Objective—To describe the outcome of cats treated with gastrointestinal tract decontamination, IV fluid diuresis, or both after ingestion of plant material from lilies of the Lilium and Hemerocallis genera.
Design—Retrospective case series.
Animals—25 cats evaluated after ingestion of lily plants.
Procedures—Medical records of cats examined at the Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania with known lily ingestion between July 2001 and April 2010 were reviewed. Inclusion in the study required evidence of lily plant ingestion within the preceding 48 hours. Type of lily ingested, time of ingestion, gastrointestinal tract decontamination procedures performed, and IV fluid diuresis were recorded. The presence or absence of acute kidney injury was determined by evaluating BUN concentration, creatinine concentration, and urine specific gravity. Outcome was defined as survival to discharge, death, or euthanasia.
Results—The time from ingestion until evaluation at the Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania ranged from < 30 minutes to 48 hours. Nineteen cats received gastrointestinal tract decontamination (18 cats at our hospital and 1 cat by the referring veterinarian). Twenty-three cats were admitted to the hospital for IV fluid diuresis, supportive care, and monitoring. Seventeen of these 23 (74%) cats had normal BUN and creatinine concentrations throughout hospitalization. At the time of discharge from the hospital, 2 of the 23 (9%) hospitalized cats had an increased BUN concentration, creatinine concentration, or both. All 25 (100%) cats survived to discharge from the hospital.
Conclusions and Clinical Relevance—In this series of cats treated with gastrointestinal tract decontamination, IV fluid diuresis, or both within 48 hours after lily ingestion, the outcome was good, with a low incidence of acute kidney injury. Future studies are needed to determine the most effective gastrointestinal tract decontamination procedures and optimal duration of IV fluid therapy.
Objective—To characterize clinical signs, diagnostic test results, foreign body location, treatment, and outcome for dogs and cats with sewing needle foreign bodies.
Design—Retrospective case series.
Animals—65 dogs and cats with sewing needle foreign bodies.
Procedures—Medical records of 27 dogs and 38 cats examined because of sewing needle foreign bodies from January 2000 to February 2012 were reviewed for signalment, medical history, physical examination findings, diagnostic test results, interval from witnessed exposure and radiographic imaging to definitive treatment, definitive treatment, sewing needle location, complications, and outcome.
Results—7 (10.8%) animals had sewing needles in extragastrointestinal locations that were not causing clinical signs. The remaining 58 (89.2%) animals had known sewing needle exposure or acute clinical signs associated with ingestion. The esophageal and gastric regions were the most common location for a sewing needle (10/21 [47.6%] dogs; 19/37 [51.4%] cats), followed by the oropharynx (7/21 [33.3%] dogs; 11/37 [29.7%] cats) and small and large intestines (4/21 [19.0%] dogs; 7/37 [18.9%] cats). Gastrointestinal perforation was detected in 10 of 58 (17.2%) animals (5/21 [23.8%] dogs; 5/37 [13.5%] cats). Sewing needles in the esophagus and stomach were successfully removed endoscopically in 8 of 9 dogs and 18 of 19 cats. Survival rate was 98.1% (51/52) for animals receiving definitive treatment.
Conclusions and Clinical Relevance—Endoscopic removal of ingested sewing needles was highly successful and should be recommended to prevent gastrointestinal tract perforation and associated morbidity. Prognosis for dogs and cats receiving definitive treatment for sewing needle foreign body ingestion was excellent.
Objective—To determine the association of blood lactate concentration with physically assessed perfusion variables, systolic arterial blood pressure (SAP), and outcome in cats evaluated by an emergency service.
Design—Prospective, observational study.
Procedures—Initial blood lactate concentration and SAP (prior to any therapeutic interventions) as well as physically assessed perfusion variables (mucous membrane color, capillary refill time, peripheral pulse quality, heart rate, and rectal temperature) were determined. Cats were categorized as having no shock, mild to moderate shock, or severe shock. Outcomes were recorded. Associations between lactate concentration and these variables were assessed.
Results—Median initial blood lactate concentration was 2.7 mmol/L (range, 0.5 to 19.3 mmol/L); cats with white mucous membranes, abnormal peripheral pulse quality, and hypothermia had significantly higher lactate concentration than did cats without these findings. Median lactate concentration for cats with SAP < 90 mm Hg (3.3 mmol/L) was significantly higher than that of cats with SAP ≥ 90 mm Hg (2.35 mmol/L). Cats with severe shock had significantly higher lactate concentration (4.3 mmol/L) than did cats in other shock categories. Median initial lactate concentration at admission did not differ between cats that did (2.45 mmol/L) and did not (3.2 mmol/L) survive to discharge from the hospital. Change in lactate concentration during hospitalization (when applicable) was not associated with outcome.
Conclusions and Clinical Relevance—Findings indicated that blood lactate concentration, together with physical examination findings and SAP, may be a useful tool for identifying abnormalities in tissue oxygen delivery in cats. However, lactate concentrations were not associated with outcome in the present study.
Animals—20 dogs that had hemorrhagic diarrhea with < 3 episodes of vomiting.
Procedures—All dogs underwent testing for parvovirus infection, were given maropitant citrate to control emesis, and were offered an OES. Intravenous crystalloid fluid administration was performed when dogs refused the OES or had vomiting, a 5% increase in PCV, 5% decrease in body weight, serum creatinine or BUN concentration higher than at admission, or clinically important alterations in blood electrolyte or serum glucose concentrations.
Results—13 (65%) dogs voluntarily consumed the OES; 7 (35%) dogs refused the OES and received a balanced electrolyte solution IV instead. All 13 dogs in the OES group consumed the solution ≤ 5 hours after hospital admission. Eight and 16 hours after admission, PCV and serum total protein and BUN concentrations were significantly lower than at hospital admission in the OES group, whereas no significant changes were identified in venous blood pH, base excess, and concentrations of sodium, potassium, chloride, ionized calcium, ionized magnesium, and lactate. The cost of treatment was significantly less for the OES group than for the IV treated group.
Conclusions and Clinical Relevance—Rehydration therapy with an OES was effective and safe in dogs with mild to moderate dehydration associated with hemorrhagic diarrhea. Potential benefits of this treatment approach for gastroenteritis in dogs, compared with traditional IV fluid administration, include lower owner-related veterinary costs and decreased staff time associated with treatment. (J Am Vet Med Assoc 2013;243:851–857)
Objective—To compare rectal versus axillary temperatures in dogs and cats.
Design—Prospective observational study.
Animals—94 dogs and 31 cats.
Procedures—Paired axillary and rectal temperatures were measured in random order with a standardized method. Animal signalment, initial complaint, blood pressure, blood lactate concentration, and variables associated with vascular perfusion and coat were evaluated for associations with axillary and rectal temperatures.
Results—Axillary temperature was positively correlated with rectal temperature (ρ = 0.75 in both species). Median axillary temperature (38.4°C [101.1°F] in dogs, and 38.4°C [101.2°F] in cats) was significantly different from median rectal temperature in dogs (38.9°C [102.0°F]) but not in cats (38.6°C [101.5°F]). Median rectal-axillary gradient (difference) was 0.4°C (0.7°F; range, −1.3° to 2.3°C [−2.4° to 4.1°F]) in dogs and 0.17°C (0.3°F; range −1.1° to 1.6°C [−1.9° to 3°F]) in cats. Sensitivity and specificity for detection of hyperthermia with axillary temperature were 57% and 100%, respectively, in dogs and 33% and 100%, respectively, in cats; sensitivity and specificity for detection of hypothermia were 86% and 87%, respectively, in dogs and 80% and 96%, respectively, in cats. Body weight (ρ = 0.514) and body condition score (ρ = 0.431) were correlated with rectal-axillary gradient in cats.
Conclusions and Clinical Relevance—Although axillary and rectal temperatures were correlated in dogs and cats, a large gradient was present between rectal temperature and axillary temperature, suggesting that axillary temperature should not be used as a substitute for rectal temperature.
Case Description—A 2-year-old spayed female Border Collie was treated with IV lipid emulsion (ILE) after ingesting 6 mg/kg (2.73 mg/lb) of an equine ivermectin anthelmintic paste 8 hours prior to examination.
Clinical Findings—On initial examination, the dog had stable cardiovascular signs but had diffuse muscle tremors and was hyperthermic. Neurologic evaluation revealed that the dog was ataxic and had mydriasis with bilaterally absent menace responses and pupillary light reflexes. The remaining physical examination findings were unremarkable. Results of CBC, serum biochemical analysis, venous blood gas analysis, and measurement of plasma lactate concentration were also within reference limits.
Treatment and Outcome—The dog was treated with ILE in addition to supportive care with IV fluid therapy and cardiovascular, respiratory, and neurologic monitoring. The use of ILE treatment was initiated in this patient on the basis of previous clinical and experimental evidence supporting its use for toxicosis resulting from lipid-soluble agents. An initial bolus of 1.5 mL/kg (0.68 mL/lb) of a 20% sterile lipid solution was administered IV over 10 minutes, followed by a constant rate infusion of 0.25 mL/kg/min (0.11 mL/lb/min) over 60 minutes that was administered twice to treat clinical signs of ivermectin toxicosis. The dog was discharged from the hospital 48 hours after admission and was clinically normal within 4 days after ivermectin ingestion. Further diagnostic evaluation subsequently revealed that this dog was unaffected by the multidrug resistance gene (MDR-1) deletion, known as the ATP-binding cassette polymorphism.
Clinical Relevance—Ivermectin toxicosis in veterinary patients can result in death without aggressive treatment, and severe toxicosis often requires mechanical ventilation and intensive supportive care. This is particularly true in dogs affected by the ATP-binding cassette polymorphism. Novel ILE treatment has been shown to be effective in human patients with lipid-soluble drug toxicoses, although the exact mechanism is unknown. In the patient in the present report, ILE was used successfully to treat ivermectin toxicosis, and results of serial measurement of serum ivermectin concentration supported the proposed lipid sink mechanism of action.
To investigate the incidence and patterns of gunshot wound trauma in patients that were presented to an urban level 1 veterinary trauma center before and after the start of the coronavirus disease of 2019 (COVID-19) pandemic.
24 dogs and 1 cat.
Medical records were retrospectively reviewed for patients presenting with gunshot wound injuries between March 2018 and February 2020 (prepandemic) and March 2020 and February 2022 (pandemic). The total number of patients presented to the hospital during those same time periods was also obtained. Patient data were collected including species, breed, age, sex, location of injury, trauma score (if available), surgical procedures performed, length of hospitalization, and case outcome.
In the prepandemic period, 9 patients were presented for gunshot wound injuries, whereas there were 16 patients evaluated for gunshot wound injuries during the pandemic period. The total number of gunshot wound cases increased by 77.8% in the pandemic period. The total number of hospital patient visits, however, decreased by 12.2% in the pandemic period as compared to the prepandemic period: 65,168 versus 74,262 patients, respectively. Injuries were predominantly localized to the extremities (55%) in the prepandemic period versus maxillofacial (56%) in the pandemic period.
There was an increased number of gunshot wound injuries in companion animals presenting to an urban level 1 veterinary trauma center during the COVID-19 pandemic. A shift in the predominant location of injury was also identified during the pandemic period. This study highlights the ramifications that societal dynamics can have on animal health and welfare.
To identify associations between admission variables, Animal Trauma Triage (ATT) score, and Modified Glasgow Coma Scale (MGCS) score with need for transfusion or surgical interventions and survival to discharge in cats with bite wounds.
1,065 cats with bite wounds.
Records of cats with bite wounds were obtained from the VetCOT registry from April 2017 to June 2021. Variables included point of care laboratory values, signalment, weight, illness severity scores, and surgical intervention. Associations between admission parameters, terciles of MGCS, quantiles of ATT scores, and death or euthanasia were assessed using univariable and multivariable logistic regression analysis.
872 cats (82%) survived to discharge, while 170 (88%) were euthanized and 23(12%) died. In the multivariable model, age, weight, surgical treatment, ATT and MGCS scores were associated with nonsurvival. For every 1 year of age, odds of nonsurvival increased by 7% (P = .003) and for every 1 kg of body weight, odds of nonsurvival decreased by 14% (P = .005). Odds of dying increased with lower MGCS and higher ATT scores (MGCS: 104% [95% CI, 116% to 267%; P < .001]; ATT: 351% [95% CI, 321% to 632%; P < .001). Odds of dying decreased by 84% (P < .001) in cats that underwent surgery versus those that did not.
This multicenter study indicated association of higher ATT and lower MGCS with worse outcome. Older age increased the odds of nonsurvival, while each kilogram increase in bodyweight decreased odds of nonsurvival. To our knowledge, this study is the first to describe associations of age and weight with outcome in feline trauma patients.
To retrospectively assess the hospital prevalence and risk factors associated with iatrogenic lower urinary tear in cats with urethral obstruction (UO).
15 client-owned cats diagnosed with concurrent UO and lower urinary tears and year-matched control population of 45 cats diagnosed with UO.
University teaching hospital records were reviewed for cats presenting with UO between January 2010 and December 2022. Signalment, anatomic location of tear, experience of the individual passing the urinary catheter, difficulty level of catheter passage, history of previous UO, blood work parameters on presentation, presence of visible grit in urine, and survival to discharge were recorded. In addition, prevalence of lower urinary tears in cats presenting with UO was calculated.
The prevalence of lower urinary tears was 0.92% in UO cats. Cats with lower urinary tears were significantly less likely to survive to discharge and had a longer period of hospitalization than cats without tears. In addition, cats with tears were more likely to have a history of previous UO and had more difficult urinary catheter passage than cats in the control group. Cats with tears also had a higher Hct than the control UO cats.
Cats that develop lower urinary tears are more likely to have a history of previous UO and difficult catheter passage. This group of cats is also more likely to have a longer hospitalization period and lower survival to discharge rates.
To investigate whether decompressive cystocentesis (DC) safely facilitates urethral catheterization (UC) in cats with urethral obstruction (UO).
88 male cats with UO.
Cats were randomly assigned to receive DC prior to UC (ie, DC group cats; n = 44) or UC only (ie, UC group cats; 44). Abdominal effusion was monitored by serial ultrasonographic examination of the urinary bladder before DC and UC or before UC (DC and UC group cats, respectively), immediately after UC, and 4 hours after UC. Total abdominal effusion score at each time point ranged from 0 (no effusion) to 16 (extensive effusion). Ease of UC (score, 0 [easy passage] to 4 [unable to pass]), time to place urinary catheter, and adverse events were recorded.
No significant difference was found in median time to place the urinary catheter in UC group cats (132 seconds), compared with DC group cats (120 seconds). Median score for ease of UC was not significantly different between UC group cats (score, 1; range, 0 to 3) and DC group cats (score, 1; range, 0 to 4). Median change in total abdominal effusion score from before UC and DC to immediately after UC was 0 and nonsignificant in UC group cats (range, −5 to 12) and DC group cats (range, −4 to 8). Median change in effusion score from immediately after UC to 4 hours after UC was not significantly different between UC group cats (score, −1; range, −9 to 5) and DC group cats (score, −1; range, −7 to 5).
CONCLUSIONS AND CLINICAL RELEVANCE
DC did not improve time to place the urinary catheter or ease of UC in cats with UO.