scott@vtx-cpd.com

Replying to Katherine Howie 26/05/2024 - 21:00

Hi Kath,

Thanks for elaborating on this. It’s a great reminder that even without all the advanced monitors, we can still gather crucial information through thorough physical exams and assessing perfusion parameters. Your point about hypotension only appearing after a significant drop in cardiac output is really important—it’s good to remember that a patient can be hypoperfused even with normal blood pressure.

I completely agree that hands-on assessments and repeated serial physical exams are invaluable. It’s reassuring to know that these fundamental skills can provide us with so much insight into a patient’s cardiovascular status.

Thanks again for sharing your expertise!

Best regards,

Scott

Replying to Raquel M. 25/05/2024 - 15:34

Hi there,

Thanks for your question! Urine dipstick strips that differentiate between RBCs, hemoglobin, and myoglobin based on the pattern of the color change can be quite useful in a clinical setting. These strips can provide a quick and easy way to get a preliminary assessment of hematuria versus hemoglobinuria or myoglobinuria.

However, there are a few points to keep in mind:

Accuracy: While dipstick tests can be helpful, they are not always 100% accurate. False positives and false negatives can occur, so it’s important to confirm any suspicious results with more definitive testing, such as microscopic examination of the urine sediment or additional blood tests.

Interference: Various substances in the urine, such as certain medications, foods, or contamination, can sometimes interfere with the results of the dipstick test.

Clinical Context: Always interpret dipstick results within the broader clinical context. For example, the presence of RBCs in the urine should be correlated with clinical signs and other diagnostic findings to determine the underlying cause.

Follow-Up: If the dipstick test indicates the presence of hemoglobin or myoglobin, further testing may be needed to determine the source. Conditions like hemolysis or muscle damage can cause these substances to appear in the urine, and additional diagnostics will be necessary to address the underlying issue.

In summary, urine dipstick strips can be a valuable tool for initial screening, but they should be used alongside other diagnostic methods to ensure accurate and comprehensive assessment.

Hope this helps, and feel free to ask if you have any more questions!

Best regards,

Scott 🙂

Replying to Katherine Howie 12/05/2024 - 21:19

Hi Kath,

I completely agree with you.

Recognizing patients at risk for SIRS or sepsis is crucial. Your red flag system sounds very effective—persistent tachycardia and other unresponsive parameters are definitely key indicators to watch for.

Cats are definitely more challenging compared to dogs. Their clinical signs can be so subtle and different, making it harder to detect early signs of deterioration. Continuous monitoring and being vigilant about any changes in their behavior or vitals are essential.

I’m curious about the red flag system you use—is this a defined system with set parameters, or is it more of an intuitive approach based on experience?

Best regards,

Scott

Replying to Raquel M. 23/05/2024 - 22:49

Hi there,

I’m glad to hear you’re doing well! Yes, avoiding the hamstring muscles in cats and dogs when administering intramuscular injections is indeed a common practice. It’s interesting to hear that some students from North America were not familiar with this approach. While it’s a well-established practice in many veterinary settings, it’s possible that variations in training and protocols exist across different regions and educational programs.

If you have any further questions or need clarification on this or any other topic, feel free to ask!

Best regards,

Scott 🙂

Hello Raquel,

Urine dipstick tests for animals can indeed differentiate between hemoglobin/myoglobin and red blood cells (RBCs), although their accuracy can vary depending on factors such as the specific dipstick used and the condition of the sample. Generally, these dipstick tests can detect the presence of blood in the urine, which may indicate bleeding or other underlying conditions.

Freshly collected urine that is red, brown, or black suggests the presence of blood, hemoglobin, myoglobin, or some of their degradation products. The urine concentration, pH, and time in contact with blood can affect color. Red blood cells progressively disintegrate and release hemoglobin in urine, which may be oxidized to methemoglobin and result in brown or black urine color. A negative reagent strip test for blood in red, black, or brown urine suggests the presence of a chromogen other than hemoglobin or myoglobin.

A positive reagent strip test for blood should be followed by analysis of the urine sediment. If the discoloration is due to hematuria, there will be numerous red blood cells and increased turbidity. In contrast, urine remains transparent when the color change is due to hemoglobinuria. If no red blood cells are present on microscopic examination of the urine sediment, hemoglobin or myoglobin should be suspected.

I would suggest additional investigations to differentiate these possibilities, such as ruling out oxidized bilirubin and analyzing serum bilirubin concentration. Furthermore, examination of the plasma color may aid in differentiating these explanations. If the discolored urine is due to myoglobin, the plasma will usually be clear because myoglobin is not bound significantly to proteins and is rapidly excreted.

If plasma from a non-traumatic venipuncture sample is pink, it is suggestive of hemoglobin. Hemoglobinemia and hemoglobinuria are indicative of significant intravascular hemolysis, resulting from various conditions such as immune-mediated destruction of red blood cells or fragmentation due to microangiopathic conditions.

Overall, I would use the dipstick as a guide and not to definitively determine the difference between blood and hemoglobin.

Best regards,

Scott 🙂