86 dogs and 18 cats.

PROCEDURES

Blood samples were run in duplicate on the POC meter, which reported Hgb concentration, measured via optical reflectance, and a calculated Hct value. The POC meter results were compared with results from a LAB analyzer. Blood samples with grossly visible lipemia, icterus, hemolysis, and autoagglutination were noted.

RESULTS

Mean ± SD values for LAB Hct were 33.9 ± 15.73% (range, 3.9% to 75.8%), and for LAB Hgb were 11.2 ± 5.4 g/dL (range, 1 to 24.6 g/dL). Mean bias between POC Hct and LAB Hct values was -1.8% with 95% limits of agreement (LOAs) of -11.1% to 7.5% and between POC Hgb and LAB Hgb concentrations was -0.5 g/dL with 95% LOAs of -3.8 to 2.8 g/dL. There was no influence of lipemia (14 samples), icterus (23), autoagglutination (14), hemolysis (12), or high reticulocyte count (15) on the accuracy of the POC meter. The POC meter was unable to read 13 blood samples; 9 had a LAB Hct ≤ 12%, and 4 had a LAB Hct concentration between 13% and 17%.

CONCLUSIONS AND CLINICAL RELEVANCE

Overall, measurements from the POC meter had good agreement with those from the LAB analyzer. However, LOAs were fairly wide, indicating that there may be clinically important differences between measurements from the POC meter and LAB analyzer.

Retrospective evaluation of refeeding syndrome in cats: 11 cases (2013-2019)

OBJECTIVES

The aim of this study was to describe the clinicopathological findings, management and outcome of cats with refeeding syndrome (RS) following prolonged starvation.

METHODS

Records from four referral hospitals were searched between May 2013 and November 2019 and retrospectively evaluated. Inclusion criteria were the presence of a risk factor for RS, such as severe weight loss or emaciation following a period of presumed starvation, hypophosphataemia or a delta phosphorous exceeding 30% reduction following refeeding, being treated on the basis of a clinical diagnosis of RS and one or more derangement of hypokalaemia, hypoglycaemia or hyperglycaemia.

RESULTS

Eleven cats were identified, which had been missing for a median of 6 weeks (range 3-104 weeks). Mean ± SD percentage weight loss was 46% ± 7% (n = 8). Eight of 11 cats developed hypophosphataemia with a mean delta phosphorous of -47% ± 9%. All cats were documented to be hypokalaemic. During hospitalisation, 10/11 cats developed hyperglycaemia and 7/11 cats developed hypoglycaemia. Cardiovascular, gastrointestinal and neurological signs were common. Eight of 11 cats displayed new or progressive neurological deficits after refeeding, including mentation changes and cerebellar dysfunction. All cats became anaemic and seven cats required a blood transfusion. Eight cats survived to discharge after a mean of 14 ± 4 days of hospitalisation. Six cats developed acute kidney injury (AKI; International Renal Interest Society stage 1). The presence of AKI (P = 0.024) was associated with non-survival and maximum bilirubin concentration was significantly higher in non-survivors (P = 0.018).

CONCLUSIONS AND RELEVANCE

Cats with RS in this cohort had been missing, presumed starved, for more than 3 weeks. In addition to hypophosphataemia and hypokalaemia, altered glucose homeostasis and organ damage involving the liver and kidneys were common. Cats with RS appear to have a good prognosis, but prolonged intensive care is required.

Hemorrhage and complications associated with percutaneous ultrasound guided liver biopsy in dogs

BACKGROUND

Liver biopsy is often necessary to obtain a diagnosis in dogs with hepatobiliary disease. Hemorrhage after biopsy is a concern.

OBJECTIVE

To describe the extent of hemorrhage and incidence of complications after percutaneous ultrasound guided liver biopsy (PUGLB) in dogs and to examine risk factors for hemorrhage or complications.

ANIMALS

One hundred two client owned dogs with suspected hepatobiliary disease that underwent PUGLB.

METHODS

Medical records were retrospectively reviewed. Using human guidelines, major hemorrhage was defined as an absolute decrease in the PCV (ΔPCV) ≥ 6%. Complications were defined separately as clinically relevant physiologic compromise that necessitated intervention or death. The relationship between ΔPCV and the occurrence of complications and the initial PCV, coagulation variables, serum activity of liver-derived enzymes, serum bilirubin concentration, number of biopsies, biopsy needle gauge, radiologist experience, histological diagnosis, and ultrasound variables were compared.

RESULTS

Before PUGLB, most aberrations in coagulation variables were mild. After biopsy a decrease in PCV occurred in 87/102 (85.3%) dogs. The mean ΔPCV was -7.2% ± 4.5%. Major hemorrhage occurred in 43/102 (42.2%) dogs and complications in 2/102 (1.9%). ΔPCV was significantly positively correlated with PCV before biopsy (r = .47, P = .004). There was no correlation between ΔPCV or complications with any of the variables examined.

CONCLUSION AND CLINICAL IMPORTANCE

Percutaneous ultrasound guided liver biopsy in the population of dogs in the current study, with normal or mild abnormalities in coagulation, results in a high incidence of clinically silent, major hemorrhage (42.5%), but few complications (1.9%).

Hypocholesterolemia in cats: a multicenter retrospective study of 106 cats

OBJECTIVES

The aim of this study was to describe the clinicopathologic findings and associated diseases found in a population of hypocholesterolemic cats referred to two tertiary care facilities.

METHODS

An electronic medical record search was performed at two veterinary university referral centers to identify cats with serum cholesterol values below the reference interval between January 2004 and 2016. Clinicopathologic data were reviewed for each case and cats were classified into specific disease categories based on clinical diagnosis. Median cholesterol values were compared between disease categories, as well as between survivors and non-survivors.

RESULTS

In total, 106 hypocholesterolemic cats were included. The median age of the cats was 6 years (range 0.24-18 years). The most common disease categories were gastrointestinal (25.9%), hepatobiliary (19.8%), hematologic (14.8%) and urogenital (14.8%). Though median serum cholesterol values did not differ significantly between survivors and non-survivors, cats with concurrent hypoalbuminemia were at higher risk (odds ratio 15.6, 95% confidence interval 5.2-46.6; P <0.0001) of not surviving to discharge than cats with normal serum albumin concentrations.

CONCLUSIONS AND RELEVANCE

Taken together, our data suggest that while the degree of hypocholesterolemia did not appear to influence survival rates, the concurrent presence of hypocholesterolemia and hypoalbuminemia was associated with a worse prognosis.

The influence of packed cell volume versus plasma proteins on thromboelastographic variables in canine blood

OBJECTIVE

Determine the correlation between kaolin-activated thromboelastography (TEG) variables (R, K, angle, and maximum amplitude [MA]) and PCV, fibrinogen concentration (FC), and total fibrinogen (TF) in an ex vivo model.

ANIMALS

Two healthy adult mixed-breed dogs.

PROCEDURES

Citrated whole blood was obtained and separated into packed red cells, platelet rich plasma, and platelet poor plasma (PPP). An aliquot of PPP was heated to denature heat labile proteins (fibrinogen, factor V, factor VIII). Blood components were recombined for analyses of 6 physiological scenarios: anemia with low fibrinogen; anemia with moderate fibrinogen; anemia with normal fibrinogen; anemia with normal saline; normal PCV and normal fibrinogen; and normal PCV and low fibrinogen. A Kruskal-Wallis test, along with linear regressions on pairwise combinations of TEG variables, was used to determine the correlation between TEG variables and PCV, FC, and TF.

RESULTS

Maximum amplitude correlated with FC (R² 0.60, P < 0.001) and TF (R² 0.57, P < 0.001) but not PCV (R² 0.003, P = 0.7). Angle and K time were moderately correlated with FC ([angle: R² 0.53, P < 0.001]; [K: R² 0.55, P < 0.001]) and TF ([alpha angle: R² 0.52, P < 0.001]; [K: R² 0.51, P < 0.001]) but not PCV. The R time was weakly correlated with PCV (R² 0.15, P < 0.009) but not FC or TF.

CONCLUSIONS AND CLINICAL RELEVANCE

In an ex vivo model, plasma proteins but not PCV impacted TEG variables. This suggests that TEG changes noted with anemia are imparted by changes in available fibrinogen in a fixed microenvironment rather than artifact of anemia.

The use of smartphone-obtained images to extrapolate canine packed cell volume

OBJECTIVE

To determine whether a smartphone-obtained image can be used to extrapolate the PCV of canine blood samples.

DESIGN

Prospective study of surplus blood obtained from clinical cases.

SETTING

University teaching hospital.

INTERVENTIONS

Blood samples were placed on filter paper, and images were obtained with a smartphone in different environments. These results were then compared to the PCV measurements on the same samples following the World Health Organization guidelines.

MEASUREMENTS

Sixty-nine samples were assessed and identified that smartphone images, obtained in a controlled environment, were able to predict the PCV of the samples. This prediction was most accurate when assessing samples of a normal erythroid mass or polycythemic samples.

CONCLUSIONS

The results of this study suggest that smartphone-obtained images do have a utility in predicting canine PCV. If this can be incorporated into a smartphone application, there would be scope to use this in low resource settings.

Accuracy of a flash glucose monitoring system in dogs with diabetic ketoacidosis

Background

A factory‐calibrated flash glucose monitoring system (FGMS; FreeStyle Libre) recently was evaluated in dogs with uncomplicated diabetes mellitus. It is not known if this system is reliable during diabetic ketoacidosis (DKA).

Objectives

To assess the performance of the FGMS in dogs with DKA and to determine the effect of severity of ketosis and acidosis, lactate concentration, body condition score (BCS), and time wearing the sensor on the accuracy of the device.

Animals

Fourteen client‐owned dogs with DKA.

Methods

The interstitial glucose (IG) measurements were compared with blood glucose (BG) measurements obtained using a validated portable glucometer. The influence of changes in metabolic variables (β‐hydroxybutyrate, pH, bicarbonate, and lactate) and the effect of BCS and time wearing on sensor performance were evaluated. Accuracy was determined by fulfillment of ISO15197:2013 criteria.

Results

Metabolic variables, BCS, and time wearing were not associated with the accuracy of the sensor. Good agreement between IG measurements and BG was obtained both before and after DKA resolution (r = .88 and r = .93, respectively). Analytical accuracy was not achieved, whereas clinical accuracy was demonstrated with 100% and 99.6% of results in zones A + B of the Parkes consensus error grid analysis before and after DKA resolution, respectively.

Conclusions and Clinical Importance

Changes in metabolic variables, BCS, and time wearing do not seem to affect agreement between IG and BG. Despite not fulfilling the ISO requirements, the FGMS provides clinically accurate estimates of BG in dogs with DKA.

Neutrophil-to-lymphocyte ratio, nucleated red blood cells and erythrocyte abnormalities in canine systemic inflammatory response syndrome

Systemic inflammatory response syndrome (SIRS) is the manifestation of the systemic response to an infectious or non-infectious disease. We evaluated the association between erythrocyte parameters, including nucleated red blood cells (NRBCs) and leukocyte ratios (NLR, neutrophil-to-lymphocyte ratio; BLR, band neutrophil-to-lymphocyte ratio; BLNR, band neutrophil-to-neutrophil-to-lymphocyte ratio). A review of the medical records was conducted searching SIRS dogs among those admitted to our intensive care unit and a SIRS grading was obtained based on how many criteria were fulfilled. The Acute Patient Physiology and Laboratory Evaluation (APPLE_fast) score was assessed in each dog. Survival rate was assessed 15 days after admission. Dogs with clinical and/or clinicopathological signs of hemolytic or hemorrhagic disorders were excluded. Dogs with ≥2 criteria of SIRS along with a documented underlying infectious cause were recorded as septic (32/90, 35%). A SIRS grading >2 (p = .001) and an APPLE_fast score > 25 (p = .03) were associated with mortality. Twenty-two of SIRS dogs (24%) showed circulating NRBCs. The occurrence of circulating NRBCs was associated with the mortality in SIRS groups (p = .0025). The median NLR was 11.69 and NLR was lower in septic dogs compared to non-septic ones (p = .0272). APPLE_fast, SIRS grading and circulating NRBCs may be considered as negative prognostic factors in canine SIRS. NLR could be a useful tool in dogs with SIRS, which was significantly lower in the septic group. Further prospective, large-scale studies investigating BLR and BNLR in canine SIRS are warranted.

Feline non-regenerative anemia: Diagnostic and treatment recommendations

PRACTICAL RELEVANCE

Non-regenerative anemia, or anemia with reticulocytopenia, is a daily diagnosis in feline practice.

CLINICAL CHALLENGES

The disease processes underlying non-regenerative anemia are many and diverse. A major diagnostic evaluation may be required to correctly diagnose and treat the underlying cause.

AUDIENCE

All veterinarians caring for cats will face the diagnostic and therapeutic challenge of non-regenerative anemia. Readers will benefit from the review of diagnostic testing and therapeutic options for non-regenerative anemia.

EVIDENCE BASE

This review summarizes the currently available literature informing diagnostic and treatment recommendations related to non-regenerative anemia. The evidence available to support the recommendations in this review is graded as low and includes predominantly expert opinion, case reports and cases series, on which the authors' interpretation/consensus is based.

Bleeding risk and complications associated with percutaneous ultrasound-guided liver biopsy in cats

OBJECTIVES

Liver biopsy is necessary for a diagnosis of liver disease; however, post-biopsy bleeding is a concern. The aim of this study was to describe the extent of bleeding and the occurrence of complications after percutaneous ultrasound-guided liver biopsy (PUGLB) in cats.

METHODS

The medical records of 30 cats that had a PUGLB were retrospectively reviewed. Using human guidelines, bleeding was classified as minor or major when the absolute change in packed cell volume (ΔPCV) was <0 and >-6% or ≤-6%, respectively. Complications were defined as physiologic compromise necessitating an intervention, or death. The relationship between ΔPCV and the occurrence of complications and the signalment, initial PCV, coagulation parameters, serum liver enzymes and bilirubin, number of biopsies, histological diagnosis, ultrasound findings, radiologist experience, concurrent procedures and vitamin K administration were assessed using Fisher's exact test, ANOVA and Pearson's correlation coefficient, with a P value <0.05 considered significant.

RESULTS

All cats had a decrease in PCV after biopsy. The mean ΔPCV was -6.9% ± 4.1%. Minor and major bleeding occurred in 13/30 (43.3%) and 17/30 (56.7%) cats, respectively, and non-lethal bleeding complications occurred in 5/30 (16.7%). Cats with complications had a lower pre-biopsy PCV ( P <0.003). Major bleeding was more likely with a diagnosis of hepatic lipidosis ( P = 0.03). There was no correlation between ΔPCV or complications and signalment, coagulation parameters, serum parameters, number of biopsies, ultrasound findings, radiologist experience, concurrent procedures and vitamin K administration.

CONCLUSIONS AND RELEVANCE

PUGLB is a relatively safe procedure in cats, although many cats have a subclinical decrease in PCV. As conventional coagulation tests did not predict complications or the magnitude of ΔPCV, there is a need for more sensitive indicators of bleeding risk in cats undergoing PUGLB.

The impact of botfly parasitism on the health of the gracile mouse opossum (Gracilinanus agilis)

Fragmented habitats generally harbour small populations that are potentially more prone to local extinctions caused by biotic factors such as parasites. We evaluated the effects of botflies (Cuterebra apicalis) on naturally fragmented populations of the gracile mouse opossum (Gracilinanus agilis). We examined how sex, food supplementation experiment, season and daily climatic variables affected body condition and haemoglobin concentration in animals that were parasitized or not by botflies. Although parasitism did not affect body condition, haemoglobin concentrations were lower in parasitized animals. Among the non-parasitized individuals, haemoglobin concentration increased with the increase of maximum temperature and the decrease of relative humidity, a climatic pattern found at the peak of the dry season. However, among parasitized animals, the opposite relationship between haemoglobin concentration and relative humidity occurred, as a consequence of parasite-induced anaemia interacting with dehydration as an additional stressor. We conclude that it is critical to assess how climate affects animal health (through blood parameters) to understand the population consequences of parasitism on the survival of individuals and hence of small population viability.

Incidence of hospital-acquired anemia in hospitalized dogs and cats

OBJECTIVE To determine the incidence of hospital-acquired anemia among dogs and cats hospitalized at a private emergency and referral center and identify possible risk factors. DESIGN Prospective, observational study. ANIMALS 56 patients (46 dogs and 10 cats). PROCEDURES Patients admitted from August 2014 through March 2015 and hospitalized for ≥ 48 hours were eligible for inclusion. Hospital-acquired anemia was defined as a PCV within reference limits on admission with development of anemia during hospitalization. Packed cell volume was measured once every 24 hours, and IV fluid volumes and blood volumes removed by means of phlebotomy were recorded. RESULTS The incidence of hospital-acquired anemia for dogs and cats combined was 34% (19/56) by 24 hours, 43% (24/56) by 48 hours, and 48% (27/56) by 72 hours. The incidence of hospital-acquired anemia was 70% (7/10) in cats and 43% (20/46) in dogs. Patients that underwent surgery had an increased odds of developing hospital-acquired anemia, compared with patients that did not undergo surgery (OR, 9.79; 95% confidence interval, 1.92 to 50.0). Cumulative phlebotomy volumes > 3% of total estimated blood volume significantly increased the risk of developing hospital-acquired anemia. CONCLUSIONS AND CLINICAL RELEVANCE Cumulative phlebotomy volumes > 3% of total blood volume and undergoing surgery significantly increased the risk that dogs and cats would develop hospital-acquired anemia. Further investigation is warranted for early identification of small animal patients at risk for development of hospital-acquired anemia and to inform effective treatment strategies.

Propofol infusion-like syndrome in a dog

An 8-year-old, spayed female Chihuahua mixed breed dog was presented for dyspnea and was subsequently mechanically ventilated. Propofol was utilized as part of the anesthetic protocol. The dog developed rhabdomyolysis, myoglobinuria, cardiac arrhythmias, liver enzyme elevation, and methemoglobinemia. Propofol was discontinued and N-acetylcysteine was administered after which the clinical signs resolved.

Diabetic ketoacidosis in the cat: Recognition and essential treatment

Practical relevance: Diabetic ketoacidosis (DKA) is a not uncommon emergency in both newly diagnosed and poorly regulated diabetic cats. When there is a heightened metabolic rate and energy requirement due to concurrent illness, an increase in the release of glucose counter-regulatory hormones causes insulin receptor resistance, lipolysis, free fatty acid release and ketogenesis. This necessitates not only treatment to eliminate the ketosis and control blood glucose, but also investigation of concurrent illnesses. Clinical challenges: A number of metabolic derangements can occur with DKA, requiring a comprehensive diagnostic evaluation, elimination of ketones, careful correction of glucose, electrolyte and acid base abnormalities, and close monitoring.

AUDIENCE

Any veterinarian that cares for cats in urgent and emergency situations should understand the pathophysiology of DKA in order to address an individual's clinical signs and metabolic derangements. Evidence base: This review draws evidence from the peer-reviewed literature as well as the author's personal clinical experience.

Placement of subcutaneous ureteral bypasses without fluoroscopic guidance in cats with ureteral obstruction: 19 cases (2014-2016)

Objectives The purpose of this study was to describe the perioperative and postoperative complications as well as short-term and long-term outcomes in cats with ureteral obstructions treated by placement of a subcutaneous ureteral bypass (SUB) device without imaging control. The second objective of this study was to compare cats treated by SUB device with cats treated by traditional surgical intervention. Methods Data were obtained retrospectively from the medical records (2014-2016) of cats that underwent SUB placement (SUB cats) and cats that underwent traditional ureteral surgery (C cats). Results Nineteen SUB devices were placed without fluoroscopic, radiographic or ultrasonographic guidance in 13 cats. Fifteen traditional interventions (ureterotomy and neoureterocystostomy) were performed in 11 cats. Successful placement of the SUB device was achieved in all cats with only one major intraoperative complication (kinking of the kidney catheter) and one minor intraoperative complication (misplacement of the kidney catheter). Eleven SUB cats recovered from the surgical procedure; two SUB cats and three C cats died during the anaesthesia recovery period. Postoperative SUB complications included anaemia (n = 2), urinary tract infection (UTI) (n = 4), non-infectious cystitis (n = 5) and SUB device obstruction (n = 1). Postoperative traditional surgery complications included anaemia (n = 7), UTIs (n = 6), non-infectious cystitis (n = 1), re-obstruction (n = 4) and ureteral stricture (n = 1). Median postoperative duration of hospitalisation (3 days) was significantly shorter for SUB cats than for C cats ( P = 0.013). Ten SUB cats (76.9%) and four C cats (40%) were still alive at a median follow-up of 225 days and 260 days, respectively. Owners were completely (90%) or mostly (10%) satisfied with the SUB device placement. Conclusions and relevance SUB device placement appears to be an effective and safe option for treating ureteral obstruction in cats, and this study has shown that fluoroscopic guidance is not essential in all cases.

Investigation of iron status and markers of inflammation in anaemic and non-anaemic hospitalised cats

OBJECTIVES

To measure iron parameters and markers of inflammation in anaemic cats presented for intensive care unit hospitalisation, and to compare these to cohorts of non-anaemic hospitalised cats and cats that develop hospital-acquired anaemia.

METHODS

Blood samples were collected for measurement of iron panel and serum amyloid A in addition to routine investigation in cats admitted to the intensive care unit. Medical records were reviewed to determine how many of the Systemic Inflammatory Response Syndrome criteria were met and to assign Acute Patient Physiologic and Laboratory Evaluation scores as a measure of illness severity.

RESULTS

Seventy-eight cats were enrolled. Anaemia was documented in 34·6% of cats on presentation and another 10·3% developed anaemia during hospitalisation. Compared with non-anaemic cats, animals that were anaemic on presentation had higher neutrophil and white blood cell counts, and longer hospitalisation. Iron status was consistent with anaemia of inflammation in most anaemic patients. Iron status, serum amyloid A concentration, and prevalence of systemic inflammatory response syndrome did not differ between anaemic and non-anaemic cohorts. All cause mortality was higher in anaemic cats.

CLINICAL SIGNIFICANCE

Anaemia is common in cats hospitalised in the intensive care unit. Systemic inflammation is also common in these cats. Iron status in anaemic cats suggests that anaemia of inflammatory disease may be a significant contributor to anaemia in this patient population.

Gastroduodenal Ulceration in Small Animals: Part 2. Proton Pump Inhibitors and Histamine-2 Receptor Antagonists

In the first part of this review, we discussed the pathophysiology and epidemiology of gastric acid secretion and the epidemiology of gastroduodenal ulceration in dogs and cats. In this section, we discuss the pharmacology and evidence-based clinical use of histamine-2 receptor antagonists and proton pump inhibitors.