scott@vtx-cpd.com
Forum Replies Created
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Hello everyone,
I went down a bit of a ketamine rabbit hole after you started this discussion—I didn’t realize people were using ketamine in such a sporadic subcutaneous way, and I think that’s really interesting.
I also came across this case report that I thought was worth sharing. A dog accidentally received an extreme ketamine overdose—338 times the intended dose—due to a misinterpretation of an electronic treatment sheet. The dog was on a 67.6 mg/kg/hr CRI for four hours, receiving 270 mg/kg total, and developed tachycardia, hyperthermia, anisocoria, and hypoglycemia. Fortunately, with aggressive supportive care, he made a full recovery within 18 hours without lasting effects.
The case is published in Can Vet J. 2023 Mar;64(3):235–238 (PMC9979721, PMID: 36874544) and highlights both the potential resilience of patients in extreme circumstances and the importance of clear doctor-technician communication when using electronic treatment sheets.
Scott
Replying to Josep B. 24/02/2025 - 10:08
It is a really interesting topic!
I am considering it more and more, I have been sing it with some chronic regurgitation/GI cases too.
Scott 🙂
Josep, what are your thoughts on this paper?
J Vet Intern Med. 2024 Jul-Aug;38(4):2221-2227 – a prospective randomized trial comparing relapse rates in dogs with SRMA treated with either a 6-week or 6-month prednisolone protocol.
A few key takeaways:
Both groups had similar response rates.
Relapse occurred in 30% (6-month protocol) vs. 38% (6-week protocol), but there was no statistically significant difference between them (P = 0.60).
Among relapsed cases, most dogs only relapsed once, with very few having multiple recurrences.
Suggests a shorter steroid course may be viable, potentially reducing adverse effects and improving quality of life.
Given the historical reliance on prolonged immunosuppression for SRMA, do you think this study is enough to shift treatment protocols towards shorter courses? Or are there limitations that make you hesitant to change standard practice?Does this change your tapering approach? What is your current approach to tapering in SRMA cases?
Scott 🙂
Replying to Josep B. 24/02/2025 - 10:13
“I know a really good paper on this topic… oh wait… did we write that?! 🙂
For anyone who somehow hasn’t read this masterpiece yet, let me summarize:
Front Vet Sci. 2023 Feb 14:10:1091318 – a fine example of scientific rigor, if I do say so myself! In this multicentric retrospective study, we analysed data from 167 dogs diagnosed with either SRMA or IMPA, looking at how CRP concentrations varied between the two diseases.
Key findings:
SRMA was significantly more common in dogs <12 months old, whereas IMPA was more frequent in dogs ≥12 months old (P < 0.001). Dogs with SRMA had higher CRP concentrations than those with IMPA (P = 0.02). However, CRP’s diagnostic role wasn’t as straightforward as expected—its predictive value actually shifted with age. In dogs <12 months old, higher CRP was paradoxically more suggestive of IMPA (P = 0.02). In dogs ≥12 months old, higher CRP was more indicative of SRMA (P = 0.02). When looking at overall discriminatory ability, CRP alone was only fair at differentiating between the two (ROC AUC ~0.7), meaning it shouldn't be used as a sole diagnostic tool. Take-home message: CRP is a useful marker of inflammation, but interpreting it in the context of SRMA vs. IMPA requires nuance—particularly considering patient age. It’s another reminder that clinical context always matters! Nothing like a bit of shameless self-promotion. Scott 🙂
