scott@vtx-cpd.com
Forum Replies Created
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Replying to Aileen D. 19/06/2024 - 12:02
Hello Aileen!
Lovely to hear from you! I hope you are well! I will ask Felipe to answer this one!
I hope you are enjoying the course.
Scott
Just as a bit of a fun fact!
Adobe-Stock-427094049
The enrofloxacin issue is not thought to be as much of a problem in lions and tigers!
Scott
INVESTIGATION OF ENROFLOXACIN-ASSOCIATED RETINAL TOXICITY IN NONDOMESTIC FELIDS
Kim M Newkirk, L Kathryn Beard, Xiaocun Sun, Edward C Ramsay
Abstract
Enrofloxacin is known to cause retinal toxicity in domestic cats. The hallmark lesion of enrofloxacin-associated retinal toxicity in domestic cats is thinning of the outer nuclear layer of the retina. Enrofloxacin is commonly used to treat bacterial infections in nondomestic felids because of its action against a wide spectrum of bacteria and the ability for it to be given orally. No previous studies have investigated the potential retinal toxicity of enrofloxacin in nondomestic felids. This retrospective study evaluated 81 eyes from 14 lions ( Panthera leo ) and 33 tigers ( Panthera tigris ) that had been enucleated or collected postmortem. The thickness of the outer nuclear retina was assessed in two separate sites in each eye by counting the rows of nuclei and by using digital image analysis software to determine the area of the nuclei at each site. Medical records were reviewed to determine the enrofloxacin dose for each cat. Cats that had not received enrofloxacin (n = 11) were compared with treated animals (n = 36). The outer nuclear layer thickness or area in treated versus untreated cats was not significantly different. Additionally, no clinical blindness was reported in any of the cats. This study showed no evidence of enrofloxacin-associated thinning of the outer nuclear layer in the lions and tigers evaluated, suggesting that enrofloxacin can be used safely in these animals.Hello again.
Here are some thoughts on this topic from one of our ECC specialists Neus:
“So… yes I would use them in dogs with severe haemorrhagic diarrhoea/gastroenteritis a lot. I think I may be biased to the ones we see, so I am talking about the ones that come unwell with signs of hypovolaemic shock and severe dehydration/haemoconcentration. These ones typically come with high PCV and “normal” TS so for example 65%/60g/L, in these ones I know that if hypovolaemic I will need to fluid resuscitate so may end up needing 5-20mL/kg over a few boluses and then I will need high rates of IVFT to account for on going losses, rehydration and maintenance and when you calculate this sometimes is as high as 6-8mL/kg/h. There is two sides to this and one is that we know that actually the use of crystalloids itself will damage the glycocalyx and you will gave shedding and then this will lead to increased vascular permeability etc. and the second side to this is that when my PCV is normalised when the patient is rehydrated, say comes from 65 to 45%, I know my solids will ave tanked and probably be from 60 to 30-40g/L and at this stage this becomes a problem also with on going increased permeability, increased oncotic pressure etc. So that is why I tend to come in early with plasma to prevent this from happening, and when plasma is used as is a colloid… you can also allow yourself to use lower fluid rates so in the same example if you calculated you may need 6-8mL/kg/h if you combine plasma and crystalloids you may get away with 4-5mL/kg/h instead.
For the hypoalbuminaemic GI patients… I don’t think there is a number really. So if I think PLE that I have treated alongside medicine; these patients are different as stable so unless I had to fluid resuscitate or need IVFT I would not consider it, even if their albumin is really low. Now for a PLE patient who isn’t great and is now third spacing and say it has abdominal effusion, and that is increasing the abdominal pressure which is compromising the gut blood supply and they are not doing great. I tend to remove abdominal fluid really slowly over a few hours, then replace with plasma – and the times we have done this they tend to have really low alb on low teens.”
I hope that helps!
Scott
Hi Rosie,
I hope you are well! I wanted to share some insights from a recent conversation about the use of plasma transfusions in septic patients, focusing on the potential benefits of plasma in repairing the glycocalyx.
Key Points:
1. Fluid Therapy and Crystalloid Sparing:
Neus highlighted that plasma can be used as a fluid therapy to provide oncotic support and reduce the volume of crystalloids needed. In septic patients, especially those with significant fluid losses and hypoproteinemia, plasma helps maintain colloid osmotic pressure (COP) and minimizes the damage to the glycocalyx caused by crystalloids.2. Glycocalyx Protection:
The glycocalyx, a crucial component of the vascular endothelium, plays a significant role in vascular permeability and endothelial function. It can be damaged in conditions like sepsis, trauma, and inflammation. Animal studies suggest that resuscitation with plasma can partially restore the glycocalyx, whereas crystalloids and synthetic colloids do not have the same effect. This is potentially due to the albumin in plasma, which helps preserve endothelial integrity and reduce glycocalyx shedding.Practical Applications:
HGE Cases:
Neus also mentioned using plasma in dogs with severe hemorrhagic gastroenteritis (HGE), particularly those presenting with hypovolemic shock and severe dehydration. By combining plasma with crystalloids, we can use lower fluid rates and provide better oncotic support.Hypoalbuminemic Patients:
For GI patients with severe hypoalbuminemia, Neus tends to use plasma when there’s third spacing or abdominal effusion. This helps stabilize albumin levels and supports vascular integrity.Questions and Considerations:
Combining Plasma with Crystalloids:
In septic patients, combining plasma with crystalloids can be beneficial. For instance, using plasma early on in resuscitation can help maintain COP and reduce the need for high crystalloid volumes.
Using Plasma in Other Types of Shock:Plasma can be considered in other types of shock, such as hypovolemic shock in patients with protein-losing enteropathy (PLE), especially when albumin levels are critically low.
Alternatives to Plasma:If plasma is not available, synthetic colloids could be considered for patients with low albumin, although they do not offer the same glycocalyx protection as plasma.
Overall, the conversation emphasized the importance of considering plasma for its unique benefits, especially in maintaining the glycocalyx and providing oncotic support in critical patients.I will share some more specifics on HGE too!
Best,
Scott
Hello.
I hope you are well. Hopefully this information is helpful! Let us know if you have any more questions!
Scott
Great question Victoria.
I have asked our ECC and anesthesia specialists to help with this one too!
Scott
Hello,
I don’t routinely auscultate the abdomen for gut sounds in animals as part of every physical examination. There isn’t an accurate standardization of what constitutes normal gut sounds, and I think this practice is most useful in patients suffering from gastrointestinal ileus. However, I base my assessment of ileus more commonly on clinical signs and potentially using abdominal ultrasound to look for peristalsis.
While I would not consider abdominal auscultation part of every examination, it may be useful in some specific cases. Here are a few general guidelines if you choose to incorporate this practice:
Normal: Regular, gurgling sounds occurring every 1-2 minutes.
Hyperactive: More frequent sounds, which may suggest gastrointestinal hypermotility (common with diarrhea, certain dietary changes, or gastrointestinal upset).
Hypoactive or absent: Fewer sounds or silence, which can indicate ileus, obstruction, or other significant gastrointestinal problems.
Incorporating this practice can help detect abnormalities early and provide a more comprehensive assessment of your patients, especially in cases where gastrointestinal issues are suspected.I would be interested to hear the experience of others!
Best regards,
Scott
Replying to shimin cheong 08/06/2024 - 08:08
Hi there,
Thanks for your message and for sharing your thoughts. It’s great to hear that you found the information helpful.
Regarding your case, the clinical signs are indeed a crucial aspect of monitoring, and it’s good to know that the owner feels they are well controlled.
Looking at the ACTH stim results, a baseline cortisol of 1.7µg/dL and post-ACTH cortisol of 8.9µg/dL are within the acceptable range, which suggests that the trilostane dose is not overly suppressing the adrenal function. However, the mildly elevated potassium at 5.9mmol/L and the Na/K ratio of 25 are worth noting.
While hyperkalaemia can be a sign of hypoadrenocorticism (Addison’s disease), it’s also important to consider other potential causes, even if the kidneys appear normal.
In this scenario, if the patient is well and not showing any clinical signs of hypoadrenocorticism, I would not adjust the trilostane dose at the moment. Instead, continue to monitor the potassium levels and the patient’s clinical signs closely. If the potassium levels continue to rise or if the patient starts showing signs of hypoA (e.g., lethargy, vomiting, diarrhoea), then reducing the dose of trilostane might be warranted.
By the way, was the potassium run in-house or sent to an external lab? Could the elevated levels be due to a transport error or haemolysis?
Thank you for bringing up this important discussion. Feel free to reach out if you have any further questions or updates on the case.
Best regards,
Scott