Validation of 3-dimensional mathematical computation of feline bladder volume using orthogonal ultrasonographic bladder images

Urine output measurement is critical for the management of hospitalized cats and their underlying conditions. Ultrasound-guided estimation of urinary bladder volume (UBV) is a non-invasive surrogate measurement that can provide important clinical information. The purpose of this study was to validate the accuracy of a novel 3D computation method in estimating UBV using 2D point-of-care ultrasonographic images. Bladder volume estimation was performed using coordinates from bladder circumference tracings on paired longitudinal and transverse ultrasonographic images (n = 359) aligned in 3D space for mathematical algorithmic computation. Ultrasonographic images were obtained by 2 different observers at 18 different time points on 10 healthy, purpose-bred male cats under general anesthesia in sternal recumbency. Actual urine volumes were measured via urinary catheterization and compared to UBV estimations using Lin's concordance correlation coefficient and Bland-Altman analysis. Estimation of UBV using the 3D computational bladder circumference tracing method showed moderate strength-of-agreement with actual bladder volume (ρ_c = 0.94 to 0.95) with clinically insignificant bias (3D computation-derived minus actual volume) of -1.96 mL (IQR = -3.89 to -0.57 mL, P < 0.001) and -2.42 mL (IQR = -4.64 to -0.66 mL, P < 0.001) for the 2 observers, respectively. Our study demonstrated acceptable accuracy of 3D computation method for UBV estimation in healthy cats. This method may provide a bridging alternative until 3D ultrasound becomes more readily accessible.

Validation of a commercial human ELISA to measure hyaluronic acid concentration in feline plasma

Our goal was to validate a human hyaluronic acid (HA) ELISA (Hyaluronic acid plus ELISA; TECOmedical Group) for use in feline plasma. Plasma from 5 healthy cats and 5 critically ill cats was used for validation of the assay. Validation methods performed included intra- and inter-assay variability, spike-and-recovery, and dilutional linearity. All measurements were performed in duplicate. The precision study revealed good intra-assay CV of 7.4-8.9%; inter-assay CV was 3.4-4.2%. Extraction efficiency via spiking tests yielded mean recovery of 89.6%. The assay met criteria for acceptable linearity using 3 serial dilutions. Our results demonstrate that this commercial HA ELISA had acceptable analytical performance using feline plasma and could be a useful tool in the veterinary clinical research setting.

Use of serum hyaluronic acid as a biomarker of endothelial glycocalyx degradation in dogs with septic peritonitis

OBJECTIVE

To describe daily changes in serum concentrations of hyaluronic acid (HA), a biomarker of endothelial glycocalyx degradation, in dogs with septic peritonitis and to determine whether relationships exist among serum concentrations of HA and biomarkers of inflammation and patient fluid status.

ANIMALS

8 client-owned dogs.

PROCEDURES

Serum samples that had been collected for a previous study and stored at -80°C were used. Blood samples were collected at admission and daily thereafter during hospitalization and were analyzed for concentrations of HA and interleukins 6, 8, and 10. Patient data including acute patient physiologic and laboratory evaluation score, type and amount of fluids administered daily, and daily CBC and lactate concentration results were recorded. To determine the significant predictors of HA concentration, a general linear mixed model for repeated measures was developed.

RESULTS

All dogs survived to discharge. Concentrations of HA ranged from 18 to 1,050 ng/mL (interquartile [25th to 75th percentile] range, 49 to 119 ng/mL) throughout hospitalization. Interleukin-6 concentration was a significant predictor of HA concentration as was total administered daily fluid volume when accounting for interleukin-6 concentration. When fluid volume was analyzed independent of inflammatory status, fluid volume was not a significant predictor. Concentrations of HA did not significantly change over time but tended to increase on day 2 or 3 of hospitalization.

CONCLUSIONS AND CLINICAL RELEVANCE

Results supported the theory that inflammation is associated with endothelial glycocalyx degradation. Dogs recovering from septic peritonitis may become more susceptible to further endothelial glycocalyx damage as increasing fluid volumes are administered.

Understanding Volume Kinetics: The Role of Pharmacokinetic Modeling and Analysis in Fluid Therapy

Fluid therapy is a rapidly evolving yet imprecise clinical practice based upon broad assumptions, species-to-species extrapolations, obsolete experimental evidence, and individual preferences. Although widely recognized as a mainstay therapy in human and veterinary medicine, fluid therapy is not always benign and can cause significant harm through fluid overload, which increases patient morbidity and mortality. As with other pharmaceutical substances, fluids exert physiological effects when introduced into the body and therefore should be considered as "drugs." In human medicine, an innovative adaptation of pharmacokinetic analysis for intravenous fluids known as volume kinetics using serial hemoglobin dilution and urine output has been developed, refined, and investigated extensively for over two decades. Intravenous fluids can now be studied like pharmaceutical drugs, leading to improved understanding of their distribution, elimination, volume effect, efficacy, and half-life (duration of effect) under various physiologic conditions, making evidence-based approaches to fluid therapy possible. This review article introduces the basic concepts of volume kinetics, its current use in human and animal research, as well as its potential and limitations as a research tool for fluid therapy research in veterinary medicine. With limited evidence to support our current fluid administration practices in veterinary medicine, a greater understanding of volume kinetics and body water physiology in veterinary species would ideally provide some evidence-based support for safer and more effective intravenous fluid prescriptions in veterinary patients.

Evaluation of the Distribution and Elimination of Balanced Isotonic Crystalloid, 5% Hypertonic Saline, and 6% Tetrastarch 130/0.4 Using Volume Kinetic Modeling and Analysis in Healthy Conscious Cats

This prospective, randomized, blinded, interventional cross-over study investigated the distribution, elimination, plasma volume expansion, half-life, comparative potency, and ideal fluid prescription of three commonly prescribed intravenous (IV) fluids in 10 healthy conscious cats using volume kinetic analysis that is novel to veterinary medicine. Each cat received 20 mL/kg of balanced isotonic crystalloid (PLA), 3.3 mL/kg of 5% hypertonic saline (HS), and 5 mL/kg of 6% tetrastarch 130/0.4 (HES) over 15 min on separate occasions. Hemoglobin concentration, red blood cell count, hematocrit, heart rate, and blood pressure were measured at baseline, 5, 10, 15, 20, 30, 40, 50, 60, and every 15 min until 180 min. Urine output was estimated every 30 min using point-of-care bladder ultrasonography. Plasma dilution derived from serial hemoglobin concentration and red blood cell count served as input variables for group and individual fluid volume kinetic analyses using a non-linear mixed effects model. In general, the distribution of all IV fluids was rapid, while elimination was slow. The half-lives of PLA, HS, and HES were 49, 319, and 104 min, respectively. The prescribed fluid doses for PLA, HS, and HES resulted in similar peak plasma volume expansion of 27–30%. The potency of HS was 6 times higher than PLA and 1.7 times greater than HES, while HES was 3.5 times more potent than PLA. Simulation of ideal fluid prescriptions to achieve and maintain 15 or 30% plasma volume expansion revealed the importance of a substantial reduction in infusion rates following initial IV fluid bolus. In conclusion, volume kinetic analysis is a feasible research tool that can provide data on IV fluid kinetics and body water physiology in cats. The rapid distribution but slow elimination of IV fluids in healthy conscious cats is consistent with anecdotal reports of fluid overload susceptibility in cats and warrants further investigation.

High-flow nasal cannula oxygen therapy in acute hypoxemic respiratory failure in 22 dogs requiring oxygen support escalation

OBJECTIVE

To determine the effect of high-flow nasal cannula (HFNC) oxygen therapy on cardiorespiratory variables and outcome in dogs with acute hypoxemic respiratory failure.

DESIGN

Prospective, sequential clinical trial.

SETTING

University veterinary teaching hospital.

ANIMALS

Twenty-two client-owned dogs that failed to respond to traditional oxygen support.

INTERVENTIONS

Initiation of HFNC therapy after traditional oxygen supplementation failed to increase Spo₂ > 96% and Pao₂ > 75 mm Hg or improve respiratory rate/effort.

MEASUREMENTS AND MAIN RESULTS

Physiological variables, blood gas analyses, and dyspnea/sedation/tolerance scores were collected prior to HFNC initiation (on traditional oxygen support [time 0 or T0]), and subsequently during HFNC oxygen administration at time 30 minutes, 60 minutes, and 7 ± 1 hours. Relative to T0, use of HFNC resulted in a decreased respiratory rate at 1 hour (P = 0.022) and 7 hours (P = 0.012), a decrease in dyspnea score at all times (P < 0.01), and an increase in Spo₂ at all times (P < 0.01). There was no difference in arterial/venous Pco₂ relative to T0, although Paco₂ was correlated with flow rate. Based on respiratory assessment, 60% of dogs responded to HFNC use by 30 minutes, and 45% ultimately responded to HFNC use and survived. No clinical air-leak syndromes were observed.

CONCLUSIONS

HFNC use improved oxygenation and work of breathing relative to traditional oxygen therapies, without impairing ventilation. HFNC use appears to be a beneficial oxygen support modality to bridge the gap between standard oxygen supplementation and mechanical ventilation.

Preliminary evaluation of the use of high-flow nasal cannula oxygen therapy during recovery from general anesthesia in dogs with obstructive upper airway breathing

BACKGROUND

Brachycephalic airway syndrome can pose a risk of complicated recovery from anesthesia as a result of irritation to the excess pharyngeal andlaryngeal tissue present in affected dogs. High-flow nasal cannula (HFNC) oxygen therapy is a respiratory support modality that offers provision of continuous positive airway pressure via high gas flow rates. The HFNC system actively warms and humidifies inspired gases, which improves comfort and facilitates tolerance of the high flow rates in people and dogs. HFNC oxygen therapy was applied to brachycephalic dogs that developed increased work of breathing or hypoxemia in the recovery phase of anesthesia to determine if this device would be tolerable and effective for relief of upper respiratory difficulty.

KEY FINDINGS

The HFNC nasal prong interface is well suited to the brachycephalic facial structure. The application of HFNC was found to reduce dyspnea scores in patients with signs of upper airway obstruction after general anesthesia. Aerophagia and changes in PCO₂ were noted.

SIGNIFICANCE

Application of HFNC in the recovery period may result in improved airflow during times of somnolent obstructive breathing, not unlike the use of continuous positive airway pressure therapy in sleep-disordered breathing in people.

Prescribing patterns and comparison of culture versus empiric-based selection of meropenem in cats and dogs in a veterinary teaching hospital (2011-2018)

The utilization of meropenem in a small animal veterinary teaching hospital over a 7-year period was retrospectively analyzed, and culture (CBD) versus empiric-based decisions (EBD) were compared. Meropenem was infrequently prescribed at a rate of 0.50 prescriptions/1000 admissions in cats and 0.58/1000 in dogs. The most common condition for meropenem prescription in both cats and dogs was septic peritonitis (15/52, 28.8%). Overall 65.4% of meropenem prescriptions were initiated without, or prior to, culture results indicating a need for the drug. Based on retrospective analysis of culture and susceptibility results, only 2.9% of empirical meropenem selections were indicated, while the majority were not indicated (52.9%), or of questionable indication (44.2%).

Feasibility of a novel 3-dimensional mathematical algorithmic computation of feline bladder volumes using point-of-care longitudinal and transverse cysto-colic ultrasonographic images

Conventional geometric formulas for estimating bladder volume assume that bladders have a perfectly uniform spheroid geometry. Bladders are often irregularly shaped, however, especially when under-filled or distorted by a full colon, which results in inaccurate ultrasonographic linear measurements and volume estimation. This pilot study investigates the feasibility, inter-observer reliability (reproducibility), robustness, and agreement of a novel 3-dimensional bladder volume computation method using bladder circumference tracing compared to a published feline linear bladder dimension formula. Paired sets of longitudinal and transverse B-mode bladder ultrasound images (n = 228) were acquired by 2 observers with different point-of-care ultrasonography skills using 10 healthy purpose-bred cats positioned in dorsal recumbency at various time points. Using strict criteria for Lin's concordance correlation coefficient, inter-observer agreements (n = 223) were found to be substantial (0.95 to 0.99) with statistically significant but clinically non-significant median differences (biases) of 0.96 mL [interquartile range (IQR): 0.16 to 2.46, P < 0.001] and 0.23 mL (IQR: 0.88 to 1.97, P = 0.006) when bladder circumference tracings were made on similar sets of ultrasound images respectively. Inter-observer agreements improved from substantial (0.95 to 0.99) to almost perfect (> 0.99) strength-of-agreement as the quality of ultrasound images improved. The bladder circumference tracing method showed moderate (0.90 to 0.95) strength-of-agreement with the recently published feline linear bladder dimension formula, with significant additive median differences (biases) of -6.76 mL (IQR: -9.06 to -3.88, P < 0.001) and -6.44 mL (IQR: -11.41 to -3.81, P < 0.001) recorded by each observer (n = 111, n = 83), respectively. Data obtained from orthogonal ultrasonographic bladder circumference tracings justify further investigation into use of this method for estimating bladder volume in cats.

A pilot study evaluating the effects of prestorage leukoreduction on markers of inflammation in critically ill dogs receiving a blood transfusion

OBJECTIVES

To compare markers of inflammation after transfusion of leukoreduced (LR) packed RBCs (pRBCs) versus non-LR pRBCs in dogs with critical illness requiring blood transfusion, and to report survival to discharge and rates of transfusion reactions in these dogs.

DESIGN

Prospective randomized blinded clinical study June 2014-September 2015.

SETTING

University veterinary teaching hospital.

ANIMALS

Twenty-three client-owned critically ill dogs, consecutively enrolled.

INTERVENTIONS

Dogs requiring a single pRBC transfusion were randomized into the LR or non-LR pRBC group. Exclusion criteria included: requirement for multiple blood products, history of previous blood transfusion, and administration of anti-inflammatory or immunosuppressive medication prior to enrollment.

MEASUREMENTS

Blood samples were obtained immediately prior to transfusion, then 2 and 24 hours following transfusion. Parameters measured at each time point included: PCV, WBC count, segmented and band neutrophil counts, fibrinogen, and plasma lactate and C-reactive protein concentrations. Acute patient physiologic and laboratory evaluation fast score was calculated on admission.

RESULTS

Eleven dogs were included in the LR group and 12 in the non-LR group; scores of illness severity were not significantly different between groups. Total WBC count was significantly higher in the non-LR versus LR group 24 hours following pRBC transfusion, but this difference was not evident 2 hours following transfusion. No other inflammatory parameters at any time point were significantly different between LR versus non-LR pRBC transfused dogs. Survival rates to discharge for LR and non-LR groups were 8/11 and 9/12, respectively. Acute transfusion reactions were identified in 1/11 and 2/12 dogs in the LR and non-LR group, respectively. All transfused blood was stored ≤12 days.

CONCLUSIONS

Most markers of inflammation did not significantly increase following transfusion of LR versus non-LR pRBCs stored ≤12 days in ill dogs. Further prospective, randomized trials are needed in clinically ill dogs to determine the benefit of prestorage leukoreduction.

Comparison of high flow nasal cannula oxygen administration to traditional nasal cannula oxygen therapy in healthy dogs

OBJECTIVE

To determine the feasibility, degree of respiratory support, and safety of high flow nasal cannula (HFNC) oxygen therapy in sedated and awake healthy dogs, when compared to traditional nasal cannula (TNC) oxygen administration.

DESIGN

Randomized experimental crossover study.

SETTING

University research facility.

ANIMALS

Eight healthy dogs.

INTERVENTIONS

Variable flow rates (L/kg/min) were assessed, TNC: 0.1, 0.2, and 0.4 and HFNC: 0.4, 1.0, 2.0, and 2.5. HFNC was assessed in sedated and awake dogs.

MEASUREMENTS

Variables measured included: inspiratory/expiratory airway pressures, fraction of inspired oxygen (FiO₂ ), end-tidal oxygen (ETO₂ ), end-tidal carbon dioxide (ETCO₂ ), partial pressure of oxygen (PaO₂ ), partial pressure of carbon dioxide (PaCO₂ ), temperature, heart/respiratory rate, arterial blood pressure, and pulse oximetry. Sedation status, complications, and predefined tolerance and respiratory scores were recorded.

MAIN RESULTS

Using HFNC, continuous positive airway pressure (CPAP) was achieved at 1 and 2 L/kg/min. CPAP was not higher at 2.5 than 2 L/kg/min, with worse tolerance scores. Expiratory airway pressures were increased when sedated (P = 0.006). FiO₂ at 0.4 L/kg/min for both methods was 72%. FiO₂ with TNC 0.1 L/kg/min was 27% and not different from room air. The FiO₂ at all HFNC flow rates ≥1 L/kg/min was 95%. PaO₂ for HFNC 0.4 L/kg/min was lower than at other flow rates (P = 0.005). The only noted complication was aerophagia. PaCO₂ was increased with sedation and use of HFNC when compared to baseline (P = 0.006; P < 0.01).

CONCLUSIONS

Use of HFNC in dogs is feasible and safe, provides predictable oxygen support and provides CPAP, but may cause a mild increase in PaCO₂ . Flow rates of 1-2 L/kg/min are recommended. If using TNC, flow rates above 0.1 L/kg/min may attain higher FiO₂ .

Comparison of fentanyl and hydromorphone constant rate infusions for pain management in dogs in an intensive care unit

OBJECTIVE

To compare the efficacy and quality of analgesia provided by constant rate infusions (CRIs) of hydromorphone and fentanyl in dogs in the intensive care unit (ICU).

STUDY DESIGN

Prospective, randomized, blinded, clinical trial.

ANIMALS

A total of 29 client-owned dogs.

METHODS

Dogs prescribed a μ-opioid agonist infusion for postsurgical or medical pain were randomized to be administered either hydromorphone (0.025 or 0.05 mg kg^-1 bolus, followed by a 0.03 mg kg^-1 hour^-1 infusion) or fentanyl (2.5 or 5 μg kg^-1 bolus, followed by a 3 μg kg^-1 hour^-1 infusion). The technical staff and clinicians were blinded as to which drug was administered. Pain scores, using the Colorado State University Canine Acute Pain Scale, sedation scores and nausea scores were assigned at regular intervals and compared between groups. Dose escalation and de-escalation of the study drug were performed according to set protocols. Adverse clinical signs and all other medications administered were recorded and compared between groups. The study drug was discontinued if the animal remained painful despite dose escalations, or if adverse effects were noted.

RESULTS

The pain scores were of low magnitude and were not significantly different between groups. The use of concurrent analgesia, sedation/anxiolytic medications and antacid/antiemetic medications was not different between groups. Sedation and nausea scores were not statistically different between groups.

CONCLUSIONS AND CLINICAL RELEVANCE

Hydromorphone and fentanyl CRIs appear to be equally effective for adequate pain relief in dogs, with no significant differences in adverse effects. Therefore, either drug may be chosen for control of postsurgical or medical pain in an ICU setting.

Perioperative analgesic use by Ontario veterinarians, 2012

The objectives of this study were to describe the routine use of analgesics by Ontario veterinarians for common surgeries in dogs and cats, and to compare routine use of analgesics between species and surgeries, using Chi-square analyses. In total, 239 veterinarians responded to the questionnaires; a response rate of 13.1%. Fifty-two percent to 79% of veterinarians used meloxicam for both species and all surgeries. Approximately 9% of veterinarians did not use analgesics for dog ovariohysterectomy and castration, while 16% to 22% did not use analgesics for these surgeries in cats. Veterinarians used and dispensed analgesics to dogs more often than to cats (P < 0.05). Many (60% or more) veterinarians administered analgesics pre-emptively to both dogs and cats for all surgeries. Continuing education for veterinarians needs to focus on understanding of pre-emptive analgesia, preventive analgesia, and the importance of dispensing analgesic drugs after surgery for all surgeries.

A Quick Reference on Magnesium

This article serves as a quick reference on the distribution, handling, and supplementation of magnesium. It also lists the manifestations and causes of magnesium deficit and provides criteria for the diagnosis of a magnesium deficit.

Using focus groups to engage veterinary students in course redesign and development

Students' perceptions about the quality of teaching have been shown to influence their approaches to learning and studying. The literature suggests that understanding student perceptions is critical to making informed decisions about curriculum development so that courses meet objectives, enhance engagement, and, ultimately, improve learning. However, the assessment of students' perceptions of their courses and the quality of teaching is frequently limited to an end-of-term course evaluation survey. While these course evaluations may be useful in providing a summative assessment, they do not typically provide insight into the reasons and influences that underlie student ratings. Achieving this type of understanding can be accomplished through qualitative methodology, which is a process of investigation used to reveal the depth, complexity, and nuances of perceptions and experiences. In the current article, we report the use of focus groups as a method of gaining in-depth understanding of student perceptions for course redesign. We present the redesign of the Art of Veterinary Medicine II course, a second-year core offering within the Doctor of Veterinary Medicine curriculum at the Ontario Veterinary College in Guelph, Canada. A series of student focus groups were held to gain greater insight into student perceptions of the course objectives, format, and content. Findings were then considered in the redevelopment of the course to better engage students and their various learning styles. Summative course evaluations as well as informal feedback before and after the focus groups indicate a notable improvement in student experiences and perceptions of the course format and content following the focus-group informed course redesign.

Making sense of blood gas results

Recent technologic advances have allowed the production and marketing of cage-side blood gas analyzers to private practitioners. The widespread use of cage-side portable blood gas analyzers in veterinary practices has increased the need to develop the basic skills of blood gas analysis as part of a tool kit for practicing veterinarians. Rapid expansion of emergency and critical care medicine as a specialty and increased numbers of veterinary emergency and veterinary specialty practices have occurred concurrently with the availability of blood gas analyzers that are affordable for private practitioners. As a result, evaluation of blood gas results is no longer an activity confined to academic institutions and has become a daily part of many practicing veterinarians' activities.

Evaluation of a local anesthetic delivery system for the postoperative analgesic management of canine total ear canal ablation--a randomized, controlled, double-blinded study

OBJECTIVE

To determine if a constant rate local anesthetic delivery system is more effective than continuous intravenous (IV) morphine infusion for postoperative analgesia.

ANIMALS

Twenty client-owned dogs undergoing total ear canal ablation.

METHODS

Dogs were randomly assigned to the lidocaine group (LID) or the morphine group (MOR). The LID group received a constant rate infusion of lidocaine locally and a continuous IV infusion of saline, while the MOR group received a constant rate infusion of saline locally and a continuous IV infusion of morphine. The primary investigator evaluated each patient and determined a hospital behavior score, anesthesia recovery score, preoperative pain score, and serial postoperative pain and sedation scores over 38 hours. Pain and sedation observations were videotaped and scored by three additional evaluators. Evaluators were blinded to treatment assignments.

RESULTS

There were no significant differences in age, weight, hospital behavior scores or anesthesia recovery scores. The primary investigator's pain scores were not significantly different, but sedation scores were significantly lower for the LID group. Sedation and pain scores by the video evaluators were not significantly different between groups. Kappa agreement between observers was poor, but better agreement was noted between sedation scores than pain scores. Drug-related complications were significantly lower in the LID group (n = 0) compared with the MOR group (n = 5). Wound complications were not significantly different (LID = 4, MOR = 4). Intravenous delivery complications occurred in 12 (60%) patients. Local delivery complications occurred in five (25%) dogs. Delivery complications were not significantly different between groups.

CONCLUSIONS AND CLINICAL RELEVANCE

Continuous incisional lidocaine delivery was an equipotent and viable method of providing postoperative analgesia compared with IV morphine. Lidocaine delivery resulted in a trend toward lower pain scores, significantly lower sedation scores, and no dogs requiring analgesic rescue. Wound complications secondary to local infusion were minor and self-limiting. Drug-related complications occurred only in the MOR group.

Communication in the veterinary emergency setting

Veterinarians working in emergency situations are frequently faced with challenging communication situations. Obtaining informed consent is often difficult because of the emotional content of the situation and the limited amount of time available. Emergency veterinarians are also frequently required to deliver bad, sad, or unwelcome news to clients. Using effective communication skills in these situations may decrease the anxiety and stress for the health care team and contribute to several positive outcomes for the client.

Senior veterinary students' perceptions of using role play to learn communication skills

Recent studies of veterinary practice have suggested a correlation between well-developed communication skills and job satisfaction, career retention, customer satisfaction, decreased lawsuits, and financial remuneration for veterinarians. Veterinary educators are under growing pressure to teach functional communication skills to veterinary students; however, the methods employed have not been well evaluated. In this study we have evaluated veterinary student's attitudes to learning communication skills by participating in role play. The study indicates that experiential learning modalities such as role play are perceived as effective by students, despite reluctance to participate and some discomfort surrounding participation.

Combined use of ultrasonography and contrast enhanced computed tomography to evaluate acute necrotizing pancreatitis in two dogs

The imaging findings in two miniature schnauzers with acute necrotizing pancreatitis are described. Both dogs were treated previously for diabetes mellitus and hyperlipidemia. Vomiting, anorexia, and lethargy were observed in both dogs at presentation. Laboratory evaluations supportive of pancreatitis included left shift, abnormally high serum amylase and lipase activities, hypocalcemia, and abnormally high serum activities of liver enzymes. Sonographically, both dogs had diffusely enlarged hypoechoic pancreatic tissue with anechoic foci compatible with necrosis, abscessation, phlegmon, and pseudocysts formation. Contrast-enhanced computed tomography (CT) findings in both dogs were compatible with pancreatic necrosis. Dog 1 was managed medically for 11 days. Follow-up CT scan in this dog disclosed decreased pancreatic size and increased contrast enhancement compatible with partial resolution of pancreatitis.

Clinical findings, treatment, and outcome of dogs with status epilepticus or cluster seizures: 156 cases (1990-1995)

OBJECTIVE

To report clinical findings, treatments, and outcomes of dogs admitted to the hospital for status epilepticus or cluster seizures and evaluate factors associated with outcome.

DESIGN

Retrospective study.

ANIMALS

156 dogs admitted for status epilepticus or cluster seizures.

PROCEDURE

Medical records were reviewed for seizure and medication history, diagnostic test results, types of treatment, hospitalization costs, and outcome of hospital visits.

RESULTS

Dogs were admitted for seizures on 194 occasions. Of 194 admissions, 128 (66%), 2 (1%), 32 (16.5%), 2 (1%), and 30 (15.5%) were of dogs with a history of clusters of generalized seizures, clusters of partial complex seizures, convulsive status epilepticus, partial status epilepticus, and > 1 type of seizure, respectively. Underlying causes of seizures were primary epilepsy (26.8%; 52/194), secondary epilepsy (35.1%; 68), reactive epileptic seizures (6.7%; 13), primary or secondary epilepsy with low serum antiepileptic drug concentrations (5.7%; 11), and undetermined (25.8%; 50). One hundred and eighty-six hospital visits resulted in admission to the intensive care unit (ICU). Treatments with continuous i.v. infusions of diazepam or phenobarbital were initiated during 66.8% (124/186) and 18.7% (35) of ICU hospital stays for 22.3 +/- 16.1 hours (mean +/- SD) and 21.9 +/- 15.4 hours, respectively. Of 194 admissions, 74.7% (145) resulted in discharge from the hospital, 2.1% (4) in death, and 23.2% (45) in euthanasia. A poor outcome (death or euthanasia) was significantly associated with granulomatous meningoencephalitis, loss of seizure control after 6 hours of hospitalization, and the development of partial status epilepticus.

CONCLUSIONS AND CLINICAL RELEVANCE

Granulomatous meningoencephalitis, loss of seizure control after 6 hours of hospitalization, or the development of partial status epilepticus may indicate a poor prognosis for dogs with seizures.

Evaluation of point-of-care tests for diagnosis of disseminated intravascular coagulation in dogs admitted to an intensive care unit

OBJECTIVE

To evaluate the accuracy of point-of-care tests for the diagnosis of disseminated intravascular coagulation (DIC) in dogs and assess the correlation and agreement of results between point-of-care and laboratory tests in the evaluation of hemostatic function.

DESIGN

Prospective case series.

ANIMALS

59 critically ill dogs (affected dogs) with clinical signs of diseases known to predispose to DIC and 52 clinically normal dogs.

PROCEDURES

Accuracy of the point-of-care tests (activated clotting time [ACT], estimated platelet count and number of schizocytes from a blood smear, plasma total solids [TS] concentration, and the protamine sulfate test) was evaluated, using receiver operating characteristic curves and likelihood ratios. A strategy, using likelihood ratios to calculate a posttest probability of DIC, was tested with 65% used as a threshold for initiation of treatment. Results of laboratory tests (coagulogram and plasma antithrombin III activity) were used as the standard for comparison in each dog.

RESULTS

ACT and estimated platelet count provided the best accuracy for detection of DIC. The plasma TS concentration, schizocyte number, and protamine sulfate test had poor accuracy. The strategy using post-test probability of DIC identified 12 of 16 affected dogs that had DIC. Estimated platelet count was correlated and had acceptable clinical agreement with automated platelet count (r = 0.70). The plasma TS (r = 0.28) concentration and serum albumin (r = 0.63) concentration were not accurate predictors of plasma antithrombin III activity. The ACT did not correlate with activated partial thromboplastin time (r = 0.28).

CONCLUSIONS AND CLINICAL RELEVANCE

Strategic use of likelihood ratios from point-of-care tests can assist clinicians in making treatment decisions for dogs suspected to have DIC when immediate laboratory support is unavailable.

Diagnosis of disseminated intravascular coagulation in dogs admitted to an intensive care unit

OBJECTIVE

To describe and evaluate hemostatic function in critically ill dogs with clinical signs of diseases that predispose to disseminated intravascular coagulation (DIC).

DESIGN

Prospective case series.

ANIMALS

59 critically ill dogs (affected dogs) with clinical signs of diseases known to predispose to DIC and 52 clinically normal dogs (control dogs).

PROCEDURE

Activated partial thromboplastin time (aPTT), prothrombin time (PT), thrombin clotting time (TCT), plasma fibrinogen concentration, serum concentration of fibrin and fibrinogen-related antigens (FRA), and plasma antithrombin III (AT III) activity were determined for all dogs. Results from affected dogs were compared with those of control dogs. In some affected dogs, postmortem tissue specimens were examined for evidence of microvascular thrombosis. A diagnosis of DIC was made by fulfilling at least 3 of the following criteria: 1) abnormal aPTT, PT, or TCT value, 2) low plasma fibrinogen concentration, 3) low plasma AT III activity, 4) high serum FRA concentration, or 5) low platelet count. To evaluate the severity of hemostatic dysfunction, 3 arbitrary categories (mild, moderate, and severe) were proposed.

RESULTS

A diagnostic strategy based on moderate hemostatic dysfunction identified DIC in 16 of 59 (27.1%) affected dogs. The AT III activity was < 70% in 15 of 16 dogs with DIC. Microvascular thrombosis was observed in tissue specimens from 7 of 8 affected dogs. Serum FRA and plasma fibrinogen concentrations did not contribute in establishing a diagnosis of DIC.

CONCLUSIONS AND CLINICAL RELEVANCE

A diagnosis of DIC can be made when hemostatic dysfunction is moderate in dogs with clinical signs of diseases associated with DIC.

Evaluation of the effect of storage at -70 degrees C for six months on hemostatic function testing in dogs

Freezing is a routine method of storage for plasma that is to be used in evaluating certain aspects of hemostatic function in many species. The purpose of this study was to evaluate the effect of storage at -70 degrees C for 6 mo on canine plasma samples. On fresh and frozen plasma from 12 clinically healthy dogs, prothrombin time, activated partial thromboplastin time, thrombin clotting time, fibrinogen determination, antithrombin III activity, fragment D and E assay, and protamine sulfate test were performed. Clinical agreement analysis was utilized to determine the effect of such storage on all assays. Individual differences detected between fresh and frozen samples were all within 2 standard deviations of the mean difference. With the exception of the activated partial thromboplastin time, storing canine plasma at -70 degrees C for 6 mo has no significant effect on hemostatic function, as assessed by these tests.