scott@vtx-cpd.com
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Emma,
Thank you so much for sharing this. Really interesting.
Happy new year!
Scott x
Hello! Hello!
How lovely to hear from you! Firstly, what the heck you doing watching my DKA webinar on a Sunday night! 🙂
Good question though. I think about the transition as soon as they are re-hydrated and electrolyte/acid-base issues back to normal. It is best to start long-acting insulin when they are eating normally. The transition itself is actually very straight forward. I will stop the CRI or IM infections of neural and you can almost immediately start the long-acting. Best to do this at the time of day the insulin is likely to be given.
Does that make sense?
Scott x
Thanks Sybil.
Megaoesophagus indeed! Initially, I was a bit confused as I thought there was a problem in the cranial lung fields. Turns out this was just all the food material in the oesophagus obscuring the lung fields!
After first assessment the cat had a general anaesthetic to undergo CT and angiography. Before this procedure, a blood sample was taken for biochemistry and did not show any abnormalities. The CT revealed marked and diffuse dilation with ventral pouching (diverticulum) of the oesophagus. The diverticulum was filled with food and part of bones . No vascular ring anomaly were detected. We then attempt upper-GI endoscopy, however that was extremely difficult due to the presence of lots of food in the cervical area of the oesophagus. For this reason was not possible to assess the oesophagus entirely.
Diagnosis: Megaoesophagus and oesophageal diverticulum
Any thoughts on the cause in such a young kitten?
Scott 🙂
Thanks so much for this.
The correlation generally between WBC number and actual infection is poor.
I would culture in any situation when an infection was a possibility.
Hope that helps. Thanks again for all of your great questions.
Scott x
Areti,
So lovely to hear from you. Thank you so much for your kind words. THank yo so much as always for your questions. I have tried to answer below:
1. So in everyday practice, when we collect urine by cysto, we keep it in ptactice during the day and we send it off to the lab in the evening and they collect it in the morning. Should i place the urine into the fridge immediately after collection? As most of times is being sent off for a comprehensive screen which includes cytological analysis and culture/sensitivity.
Yes, we also send many of our urine samples off to the lab. I would keep them in the fridge until they are collected and transported to the lab.
2. When we need to repeat a urine culture, the dog in on abts, do you repeat the culture the last day of the treatment? And do you then carry on with abts until results are back or do you stop them and then restart if still infection present?
I would only do this in more complicated infections. Simple, uncomplicated infections do not require re-culture. When longer durations of treatment are being used, urine culture is reasonable to consider after 5–7 days of treatment; however, the approach to a positive or negative result should be considered in advance. Positive cultures indicate the need for evaluation of compliance and further diagnostic testing, to determine why the bacterium has not been eliminated, not simply a change in antimicrobial, particularly if clinical cure has been documented. Negative results could be used to help determine when to stop therapy if a long course of treatment is being used, but are not a guarantee of microbiological cure. Culture of urine specimens, ideally collected by cystocentesis, can be considered 5–7 days after cessation of antimicrobials in animals where clinical cure is documented. However, this
should be used as part of the diagnostic process to help differentiate relapse, re-infection and persistent infection, and to guide potential future diagnostic testing, not as an indication of a need to treat.-How long do you monitor with STT after tx with sulphonamides?
I only tend to monitor with longer courses of this drug. I would monitor on a weekly basis and after long courses, one week after the course stops.
3. What dose of amoxicillin/clavulanic acid is the most appropriate? as the dose range is 12.5-25 (quite big) and you mentioned that a reason for tx failure could be not adequate dose.
As long as you are within this range you should be fine. Often, people dose below 12.5mg/kg due to tablet size. I would make sure to go higher than this.
4. and last question: we have an automated machine for urine sediment examination which gives an exact number of RBCs and WBCs. How many per power field should we see to say that we have significant pyuria and haematuria?
Depends a little on the machine. Can you send me the details?
Hope that helps.
Scott 🙂
Perfect!
Please post the outcome when you have more information. Will be interesting to see.
Scott
Hello!
Hope you are well. Interesting case. Those bile acids are pretty impressive. I think repeating the sample if you have any doubt is never a bad idea. I am not sure how much more ammonia would add to this case, I am not sure I would bother running that. Aquired shunts definitely have to be a consideration but you could not completely rule out a congenital shunt! I have diagnosed them in 11-year-old dogs before!
Typical cutoff values for pre- and postprandial bile acids are 15 mcmol/L and 25 mcmol/L, respectively. Pre- and postprandial bile acids elevations have been reported to be 99% sensitive and 95-100% specific for the diagnosis of a PSS in dogs and cats. A study investigating the sensitivity and specificity of fasting bile acids in diagnosing PSS found them to be 93% and 67% in dogs, and 100% and 71% in cats, respectively. When increasing the cutoff value to 58 mcmol/L in dogs and 34 mcmol/L in cats the sensitivity was unchanged in dogs (91%) and was decreased in cats (83%), but the specificity increased in both species (84% in dogs, 86% in cats).
Falsely elevated postprandial values can occur with lipemia. When used as a test of hepatobiliary function, the magnitude of elevation in serum bile acids does not allow differentiation of the category of disease, with the exception that patients with vacuolar hepatopathy rarely have marked elevations (greater than 75-100 mcmol/L).
If increased next steps would definitely be abdominal imaging (ultrasound or CT).
Hope that helps.
Scott 🙂
Hahah!
Yes, you are right. A PEG tube and a MILA chest drain.
Scott 🙂
Yes! Indeed!
There is another tube…
Scott 🙂
Yes,
I think trimethoprim is the most reasonable choice.
Scott 🙂
Yes,
I think trimethoprim is the most reasonable choice.
Scott 🙂
Thank you, everyone.
Hope you are all having a lovely weekend.
Scott 🙂
Thank you so much for this.
Really helpful. I also wanted to ask about the use of platelet products in cases of immune-mediated thrombocytopenia. I am currently involved in a study where we are trialing the use of lyophilized platelets in these cases. I notice in your literature that you do not recommend your platelet products in these cases. Can you explain that a bit more?
Thank you again.
Scott 🙂
Sophi, thanks for the questions.
Injectable Amoxicillin is definitely an option. Especially as we are moving towards shorter courses of drugs. The problem comes with long-acting antibiotics by injection. I totally understand the need for these due to our patients being difficult to tablet (cats – cough, cough). However, 2 weeks of action is probably excessive.
Good old Amox LA… right!?
I could not find good evidence that these coated catheters were at higher risk of irritation, but there definitely is this possibility I would think. It seems there is not a massive benefit to these catheters, so normal catheters seem to do fine!
Scott 🙂
Hey.
Yes, I used a combination of marbofloxacin and clindamycin. I would then change depending on culture, but many cases will come back with a surprising negative culture. Treatment with an antimicrobial drug with activity against anaerobes should be continued regardless of culture results because fastidious anaerobic bacteria could be present.
I must admit that I do not use continuous suction in these cases. I would place chest drains and use intermittent suction. We tend to use continuous suction for some pneumothorax cases:
These one-way valves can help with pneumothorax too:
Hope that helps.
Scott 🙂
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