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So the basic principals are…

In peripheral vestibular disease, the nystagmus can be horizontal or rotary and the fast phase is always away from the lesion. In central disease the pathologic nystagmus can be in any plane (including vertical), can change direction with different positions of the head, and the fast phase can be toward the lesion. Therefore, identification of a vertical nystagmus or a nystagmus with the fast phase toward the lesion is an indication of central involvement. However, caution should be exerted when labeling a patient with central disease based on vertical nystagmus alone since it is easy to confound nystagmus with a slight rotary component with vertical nystagmus. One comparative clinical study also suggested that the number of beats of the resting nystagmus was significantly higher in peripheral vs. central disease. A resting nystagmus rate of more than 66 beats per minute was found to be very specific (95%) and sensitive (85%) of peripheral disease.

I have contacted one of our neurology specialists to get a final call location!

Scott x

Hello.

Thanks so much again for the question. Could you double check the ACP dose. The only reason I ask is that that would be quite a high dose and may explain the prolonged sedation. Just a thought.

Scott x

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You can use this link to upload videos and pictures. Once uploaded paste the like that it generates in another comment.

Scott x

Thank you so much for this. Really interesting question.

Diet, drugs or supplements all might be effective in improving signs and slowing the progress of CDS. Canine studies have demonstrated that mental stimulation in the form of training, play, exercise, and use of manipulation toys can help to maintain quality of life as well as cognitive function, but are most effective together with an appropriate nutritional base. This is consistent with studies in humans in which education, and brain and physical exercise, have been found to delay the onset of dementia.
Currently there is one pharmaceutical in North America, selegiline (Anipryl, Zoetis Animal Health), that is approved for the treatment of CDS in aged dogs. Selegiline hydrochloride is a selective reversible monoamine oxidase B inhibitor, which was found to significantly improve cognitive signs in aged dogs. In the canine brain, selegiline increases 2-phenylethylamine, a neuromodulator that enhances dopamine and catecholamine function. Its metabolites l-amphetamine and l-methamphetamine could further enhance cognitive function and improve behavior. Selegiline also might contribute to a decrease in free radical load in the brain.

Propentofylline, a xanthine derivative, is licensed in Europe and Australia for the treatment of dullness, lethargy, and depressed demeanor in old dogs. It could increase blood flow and inhibit platelet aggregation and thrombus formation. In a laboratory trial with aged Beagle dogs, it had no effect on behavioral activity.

No drugs are approved for treatment of CDS in cats; however, both selegiline and propentofylline have been reported anecdotally to be useful.

Another therapeutic strategy for cognitive dysfunction in dogs, cats, and humans is diets and natural supplements that might reduce the risk factors that contribute to brain aging and cognitive decline. It is likely that an integrative approach is required to achieve and maintain brain health, such as diets supplemented with polyunsaturated fatty acids, antioxidants, and mitochondrial co-factors. Two veterinary therapeutic diets that have been developed for the management of CDS have been demonstrated in laboratory studies to improve learning and memory in dogs. A diet from Hills Pet Nutrition (Canine b/d) is supplemented with fatty acids, antioxidants (vitamins C and E, beta carotene, selenium, flavonoids, carotenoids), and dl-alpha-lipoic acid and l-carnitine to enhance mitochondrial function. When the diet was combined with environmental enrichment, the greatest level of improvement was achieved. I have a funny feeling this diet is no longer available. In a clinical trial, significant effects were obtained from the diet alone. A diet from Nestle Purina Research (Purina Pro Plan Bright Minds) is supplemented with botanic oils containing medium chain triglycerides to provide ketone bodies as an alternate source of energy for aging neurons. A dietary supplement from Nestle Purina (not yet commercially available) with antioxidants, (vitamins E and C, and selenium), arginine, B vitamins, and fish oil significantly improved learning and memory tasks in cats aged 5.5 to 8.7 years.

A number of nutritional supplements also might be effective in the management of CDS based on laboratory and/or clinical studies. Senilife (CEVA Animal Health), which contains phosphatidylserine (a membrane phospholipid) and Gingko biloba, vitamins Eand B6, and resveratrol, is labeled for both dogs and cats but only has been evaluated in canine studies to date. Activait (Vet Plus Ltd), which contains phosphatidylserine, omega-3 fatty acids, vitamins E and C, l-carnitine, alpha-lipoic acid, coenzyme Q, and selenium, has been evaluated in a canine clinical trial. A feline product also is available with alpha-lipoic acid removed. S-adenosyl-l-methionine (Novifit, Virbac Animal Health) might help to maintain cell membrane fluidity and receptor function, regulate neurotransmitter levels, and increase production of glutathione. Apoaequorin (Neutricks, Neutricks, LLC), is a calcium-buffering protein found in jellyfish that improved learning and attention in dogs in laboratory trials. Immunotherapy has also been evaluated in aged dogs, involving the vaccination of aged animals against the A-beta protein. Although the study was not successful in reversing cognitive deficits, this approach might have future treatment potential.

Hope that helps.

Scott x

Thanks so much for the question… it is a good one!

The combined effects of hyperglycemia, ketonemia, acidosis and many co-morbid processes often causes significant electrolyte derangements in both DKA and HHS. Hyperglycemia-induced osmotic diuresis results in severe fluid and electrolyte losses. Ketones contribute to the solute diuresis via excretion of ketoanions, which obligates urinary cation excretion of Na, K and ammonium salts. Decreases in Na can also follow hyperglycemia. For each 3.44 mmol/L increase in glu, serum Na decreases by 1 mmol/L. If a patient has severe hyperglycaemia with normal serum sodium, their true sodium is probably high. This formula may underrepresent the effect on Na. Low Na concentrations can also be seen with hypertriglyceridemia, “pseudohyponatremia.” Insulin deficiency also contributes to solute loss as insulin stimulates salt and water reabsorption from both proximal and distal tubules and phosphate from proximal tubules.

In summary, the large increase in glucose in the circulation will draw water into the vasculature from the interstitial fluid and have a dilutional effect on the sodium!

Hope that helps.

Scott x

This is a really good point. I have just been downstairs to check out what the data sheet actually says currently…

I think the issue was that when these catheters first came out there was no issue using them as longer term indwelling catheter. It was only after there was some instances of detachment that there became an issue. As Gail has said, the data sheen now specifically says that:

“the catheter and silicone hub are not permanently affixed to each other. The hub can be secured to the patient using the secure holes, but it is advised not to leave the catheter in place for more than 6 hours and the patient must be observed at all times”

The biggest problem comes now that the data sheet says this, we would have little come back if the catheter detached and we had to surgically retrieve from the bladder.

Hope that helps.

Scott x

Thanks again for this question. I have pulled a few thoughts together.

Plasma is occasionally used in dogs and cats to transfuse albumin as a colloid to treat hypovolemia, but synthetic colloids are preferred. Plasma is not used in humans as a colloid, but this is because albumin solutions are available for this use. Human and bovine albumin solutions have been used in dogs and cats without side effects, but severe acute and delayed hypersensitivity reactions have also been reported. Commercial canine albumin is available as an alternative.

Canine albumin has been tested in healthy dogs and dogs with hypoalbuminemia and septic peritonitis. In healthy dogs, intravenous canine albumin administration caused no adverse effects (AEs). In the sick dogs, postsurgical canine albumin treatment markedly raised albumin levels without owner-reported AEs. Unfortunately, canine albumin is not readily available.

BSA is readily available yet reportedly has caused anti-albumin antibody development and hypersensitivity reactions in healthy dogs.

Plasma and albumin solutions may also be used to improve plasma oncotic pressure and reduce oedema. Unfortunately this is inefficient, but will provide short-term benefit. About 22.5 mL/kg is required to raise plasma albumin by 0.5 mg/dL (5 g/L). 40% of total body albumin is normally found in the plasma and 60% in the interstitium, with the ratio shifted towards plasma in hypoproteinaemia. Upon albumin transfusion, the ratio shifts back towards the interstitium. Frequent large volume plasma transfusions or albumin transfusions are needed to maintain albumin levels, especially if hypoproteinaemia is caused by protein loss.

Hope this helps.

Scott x

Thansk again.

Essentially it’s not a problem drawing up benzodiazepines and leaving them in syringes until you use them.

Historically, syringes in the 1970s and 80s contained a lot more rubber than the ones we use now which could react with diazepam if allowed to sit together for some time. Unfortunately, it’s been accepted into the received wisdom people cite without an update for modern materials. Therefore I wouldn’t worry about it if it’s just for a few hours.

Hope that helps.

Scott x