Severe extrapyramidal syndrome in a dog caused by a Haloperidol (Serenase®) intoxication

Summary The case history of a one-year-old male mongrel dog intoxicated with 120 mg haloperidol is described. The dog showed a coma with a severe extrapyramidal syndrome and was treated with orphenadrine. Symptoms, occurrence, and therapy of the extrapyramidal syndrome are discussed. Emphasis is laid on the importance to differentiate this syndrome from epilepsy and other neurological disorders.     

Generalised peripheral oedema associated with amlodipine therapy in two dogs

This report details two cases of adverse drug reactions to amlodipine. The first case presented with diffuse peripheral oedema and a history of amlodipine therapy. Haematology, clinical chemistry, endocrine testing, thoracic, abdominal and cardiac imaging revealed no cause for oedema. Amlodipine therapy was discontinued and oedema diminished markedly within 72 hours. The second case presented for bilateral retinal detachments secondary to systemic hypertension. Haematology, clinical chemistry, thoracic and abdominal imaging were unremarkable and amlodipine therapy was begun. Within 72 hours, diffuse peripheral oedema developed that was unresponsive to therapy and the dog was euthanised. Veterinarians should be aware of the potential serious adverse events associated with commonly used drugs; severe, diffuse oedema is a possible adverse drug event in dogs treated with amlodipine .     

Severe extrapyramidal syndrome in a dog caused by a Haloperidol (Serenase®) intoxication

Summary

The case history of a one‐year‐old male mongrel dog intoxicated with 120 mg haloperidol is described. The dog showed a coma with a severe extrapyramidal syndrome and was treated with orphenadrine.

Symptoms, occurrence, and therapy of the extrapyramidal syndrome are discussed. Emphasis is laid on the importance to differentiate this syndrome from epilepsy and other neurological disorders.     

Haemoabdomen and colitis following a colon displacement in a 9‐year‐old Thoroughbred mare

This report describes acute haemoabdomen following phenylephrine administration in a case treated for left dorsal displacement of the large colon. The horse also subsequently developed a severe colitis which was treated with aggressive medical therapy.     

Percutaneous heartworm removal from dogs with severe heart worm (Dirofilaria immitis) infestation

Canine heart worm disease is often life-threatening due to its various complications, including right side heart failure, caval syndrome and pulmonary eosinophilic granulomatosis. Several preventive medications and melarsomine have been developed and they are very effective to control heartworm infestation. However, in a case of severe infestation, melarsomine therapy often results in an unfavorable outcome because of the severe immune reaction caused by rapid killing of the adult worm. Surgical removal and an interventional method using flexible alligator forceps have been well described in the literature. Despite the usefulness of mechanical removal using flexible alligator forceps, the methodology still needs to be upgraded for increasing the applicability for treating dogs with severe infestation. We describe herein a newly developed percutaneous removal method for heartworms and this was successfully applied to 4 dogs with severe heartworm infestation. The follow-up studies also showed favorable outcomes with no complications.     

Diabetic retinopathy in a cat with megestrol acetate-induced diabetes

A case of diabetes mellitus in a cat is described, associated with prolonged administration of megestrol acetate for miliary dermatitis. The cat was presented with blindness due to diabetic retinopathy. Following the diagnosis, megestrol acetate was withdrawn. The diabetes proved to be transient and resolved after insulin therapy; however, severe visual impairment remained. The mechanism by which megestrol acetate induces diabetes is discussed.     

Surgical management of cicatricial ectropion following scarring dermatopathies in two dogs

Two dogs were presented with severe dermatopathies leading to cicatricial ectropion and severe surface ocular pathology. In one case, idiopathic sterile pyogranuloma was diagnosed on histopathology and managed with systemic immunosuppressive therapy. In the second case, demodicosis was diagnosed on skin scrapings and successfully treated with acaricidal medication. Following control of the underlying dermatopathies, both cases developed cicatricial ectropion as a result of scarring and contracture of eyelid tissue. Wharton-Jones (V-Y) blepharoplasties were performed on the affected eyelids and resulted in improved eyelid function and reduced corneal exposure in both cases.     

Platelet-Rich Plasma as an Adjunctive Therapy for the Management of a Severe Chronic Distal Limb Wound in a Foal

Distal limb wounds are frequent in horses after traumatic events. The use of platelet-rich plasma (PRP) represents a simple method of treating wounds in equines. A case of a chronic severely contaminated distal limb wound in an 8-month-old foal is presented. The patient was managed with the combination of standard wound therapy (debridement and bandages), surgery, and PRP obtained by a manual tube protocol. No complications were observed with the PRP treatment, and the foal was fully recovered 2 months later. The results from this case report indicate that PRP and its by-products (platelet-poor plasma) could be used as an adjunctive treatment in severe distal limb wounds in horses. A clinical controlled study should be performed to test this hypothesis.     

Type 1 diabetes mellitus and hyperadrenocorticism in a ferret

Diabetes mellitus (DM) was diagnosed in a 6-year-old neutered male ferret with polyuria/polydipsia, symmetrical alopecia, and weight loss. Laboratory tests revealed severe hyperglycemia, glucosuria, and increased steroid hormone profile. Abdominal ultrasound revealed a bilateral enlargement of the adrenal glands. Significant clinical improvement was achieved with insulin- and leuprolide acetate-based therapy. After 2 months of therapy, the ferret showed a severe ketoacidosis, and the owner decided to euthanize the animal. Histological findings revealed carcinoma of the left adrenal cortex and cortical hyperplasia of the right adrenal gland. Moderate, chronic, and active pancreatitis with a marked decrease in the number of β-cells was also present. This is the first reported case of type 1 DM associated with hyperadrenocorticism and chronic pancreatitis in a ferret.

     

Acute corneal hydrops of presumed traumatic origin: An uncontrolled case series (three horses)

This case series describes acute corneal hydrops in three young horses. Due to similarities in the clinical appearance and progression of the disease with that which is reported in humans and cats with acute corneal hydrops, traumatic Descemet’s membrane rupture was suspected to be the underlying aetiology in these equine cases. The horses presented with acute severe corneal oedema with intrastromal bullae formation and anterior bulging of the corneal contour. Focal posterior corneal changes were also seen in two of three cases. Mild anterior uveitis was also present. Other causes of corneal oedema (e.g. glaucoma) were ruled out based on presentation and clinical examination. Treatment approaches were medical and included various combinations of prophylactic topical antimicrobial therapy in case of secondary corneal ulceration, anti-inflammatory therapy for uveitis, targeted oedema therapy with topical hypertonic saline and corneal cross-linking, and placement of a temporary partial tarsorrhaphy for corneal tamponade. The outcome was excellent in all cases, with rapid resolution of the ocular changes. Acute corneal hydrops of presumed traumatic Descemet’s membrane rupture origin should be considered in cases of young horses presenting with acute corneal oedema. However, further studies are warranted to better characterise the disease and to try to confirm the suspected aetiology.     

Intra-articular therapy to treat septic arthritis in a dog

A 6 yr old female spayed Labrador retriever was examined for severe pain and a nonweight-bearing right forelimb lameness due to swelling and wounds with direct communication into the elbow joint. The medical management of β hemolytic Streptococcus septic arthritis with needle lavage of the joint, systemic and local antibiotic therapy, and analgesic therapy is described. This case provides information on the need to address septic arthritis in the dog as an emergency situation and the treatment with intra-articular medication. Earlier medical management for septic joints could be considered in dogs to help decrease the long-term complications that can result from septic arthritis.     

Pasteurella anatipestifer infection in turkeys

In a case of excessive mortality in seven-week-old turkeys, the primary lesion at necropsy was severe fibrinous pericarditis and epicarditis. After 48 hours of incubation at 37 C, Pasteurella anatipestifer was isolated. The infection responded to antibiotic therapy with a combination of neomycin and oxytetracycline in the drinking water. The lesions suggested chlamydial infection, but cultural procedures for chlamydia were negative.     

Successful treatment of severe salt intoxication in a dog

Objective: To report successful treatment of severe salt intoxication and hypernatremia in a dog. Case summary: A 5‐year‐old intact female Doberman Pinscher was admitted to the intensive care unit with a history of seizures and coma. The owner had administered approximately 100 g of cooking salt to induce vomiting following ingestion of a nontoxic dose (10 g) of chocolate. Upon admission, the dog was comatose with intermittent seizures and vomiting. Diagnostic tests confirmed salt intoxication (Na: 200 mEq/L, Cl: 180 mEq/L) and metabolic acidosis (pH: 7.18; pCO₂: 39 mmHg; HCO₃: 14.3 mmol/L). Immediate treatment included intravenous fluid therapy, an anticonvulsant, antiemetic, diuretic, low molecular weight heparin, and supplemental oxygen. A fluid therapy protocol was initiated to decrease serum sodium concentration by approximately 2 mEq/L/hr. After 24 hours of intensive care, the patient regained consciousness and volume and acid‐base abnormalities improved. The patient developed a variety of abnormal clinical signs as a result of the severe hypernatremia. After 5 days of treatment, the serum sodium concentration returned to the established reference range. The patient recovered completely in 10 days. New information provided: Severe hypernatremia due to salt ingestion is a rare condition in dogs. All dogs in previous case reports of salt intoxication have died. This case report is the first to report survival of a dog with severe salt intoxication.     

Photodynamic hyperthermal chemotherapy with indocyanine green: a novel cancer therapy for 16 cases of malignant soft tissue sarcoma

Sixteen cases of malignant soft tissue sarcoma (STS; 10 canines and six felines) were treated with a novel triple therapy that combined photodynamic therapy, hyperthermia using indocyanine green with a broadband light source, and local chemotherapy after surgical tumor resection. This triple therapy was called photodynamic hyperthermal chemotherapy (PHCT). In all cases, the surgical margin was insufficient. In one feline case, PHCT was performed without surgical resection. PHCT was performed over an interval of 1 to 2 weeks and was repeated three to 21 times. No severe side effects, including severe skin burns, necrosis, or skin suture rupture, were observed in any of the animals. No disease recurrence was observed in seven out of 10 (70.0%) dogs and three out of six (50.0%) cats over the follow-up periods ranging from 238 to 1901 days. These results suggest that PHCT decreases the risk of STS recurrence. PHCT should therefore be considered an adjuvant therapy for treating companion animals with STS in veterinary medicine.     

Presumed localized tetanus in two cats

In this report two cases of localised tetanus in two young (<1 year) intact male and outdoor DSH cats, which had been missing, are described. Clinical examination revealed severe muscular spasms on the right (case 1) or both thoracic limbs (case 2). In the latter cat, wrinkling of the forehead and mild trismus were also seen. The routine diagnostic workup (CBC, survey radiographs of the spine, CSF analysis) did not reveal any abnormalities in both cats. EMG testing on the affected muscles in the second animal showed persistent spontaneous motor unit potentials, strongly indicating tetanus. The treatment, that was symptomatic (diazepam, metronidazole) and supportive (physical therapy, assist feeding and intravenous fluid therapy) resulted in the progressive improvement of limb rigidity and the restoration of motor dysfunction in a period of 5- (case 1) and 2- (case 2) month duration.     

Uterine prolapse in a mare leading to metritis,systemic inflammatory response syndrome,septic shock and death

This Case Report describes severe complications associated with uterine prolapse in a mare. A 6‐year‐old Trakehner mare was examined for depression, moderate pain and vaginal discharge 3 days after correction of a uterine prolapse. The clinical examination and haematology revealed that the mare had an infection with systemic inflammatory response syndrome and shock. Due to the uncontrollable, persistent pain, an exploratory celiotomy was performed which revealed severe metritis. During anaesthesia, the mare developed severe cardiovascular compromise and died in recovery. In previously reported cases of uterine prolapse in the mare, the authors warn of uterine injury, broad ligament haemorrhage, metritis, endotoxaemia and laminitis but often have a successful outcome with conventional therapy. This case describes a mare that developed severe complications and death after uterine prolapse. Mares with uterine prolapse require appropriate treatment and vigilant monitoring post treatment to prevent life threatening complications.     

A dog with alveolar echinococcosis: the larval stage of the fox tapeworm

In this report we describe the first case of alveolar echinococcosis and leukemic malignant T-cell lymphoma in a dog presented to a general practice in the Netherlands. The owner and the dog moved from Switzerland to The Netherlands a few weeks before. The clinical aspects, diagnostics, pathology, therapy and public health aspects of this severe parasitic zoonosis are described.     

Diphenhydramine Intoxication in a Dog1

We report a case of diphenhydramine intoxication in a dog. A five month old intact male Labrador Retriever was presented after ingesting approximately 36 diphenhydramine tablets (50 mg/tablet; approximate ingested dose of 1800 mg or 67 mg/kg). Physical examination findings included severe ataxia, profound disorientation, severe continuous spastic muscle tremors, hyperthermia, tachycardia, tachypnea, and hyperesthesia. The dog was unresponsive to intravenous diazepam and phenobarbital, but rapidly responded to an intravenous bolus and subsequent continuous infusion of guaifenesin and supportive fluid therapy. The serum diphenhydramine level on admission was 537 ng/ml. The toxic level is not reported for dogs, but is considered>60 ng/ml in people. The dog was discharged 24 hours after admission with no apparent residual effects.     

Clinical and pathological findings of acute zinc intoxication in a puppy

This report describes the clinical and pathological findings in a case of acute zinc poisoning in a young dog. The puppy suffered four days of progressively more severe vomiting and diarrhoea. Jaundice and pale mucous membranes, severe haematemesis and haemoglobinuria were other findings. Despite intensive therapy, the dog died a few hours after hospitalisation. Postmortem examination revealed a metallic foreign body in the stomach, catarrhal gastritis, hepatomegaly and enlarged, dark kidneys. Histology showed hepatic centrilobular vacuolar degeneration, haemoglobinuric nephrosis with early tubular necrosis, haemosiderosis and extramedullary haematopoiesis, as well as neuronal damage. The foreign body was mainly composed of zinc. Plasma zinc values were markedly raised (34.5 microg/ml; normal range 0.8 to 1.0 microg/ml). Pathophysiological mechanisms of zinc poisoning are discussed.     

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.