This could definitely be one of this situations where this could be something or nothing. I have definitely seen dogs that have bleeding and bruising like this post castration and there is no real explanation for this.
In order to fully assess primary coagulation I would make sure to run a platelet count (manual) and consider a BMBT. A BMBT would be an easy way to asses for a thrombocytopathia. Can be tricky though in a conscious dog!
If PT and aPTT are normal then you could also consider D-dimers and fibrinogen.
The way to really assess coagulation in the best way would be to do TEG! That may give you the ultimate peace of mind!”
This is a very interesting point… I love this trick. When I first graduaed I remeber my mentor saying to me that I should mix 0.5ml of ketamine and 0.5ml of diazepam in a 1ml syringe and give to effect!… and I never looked back! Does work really well.
This would suggest that it is not necessary as a pre-treatment. I would consider using levetiracetam to manage any post attenuation neurological signs if they develop.
It is a really good point regarding the omeprazole. Overall, these cases seem to tolerate the omeprazole at the standard doses, so I would use at 1mg/kg BID.
I think Andy’s question about intralipid is a really good one… I might indeed be a consideration in these cases.
Why have the human medics moved away from gastric lavage? Is there evidence to support worse outcomes? I wonder if the outcomes are worse in these cases because they have the more severe toxins to begin with?
It is always a worry inducing emesis in the cases that are neurological or likely to become neurological. If they are obviously neurological on presentation when I would not induce emesis. If they are clinically normal on presentation I often will.
I did not answer the bit about the chlorambucil! It was added as a second agent from the start to deal with the inflammatory changes particularly in the GI tract, the aim being that we would be able to reduce the dose of steroid sooner.
Thank you so much. Totally agree, these are challenging cases and the decision making can be difficult. Many will do well with antibiotics, hepatoprotection and supportive care. Much of the decision making will depend on imaging too. If there seems to be disease in the GI tract and pancreas too, I will often be more proactive at taking biopsies. If there is any sign of significant biliary tract obstruction, them may also be more immediate surgical candidates. There is not a definitive answer as how long to wait before GA. Sometimes they are still sick when they go for GA. I am happy to send them for GA if cardiovascular system stable and blood pressure normal.
Regarding the immunophenotyping, it is something that can be done on some FNA tissue and sometimes on blood. It depends very much on the individual lab. I would contact the lab you use and they should have a list of typing and staining they are able to do.
Hope that helps.
Scott 🙂
Regarding the cats with weight loss. The answer might be yes! I definitely will run cobalamin folate and fPL in most of my cases. TLI might depend a bit on signs, but not all cats will display classic signs of diarrhoea. Any case with more chronic signs, I would definitely run all of these.
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