A novel two-catheter method for urethral catheterization improves success rates of urethral catheterization in female dogs and cats weighing less than ten kilograms

OBJECTIVE

To compare the success rates for urethral catheterization in clinical patients using the traditional and 2-catheter techniques when placed by personnel of all experience levels.

ANIMALS

38 female cats and dogs weighing less than 10 kg were prospectively enrolled.

METHODS

Enrolled animals were randomized to have a urethral catheter placed by the traditional technique or the 2-catheter method under sedation or general anesthesia. Any qualified hospital personnel of any experience level were allowed to place the catheter. If after 5 minutes the animal was not successfully catheterized, the alternate method was performed. The previous experience of the catheter placer, animal signalment, animal condition that necessitated catheter placement, time to successful placement, and which technique was successful was recorded.

RESULTS

The 2-catheter technique was more successful than the traditional method (60.5% and 34.2%, respectively) for urethral catheterization when used by a variety of hospital personnel. The 2-catheter technique was successful in 63.3% of dogs and 66.6% of cats, while the traditional method was successful in 36.6% of dogs and 33.3% of cats. Eight of 9 (88.9%) novice catheter placers that placed their first urinary catheter in this study succeeded with the 2-catheter technique and only 1 was successful with the traditional method.

CLINICAL RELEVANCE

The 2-catheter technique has a higher rate of success for placement of female urinary catheters in small patients that are unable to have concurrent digital palpation. This technique may also be helpful in the inexperienced catheter placer population to aid in guidance into the urethral papilla.

Preliminary study evaluating the assessment of changes in pulmonary function associated with body positioning in dogs with suspected aspiration pneumonia

OBJECTIVE

To evaluate the variability in arterial blood gas (ABG) assessment of pulmonary function with different body positioning in dogs with suspected aspiration pneumonia.

KEY FINDINGS

The median differences in alveolar-arterial gradient, Pao₂ , and Paco₂ values in different recumbencies were not statistically significantly different, both within patients and across the study population. No difference was noted in ABG values in the subgroups with unilateral or bilateral disease or that were more affected on the right side versus the left side.

SIGNIFICANCE

This preliminary study provides data that can be used to calculate appropriate sample sizes for subsequent studies investigating the impact of recumbency on pulmonary function in patients with aspiration pneumonia.

Safety profile of repeated infusion of platelet-like nanoparticles in healthy dogs

OBJECTIVE

To assess the safety and efficacy of the platelet-like nanoparticle (PLN), and to assess its safety in repeated administration.

ANIMALS

6 purpose-bred dogs.

PROCEDURES

The PLN was administered IV at 3 different doses using a randomized crossover design. Each dog received a full dose of 8 X 1010 particles/10 kg, half dose, and 10 times the dose, with a 14-day washout period between doses. Biochemical, prothrombin time, partial thromboplastin time, and fibrinogen analyses were performed at baseline and 96 hours postinfusion. A CBC, kaolin-activated thromboelastography, platelet function assay closure time, and buccal mucosal bleeding time were performed at baseline and 1, 6, 24, 48, 72, and 96 hours postinfusion.

RESULTS

No significant changes were observed over time in the thromboelastography parameters, closure time, and buccal mucosal bleeding time. After the administration of the half dose, hematocrit levels decreased significantly at 1, 6, 24, 48, and 96 hours, with all values within the reference range. The platelet count was decreased significantly at hours 1, 6, 24, 48, and 72 after administration of the half dose, with values less than the reference range at all hours but hour 72. No significant changes in serum biochemistry, coagulation panel, and fibrinogen were observed for all doses. No adverse events were noted during the first infusion. Three dogs experienced transient sedation and nausea after repeat infusion.

CLINICAL RELEVANCE

The PLN resulted in a dilution of hematocrit and platelets, and did not significantly alter hemostasis negatively. The safety of repeated doses should be investigated further in dogs.

Impact of cytidine diphosphocholine on oxygenation in client-owned dogs with aspiration pneumonia

BACKGROUND

New drugs for veterinary patients with acute respiratory distress syndrome (ARDS) are urgently needed. Early or late postinfection treatment of influenza-infected mice with the liponucleotide cytidine diphosphocholine (CDP-choline) resulted in decreased hypoxemia, pulmonary edema, lung dysfunction, and inflammation without altering viral replication. These findings suggested CDP-choline could have benefit as adjunctive treatment for ARDS in veterinary patients (VetARDS).

OBJECTIVES

Determine if parenterally administered CDP-choline can attenuate mild VetARDS in dogs with aspiration pneumonia.

ANIMALS

Dogs admitted to a veterinary intensive care unit (ICU) for aspiration pneumonia.

METHODS

Subjects were enrolled in a randomized, double-blinded, placebo-controlled trial of treatment with vehicle (0.1 mL/kg sterile 0.9% saline, IV; n = 8) or CDP-choline (5 mg/kg in 0.1 mL/kg 0.9% saline, IV; n = 9) q12h over the first 48 hours after ICU admission.

RESULTS

No significant differences in signalment or clinical findings were found between placebo- and CDP-choline-treated dogs on admission. All dogs exhibited tachycardia, tachypnea, hypertension, hypoxemia, hypocapnia, lymphopenia, and neutrophilia. CDP-choline administration resulted in rapid, progressive, and clinically relevant increases in oxygenation as determined by pulse oximetry and ratios of arterial oxygen partial pressure (Pa O2 mmHg) to fractional inspired oxygen (% Fi O2 ) and decreases in alveolar-arterial (A-a) gradients that did not occur in placebo (saline)-treated animals. Treatment with CDP-choline was also associated with less platelet consumption over the first 48 hours, but had no detectable detrimental effects.

CONCLUSIONS AND CLINICAL IMPORTANCE

Ctyidine diphosphcholine acts rapidly to promote gas exchange in dogs with naturally occurring aspiration pneumonia and is a potential adjunctive treatment in VetARDS patients.

Developing a predictive model for spinal shock in dogs with spinal cord injury

BACKGROUND

Reduced pelvic limb reflexes in dogs with spinal cord injury typically suggests a lesion of the L4-S3 spinal cord segments. However, pelvic limb reflexes might also be reduced in dogs with a T3-L3 myelopathy and concurrent spinal shock.

HYPOTHESIS/OBJECTIVES

We hypothesized that statistical models could be used to identify clinical variables associated with spinal shock in dogs with spinal cord injuries.

ANIMALS

Cohort of 59 dogs with T3-L3 myelopathies and spinal shock and 13 dogs with L4-S3 myelopathies.

METHODS

Data used for this study were prospectively entered by partner institutions into the International Canine Spinal Cord Injury observational registry between October 2016 and July 2019. Univariable logistic regression analyses were performed to assess the association between independent variables and the presence of spinal shock. Independent variables were selected for inclusion in a multivariable logistic regression model if they had a significant effect (P ≤ .1) on the odds of spinal shock in univariable logistic regression.

RESULTS

The final multivariable model included the natural log of weight (kg), the natural log of duration of clinical signs (hours), severity (paresis vs paraplegia), and pelvic limb tone (normal vs decreased/absent). The odds of spinal shock decreased with increasing weight (odds ratio [OR] = 0.28, P = .09; confidence interval [CI] 0.07-1.2), increasing duration (OR = 0.44, P = .02; CI 0.21-0.9), decreased pelvic limb tone (OR = 0.04, P = .003; CI 0.01-0.36), and increased in the presence of paraplegia (OR = 7.87, P = .04; CI 1.1-56.62).

CONCLUSIONS AND CLINICAL IMPORTANCE

A formula, as developed by the present study and after external validation, could be useful for assisting clinicians in determining the likelihood of spinal shock in various clinical scenarios and aid in diagnostic planning.

Successful management of massive lamotrigine extended-release intoxication in a dog

A 3-year-old spayed female Siberian Husky presented for evaluation following ingestion of approximately 429 mg/kg of lamotrigine extended-release. She demonstrated severe neurologic and cardiac signs and was treated with lipid emulsion, anticonvulsants, antiarrhythmics and aggressive decontamination and supportive care. She was successfully discharged from the hospital 5 days later.

Assessment and Revision of the Veterinary Internship and Residency Matching Program Standardized Letter of Reference

The Veterinary Internship and Residency Matching Program (VIRMP) recently revised its electronic standardized letter of reference (SLOR) to improve the quality and usefulness of the data obtained from it and to enhance the relevance of non-cognitive and cognitive candidate attributes assessed. We used a stepwise process including a broad survey of SLOR readers and writers, analysis of past SLORs, and a multi-wave iterative revision that included key stakeholders, such as residency and internship program directors from academia and private practice. Data from the SLOR survey and analysis of past SLOR responses identified opportunities to improve applicant differentiation, mitigate positive bias, and encourage response consistency. The survey and other analytics identified and confirmed performance domains of high relevance. The revised SLOR assesses four performance domains: knowledge base and clinical skills, stress and time management, interpersonal skills, and personal characteristics. Ratings within the revised SLOR are predominantly criterion-referenced to enhance discernment of candidate attributes contained within each domain. Questions assessing areas of strength and targeted mentoring were replaced with free-text boxes, which allow writers to comment on positive and neutral/negative ratings of attributes within domains. Minor revisions were made to certain questions to enhance readability, streamline responses, or address targeted concerns identified in the SLOR survey or stakeholder review. The revised SLOR was deployed in the 2020 VIRMP; data from a survey of writers (n = 647) and readers (n = 378) indicate that the redesign objectives were achieved.

Retrospective evaluation of the use of hydrocortisone for treatment of suspected critical illness-related corticosteroid insufficiency (CIRCI) in dogs with septic shock (2010-2017): 47 cases

OBJECTIVE

To evaluate characteristics of septic shock patients treated with hydrocortisone (HC) due to suspicion of critical illness-related corticosteroid insufficiency (CIRCI) as compared to septic shock patients without suspicion of CIRCI.

DESIGN

Retrospective study between February 2010 and October 2017.

SETTING

University teaching hospital ICU.

ANIMALS

Data were collected for 47 dogs with septic shock. Twenty-one dogs were treated with HC (HC-treated) due to suspicion of CIRCI. Twenty-six dogs did not receive HC (non-HC-treated).

INTERVENTIONS

HC was administered either as an intermittent IV bolus or as a constant rate infusion (CRI) to those patients with suspected CIRCI.

MEASUREMENTS AND MAIN RESULTS

Significantly higher baseline APPLE_full scores and predicted mortality were detected in the HC-treated patients compared to non-HC-treated patients (0.87 vs 0.44 for predicted mortality, P = 0.039). Patients in the HC-treated group were on more vasopressors and cardiotonics than those in the non-HC-treated group (2.5 vs 1.5, P <0 .001). All patients initially responded to vasopressor administration, with average time to resolution of hypotension being 90 minutes for the HC-treated group compared to 60 minutes for the non-HC-treated group (P = 0.640). However, HC-treated patients took significantly longer to have a sustained resolution (a systolic blood pressure > 90 mm Hg or a mean blood pressure > 65 mm Hg for at least 4 h) of their hypotension after starting vasopressors, as compared to their non-HC-treated counterparts (8.5 vs 4 h, P = 0.001). Three (14.3%) HC-treated patients survived to discharge compared to 9 (34.6%) non-HC-treated patients, but this was not statistically significant.

CONCLUSIONS

HC-treated patients had a higher baseline risk of mortality than non-HC-treated patients. There was no significant difference in survival between the HC-treated and non-HC-treated septic shock patients. Further studies are needed to evaluate the use of HC in patients with suspected CIRCI.

Clinical use of cryopoor plasma continuous rate infusion in critically ill, hypoalbuminemic dogs

OBJECTIVE

To investigate the impact of cryopoor plasma (CPP) continuous rate infusion (CRI) on albumin concentration and colloid osmotic pressure (COP) in critically ill dogs with hypoalbuminemia.

DESIGN

Retrospective study between 2013 and 2015 with a 90-day follow-up on survivors.

SETTING

University teaching hospital.

ANIMALS

Ten hypoalbuminemic dogs receiving a CPP CRI for albumin replacement or oncotic support. All patients with documented hypoalbuminemia or low COP receiving CPP administration for albumin or oncotic support during the study period were included.

INTERVENTIONS

CRI of CPP.

MEASUREMENTS AND MAIN RESULTS

Mean age was 7.4 ± 4.5 years. Mean survival prediction index score was 0.66 ± 0.13. Seven dogs were septic, with 2 of 7 in septic shock and 5 of 7 having septic peritonitis. The mean pre- and postinfusion albumin was 15 ± 4 g/L and 21 ± 2 g/L, respectively. The median pre- and postinfusion COP was 8.6 mm Hg (4.9-9.7 mm Hg) and 10.2 mm Hg (8.1-13.3 mm Hg), respectively. The median duration of CRI was 16 hours (11-121 h). The mean CPP rate was 1.8 ± 0.6 mL/kg/h, the mean crystalloid rate administered concurrently was 0.8 ± 0.9 mL/kg/h, and the mean hydroxyethyl starch rate administered concurrently was 1.2 ± 0.9 mL/kg/h. The difference in pre- and postinfusion albumin was significantly correlated with CPP rate (P = 0.0004), whereas the difference in pre- and postinfusion COP was correlated with hydroxyethyl starch rate (P = 0.0128). Mean duration of hospitalization was 8.6 ± 3.9 days. Mann-Whitney U and Fisher's exact tests were used to compare survivors and nonsurvivors. Survivors were significantly younger than nonsurvivors (3.5 vs 11.5 y, P = 0.033). No side effects were reported. Survival to discharge was 40% with identical 90-day survival. Of the nonsurvivors, 50% died naturally.

CONCLUSIONS

There was an association between the rate of CPP and the change in albumin after CPP CRI in critically ill dogs, suggesting that CPP may be a viable option for treatment of hypoalbuminemia.

Successful management of minoxidil toxicosis in a dog

CASE DESCRIPTION A 2-year-old sexually intact female mixed-breed dog was evaluated at an emergency hospital approximately 5 hours after ingestion of an unknown amount of over-the-counter topical hair growth promoter containing 5% minoxidil foam. Vomiting and signs of lethargy were reported by the owner, and physical examination revealed tachycardia and hypotension. No treatments were performed, and the dog was transferred to a veterinary referral hospital for management of suspected minoxidil toxicosis. CLINICAL FINDINGS On arrival at the referral hospital, the dog was tachycardic (heart rate, 200 to 220 beats/min) and hypotensive (systolic arterial blood pressure, 70 mm Hg). Electrocardiography revealed a regular, narrow-complex tachycardia with no evidence of ventricular ectopy. TREATMENT AND OUTCOME Hypotension was effectively managed with a constant rate infusion of dopamine hydrochloride (12.5 μg/kg/min [5.7 μg/lb/min], IV). Once normotensive, the dog remained tachycardic and a constant rate infusion of esmolol hydrochloride (40 μg/kg/min [18.2 μg/lb/min], IV) was initiated for heart rate control. A lipid emulsion was administered IV as a potential antidote for the toxic effects of the lipophilic minoxidil, with an initial bolus of 1.5 mL/kg (0.7 mL/lb) given over 15 minutes followed by a continuous rate infusion at 0.25 mL/kg/min (0.11 mL/lb/min) for 60 minutes. While hospitalized, the dog also received maropitant citrate and ondansetron. Resolution of clinical signs was achieved with treatment, and the dog was discharged from the hospital 36 hours after admission. Four days later, the owner reported that the dog had made a full recovery and had returned to its typical behavior and activity level at home. CLINICAL RELEVANCE To the authors' knowledge, this is the first report of successful clinical management of accidental minoxidil toxicosis in a dog.