Successful management of persistent tachycardia using esmolol in 2 dogs with septic shock

OBJECTIVE

To describe the successful management of 2 dogs with septic shock and persistent tachycardia using norepinephrine and esmolol, a short-acting beta receptor antagonist.

SERIES SUMMARY

Two cases are reviewed. In the first case, septic shock with ventricular tachycardia was diagnosed in a 4-year-old neutered female Great Dane that underwent jejunoileal resection and anastomosis for a partial mesenteric torsion. The patient's tachyarrhythmias failed to respond to lidocaine, and an esmolol infusion was used for heart rate control. The condition of the dog improved and she was discharged after 4 days of hospitalization. The second case was a 7-year-old neutered female Cavalier King Charles Spaniel with septic peritonitis. Following surgery for intestinal resection and anastomosis, supraventricular tachycardia developed that was not responsive to volume resuscitation and was treated with an esmolol infusion. The condition of the dog improved and she was discharged after 6 days of hospitalization. Both patients were doing well at the time of long-term follow-up.

NEW OR UNIQUE INFORMATION PROVIDED

This case series highlights a novel method of managing dogs in septic shock with persistent tachycardia based on recently published data in the human literature. The use of esmolol may be considered in certain veterinary patients with septic shock to improve persistent tachycardia not related to hypovolemia.

Severe anemia in cats with urethral obstruction: 17 cases (2002-2011)

OBJECTIVE

To characterize clinical parameters of cats with severe anemia due to suspected urinary bladder hemorrhage associated with urethral obstruction.

DESIGN

Retrospective case-control study.

SETTING

University teaching hospital.

ANIMALS

Seventeen cats with urethral obstruction and severe anemia (group "UO-A") that required transfusion were identified via medical record database search. Thirty cats with urethral obstruction and mild or no anemia (group "UO") were included as controls.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

The median PCV of all cases at presentation was 28% (range, 9%-47%). Seven cats had PCV ≤20% at presentation, and all transfused cats had PCV ≤20% at the time of transfusion. Three cats did not receive a transfusion despite PCV ≤18%. Cats in the UO-A group had a significantly longer duration of clinical signs (P = 0.001), and were more likely to have a history of previous urethral obstruction (P = 0.011), have a heart murmur (P = 0.002), have a gallop rhythm (P = 0.005), and have lower blood pressure (P = 0.007) compared to those in the UO group. Additionally, UO-A cats had significantly lower pH, more negative base excess, higher BUN, and higher creatinine compared to UO cats. Duration of urinary catheterization was significantly (P = 0.016) longer in UO-A cats. All UO cats survived to discharge, whereas 4/17 (23.5%) UO-A cats were euthanized (P = 0.013).

CONCLUSIONS

A history of previous urethral obstruction and longer duration of clinical signs may be important risk factors for severe anemia in UO cats. Additionally, UO-A cats appeared to be more severely affected, as evidenced by lower blood pressure, more severe metabolic acidosis, higher BUN and creatinine, and worse outcome.

Perioperative Acid-Base and Electrolyte Disturbances

Obtaining and interpreting blood gas and electrolyte levels is essential in the management of perioperative veterinary patients. Metabolic and electrolyte alterations are common in critically ill surgical patients, and can lead to alterations in cardiovascular function, neurologic status, respiratory function, and even response to various drug therapies. Several common perioperative conditions are discussed in this article, including metabolic disturbances, electrolyte abnormalities (hyponatremia and hypernatremia, hyperkalemia), and respiratory abnormalities.

Controversies in the use of fresh frozen plasma in critically ill small animal patients

OBJECTIVE

To review the literature supporting or discouraging the use of fresh frozen plasma (FFP) transfusion in critically ill patients.

DATA SOURCES

Human and animal publications were searched using PubMed without time limits and the following keywords were used: "fresh frozen plasma," "coagulopathy," "hypocoagulable state," "hypercoagulable states," and "critical illness."

HUMAN DATA SYNTHESIS

The commonly used tests of coagulation (eg, prothrombin time, activated partial thromboplastin time, international normalized ratio) are poorly predictive of clinical bleeding. FFP use in critically ill patients is unlikely to result in improved outcomes and may be associated with increased risks.

VETERINARY DATA SYNTHESIS

There is insufficient evidence to make definitive conclusions regarding the use of FFP in critically ill animals, but clinical studies are underway that may provide further data that clarify the optimal use of FFP in animals.

CONCLUSIONS

The use of FFP in critically ill patients remains controversial. In the absence of clinical bleeding or a risk for clinical bleeding associated with a planned procedure, treatment use of FFP is not recommended in human patients. There are insufficient data in critically ill animals to enable formulation of recommendations. Further research is warranted in dogs and cats to establish evidence-based guidelines.