scott@vtx-cpd.com
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Thank you for this.
I think this is a really good question. I think cases of diarrhoea are difficult ones. We know more and more that shorter courses of antibiotics are much more appropriate for infections like urinary tract infections. I think if you are faced with cases of uncomplicated HGE then you will be fine to stop antibiotics even if they have already been started. This is obviously cases dependant. As we mentioned in the webinar, if the animal is systemically unwell or pyrexic etc. then antibiotics may need to be continued.
It is unlikely for you to do massive harm or come up against significant resistant problems by stopping the course.
Hope that helps.
Scott
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
Thank you for the question!
Were you thinking of a specific case? I suppose one of the first questions I would ask is what level the albumin is at, what is the reason for this and is the animal displaying signs related to having low protein levels?
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
This is an excellent question Gail… as always, thank you for your question!
Were there particular drugs they were discussing? I have been in touch with an anaesthesia specialist and will see if there is a comprehensive resource we can get for you.
Scott x
Thanks for this Gail.
I would agree. Do not think a VHS would be first thing on my mind when dealing with a dyspnoeic patient. I would struggle to think of the last time I calculated one in the emergency setting.
Another question for Liz… how useful are VHS generally in cats?
Scott 🙂
Thank you so much Scott for your great questions… and thank you Liz for that answer. Was there a particular case you were thinking of when asking your question?
Thank you again and welcome to vtx!
Scott x
Thank you so much for this. I hope all is well with you.
1. would transplanting faeces from a skinny dog help an obese one. There certainly seems to be some evidence from humans but I am not sure of how good it is.
I have had a look at the human and canine literature. Looks like there is limited evidence for this concept in both. Definitely nothing in the dog that would support this being useful. Do you know what the theory behind this is?
2. would transplanting faeces into a dog with chronic GI disease have the potential to precipitate something other than the effect you are looking for.
Do you mean negative effects? Besides lack of data regarding treatment guidelines and methods of FMT, there are only limited data in a few cases on the clinical efficacy of FMT in small animals. It is therefore impossible to determine the safety of the procedure, although adverse effects are uncommon in humans. Potential adverse effects might include direct pathogen transmission of infectious agents or weight gain; however, rigid screening guidelines for donors might exclude them in the first place.
3. how would you rule out potential pathogens and still have a fresh viable population?
It is best to have pre-screened donors which you would keep up to date with screening/worming and take a fresh donation from them. No need to screen every donation.
The following is a good review (and is free) and has some good references:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6055767/
Hope that helps.
Scott x
Hello.
Not going to be massively helpful here. I presume it has some association with colic… are these colic cases you are talking about? I think these is a like between the endotoxemia from colic and DIC. Maybe some of the other members will have more light to shed.
Dogs and cats definitely get DIC. I wonder whether cases of DIC are underdiagnosed in small animal practice? Dogs and cats will get DIC secondary to lots of different underlying conditions but definitely don’t get colic like horses do!
Hope that helps.
Scott x
It is essential that initial treatment of systemic hypotension always be aimed at correction of the underlying physiologic problem: decreased preload, cardiac dysfunction, or peripheral vasodilation. Differentiation of cardiac and noncardiac causes of systemic hypotension is a critical first step. If the animal is hypovolemic, intravenous fluids and/or blood products should be administered until euvolemia has been attained. If hypovolemia is severe enough to cause hypotension, a shock bolus should be given, up to 60 to 90 mL/kg for dogs and 45 to 60 mL/kg for cats (given incrementally as you know!).
If the animal remains hypotensive once euvolaemia has been achieved, the use of pressors should be considered. Commonly used pressors for treating vasodilation include dopamine (5-15 mcg/kg/min), epinephrine (0.05-1 mcg/kg/min), norepinephrine (0.1-1 mcg/kg/min), or phenylephrine (0.5-5 mcg/kg/min), administered for their alpha-agonist effects, as constant-rate IV infusions. Only phenylephrine is a pure alpha-agonist; the others have varying degrees of beta effects in addition to their alpha effects. Vasopressin (0.5-5 mU/kg/min) also can be used in cases with vasodilatory shock and may be especially useful in cases of sepsis/SIRS as the vessels can become refractory to catecholamines. These drugs need to be titrated to effect, requiring frequent blood pressure monitoring. They should never be used in place of adequate volume expansion, because most patients with hypovolemic shock already have compensatory vasoconstriction.
My first choice drug wise would probably be norepinephrine.
Hope that helps.
Scott x
It is essential that initial treatment of systemic hypotension always be aimed at correction of the underlying physiologic problem: decreased preload, cardiac dysfunction, or peripheral vasodilation. Differentiation of cardiac and noncardiac causes of systemic hypotension is a critical first step. If the animal is hypovolemic, intravenous fluids and/or blood products should be administered until euvolemia has been attained. If hypovolemia is severe enough to cause hypotension, a shock bolus should be given, up to 60 to 90 mL/kg for dogs and 45 to 60 mL/kg for cats (given incrementally as you know!).
If the animal remains hypotensive once euvolaemia has been achieved, the use of pressors should be considered. Commonly used pressors for treating vasodilation include dopamine (5-15 mcg/kg/min), epinephrine (0.05-1 mcg/kg/min), norepinephrine (0.1-1 mcg/kg/min), or phenylephrine (0.5-5 mcg/kg/min), administered for their alpha-agonist effects, as constant-rate IV infusions. Only phenylephrine is a pure alpha-agonist; the others have varying degrees of beta effects in addition to their alpha effects. Vasopressin (0.5-5 mU/kg/min) also can be used in cases with vasodilatory shock and may be especially useful in cases of sepsis/SIRS as the vessels can become refractory to catecholamines. These drugs need to be titrated to effect, requiring frequent blood pressure monitoring. They should never be used in place of adequate volume expansion, because most patients with hypovolemic shock already have compensatory vasoconstriction.
My first choice drug wise would probably be norepinephrine.
Hope that helps.
Scott x
This is an excellent point.
I think that is such a good discussion point… there might be more than one factor contributing to the acidaemia!
Scott 🙂
Thanks so much for this Simon!
This is brilliant… you are spot on! Thanks so much for the contribution. Really valuable!
Scott 🙂
Thank you so much for this excellent question Gail!
Scott 🙂
Sounds very sensible to me!
Did you use the cheat sheet Annette? Scott 🙂
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