Thursday, January 31, 2013

Introduction to Multiple Organ Dysfunction and Failure


Veterinary Clinics of North America: Small Animal Practice
Volume 41, Issue 4 , Pages 703-707, July 2011


Introduction to Multiple Organ Dysfunction and Failure

Department of Clinical Sciences, Colorado State University, 300 West Drake Road, Fort Collins, CO 80523, USA


Multiple organ failure and multiple organ dysfunction syndrome (MODS) were first recognized as undesirable complications of advancements in emergency and critical care. MODS remains the leading cause of death and resource expenditure in human intensive care units. MODS has been documented in small animal veterinary patients raising similar concerns. The understanding of the pathogenesis of MODS has evolved from uncontrolled infection to uncontrolled inflammation. Management is primarily through supportive care, early and aggressive monitoring of organ function, and intensive care nursing. Tissue hypoxia, microvascular thrombosis, increased vascular permeability, and disrupted cell-cell communication are prominent features of MODS.





Association between outcome and organ system dysfunction in dogs with sepsis: 114 cases


Association between outcome and organ system dysfunction in dogs with sepsis: 114 cases (2003–2007)

Eileen M. KenneyDVMElizabeth A. RozanskiDVM, DACVIM, DACVECCJohn E. RushDVM, MS, DACVECC, DACVIMArmelle M. deLaforcade-BuressDVM, DACVECCJohn R. BergDVM, DACVS;Deborah C. SilversteinDVM, DACVECCCatalina D. MontealegreDVML. Ari JutkowitzVMD, DACVECC;Sophie AdamantosBVSc, DACVECCDianna H. OvbeyDVMSoren R. BoysenDVM, DACVECC;Scott P. ShawDVM, DACVECC
Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA 01536. (Kenney, Rozanski, Rush, deLaforcade-Buress, Berg, Shaw); Tufts Veterinary Emergency Treatment and Specialties, 525 South St, Walpole, MA 02081. (Kenney, deLaforcade-Buress); Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104. (Silverstein, Montealegre); Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824. (Jutkowitz); Department of Veterinary Clinical Sciences, Royal Veterinary College, North Mymms, Hatfield, Herts AL9 7TA, England. (Adamantos); Department of Small Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA 30602. (Ovbey); Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, QC J2S 7C6, Canada. (Boysen)
Objective—To determine whether multiple organ dysfunction syndrome (MODS) could be identified in dogs with sepsis secondary to gastrointestinal tract leakage, and whether the number of affected organ systems was significantly associated with mortality rate.
Design—Multicenter retrospective case series.
Animals—114 dogs.
Procedures—Medical records for dogs treated surgically because of sepsis secondary to gastrointestinal tract leakage between 2003 and 2007 were reviewed. Sepsis was diagnosed on the basis of results of bacterial culture of peritoneal fluid, gross evidence of gastrointestinal tract leakage at surgery, or both. Renal dysfunction was defined as a ≥ 0.5 mg/dL increase in serum creatinine concentration after surgery. Cardiovascular dysfunction was defined as hypotension requiring vasopressor treatment. Respiratory dysfunction was defined as a need for supplemental oxygen administration or mechanical ventilation. Hepatic dysfunction was defined as a serum bilirubin concentration > 0.5 mg/dL. Dysfunction of coagulation was defined as prolonged prothrombin time, prolonged partial thromboplastin time, or platelet count ≤ 100,000/μL.
Results—89 (78%) dogs had dysfunction of 1 or more organ systems, and 57 (50%) dogs had MODS. Mortality rate increased as the number of dysfunctional organ systems increased. Mortality rate was 70% (40/57) for dogs with MODS and 25% (14/57) for dogs without.
Conclusions and Clinical Relevance—Results indicated that MODS, defined as dysfunction of at least 2 organ systems, can be identified in dogs with sepsis and that organ system dysfunction increased the odds of death.

January 1, 2010, Vol. 236, No. 1, Pages 83-87
doi: 10.2460/javma.236.1.83

Wednesday, January 30, 2013

Heart, kidney, and intestine have different tolerances for anemia


Heart, kidney, and intestine have different tolerances for anemia

JASPER VAN BOMMEL, MARTIN SIEGEMUND, CH. PIETER HENNY, and CAN INCE
ROTTERDAM, THE NETHERLANDS; BASEL, SWITZERLAND; AND AMSTERDAM, THE NETHERLANDS


Organ systems do not respond uniformly to changes in systemic oxygen delivery
because of global and local redistributive mechanisms. We hypothesized that
progressive hemodilution would evoke a different response in the microvascular
oxygenation of the heart compared with kidney and gut. To evaluate this hypothesis,
we studied the effect of stepwise isovolemic hemodilution on systemic hemodynamic
and oxygenation parameters as well as the relation between systemic
hematocrit (Ht) and microvascular PO2 ( PO2) in heart, kidney, and intestines in an
anesthetized and mechanically ventilated rat model.
Baseline conditions were similar in the hemodilution group and in the control group.
In the hemodilution group, Ht was diminished from 46.6 3.8% to 7.0 1.8% [mean
standard deviation (SD)]. This group had no effect on measured hemodynamics;
only when Ht fell below 10% did blood pressure start to decrease. The PO2 values
in heart, kidney, and intestines did not respond uniformly. Renal PO2 (56 10 mm
Hg at baseline) started to decrease at a Ht of 38.5 8.6%, whereas intestinal PO2
(59 6 mm Hg at baseline) did not start to decrease until Ht reached 17.4 7.1%.
Finally, cardiac PO2 (40 6 mm Hg at baseline) decreased only in the ultimate
stage of the experiment at Ht of 8.7 3.5%.
Based on these observations, we conclude that the regulation of microvascular
oxygenation during progressive anemia is specific for each organ system. The
relation between these observations and organ function and damage needs to be
determined. (Translational Research 2008;151:110-117)

Retrospective study of fever in dogs: laboratory testing, diagnoses and influence of prior treatment


Retrospective study of fever in dogs: laboratory testing, diagnoses and influence of prior treatment

  1. I. A. Battersby, 
  2. K. F. Murphy, 
  3. S. Tasker, 
  4. K. Papasouliotis
Article first published online: 28 JUN 2006
DOI: 10.1111/j.1748-5827.2006.00042.x
Journal of Small Animal Practice

Journal of Small Animal Practice

Volume 47Issue 7pages 370–376July 2006

ObjectivesTo analyse the demographic information of dogs referred for investigation of fever, to determine the usefulness of various diagnostic investigations and to assess the effect of treatment before referral on the presence of fever at referral, the duration of the investigation and the ability to reach a final diagnosis.
MethodsThe clinical records of 66 dogs, in which fever was part of the clinical signs documented by the referring veterinary surgeon, were reviewed. The effects of treatment 24 hours before referral on temperature at initial consultation and on time to diagnosis were evaluated. The effect of body temperature at initial consultation on cost and on time to diagnosis was also determined. The effect of insurance on costs incurred was assessed. The utility of different diagnostic investigations was recorded, and cases were classified according to the final diagnosis.
ResultsOnly 34·8 per cent of dogs were diagnosed with immune-mediated disease, with most frequent diagnoses being steroid-responsive meningitis and polyarthritis. Treatment 24 hours before referral significantly increased the time to diagnosis (P=0·004) and affected the presence of fever at referral (P=0·006). Insurance status did not significantly affect cost incurred by the owner.
Clinical SignificanceThis study documents a high incidence of immune-mediated disease in dogs referred for investigation of fever. It also documents a higher incidence of inflammatory central nervous system disease in febrile dogs than that reported previously. Of the diagnostic modalities employed in the majority of cases, radiography, cytology and bacteriological and fungal cultures (fluids/tissues) were the most useful. It is suggested that treatment is withdrawn or withheld before commencing diagnostic investigation of fever.

Causes, diagnostic signs, and the utility of investigations of fever in dogs: 50 cases


Can Vet J. 2012 May; 53(5): 525–530.
PMCID: PMC3327591

Causes, diagnostic signs, and the utility of investigations of fever in dogs: 50 cases

Abstract

This study aimed to determine the distribution of diseases causing fever in dogs in France. Dogs with fever were reviewed and 50 dogs were retrospectively assigned to disease groups. Fever profile and intensity, the time taken to reach a diagnosis, and inflammatory status were compared among groups. Almost half the dogs (48%) were diagnosed with non-infectious inflammatory diseases. No final diagnosis was reached in 14 dogs, 13 of which belonged to owners who did not wish to pursue the investigations. No association was found between disease group and the intensity of fever, fever profile, or serum C-reactive protein concentration. Cytological examinations were most frequently found to be the most important determinant for diagnosis (55.7%). This study confirms the predominance of non-infectious inflammatory diseases as causes of fever. Neither clinical nor biological factors were found to be predictive of disease group.

Tuesday, January 29, 2013

A retrospective study of 180 anaemic cats: Features, aetiologies and survival data


A retrospective study of 180 anaemic cats: Features, aetiologies and survival data


  1.  2012 Sep 18.

  2. Rachel M Korman1,*
  3. Natasha Hetzel1,
  4. Toby G Knowles2
  5. Andrea M Harvey1,
  6. Séverine Tasker1
  1. 1The Feline Centre, Langford Veterinary Services, School of Veterinary Sciences, University of Bristol, UK
  2. 2Animal Behaviour and Welfare, School of Veterinary Sciences, University of Bristol, UK
  3. *Rachel M Korman is now at Veterinary Specialist Services, Underwood, QLD, Australia
  4. Natasha Hetzel is now at Cave Veterinary Specialists, North Wellington, UK
  5. Andrea M Harvey is now at Small Animal Specialist Hospital, Sydney, NSW, Australia
  1. Rachel M Korman BVSc GPCertFelP MACVSc MRCVS, Veterinary Specialist Services, Underwood, QLD 4217, Australia Email: rkorman@vss.net.au

Abstract

The study comprised 180 anaemic cats. Descriptive and survival data were obtained. Cats were classified by aetiology of anaemia development and degenerative, anomalous, metabolic, miscellaneous, neoplastic, infectious, inflammatory, immune-mediated, toxic, traumatic or vascular disease (DAMNITV) classification and anaemia severity. Sixty-four (35.6%) cats had mild [packed cell volume (PCV)/haematocrit (HCT) 20–24.9%], 58 (32.2%) moderate (14–19.9%), 23 (12.8%) severe (11–13.9%) and 35 (19.4%) very severe (<10.9%) anaemia. By aetiology of anaemia development, bone marrow (BM) abnormalities were more common (95, 52.8%) than haemorrhage (37, 20.6%) or haemolysis (19, 10.6%). By DAMNITV classification, infectious diseases were more common (39, 21.7%) than neoplasia (36, 20%), metabolic (21, 11.7%), trauma (15, 8.3%), miscellaneous (14, 7.8%), inflammatory (11, 6.1%), immune-mediated (11, 6.1%), anomalous (8, 4.4%), toxic (2, 1.1%) or vascular disease (1, 0.6%). BM abnormalities were significantly associated with more severe anaemia (P = 0.003). Most cats (112, 62.2%) survived to discharge whereas 55 (30.6%) were euthanased and 13 (7.2%) died. Survival to discharge was not associated with anaemia severity but was associated significantly with aetiology of anaemia development (P = 0.046), as cats with haemolysis were more likely to survive to discharge than cats with BM abnormalities. Survival to discharge was also associated significantly with DAMNITV classification (P = 0.010) with cats with neoplasia being less likely, and cats with immune-mediated disease more likely, to survive to discharge. Cox regression analysis found that survival was not associated with anaemia severity, but was associated with DAMNITV classification (P = 0.011) and age (P = 0.082), with cats with immune-mediated disease and younger cats more likely to survive.


Monday, January 28, 2013

Use of the vertebral heart scale for differentiation of cardiac and noncardiac causes of respiratory distress in cats


Use of the vertebral heart scale for differentiation of cardiac and noncardiac causes of respiratory distress in cats: 67 cases (2002–2003)

Meg M. SleeperVMD, DACVIMRisa RolandDVM, DACVIMKenneth J. DrobatzDVM, MSCE, DACVECC, DACVIM
Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104. (Sleeper, Roland, Drobatz)

Objective—To assess the effectiveness of the vertebral heart scale (VHS) system to differentiate congestive heart failure from other causes of dyspnea in cats.
Design—Retrospective case series.
Animals—67 cats with acute respiratory distress.
Procedures—Medical records of client-owned cats evaluated on an emergency basis because of acute respiratory distress during a 1-year period were reviewed. For study inclusion, cats must have undergone evaluation with echocardiography and thoracic radiography within 12 hours after hospital admission. The VHS was calculated for each cat by 2 investigators. Signalment, physical examination, and echocardiographic findings were reviewed for each patient.
Results—There was 83% agreement overall between the 2 investigators in assessment of cardiomegaly in cats with dyspnea (κ = 0.49). The VHS cutpoints were the same for both observers in terms of optimizing sensitivity and specificity. A VHS of > 8.0 vertebrae was the best cutpoint when screening for heart disease, whereas a VHS of > 9.3 vertebrae was very specific for the presence of heart disease. Measurements between 8.0 and 9.3 vertebrae suggested the cause of dyspnea was equivocal (ie, secondary to congestive heart failure or respiratory disease), in which case echocardiography would be most useful in providing additional diagnostic information.
Conclusions and Clinical Relevance—Results suggested that the VHS system may be a useful tool to help differentiate cardiac from noncardiac causes of respiratory distress in cats in an emergency situation when an echocardiogram is not available or is not plausible in an unstable patient.

February 1, 2013, Vol. 242, No. 3, Pages 366-371
doi: 10.2460/javma.242.3.366

Incidence, Nature, and Etiology of Metabolic Acidosis in Dogs and Cats


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Incidence, Nature, and Etiology of Metabolic Acidosis in Dogs and Cats

  1. K. Hopper*
  2. S.E. Epstein
Article first published online: 3 AUG 2012
DOI: 10.1111/j.1939-1676.2012.00983.x
Journal of Veterinary Internal Medicine

Journal of Veterinary Internal Medicine

Volume 26Issue 5pages 1107–1114September–October 2012


Background

Metabolic acidosis is an important abnormality in ill and injured dogs and cats.

Objectives

To describe the incidence, nature, and etiology of metabolic acidosis in dogs and cats that had arterial or venous blood gases measured for any reason at a university teaching hospital.

Animals

Dogs and cats at the Veterinary Medical Teaching Hospital.

Methods

Acid base parameters and electrolyte and lactate concentrations in dogs and cats measured during a 13-month period were retrospectively retrieved from a computer database. Metabolic acidosis was defined as a standardized base excess (SBE) in dogs of <−4 mmol/L and in cats <−5 mmol/L.

Results

A total of 1,805 dogs and cats were included; of these, 887 (49%) were classified as having a metabolic acidosis (753 dogs and 134 cats). Primary metabolic acidosis was the most common disorder in dogs, whereas mixed acid base disorder of metabolic acidosis and respiratory acidosis was most common in cats. Hyperchloremic metabolic acidosis was more common than a high anion gap (AG) metabolic acidosis; 25% of dogs and 34% of cats could not be classified as having either a hyperchloremic metabolic acidosis or a high AG metabolic acidosis.

Conclusions and Clinical Importance

Metabolic acidosis was found commonly in this patient population and was associated with a wide variety of disease processes. Mixed acid base disorders occur frequently and routine categorization of metabolic acidosis based on the presence of high AG or hyperchloremia may be misleading in a large proportion of cases.

Sunday, January 27, 2013

Peritoneal dialysis in the management of acute renal failure in 5 dogs with leptospirosis


Peritoneal dialysis in the management of acute renal failure in 5 dogs with leptospirosis

  1. Nicole F. Beckel DVM, 
  2. Therese E. O'Toole DVM, 
  3. Elizabeth A. Rozanski DVM, DACVECC, DACVIM, 
  4. Mary A. Labato DVM, DACVIM
Article first published online: 23 AUG 2005
DOI: 10.1111/j.1476-4431.2005.00142.x
Journal of Veterinary Emergency and Critical Care

Journal of Veterinary Emergency and Critical Care

Volume 15Issue 3pages 201–205September 2005


Abstract

Objective: To describe the use of peritoneal dialysis (PD) in the management of 5 dogs with acute renal failure (ARF) caused by leptospirosis.
Case Series Summary: All dogs were treated for leptospirosis with intravenous (IV) fluids and ampicillin prior to PD. Median age of dogs was 5 years (range 2–6 years). All dogs had positive titers for Leptospira bratislava. Median duration of PD was 4 days (range 3–16 days). PD resulted in a decrease in azotemia in all dogs. Median serum blood urea nitrogen at the start of PD was 192 mg/dL (range 140–235 mg/dL) and at the end of PD was 63 mg/dL (range 48–139 mg/dL). Median serum creatinine at the start of PD and the end was 12.8 mg/dL (range 7.7–16.9 mg/dL) and 3.4 mg/dL (range 1.4–11.1 mg/dL), respectively. Complications identified during PD included hypokalemia (n=3, 60%), hypoalbuminemia (n=2, 40%), hypomagnesemia (n=1, 20%), pelvic limb edema (n=2, 40%), central nervous system signs (n=2, 40%), dialysate retention (n=1, 20%), and leakage from the catheter site (n=1, 20%). Peritonitis was not identified in any of the dogs. Four dogs (80%) survived to discharge from the hospital. PD was effective for management of uremia in dogs with ARF caused by leptospirosis.

Pulmonary Abnormalities in Dogs with Leptospirosis


Pulmonary Abnormalities in Dogs with Leptospirosis

  1. B. Kohn1
  2. K. Steinicke1
  3. G. Arndt2
  4. A.D. Gruber3
  5. B. Guerra4
  6. A. Jansen5
  7. B. Kaser-Hotz1
  8. R. Klopfleisch3
  9. F. Lotz2
  10. E. Luge4
  11. K. Nöckler4
Article first published online: 24 AUG 2010
DOI: 10.1111/j.1939-1676.2010.0585.x
Journal of Veterinary Internal Medicine

Journal of Veterinary Internal Medicine

Volume 24Issue 6pages 1277–1282,November/December 2010


Background: Leptospirosis in dogs is a multiorgan disease affecting mostly kidneys and liver.
Objectives: The objective was to characterize prevalence, clinical, and radiological features and outcome of dogs with leptospirosis and pulmonary abnormalities.
Animals: Fifty dogs with leptospirosis.
Methods: Medical records of dogs diagnosed with leptospirosis at the Small Animal Clinic, Berlin, were reviewed. Diagnosis was based on microscopic agglutination test, blood or urine polymerase chain reaction, and histopathology. Based on clinical and/or radiological signs, patients were grouped into dogs with lung abnormalities (group 1) or without (group 2). Severity of respiratory distress was scored as mild to moderate (grade 1) or severe (grade 2). Thoracic radiographs were scored based on pulmonary changes and location as grade 1 (caudal interstitial pattern), 2 (generalized mild to moderate reticulonodular interstitial pattern), or 3 (generalized severe reticulonodular interstitial pattern with patchy alveolar consolidations). Results of CBC and biochemistry were compared between groups.
Results: Thirty-five dogs had radiological pulmonary changes (grade 1: 5; grade 2: 14; grade 3: 16); 31 of them had pulmonary distress (grade 1: 13, grade 2: 18). Sixty-seven percent of the dogs with dyspnea grade 2 were mainly euthanized because of respiratory distress. Fifteen percent of the dogs with dyspnea grade 1 and 21% without clinical respiratory signs were euthanized because of acute renal failure or sepsis.
Conclusions and Clinical Importance: In 70% of dogs with leptospirosis pulmonary changes were detected. Lung involvement represented a severe complication causing increased case fatality depending on the severity of respiratory distress.