vtx logo

request clinical advice

vtx logo sticky

scott@vtx-cpd.com

Forum Replies Created

Viewing 15 posts - 1,921 through 1,935 (of 2,068 total)
  • Author
    Posts
  • scott@vtx-cpd.com
    Keymaster

    Thanks so much for picking this discussion back up! 🙂

    Initially the patient was placed in an oxygen chamber. Butorphanol 0.3mg/kg was administered, intramuscularly. After twenty minutes, the patient’s respiratory rate was still 50 breaths per minute and no change in respiratory effort was noted. The patient was removed from the oxygen chamber and flow-by oxygen therapy was administered. It was not possible to obtain an arterial blood sample. An intravenous catheter was placed into the right cephalic vein. A venous blood sample was obtained for a minimum database (PCV, total solids, glucose and blood urea nitrogen (BUN)), acid-base analysis, electrolytes and haematology. Manual PCV and total solids were 74g/l and 70g/l respectively. Both glucose and BUN were within the normal reference range. The patient was hyperkalaemic; 4.8mmol/L (2.9 – 4.2). Haematocrit was 72% (24-40) and cHgb was 24.4 g/dL (8.0-13.0). All other haematological and electrolyte results were within the normal reference range. Coagulation testing showed that partial prothrombin (PT) time was within the normal reference range, however activated partial thromboplastin time (aPPT) was mildly prolonged at 167.2s (94-125) (Table 2). A thoracic ‘point of care’ ultrasound examination was performed and was negative for free fluid. Subjectively the left atrium was dilated with an abnormal left atrial to aortic (LA:Ao) ratio, however further assessment of the heart was not possible due to the cat’s temperament. No free fluid was present on abdominal point of care ultrasound. SpO2 was 97% from pinna.

    It was initially suspected that the patient’s haemoconcentration was due to severe dehydration. As such, a fluid therapy plan was implemented. A 15ml/kg intravenous fluid bolus of Hartmann’s solution (Vetivex 11; Dechra) was administered over 15 minutes, after which intravenous fluid therapy (IVFT) was continued at a rate of 4ml/kg/hr for eight hours . Seven hours post presentation the patients PCV was 67%, and IVFT was continued at a reduced rate of 2ml/kg/hr thereafter. After twenty-four hours of fluid therapy the patient’s PCV was 65%. The patient was quiet, alert and responsive; however, the breathing had become more laboured despite continued oxygen therapy, and her respiratory rate was consistently between 60-70 breaths per minute .

    The PCV and haematocrit are elevated, indicating that the patient is polycythemic; PCV>55%. It is important to distinguish between a relative polycythemia and an absolute polycythemia. Relative polycythemia is the loss of plasma water without the loss of red blood cells. It is caused by fluid imbalances causing reduced plasma fluid volume, such as dehydration, reduce fluid intake, redistribution of vascular blood, cutaneous losses or splenic contraction (in the dog). Absolute polycythemia occurs when red blood cell number increases and is classed as either primary or secondary. Despite fluid therapy, although slightly improved, the patient’s PCV was still significantly increased and as such this case is termed an absolute polycythemia.

    What would be the differentials for an absoute polycythemia in this patient? Or is that an unfair question for a saturday night?!?!?

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    Yes! I had all the question marks too!!!

    So… there is definately something abnormal in the stomach. The DV really allows us to see that it is definatley still in there. So… I did decide to scope this dog. There was lots of thick mucus in stomach with likley food material in it. Definately nothing obstructive and nothing I could remove with the scope.

    I took a radiograph post endoscopy and the same opacity was there… what might be the other reason for this radiographic abnormaity?

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    Thanks for the update!

    I do think some dogs just do this after castrayion, it would be good to hear others experience.

    Do you think you will do further investigations? If not, it may be good to consider tranexamic acid before future surgery?

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    My relpy…

    “Hope the wee guy is doing better.

    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!”

    What do you all think?

    Scott x

    scott@vtx-cpd.com
    Keymaster

    Yes.

    I did say that. I just watched it back. Sorry the quality was not up to standard.

    Let me know if you have any other questins.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    Sooo…

    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.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    This is really helpful Gemma.

    Thank you!

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    Really good point.

    The numbers in the dog studies are so much better.

    It definately highlights the need for owner discussion prior to surgery.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    Hello.

    Thank you so much for the questions. I am glad you are enjoying the course.

    The cat question is a good one! There is a very recent paper looking at that exact question:

    https://pubmed.ncbi.nlm.nih.gov/32691934/

    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.

    Hope that helps.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    This is really interesting Simon!

    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.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    I feel your pain! Hope things settle down a bit! 🙂

    scott@vtx-cpd.com
    Keymaster

    Thank you Gemma.

    This is really useful. Thank you so much for this.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    Andy…

    I think this actually raises a really good point. Is an epidural something a nurse can do?!

    I dont know the answer?!

    Anyone?

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    Hey Charlotte.

    Hope that sounds OK. If your clinics are anything like mine at the moment, I understand why you are a bit behind!

    The discussion forum will be live till then, so feel free to keep asking questions.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    Thanks again for all of this discussion.

    I think this is why it so interesting/important to look what is actually included in the products we have on the shelve!

    I had a question for our friends at Protexin. Why have you included SAMe over DL-methionine in Denamarin?

    Loving asking the questions for a change! 🙂

Viewing 15 posts - 1,921 through 1,935 (of 2,068 total)