Baclofen intoxication in a dog successfully treated with hemodialysis and hemoperfusion coupled with intensive supportive care

Objective: To describe a case of confirmed baclofen intoxication in a dog that was successfully treated with hemodialysis and hemoperfusion (HD/HP) and to report the serum baclofen kinetics. Case summary: A 2.5‐year‐old, 23 kg, spayed female Brittany Spaniel‐mix was treated after ingesting 21‐52 mg/kg of baclofen. The dog was comatose and was receiving manual ventilation at the time of presentation. Extracorporeal HD/HP was started 10 hours after admission. Within 3 hours of starting HD/HP the dog began initiating breaths and was extubated 18 hours after admission. Serial serum samples that were obtained during the first 24 hours of hospitalization were later analyzed for baclofen concentrations. The dog had elevated creatine phosphokinase and liver enzymes that correlated with an agitated recovery period. The dog had thrombocytopenia that resolved by 10 days after presentation. New or unique information provided: HD/HP shortened the baclofen serum elimination half‐life from 5 to 1.5 hours in the initial 2 hours of treatment. The intrinsic elimination rate constant (K_intr) for this dog was 0.138/hour and the total elimination rate constant (K_tot) during the first 2 hours of HD/HP treatment was 0.458/hour. In this dog, HD/HP was an effective method for rapidly decreasing serum baclofen concentration after an acute overdose.     

Successful management of saltwater submersion injury in a dog using mechanical ventilation

Objective– To describe successful management of saltwater near-drowning in a dog using mechanical ventilation. Case Summary– A 7-year-old spayed female Golden Retriever weighing 37 kg was referred for mechanical ventilation after saltwater submersion injury. The dog had a history of rare seizures characterized by pre-ictal agitation. On the morning of the event, the dog became agitated and ran toward Puget Sound. The owners discovered the dog unconscious in approximately 25.4 cm (10 in) of water, with her head submerged. The owners estimated that the dog was submerged for approximately 30 seconds. The dog was presented immediately to the nearest emergency facility where initial diagnostic testing and treatment included venous blood gases, nasal oxygen, and IV fluids. The dog was dyspneic despite nasal oxygen administration and was referred for mechanical ventilation. Upon arrival the patient was cyanotic with an arterial partial pressure of oxygen of 38 mm Hg (reference interval 85–100 mm Hg) and oxygenation saturation of 62% (reference interval >95%). Thoracic radiographs were taken and revealed severe, bilateral pulmonary infiltrates. The patient was ventilated for 70 hours and was discharged 4 days later. Complications included pneumonia and phlebitis at the site of a cephalic IV catheter. Follow up thoracic radiographs 10 days after discharge were within normal limits and the owners report a full recovery at 1 year. New or Unique Information Provided– Submersion injury can result in acute respiratory distress syndrome in dogs. Mechanical ventilation provided critical support during pulmonary recovery in this dog.     

Intrathecal morphine overdose in a dog

CASE DESCRIPTION: A healthy 6-year-old 28.5-kg (62.7-lb) spayed female Boxer undergoing surgical repair of a ruptured cranial cruciate ligament was inadvertently administered an overdose of morphine (1.3 mg/kg [0.59 mg/lb]) via subarachnoid injection. CLINICAL FINDINGS: 50 minutes after administration of the overdose, mild multifocal myoclonic contractions became apparent at the level of the tail; the contractions migrated cranially and progressively increased in intensity and frequency during completion of the surgery. TREATMENT AND OUTCOME: The myoclonic contractions were refractory to treatment with midazolam, naloxone, phenobarbital, and pentobarbital; only atracurium (0.1 mg/kg [0.045 mg/lb], IV) was effective in controlling the movements. The dog developed hypertension, dysphoria, hyperthermia, and hypercapnia. The dog remained anesthetized and ventilated mechanically; treatments included continuous rate IV infusions of propofol (1 mg/kg/h [0.45 mg/lb/h]), diazepam (0.25 mg/kg/h [0.11 mg/lb/h]), atracurium (0.1 to 0.3 mg/kg/h [0.045 to 0.14 mg/lb/h]), and naloxone (0.02 mg/kg/h [0.009 mg/lb/h]). Twenty-two hours after the overdose, the myoclonus was no longer present, and the dog was able to ventilate without mechanical assistance. The dog remained sedated until 60 hours after the overdose, at which time its mentation improved, including recognition of caregivers and response to voice commands. No neurologic abnormalities were detectable at discharge (approx 68 hours after the overdose) or at a recheck evaluation 1 week later. CLINICAL RELEVANCE: Although intrathecal administration of an overdose of morphine can be associated with major and potentially fatal complications, it is possible that affected dogs can completely recover with immediate treatment and extensive supportive care.     

Coma and respiratory failure due to moxidectin intoxication in a dog

Objective: To describe the clinical consequences following ingestion by a dog of a moxidectin‐containing equine deworming product. Few reports exist concerning the treatment and outcome of severe moxidectin toxicity. Treatment, known factors influencing intoxication, and prognosis are reviewed. Case summary: A 10‐month‐old female Border Collie ingested an unknown quantity of a moxidectin‐containing equine deworming product several hours before presentation. Severe neurological signs subsequently developed and included: ataxia, seizures, coma, and respiratory failure. The dog was treated with supportive care including intravenous fluids, activated charcoal, and positive pressure ventilation. Normal spontaneous respiration returned in 34 hours and the patient was discharged 58 hours after ingestion. Full recovery occurred within 1 week of intoxication. New information provided: This report describes moxidectin intoxication and associated respiratory failure in a dog that required mechanical ventilation. The dog's recovery was rapid. Despite severity of signs, the prognosis for patients with moxidectin intoxication is good with appropriate supportive care.     

Pulmonary function changes in goats given 3-methylindole orally

Six adult goats were given 0.2 g of 3-methylindole (3MI)/kg of body weight orally. Lung mechanics and ventilatory function were obtained before 3MI and 2, 4, 6, 24, 48, and 72 hours after 3MI administration. Clinical signs were also monitored. Lungs were removed for gross and microscopic examination and for morphometric analysis from goats that died spontaneously or were killed with an overdose of pentobarbital after 72 hours. The major pulmonary function changes observed included a marked decrease in dynamic lung compliance with a moderate increase in airway resistance, a concomitant hypoxemia, sustained increase in respiratory frequency, a progressive decrease in tidal volume and alveolar ventilation, and increased dead space to tidal volume ratio. A mild metabolic acidosis was also noticed.     

The influence of age on patellar reflex response in the dog

The patellar tendon reflex is a clinical parameter commonly used to assess neurological status. Factors such as quadriceps muscle fiber composition, femur length, and patient age have been reported to influence total and fractionated reflex times in human beings. The purpose of this blinded, cross-sectional study was to examine the effect of age on the patellar reflex in the dog. Eighty-six dogs without evidence of neurological impairment or orthopedic disease of the stifle (eg, patellar luxation or cranial cruciate ligament rupture) were assigned to 1 of 2 groups on the basis of age: group 1, <10 years old (n = 72); or group 2, > or =10 years old (n = 14). Patellar reflexes were elicited in both pelvic limbs by a reflex hammer while the dog was in lateral recumbency. The reflex was scored as present or absent by a blinded individual. Two dogs in group I had reflexes absent in both limbs, 3 dogs in group 2 had reflexes absent in both limbs, and 1 dog in group 2 lacked a response in 1 limb. The proportion of dogs with absent patellar reflexes in group 2 (4 of 14, 95% CI, 8-58%) was significantly higher than the proportion of dogs with absent patellar reflexes in group 1 (2 of 72, 95% CI, 0-10%) (P < .006). Furthermore, dogs lacking at least 1 patellar reflex were older than those having both reflexes present (P = .04). Weight was not related to the presence of both reflexes (P = .49). These findings suggest that neurologically normal dogs may have an age-dependent decline in patellar reflex magnitude or a prolongation of total reflex time (TRT).     

Treatment of traumatic cervical myelopathy with surgery, prolonged positive-pressure ventilation, and physical therapy in a dog

CASE DESCRIPTION: A 9-year-old dog was evaluated for traumatic cervical myelopathy after a surgical attempt to realign and stabilize the C2 and C3 vertebrae. CLINICAL FINDINGS: The dog could not ventilate spontaneously and was tetraplegic; positive-pressure ventilation (PPV) was maintained. Myelography and computed tomography revealed spinal cord compression with subluxation of the C2 and C3 vertebrae and extrusion of the C2-3 intervertebral disk. TREATMENT AND OUTCOME: Surgically, the protruding disk material was removed and the vertebrae were realigned with screws and wire. For PPV, assist control ventilation in volume control mode and then in pressure control mode was used in the first 6 days; this was followed by synchronized intermittent mandatory ventilation until 33 days after the injury; then only continuous positive airway pressure was provided until the dog could breathe unassisted, 37 days after the injury. Physical therapy that included passive range of motion exercises, neuromuscular electrical stimulation, and functional weight-bearing positions was administered until the dog was discharged 46 days after injury; the dog was severely ataxic and tetraparetic but could walk. Therapy was continued at home, and 1 year later, the dog could run and had moderate ataxia and tetraparesis. CLINICAL RELEVANCE: Hypoventilation with tetraparesis in traumatic spinal cord injury can be successfully treated with PPV exceeding 30 days, surgery, and physical therapy.     

The pentobarbital anesthetized dog: an animal model for assessing chemically induced changes in renal function and ultrastructure

An experimental procedure was devised using the pentobarbital-anesthetized dog that could be used for the comprehensive evaluation of the renal effects of chemicals. After IV or renal arterial administration of 0.9% saline solution (vehicle), 12 renal function determinants were continuously monitored for periods of 2 and 6 hours. At the completion of the 2 or 6 hours of study, the kidneys of a number of dogs (usually between 1 and 7) in each vehicle-treated group were subjected to a modification of the intravascular perfusion-of-fixative technique to evaluate the ultrastructural status of the outer cortical, inner cortical, and outer medullary tissue. The remaining dogs (at least 3) in each vehicle-treated group were given a nonnephrotoxic, but maximally effective, diuretic dose of ethacrynic acid, which enabled an assessment of the functional integrity of the thick ascending limb of Henle's loop. Renal function and glomerular and tubular ultrastructure remained stable in the pentobarbital-anesthetized dog for up to 6 hours after administration of vehicle. Sustained infusion of inulin (included in the procedure to estimate glomerular filtration rate) throughout the duration of the experiments, and pentobarbital anesthesia of various durations did not alter the morphologic status of the canine nephron. The procedure used for the renal perfusion of fixative circumvented any manipulation of the kidneys before fixation and allowed for the acquisition of normal (unaltered) appearing tissue from all areas of the kidneys. The responses of pentobarbital-anesthetized dogs to ethacrynic acid administration were similar when given 2 and 6 hours after the vehicle administration.(ABSTRACT TRUNCATED AT 250 WORDS)     

Clinical Tolerance and Bronchoscopic Changes Associated With Transtracheal High-Frequency jet Ventilation in Dogs and Cats

Eleven awake dogs and two cats received high-frequency jet ventilation (HFJV) via a transtracheal catheter for 6 hours to evaluate their clinical tolerance to the technique. A bronchoscopic examination was performed in all animals prior to and the morning of the day after the procedure to determine the gross effects of the technique on the tracheal epithelium.
All animals tolerated the technique well, exhibiting no discomfort and only a minimal amount of coughing. Only one dog exhibited coughing on the day following the procedure. No bronchoscopic changes were noted after HFJV in one dog. In one dog and one cat, the only observed change was an increase in the prominence of the vascularity compared to that observed prior to HFJV. The remaining animals exhibited more severe tracheal changes that included: an accumulation of mucus (seven dogs, one cat), focal spots of hemorrhage (two dogs), linear stretches of epithelial denuding (two dogs), and diffuse reddening and epithelial denuding (four dogs).
High-frequency jet ventilation by a transtracheal intravenous catheter is well tolerated for short-term ventilatory support in dogs and cats, but the magnitude of the tracheal damage observed in the present report may preclude long-term ventilatory support by this tecnique.     

Development of a polymerase chain reaction-based method to identify species-specific components in dog food

OBJECTIVES: To determine whether there is a relationship between species-specific mitochondrial DNA (mtDNA), especially canine and feline mtDNA, and detectable amounts of pentobarbital in previously analyzed dog food samples. SAMPLE POPULATION: 31 dog food samples previously analyzed for pentobarbital (limit of detection, 1 microg/kg). PROCEDURE: Polymerase chain reaction (PCR) analysis was performed on dog food samples by use of PCR primers specific for either canine, feline, equine, bovine, porcine, ovine, or poultry mtDNA. RESULTS: PCR amplicons specific for feline or canine mtDNA at a 0.007% (70 microg/g [wt/wt basis]) or 0.0007% (7 microg/g) level, respectively, were not found in the 31 dog food samples. Most of the 31 dog food samples had a PCR amplicon on PCR analysis when a PCR primer set capable of simultaneously detecting mtDNA of cows, pigs, sheep, goats, deer, elk, and horses was used. Results of PCR analysis by use of primers specific for bovine, swine, sheep and goat, or horse mtDNA revealed amplicons specific for bovine or swine mtDNA only in 27 of the 31 samples. Analysis of the remaining 4 samples failed to yield amplicons for any mammalian mtDNA. Pentobarbital was detected in 2 of these 4 samples. Results of PCR analysis correlated with the stated ingredient list for most, but not all samples. CONCLUSIONS AND CLINICAL RELEVANCE: Because canine and feline mtDNA were not found in a set of retail dog food samples, these results indicate that the source of pentobarbital in dog food is something other than proteins from rendered pet remains.     

Effectiveness of various barbiturates in chickens of different ages]

Phenobarbital, allobarbital, and pentobarbital in the doses of 40 and 80 mg per 1 kg body mass were applied intramuscularly to groups of the cockerels of the WL breed at the age of two days, one, two, and six weeks (each group had ten birds) and to eight-week-old WL cockerels in groups of five birds. The methods of clinical observation and repeated determination of the response of the animals to sonic stimuli and contact stimuli, and the evaluation of the quality of some reflexes (particularly the spontaneous position of the body and the correction of the lateral position) were used for the study of suppression evoked by the applied barbiturates. Sleep occurred first after the application of pentobarbital (sooner in younger age groups). The latest beginning of sleep was observed after phenobarbital; in the latter case, sleep was hard to evaluate because it was not very deep. The time of sleep had the longest duration after allobarbital (only in the eight-week-old sleep was longer after pentobarbital), and the shortest after phenobarbital; there were also differences in the duration of sleep between the age groups of birds. The pentobarbital dose of 80 mg kg-1 of body mass killed birds in the three youngest age groups )in the two-day-old it killed nine of ten birds, in the one-week-old eight of ten birds, and in the two-week-old two of ten birds). The differences in the effectiveness of the applied barbiturates in two doses per unit of body mass were related to the age of the animals, even in the cases of the shortest age intervals between individual groups. Very high interspecies differences ensue from a comparison with the doses of these barbiturates usually applied to man.     

Rebound hyperkalemia in a dog with albuterol toxicosis after cessation of potassium supplementation

Objective

To describe the presentation of rebound hyperkalemia as a delayed side effect of albuterol toxicity in a dog.

Case Summary

A 3-year-old female neutered mixed-breed dog was presented for albuterol toxicosis that led to a severe hypokalemia, hyperlactatemia, and hyperglycemia. The dog also experienced sinus tachycardia and generalized weakness. Treatment was instituted with intravenous fluid therapy and potassium supplementation, and the dog was monitored with a continuous electrocardiogram. Resolution of hypokalemia was documented 12 hours after initial presentation, at which time fluid therapy and potassium supplementation were discontinued. There were no further periods of sinus tachycardia, but instead the dog developed ventricular ectopy with rapid couplets (instantaneous rates of 300/min). An echocardiogram revealed normal cardiac size and function. Twenty-four hours after presentation, the patient developed severe hyperkalemia, despite discontinuation of fluids and potassium supplementation for 12 hours. Serial venous and urinary electrolytes were performed for determination of the fractional excretion of electrolytes. These data confirmed rebound hyperkalemia (7.0 mmol/L), consistent with a markedly increased fractional excretion of potassium, and secondary to the release of potassium from inside the cells. Fluid therapy with dextrose supplementation was provided until 36 hours postpresentation. The hyperkalemia resolved, and the dog was discharged after 44 hours of hospitalization.

New or Unique Information Provided

This case documents rebound hyperkalemia following treatment of albuterol toxicosis in a dog. This case highlights the importance of understanding the distribution of total body potassium when treating serum hypokalemia. Transcellular shifts of potassium, as in the case of albuterol toxicosis, can lead to rebound hyperkalemia even after discontinuation of potassium supplementation. This case further explores the utility of fractional excretion of electrolytes in elucidating the etiology and management of electrolyte disturbances.     

Electroretinographic changes after intravenous lipid emulsion therapy in a dog and a foal with ivermectin toxicosis

This case report describes ivermectin‐induced blindness in a dog and a foal with normal ophthalmic fundic examinations and attenuated electroretinography (ERG). Subsequent recovery in ERG was noted following intravenous lipid emulsion (ILE) therapy. A dog and a foal were evaluated for ivermectin‐induced blindness. Clinical signs included dull mentation, absent pupillary light reflexes (PLRs), and absent menace on presentation. The animals had normal fundoscopic examinations; however, in both cases ERG was consistent with neurosensory retinal dysfunction. Following ILE therapy for ivermectin toxicosis, return of menace, PLRs, and normal mentation were noted, as was improvement in ERG and serum ivermectin levels. These are the first documented cases of ivermectin‐induced blindness in a dog and a foal with normal fundic examinations and attenuated ERG. ERG improved in both animals after ILE therapy. ERG may assist in the diagnosis of ivermectin toxicosis in dogs and horses. ILE therapy may hasten recovery in treatment of ivermectin‐induced blindness.     

Acute overdose of levothyroxine in a dog.

An overdose of up to 850 levothyroxine sodium tablets (0.2 mg) in a healthy 6-year-old 16.8-kg dog induced an episode of vomiting and hippus within 9 hours of ingestion. The dog was treated with activated charcoal and saline (magnesium sulfate) cathartic. Initially the serum concentration of thyroxine (T4) 4,900.9 nmol/L. On the second day, serum concentration of triiodothyronine (T3) was 5.3 nmol/L. Serum T4 concentration decreased slowly and was not determined to be normal until day 36. Serum T3 concentration was found to be normal on day 6. Serum alanine transaminase activity peaked on day 6 at 345 U/L. Significant abnormalities were not found during the following 36 days. Clinical signs of thyroid hormone toxicosis in dogs and cats include hyperactivity, lethargy, tachycardia, tachypnea, dyspnea, abnormal pupillary light reflexes, vomiting, and diarrhea. High overdoses of levothyroxine sodium in dogs should be managed by initial decontamination and administration of activated charcoal with a cathartic followed by supportive care.     

Treatment of a dog with severe baclofen intoxication using hemodialysis and mechanical ventilation

Objective: This case report describes the successful management of a dog with coma and respiratory depression due to severe baclofen intoxication. Case summary: A Doberman Pinscher mixed breed dog ingested 500 mg (20 mg/kg) of baclofen. Signs of severe intoxication included coma and profound respiratory muscle weakness. The dog was supported with positive pressure ventilation and treated with one session of hemodialysis. Weaning from the ventilator was achieved within 4 hours of hemodialysis, and recovery from coma occurred over the following 12–36 hours. The dog regained full neurologic function and was normal at discharge following 3 days of hospitalization. New or unique information provide: Severe central nervous system depression and respiratory depression due to baclofen intoxication can be life threatening. In addition to other supportive care, hemodialysis may hasten recovery and ventilatory support may be essential to achieve a positive outcome. With successful treatment, toxicity can be decreased and the associated life‐threatening central nervous system and ventilatory depression can resolve. Prognosis for return of normal function is excellent.     

Cerebral and Brainstem Electrophysiologic Activity During Euthanasia with Pentobarbital Sodium in Horses

Background

An overdose of pentobarbital sodium administered IV is the most commonly used method of euthanasia in veterinary medicine. Determining death after the infusion relies on the observation of physical variables. However, it is unknown when cortical electrical activity and brainstem function are lost in a sequence of events before death.

Hypothesis/Objectives

To examine changes in the electrical activity of the cerebral cortex and brainstem during an overdose of pentobarbital sodium solution for euthanasia. Our testing hypothesis is that isoelectric pattern of the brain in support of brain death occurs before absence of electrocardiogram (ECG) activity.

Animals

Fifteen horses requiring euthanasia.

Methods

Prospective observational study. Horses with neurologic, orthopedic, and cardiac illnesses were selected and instrumented for recording of electroencephalogram, electrooculogram, brainstem auditory evoked response (BAER), and ECG. Physical and neurologic (brainstem reflexes) variables were monitored.

Results

Loss of cortical electrical activity occurred during or within 52 seconds after the infusion of euthanasia solution. Cessation of brainstem function as evidenced by a lack of brainstem reflexes and disappearance of the BAER happened subsequently. Despite undetectable heart sounds, palpable arterial pulse, and mean arterial pressure, recordable ECG was the last variable to be lost after the infusion (5.5–16 minutes after end of the infusion).

Conclusions and Clinical Importance

Overdose of pentobarbital sodium solution administered IV is an effective, fast, and humane method of euthanasia. Brain death occurs within 73–261 seconds of the infusion. Although absence of ECG activity takes longer to occur, brain death has already occurred.     

Bromocyclen poisoning in the dog.

An 18-week-old male German shepherd dog had a convulsion following the accidental ingestion of bromocyclen two hours previously. The dog then vomited and had a second convulsion. A pulse rate of 150 per minute and a respiratory rate of 54 per minute were recorded. The dog was treated with 2mg acepromazine and 0.6mg atropine administered intramuscularly (im) and repeated every four hours, 10ml of 20 per cent calcium borogluconate administered subcutaneously and 2ml penicillin and streptomycin im. Eighteen hours later, the respiratory rate was in excess of 60 per minute, and penicillin and streptomycin plus 2mg betamethasone were administered im. Only atropine was administered over the next 12 hours and then discontinued. Forty hours after the original convulsion, the respiratory rate had fallen to 30 per minute and the pulse rate to 84 per minute. A day later, the dog had fully recovered.     

Somatostatin receptor imaging in vivo by planar scintigraphy facilitates the diagnosis of canine insulinomas

Somatostatin receptors expressed by insulinomas in 5 dogs were imaged in vivo by means of indium in 111 pentetreotide (OctreoScan) scintigraphy. The diagnosis in each dog was supported by the presence of hypoglycemia (<60 mg/dL), hyperinsulinemia (>20 microU/mL), and histopathologic review of neoplastic tissue. All insulinomas expressed high-affinity somatostatin receptors of subtype sst2, as shown by receptor autoradiography in vitro using 125I-[tyrosine3]-octreotide and 125I-[leucine8, Dtryptophan22, tyrosine25]-somatostatin-28 with an sst2 subtype-selective analogue. Scintigrams were obtained at 1, 4, 12, and 24 hours after the i.v. administration of 74-222 MBq of OctreoScan to each patient. Abnormal foci of activity were 1st observed from 1 hour after administration of the radioligand in dog 3, to 24 hours after its administration in dog 4; in dogs 1 and 2, abnormal foci of activity were visible from 12 hours. Dog 5 showed a questionable abnormal focus of activity at 12 hours, but not at 24 hours. Scintigraphy enabled accurate prediction of the anatomical location of the primary tumor in 1 of 4 dogs, but was unable to differentiate a right- from a left-pancreatic lobe tumor, or vice versa, in 3 dogs; the 5th dog had equivocal results. 111In-pentetreotide scintigraphy is a useful diagnostic adjunct to the clinical evaluation of the insulinoma patient, but is unable to localize the tumor in some cases.     

Guaifenesin alone or in combination with ketamine or sodium pentobarbital as an anesthetic in rabbits.

Guaifenesin was administered alone and in combination with ketamine or sodium pentobarbital to adult New Zealand white rabbits. A solution of 5% guaifenesin in 5% dextrose given intravenously at a dosage of 200 mg/kg, abolished the pedal, palpebral and corneal reflexes for up to 15 minutes with little influence on cardiopulmonary function. Guaifenesin (200 mg/kg, intravenously) and ketamine (50 mg/kg, intramuscularly) produced effective and safe surgical anesthesia for over 30 minutes. This combination mildly depressed respiratory rate but heart rate and arterial blood pressure were not significantly affected. Guaifenesin (200 mg/kg, intravenously) was combined with sodium pentobarbital (20 mg/kg, intravenously) to produce surgical anesthesia for a period of more than 30 minutes. This combination depressed respiratory rate, produced a tachycardia and decreased arterial blood pressure.