scott@vtx-cpd.com
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Hello.
I am so glad you enjoyed. There are a few protocols out there, but I would go with:
IM regular insulin, not administered until patients have been adequately rehydrated with a stable cardiovascular system, is given at dosages of 0.2 U/kg initially and then 0.1 U/kg IM hourly until the blood glucose drops below 14 mmol/l, when insulin is given SC every 6 to 8 hours at dosages of 0.5 to 1 U/kg. Dextrose should be supplemented in the patient’s fluids as needed based on the patient’s blood glucose level.
Hope that helps!
Scott 🙂
Replying to Grigory Brodetsky 12/06/2022 - 21:59
Hello Grigory.
Thank you for joining us from Canada!
I really hope you enjoy the course.
Scott 🙂
Replying to Sarah Fiddy 11/06/2022 - 09:32
Hello!
Thank you for joining the course. We seem to have a strong Welsh contingent which is great to see!
I hope you are having a great week.
Scott 🙂
Replying to Stefania Albrizio 10/06/2022 - 18:33
Hello Stefania.
Welcome to the course. Please let us know if you have any questions at anytime.
Scott 🙂
Replying to Hannah B. 09/06/2022 - 11:49
Hello.
Thank you so much for these kind words. I really hope you enjoyed the course. The JC recording is here:
The Q&A should be uploaded under the lesson.
Let me know if any problems.
Scott 🙂
Replying to Laura H. 08/06/2022 - 18:15
Hello Laura.
We are so pleased to have you on the course! I have an added level of respect that you are joining us from maternity leave!
We actively encourage kids joining the live Q&A session! 🙂
Hope you are having a great week.
Scott 🙂
Replying to Emma Holt 06/06/2022 - 18:04
Emma!
Fancy seeing you here! 🙂
Thanks so much for your support and for joining the course.
Scott 🙂
Replying to Katie Swords 06/06/2022 - 13:55
Hello Katie.
Welcome to the course. Thank you so much for your support.
There is nothing like a ‘near miss’to make us stop and have a wee think! We are always learning, right?
Have a great week.
Scott 🙂
Hello everyone.
I hope you are all safe and well. My name is Scott, I am a specialist in small animal internal medicine and one of the founder of vtx. I am so excited that Felipe has joined us to deliver this exciting course.
I really hope you enjoy the course. If you have any (non anaesthesia related) then please let me know. Keep any anesthesia related ones for Filipe! 🙂
Have a brilliant week.
Scott 🙂
Hello.
This is not something I have heard of. My understanding was the follows:
NAC is usually given as a 10% solution diluted 1 to 2 with saline as an IV bolus over 20 minutes through a 0.25 micron non-pyrogenic in-line filter at a dosage of 140 mg/kg initially followed by dosages of 70 mg/kg q 8-12 h.
As far as I am aware this is the same for the IV preparation.
But I stand corrected if you have other information!
Scott 🙂
Replying to Raquel M. 27/05/2022 - 20:16
Hello Raquel.
Great to hear from you. I would definitely consider vitamin D in these cases to help with the hypocalcaemia.
The clopidogrel is a great shout. I would indeed use that in these cases. The standard tablets only come as the 75mg. I would normally use a compounding pharmacy to get different sizes. I normally use BOVA. They have a liquid version too:
https://drive.google.com/file/d/1bL4sa0V_ApBT7UpQBtZorV4ZCyxL5w5d/view?usp=sharing
They might ship to you?
I hope that helps.
Scott 🙂
Replying to Kathryn B. 30/05/2022 - 08:10
Hello.
Thank you for the answer! I love that we now know what the weird pink things are!
I have popped the pathology report below:
Microscopic Description
The images depict highly cellular smears with good cell preservation. There is a variable quantity of
background blood and a large nucleated cell harvest dominated by large lymphocytes approximately two
erythrocytes in diameter. These have moderately thick, deep basophilic cytoplasmic rims and occasionally
contain small, ill-defined pale staining Golgi zones. Nuclei are round or plump oval and paracentric with
stippled chromatin and up to 5 variably sized dispersed pale nucleoli. There are frequent mitoses. There are
numerous spherical lymphoglandular bodies in the background, occasional neutrophils proportionate to
the quantity of background blood and low numbers of tangible body macrophages.Microscopic Interpretation
Lymphoma
Comments
Given the large size of this mass and its apparently rapid onset, the cellular harvest is
consistent with large cell lymphoma. Cytomorphology suggests diffuse large B-cell subtype. Definitive phenotyping will require some form of immunocytochemistry or immunohistochemistry. It would be unusual for this type of lymphoma to present with just one lesion and a thorough assessment for enlarged nodes and organs as well as a haematology
are suggested before considering treatment options. If disease is restricted to this single location I suggest
that the diagnosis is confirmed histologically on biopsied or excised tissue.Hope that helps.
Scott 🙂
Replying to Jen Williams 31/05/2022 - 17:18
Haha!!!
All the good guys do seem to be in there! Thank you for sharing!
Scott 🙂
Hello Austeja.
I hope you are well. Theses are really tricky cases, so don’t beat yourself up about the outcome. You did a great job.
I have popped some thoughts under your questions:
1. How long do you have to wait after discontinuing pred so you can take biopsies?
This is a great question. In an ideal world I would wait as long as possible, at least a couple of weeks. Longer if possible. Endoscopy would have maybe been a good option in this case. You could have considered endoscopic biopsies even when the albumin was lower.
2. I gave metronidazole as immunomodulatory drug, however, now I think it was unjustified. Was it wrong to prescribe it in this case?
The dog had very severe signs, so I understand your reasoning. I would probably not be rushing to use antibiotics in this case. I would have considered diet, probiotics and steroids before antibiotics.
3. Was the shaking fit similar to eclampsia, because of low calcium secondary to low albumin? I assume low glucose was secondary to long standing diarrhea and not eating?
Sounds like the shaking was due to the low calcium and I would suspect moist of this is due to the albumin. The severity of the GI disease will also contribute to issues with calcium absorption. When exactly was the low glucose documented? This could be post seizure/neurological; activity. The other possible concern for low glucose could be sepsis?
4. Could extreme liver enzymes be caused by diazepam and other drugs being more toxic with such low albumin.
I think there are lots of reasons for the liver to take a hit in this case (drugs/GI disease/hypoxia). I would suspect this was a secondary hepatopathy.
5. How would you approach hypoalbuminemic crisis like this?
These are very challenging. Treating the cause as aggressively as possible. I would also be aggressive regarding calcium supplementation (IV in a crisis) as well as considering vitamin D supplementation to help longer term. Plasma and human albumin are the only option for albumin replacement, but both options have their limitations.
6. Do you have any more comments on how would you manage this case?
I think the main thing I would have pushed for earlier on would have been endoscopic biopsies. I would also have considered vitamin D supplementation to help with calcium.
I hope that helps.
Scott 🙂
Hey Julie.
Great points. I think overall the association with Helicobacter and disease is much better determined in human medicine.
I have definitely been in a position where I have ‘treated’ the helicobacter before. I would only consider treatment if there was histopathological evidence of Helicobacter. I would tend to supplement vitamin B and change diet first and see what kind of response there was. If there was associated inflammatory change it might even be worth considering a trial of steroids too. But in some cases, more direct treatment of Helicobacter may be warranted.
Hope that helps.
Scott 🙂
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