scott@vtx-cpd.com

Hi Rosanna,

For small animal internal medicine, I highly recommend “Ettinger’s Textbook of Veterinary Internal Medicine.” It’s widely considered the go-to resource in the field. There is a new edition available, which is quite comprehensive and detailed. It’s a two-volume text, so it is heavy-duty, but it also includes online access, which is a great bonus.

You can find the latest edition here: https://www.evolve.elsevier.com/cs/product/9780323779319?role=student

This textbook is often referred to as the “Internal Medicine Bible,” and it’s definitely the one I would go for if you’re looking for the most up-to-date and thorough resource. However, if you’re looking for something a bit more quick-fire and practical, I can make other recommendations. It would also be interesting to hear other people’s thoughts on this.

This is definitely the most comprehensive text, with the benefit of being quite an up-to-date version. As you know, textbooks can become outdated quickly, so having the latest edition is crucial.

Best regards,

Scott 🙂

Replying to Felipe M. 14/06/2024 - 15:44

Hi Felipe,

Thanks for your insightful contribution! You make excellent points about the challenges and practicalities of using blood products in veterinary practice, particularly regarding availability and cost.

I appreciate you highlighting the use of synthetic colloids as a temporary measure when blood products are not immediately accessible. It’s a pragmatic approach, especially in resource-limited situations.

The reference to the CellSaver device is intriguing as well. It would indeed be a game-changer, albeit with the mentioned cost and caseload considerations.

Great discussion all around!

Best,
Scott

Replying to Neus E. 13/06/2024 - 18:20

Thank you so much, Neus, for your insightful input and detailed explanation! Your expertise is greatly appreciated, and you’ve provided valuable information on managing haemorrhagic shock in these patients. Thanks again for taking the time to share your knowledge with us!

Best regards,

Scott

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 🙂