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Czerwik A, Jarešová T, Olszewska A, Farke D, Schmidt MJ, Lehmann H. Manual therapeutic plasma exchange for treatment of a dog with suspected acute canine polyradiculoneuritis. Acta Vet Scand 2023; 65:14. [PMID: 36973731 PMCID: PMC10044371 DOI: 10.1186/s13028-023-00675-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Acute canine polyradiculoneuritis is one of the most common polyneuropathies occurring in dogs. The disease is very similar to the Guillain-Barré syndrome in humans. In veterinary medicine, there is no established treatment for this disease, while in human medicine, therapeutic plasma exchange and intravenous immunoglobulin administration are two main immunotherapy treatments of this syndrome. CASE PRESENTATION A 12-year-old male Jack Russel Terrier was presented with a history of acute weakness of the pelvic limbs progressing to flaccid tetraplegia with respiratory compromise. Complete diagnostic workup was performed including blood work, diagnostic imaging (radiographs of the thorax as well as ultrasound of the abdomen) and echocardiography. Based on the clinical course, neurological localisation and the results of electrodiagnostic examination acute canine polyradiculoneuritis was suspected. During the hospitalization, the dog deteriorated and was admitted to the intensive care unit for respiratory support via tracheostomy tube. In addition to symptomatic treatment, immunotherapy via single treatment of manual therapeutic plasma exchange was administered. This procedure was safe, and the dog showed improvement of clinical signs 3 days after therapy was initiated, as well as improvement of neurological signs (from grade 4 tetraplegia to grade 3) within 5 days. However, the dog was euthanized 3 weeks later due to complications related to the tracheostomy. CONCLUSIONS This is the first case report of a manual therapeutic plasma exchange in a dog with suspected acute canine polyradiculoneuritis suggesting that this method is safe and well tolerated in dogs with this disease. It may be a reasonable adjunctive treatment to supportive therapy in severe cases.
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Affiliation(s)
- Adriana Czerwik
- Department of Veterinary Clinical Sciences, Neuroradiology and Clinical Neurology, Small Animal Clinic, Justus-Liebig-University, Frankfurter Str.114, 35392, Neurosurgery, Giessen, Germany.
| | - Tereza Jarešová
- Department of Veterinary Clinical Sciences, Internal Medicine, Small Animal Clinic, Justus- Liebig-University, Frankfurter Str.114, 35392, Giessen, Germany
| | - Agnieszka Olszewska
- Department of Veterinary Clinical Sciences, Neuroradiology and Clinical Neurology, Small Animal Clinic, Justus-Liebig-University, Frankfurter Str.114, 35392, Neurosurgery, Giessen, Germany
| | - Daniela Farke
- Department of Veterinary Clinical Sciences, Neuroradiology and Clinical Neurology, Small Animal Clinic, Justus-Liebig-University, Frankfurter Str.114, 35392, Neurosurgery, Giessen, Germany
| | - Martin Jürgen Schmidt
- Department of Veterinary Clinical Sciences, Neuroradiology and Clinical Neurology, Small Animal Clinic, Justus-Liebig-University, Frankfurter Str.114, 35392, Neurosurgery, Giessen, Germany
| | - Hendrik Lehmann
- Department of Emergency and Critical Care Service, Vetklinikum LS, Laxenburger Str. 252a, 1230, Vienna, Austria
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Guarino AL, Cagle LA, Ehrhardt CM, Beatty SSK, Stern JK, Gilor C, Specht AJ, Londoño LA. Successful multimodal treatment of extreme hypertriglyceridemia in a juvenile diabetic dog. J Vet Emerg Crit Care (San Antonio) 2023; 33:247-256. [PMID: 36573353 DOI: 10.1111/vec.13275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To describe the therapeutic protocol used to normalize severe hypertriglyceridemia in a dog. CASE SUMMARY A 7-month-old, 1.2-kg female Pomeranian presented with acute polyuria, polydipsia, and ocular discoloration. Diagnoses included diabetic ketosis, severe hypertriglyceridemia (>225 mmol/L [>20,000 mg/dl]), lipemia retinalis, and bilateral uveitis. The triglyceride concentration was near normal within 2 days of initiating treatment with fenofibrate, regular insulin constant rate infusion (CRI), manual therapeutic plasma exchange (TPE), and a low-fat diet. All clinical signs resolved. The dog has had no relapse of hypertriglyceridemia at the time of writing the manuscript, 6 months later, with continued treatment of diabetes mellitus. NEW OR UNIQUE INFORMATION PROVIDED This is the first case report documenting the combination of fenofibrate, insulin CRI, and manual TPE for treatment of severe hyperlipidemia in a dog. Detailed protocols for manual TPE and a novel insulin CRI are provided. A discussion of multiple spurious biochemical and hematologic errors associated with the severe hypertriglyceridemia is also provided.
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Affiliation(s)
- Aria L Guarino
- Blue Pearl Veterinary Partners, Rockville, Maryland, USA
- Small Animal Hospital, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Laura A Cagle
- Diagnostic Laboratories, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Caryn M Ehrhardt
- Small Animal Hospital, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Sarah S K Beatty
- Diagnostic Laboratories, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
- Antech Diagnostics, Fountain Valley, California, USA
| | - Jere K Stern
- Diagnostic Laboratories, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
- Auburn University Clinical Pathology Laboratory, College of Veterinary Medicine, Auburn University, Auburn, Alabama, USA
| | - Chen Gilor
- Small Animal Hospital, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Andrew J Specht
- Small Animal Hospital, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Leo A Londoño
- Small Animal Hospital, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
- Capital Veterinary Specialists, Jacksonville, Florida, USA
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Niemann L, Beckmann K, Iannucci C, Wang Leandro A, Vigani A. Diagnosis of post-attenuation neurological signs syndrome in a cat with refractory status epilepticus and clinical response to therapeutic plasma exchange. JFMS Open Rep 2022; 8:20551169221121919. [PMID: 36132424 PMCID: PMC9484050 DOI: 10.1177/20551169221121919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Case summary An 8-year-old female spayed British Shorthair cat that underwent surgical portosystemic
shunt (PSS) attenuation developed progressive neurological signs 7 days postoperatively.
Neurological signs progressed, despite medical management, and seizure activity became
rapidly refractory to anticonvulsants. The diagnosis of post-attenuation neurological
signs (PANS) was made based on the timing of the occurrence of clinical signs following
surgery, absence of hyperammonaemia and suggestive MRI findings of the brain. The cat
developed status epilepticus that required treatment with general anaesthesia and
mechanical ventilation, from which the cat could not be effectively weaned without the
recurrence of seizures. Therapeutic plasma exchange (TPE) was performed as a rescue
therapy for PANS and associated refractory status epilepticus. A total of two plasma
volumes were processed during one single TPE session. The seizure activity resolved
immediately after the TPE session, the cat showed progressive improvement of
neurological signs and remained stable thereafter. No significant complications
associated with the TPE were observed. The cat was discharged 11 days after admission
and was fully recovered. Relevance and novel information This is an unusual report of PANS diagnosed in a cat based on clinical and MRI
findings. The cat developed refractory status epilepticus and had a positive outcome
following TPE as rescue therapy. The MRI findings in this report could be useful for the
diagnosis of PANS in cats. We speculate that TPE could be taken into consideration as a
possible therapeutic intervention in PANS syndrome.
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Affiliation(s)
- Lisa Niemann
- Department of Small Animals, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Katrin Beckmann
- Department of Small Animals, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Claudia Iannucci
- Department of Small Animals, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Adriano Wang Leandro
- Department of Small Animals, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Alessio Vigani
- Department of Small Animals, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Epstein SE, Hopper K, Farrell KS. Manual plasma exchange to treat an accidental overdose of intravenous lipid emulsion in a dog with baclofen toxicosis. J Am Vet Med Assoc 2022; 260:650-656. [DOI: 10.2460/javma.21.03.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
CASE DESCRIPTION
An approximately 2-year-old sexually intact male German Shorthair Pointer was presented for treatment of baclofen toxicosis.
CLINICAL FINDINGS
The dog had signs of severe baclofen toxicosis (no gag reflex, intermittent vocalization, and stupor) and received intravenous lipid emulsion (142 mL/kg) as a constant rate infusion over 11 hours. Severe hypertriglyceridemia (29,221 mg/dL; reference interval, 19 to 133 mg/dL) developed, followed by cardiovascular depression (poor peripheral perfusion, hyperlactatemia, and hypertension), severe hypoglycemia (26 mg/dL), acute kidney injury (serum creatinine, 3.6 mg/dL), intravascular hemolysis, and coagulopathy (hypocoagulable thromboelastogram and marked bilateral epistaxis).
TREATMENT AND OUTCOME
Therapeutic plasma exchange was performed in 4 stages to treat the hypertriglyceridemia. For each stage, an approximately 500-mL aliquot of blood (22 mL/kg) was removed and centrifuged, and the patient’s RBCs and allogenic fresh-frozen plasma were returned to the dog. Approximately 1.2 times the dog’s plasma volume was exchanged, reducing the serum triglyceride concentration to 1,349 mg/dL and improving the dog’s cardiovascular function and coagulation. Hours after the procedure was completed, the dog regurgitated and developed acute respiratory distress as a result of presumptive aspiration pneumonia, and the owner elected to have the dog euthanized.
CLINICAL RELEVANCE
Veterinarians should be aware of possible complications associated with administration of intravenous lipid emulsion, and veterinary-specific guidelines for the maximum dose of intravenous lipid emulsion should be developed to help prevent adverse effects. TPE appears to be an effective method for treating iatrogenic hypertriglyceridemia in dogs.
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Affiliation(s)
- Steven E. Epstein
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA
| | - Kate Hopper
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA
| | - Kate S. Farrell
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA
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Wallace ML. Updates in Hepatobiliary Surgery. Vet Clin North Am Small Anim Pract 2022; 52:369-385. [DOI: 10.1016/j.cvsm.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Buseman M, Blong AE, Walton RAL. Successful management of severe carprofen toxicity with manual therapeutic plasma exchange in a dog. J Vet Emerg Crit Care (San Antonio) 2022; 32:675-679. [PMID: 35527394 PMCID: PMC9790471 DOI: 10.1111/vec.13203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 01/14/2021] [Accepted: 02/04/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To report the use of manual therapeutic plasma exchange (TPE) in a dog with severe carprofen toxicity. SUMMARY A 12-year-old neutered female Pembroke Welsh Corgi weighing 20 kg was evaluated after ingesting 223 mg/kg of carprofen. Emesis was attempted with apomorphine at the primary care veterinarian but was unsuccessful, and a dose of activated charcoal with sorbitol was administered. On presentation to the referral center, approximately 8 hours after ingestion, the dog's physical examination revealed mild abdominal discomfort but was otherwise unremarkable. Treatment consisted of a combination of supportive care including activated charcoal with sorbitol, cholestyramine, IV lipid emulsion, and manual TPE. Blood samples were collected prior to the initiation of manual TPE and at the completion of 12 exchange cycles. Carprofen levels were determined by high-pressure liquid chromatography. A 57% decrease in carprofen levels was achieved with the combination of activated charcoal, cholestyramine, IV lipid emulsion, and manual TPE. The dog did not develop organ dysfunction secondary to toxicity and was discharged 4 days after ingestion. NEW OR UNIQUE INFORMATION PROVIDED This report describes the successful decrease of plasma carprofen in a dog with the combination of decontamination techniques and manual TPE. While TPE has been previously reported as a successful therapeutic in dogs with nonsteroidal anti-inflammatory toxicity, including carprofen, equipment and expertise of this platform is not readily available. Manual TPE is technically simple and can be performed in any hospital with a large blood centrifuge.
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Affiliation(s)
- Miranda Buseman
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineIowa State UniversityAmesIowaUSA
| | - April E. Blong
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineIowa State UniversityAmesIowaUSA
| | - Rebecca A. L. Walton
- Department of Veterinary Clinical Sciences, College of Veterinary MedicineIowa State UniversityAmesIowaUSA
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Spillane AM, Haraschak JL, McMichael MA. Resolution of Severe Neurologic Signs Following Intravenous Lipid Emulsion Therapy in a Young Dog With a Portosystemic Shunt: Case Report. Front Vet Sci 2021; 8:798198. [PMID: 34957288 PMCID: PMC8694260 DOI: 10.3389/fvets.2021.798198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
A 5-month-old male intact Great Pyrenees was presented for an acute onset of severe neurologic signs (stupor, absent menace, intermittent head turn to the left). The patient's history included possible naproxen ingestion with a maximum ingested dose of 59 mg/kg, exceeding the reported dose of >50 mg/kg known to cause neurologic signs. Blood sampling for baseline bloodwork was performed, and intravenous lipid emulsion (ILE) was subsequently administered, for treatment of the suspected toxicosis. Due to severe and life-threatening neurologic signs, other methods of decontamination were contraindicated and unlikely to be effective; extracorporeal therapy was also unavailable. Complete resolution of neurologic signs occurred 30 min after completion of ILE therapy. At this time, the owners found the missing naproxen tablets after returning home and the bloodwork results returned revealing findings consistent with hepatic encephalopathy. The fasted blood ammonia concentration immediately prior to ILE administration was 702.1 μg/dL (reference interval, RI: 24–36 μg/dL) and decreased to 194.1 μg/dL 24 h later. In the first 24 h, the patient also received three doses of lactulose, N-acetylcysteine, and intravenous fluids. The patient was subsequently diagnosed with a single, large intrahepatic portosystemic shunt via computed tomography and underwent an endovascular coil embolization procedure. Given the rapid and dramatic improvement in severe neurologic signs after ILE therapy alone, it is strongly suspected that this treatment resulted in improvement of hepatic encephalopathy.
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Affiliation(s)
- Amanda M Spillane
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Jenica L Haraschak
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Maureen A McMichael
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, United States
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