Uses and effectiveness of pamidronate disodium for treatment of dogs and cats with hypercalcemia

Uncorrected hypercalcemia can cause clinical signs such as polyuria, polydipsia, vomiting, diarrhea, lethargy, and depression and contributes to the development of primary renal failure and soft tissue mineralization. Treatment of hypercalcemia includes diagnosis and treatment of the underlying disease process and some combination of excracellular fluid volume expansion by administration of fluids intravenously and administration of glococorticosteroids, salmon calcitonin, and furosemide. Bisphosphonates such as pamidronate disodium also may be safe and effective in the treatment of hypercalcemia. The purpose of our study was to characterize the efficacy and safety of pamidronate in the treatment of hypercalcemia attritutable to several different disease processes in the dog and cat. Seven dogs and 2 cats were administered pamidronate at a dose of 1.05-2.0 mg/kg IV for a variety of disease processes, including neoplasia (n = 4), calcipotriene toxicity (n = 3), nocardiosis (n = 1), and idiopathic hypercalcemia with chronic renal failure (n = 1). In all the animals, IV pamidronate administration rapidly decreased serum calcium concentrations without evident toxicosis. Two animals received pamidronate several times without obvious toxicosis. On the basis of the findings in our retrospective study, pamidronate may be a safe and effective drug with which to lower both serum total and ionized calcium concentrations in patients with hypercalcemia arising from a wide variety of underlying disease processes.     

Evaluation of intravenous pamidronate administration in 33 cancer-bearing dogs with primary or secondary bone involvement

The purpose of this study was to evaluate the clinical safety of pamidronate when administered at a mean dosage of 1.0 mg/kg IV q28d in 33 tumor-bearing dogs. Biochemical tests of renal function were evaluated before each successive pamidronate treatment. Of 33 dogs treated with pamidronate, 1 dog had clinically relevant increases in serum creatinine and blood urea nitrogen concentrations. The biologic activity of IV pamidronate was assessed prospectively in 10 dogs with appendicular osteosarcoma and was assessed on reductions in urine N-telopeptide excretion (P = .042) and enhanced bone mineral density of the primary tumor measured with dual-energy x-ray absorptiometry (P = .024). Additionally, in these 10 dogs, pamidronate's therapeutic activity was supported by subjective improvement in pain control in 4 of the 10 dogs treated. IV pamidronate appears clinically safe in tumor-bearing dogs and may possess modest biologic activity for managing neoplastic complications associated with pathologic bone resorption.     

Acute pulmonary edema after diazepam-ketamine in a dog

An 8-year-old mixed-breed dog was anesthetized for colonoscopy. Moderate sedation was produced by premedication with glycopyrrolate, acepromazine, and hydromorphone, and anesthesia was induced by IV injection of diazepam and ketamine. Frothy, reddish-colored fluid flowed from the endotracheal tube immediately after endotracheal intubation but ceased after several minutes. Furosemide was injected IV. Anesthesia was maintained by sevoflurane in oxygen. Ventilation and arterial blood pressure were satisfactory, however, after oxygen was administered to maintain normal hemoglobin saturation. Radiography revealed changes consistent with a diagnosis of pulmonary edema. The following day, ventricular premature contractions developed and atrial dissociation, valvular regurgitation, and pulmonary hypertension were diagnosed on echocardiography. The proposed etiology is either profound transient hypotension and/or pulmonary hypertension induced by ketamine. The cardiac abnormalities that were present the following day suggest that myocardial dysfunction after induction of anesthesia was more severe than was apparent as assessed by routine physical examination and monitoring methods.     

Verapamil administration for acute termination of supraventricular tachycardia in dogs

Verapamil, a calcium channel-blocking drug, was administered IV at a dosage that ranged from 0.05 to 0.15 mg/kg of body weight to 14 dogs with supraventricular tachycardia. The dosage was titrated, administering 0.05 mg/kg every 5 to 30 minutes following the initial 0.05 mg/kg dose in all but 1 dog. The drug terminated the arrhythmia in 12 dogs and slowed the ventricular rate in 1 dog. One dog was unresponsive to verapamil administration and became transiently hypotensive after the administration of a total dose of 0.15 mg/kg over 5 to 6 minutes. Various arrhythmias occurred after verapamil administration, but none required additional treatment or caused serious sequelae. Verapamil was an effective treatment for acutely converting supraventricular tachycardia to sinus rhythm in these dogs. It appears to be safe when administered in the aforementioned dosage range.     

Post‐anesthesia deafness in dogs and cats following dental and ear cleaning procedures

Objective The present study was performed to document hearing loss in dogs and cats following procedures performed under anesthesia. Most cases of reported hearing loss were subsequent to dental and ear cleaning procedures. Study design Prospective and retrospective case survey. Animals Subjects were dogs and cats with deafness, personally communicated to one author, cases discussed on a veterinary information web site, and cases communicated through a survey of general practice and dental specialist veterinarians. Methods Reported deafness cases were characterized by species (dog, cat), breed, gender, age, and dog breed size. Results Sixty‐two cases of hearing loss following anesthesia were reported between the years 2002 and 2009. Five additional cases were reported by survey respondents. Forty‐three cases occurred following dental procedures. Sixteen cases occurred following ear cleaning. No relationship was observed between deafness and dog or cat breed, gender, anesthetic drug used, or dog size. Geriatric animals appeared more susceptible to post‐anesthetic, post‐procedural hearing loss. Conclusions Deafness may occur in dogs and cats following anesthesia for dental and ear cleaning procedures, but the prevalence is low. The hearing loss appears to be permanent. Clinical relevance Deafness can be a consequence following anesthesia for dental or ear cleaning procedures. Older animals may have greater susceptibility.     

Edrophonium-induced asystole following neuromuscular blockade antagonism in a dog: a case report

Edrophonium was used to antagonise neuromuscular block in a healthy eight-year-old dog following ophthalmic surgery; this caused arrhythmias and asystole lasting 46 sees. The complication probably occurred because of inadequate muscarinic blockade prior to antagonism. The dog made an uneventful recovery.     

Carmustine, vincristine, and prednisone in the treatment of canine lymphosarcoma

A chemotherapeutic protocol using carmustine in combination with vincristine and prednisone was tested in dogs with multicentric malignant lymphosarcoma. Of seven dogs treated, six (85.7%) achieved complete remission. A partial response occurred in one dog. Median survival time was 224 days (mean 386 days), and median duration of remission was 183 days (mean 323 days). Marked neutropenia was observed following carmustine administration. There were no significant alterations in platelets and red blood cell counts during treatment, and no abnormalities attributable to the chemotherapy were found in serum biochemical profiles. Results of this study showed that carmustine is an effective alternative option in the treatment of canine lymphosarcoma.     

Successful biphasic transthoracic defibrillation of a dog with prolonged, refractory ventricular fibrillation

Objective – To describe a case of spontaneous ventricular fibrillation in a dog in which biphasic defibrillation was life saving.
Case Summary – Ventricular fibrillation occurred in a 7-year-old female Australian Heeler during recovery from anesthesia following pacemaker implantation. Resuscitative efforts including immediate delivery of transthoracic monophasic defibrillation shocks of escalating energy and administration of vasopressors were unsuccessful. However, a single biphasic shock restored sinus rhythm despite prolonged duration of the arrhythmia.
New or Unique Information Provided – This case suggests greater efficacy of biphasic defibrillation compared with traditional monophasic defibrillation. In this dog the newer, biphasic technology was life saving after monophasic shocks failed repeatedly to terminate ventricular fibrillation.     

Cardiopulmonary effects of thiopental/lidocaine combination during anesthetic induction in the dog

The cardiopulmonary effects and tendencies to produce ventricular arrhythmias were evaluated in 13 dogs given a surgical plane of anesthesia by thiopental (IV) or a combination of thiopental and lidocaine (IV). Thiopental (22 mg/kg of body weight) was compared with a combination of thiopental (11 mg/kg) and lidocaine (8.8 mg/kg). Preanesthetic agents were not given. Both methods for IV anesthesia provided a smooth induction suitable for easy intubation. The thiopental/lidocaine combination had a shorter duration, produced no arrhythmias, and resulted in less cardiopulmonary depression than did thiopental alone. Bigeminy developed after intubation during 19 of 20 thiopental inductions as compared with that in 0 of 22 thiopental/lidocaine inductions. The bigeminies were preceded by systemic hypertension and tachycardia which developed as the trachea was being intubated. The increase in aortic pressure and heart rate was minimal after intubation during the thiopental/lidocaine inductions. Five minutes after administration of thiopental alone, increases in heart rate, aortic pressure, total peripheral vascular resistance, and left ventricular systolic and end-diastolic pressures were observed. When these increases in rate, preload, and afterload were considered in relation to a stabile maximum positive first derivative of left ventricular pressure, left ventricular contractility was considered to be decreased. Mild respiratory acidosis and hypoxemia were present at 5 and 10 minutes after thiopental induction. Because the combination of thiopental/lidocaine had less cardiopulmonary depressive effects and protected against arrhythmias, it would appear to be a good method for anesthetic induction of the patient with cardiopulmonary disease. In the patient with normal cardiopulmonary function, thiopental produces only a moderate and reversible depression.     

Increasing halothane concentration abolishes anesthesia-associated arrhythmias in cats and dogs

Fifteen cats and 6 dogs developed ventricular arrhythmias during halothane anesthesia. Halothane was administered by precision vaporizer, using a semiclosed anesthetic system. Cardiac arrhythmias were diagnosed within 5 to 10 minutes after a surgical plane of anesthesia was achieved. Arrhythmias in 9 of 15 cats and 3 of 6 dogs were converted to sinus rhythm by increasing the inspired halothane concentration. Conversion to sinus rhythm occurred within 4 minutes. Cardiac arrhythmias were reestablished in 8 of 9 cats and 2 of 3 dogs, after decreasing the inspired halothane concentration to its original value. Increasing the inspired halothane concentration can convert anesthetic-associated ventricular arrhythmias to sinus rhythm in dogs and cats.     

CASE REPORT: Suspected acute meperidine toxicity in a dog

ObservationsA 22‐month‐old male neutered Coton De Tulear dog was presented for upper gastrointestinal endoscopy under general anesthesia. The anesthetic plan included premedication with intramuscular meperidine (4 mg kg^?1) but meperidine was inadvertently administered at ten‐fold this dose. Within 5 minutes, the dog was unresponsive to external stimulation, and by 10 minutes post‐injection developed generalized signs of central nervous system (CNS) excitement. Initial therapy included inspired oxygen supplementation, and single intravenous (IV) doses of diazepam (0.68 mg kg^?1) and naloxone (0.03 mg kg^?1) to no effect. A second dose of diazepam (0.46 mg kg^?1, IV) abolished most of the signs of CNS excitement. General anesthesia was induced and the endoscopy performed. Time to extubation was initially prolonged, but administering naloxone (final dose 0.1 mg kg^?1, IV) to effect enabled extubation. After naloxone, the dog became agitated, noise sensitive, and had leg and trunk muscle twitches. Diazepam (0.30 mg kg^?1, IV) abolished these signs and the dog became heavily sedated and laterally recumbent. Naloxone administration was continued as a constant rate infusion (0.02 mg kg^?1 hour^?1, IV) until approximately 280 minutes post‐meperidine injection, at which time the dog suddenly sat up. Occasional twitches of the leg and trunk muscles were observed during the night. The dog was discharged the next day appearing clinically normal.ConclusionsGiven that the CNS excitatory effects of normeperidine are not a μ opioid receptor effect, the use of naloxone should be considered carefully when normeperidine excitotoxicity is suspected. Benzodiazepines may be beneficial in ameliorating clinical signs of normeperidine excitotoxicity.     

Anesthesia in Caspian ponies

ObjectiveTo evaluate some of the clinical and laboratory parameters following diazepam–acepromazine, thiopental, and halothane anesthesia in Caspian ponies.Study designProspective experimental trial.AnimalsSix healthy Caspian ponies of both sexes, aged 11 ± 3 years and weighing 318 ± 71 kg.MethodsThe ponies were pre-medicated with diazepam (0.2 mg kg⁻¹) and acepromazine (0.05 mg kg⁻¹) IV. Sodium thiopental 5% was administered IV, 10 minutes later and anesthesia was maintained with halothane in oxygen for 1 hour. Heart and respiratory rates, mean arterial blood pressure, cardiac rhythm, and signs of anesthetic depth were monitored during anesthesia. Hematological and serum biochemical parameters were evaluated before anesthesia and at 1, 2, 3, 24, 48, 72, and 96 hours. Urine specific gravity and cytology were evaluated at the same intervals following anesthesia. Parametric data were analyzed using repeated measures anova.ResultsConsiderable sedation/tranquilization without excitement was achieved following pre-medication. Heart rate significantly increased and mild hypotension occurred during anesthesia. Sinus arrhythmia and second degree AV block occurred in five horses. Respiratory rate decreased during anesthesia, with an accompanying respiratory acidosis. Body temperature also decreased. Recovery was scored ‘good’ in four horses and ‘satisfactory’ in the other two. Blood urea nitrogen concentration was significantly increased at 1–3 hours post-anesthesia. Blood glucose was significantly increased at 48, 72, and 96 hours, and creatine kinase and aspartate aminotransferase were significantly increased at 24 and 48 hours post-anesthesia.Conclusion and clinical relevance This simple anesthetic protocol can be used in Caspian ponies and an acceptable anesthetic with a reasonable recovery can be expected.     

The effects of doxapram hydrochloride (dopram-V) on laryngeal function in healthy dogs

Laryngeal dysfunction is assessed most accurately by direct visualization of the larynx under a light plane of anesthesia. If the plane of anesthesia used is too deep, laryngeal structures may appear paralyzed and remain in a paramedian position. Doxapram hydrochloride is a known respiratory stimulant. We hypothesized that doxapram would significantly increase intrinsic laryngeal motion in healthy anesthetized dogs. The goal of this study was to evaluate the effect of doxapram on the area of rima glottidis (RG) in healthy dogs. Thirty healthy dogs were studied. Dogs were premedicated with butorphanol tartrate (0.22 mg/kg IV), acepromazine maleate (0.05 mg/kg SC), and glycopyrrolate (0.005 mg/kg SC), followed by induction with propofol (4 mg/kg IV). Intrinsic laryngeal motion observed in each dog was recorded on videotape after induction. Doxapram then was administered (2.2 mg/kg IV) and respirations again were recorded. Representative breaths for each dog were photographed during 4 phases of respiration (inspiration at rest, inspiration with doxapram, expiration at rest, and expiration with doxapram). The area of the RG then was calculated by using a computer-assisted analysis program. Results of each category were compared by using a 1-way analysis of variance; P < or = .05 was considered significant. Doxapram visibly increased respiratory effort, and was associated with increased intrinsic laryngeal motion. Compared to the resting state, the area of the RG was significantly increased after doxapram administration during both inspiration and expiration. We propose the routine use of doxapram during laryngoscopy to increase intrinsic laryngeal motion and aid in the diagnosis of laryngeal dysfunction.     

Calcipotriene Toxicosis in a dog successfully treated with Pamidronate Disodium

Objective: To describe a case report of hypercalcemia following ingestion of calcipotriene, and successful treatment of hypercalcemia with pamidronate disodium as an adjuvant therapeutic agent. Case summary: A 3‐year‐old spayed female Boxer dog presented with polyuria, polydipsia, vomiting, lethargy and anorexia 4 days after ingesting 100 g of a topical antipsoriatic (0.005% calcipotriene). Severe hypercalcemia and moderate hyperphosphatemia were present on a serum biochemical profile. Treatment was initiated with saline ^a a Sodium chloride 0.9%, Abbott Laboratories, North Chicago, IL
diuresis, furosemide ^b b Lasix, Taylor Pharmaceuticals, Decatur, IL
, dexamethasone sodium phosphate ^c c Dexamethasone sodium phosphate, American Reagent Laboratories, Shirley, NY
, and cimetidine ^d d Cimetidine HCl, Abbott Laboratories, North Chicago, IL
. A single dose of pamidronate disodium ^e e Aredia, Novartis Pharmaceuticals Corporation, East Hanover, NJ
was administered on the first day of hospitalization. Ionized and total calcium levels normalized within 24 hours and there was immediate clinical improvement. Serum calcium concentration and renal values were monitored for 3 weeks and remained within normal limits. Unique information provided: Pamidronate disodium, used in combination with other calciuretic agents, was a safe and effective adjuvant therapeutic agent in the management of hypercalcemia due to calcipotriene toxicosis.     

Reversible megaesophagus associated with atypical primary hypoadrenocorticism in a dog.

Megaesophagus, hypercalcemia, and eosinophilia associated with glucocorticoid deficiency were detected in a 5-year-old neutered female Standard Poodle with concurrent hypothyroidism. Clinical and biochemical abnormalities resolved with glucocorticoid replacement treatment, and the dog was normal 29 months after diagnosis. The dog's breed and sex and the existence of a second endocrinopathy supported an underlying immunologic disorder.     

Use of halothane to maintain anesthesia induced with etorphine in juvenile African elephants

Sixteen 3- to 5-year-old African elephants were anesthetized one or more times for a total of 27 diagnostic and surgical procedures. Xylazine (0.1 +/- 0.04 mg/kg of body weight, mean +/- SD) and ketamine (0.6 +/- 0.13 mg/kg) administered IM induced good chemical restraint in standing juvenile elephants during a 45-minute transport period before administration of general anesthesia. After IM or IV administration of etorphine (1.9 +/- 0.56 micrograms/kg), the mean time to lateral recumbency was 20 +/- 6.6 and 3 +/- 0.0 minutes, respectively. The mean heart rate, systolic blood pressure, and respiration rate during all procedures was 50 +/- 12 beats/min, 106 +/- 19 mm of Hg, and 10 +/- 3 breaths/min, respectively. Cardiac arrhythmias were detected during 2 procedures. One elephant with hypotension responded to a decrease in the concentration of halothane and IV infusion of dobutamine HCl. Alterations in systolic blood pressure, ear flapping, and trunk muscle tone were useful for monitoring depth of anesthesia. Results indicated that halothane in oxygen was effective for maintenance of surgical anesthesia in juvenile African elephants after induction with etorphine.     

Effects of carprofen on renal function and results of serum biochemical and hematologic analyses in anesthetized dogs that had low blood pressure during anesthesia

OBJECTIVE: To investigate effects of IV administered carprofen on indices of renal function and results of serum biochemical and hematologic analyses in dogs anesthetized with acepromazine-thiopentone-isoflurane that had low blood pressure during anesthesia. ANIMALS: 6 healthy Beagles. PROCEDURE: A randomized crossover study was conducted, using the following treatments: saline (0.9% NaCl solution)-saline, saline-carprofen, and carprofen-saline. Saline (0.08 ml/kg) and carprofen (4 mg/kg) were administered IV. The first treatment was administered 30 minutes before induction of anesthesia and immediately before administration of acepromazine (0.1 mg/kg, IM). Anesthesia was induced with thiopentone (25 mg/ml, IV) and maintained with inspired isoflurane (2% in oxygen). The second treatment was administered 30 minutes after onset of inhalation anesthesia. Blood gases, circulation, and ventilation were monitored. Renal function was assessed by glomerular filtration rate (GFR), using scintigraphy, serum biochemical analyses, and urinalysis. Hematologic analysis was performed. Statistical analysis was conducted, using ANOVA or Friedman ANOVA. RESULTS: Values did not differ significantly among the 3 treatments. For all treatments, sedation and anesthesia caused changes in results of serum biochemical and hematologic analyses, a decrease in mean arterial blood pressure to 65 mm Hg, an increase of 115 pmol/L in angiotensin II concentration, and an increase of 100 seconds in time required to reach maximum activity counts during scintigraphy. CONCLUSIONS AND CLINICAL RELEVANCE: Carprofen administered IV before or during anesthesia did not cause detectable significant adverse effects on renal function or results of serum biochemical and hematologic analyses in healthy Beagles with low blood pressure during anesthesia.     

Paraneoplastic hypercalcemia in a dog with thyroid carcinoma

This case report describes a dog with thyroid carcinoma and paraneoplastic hypercalcemia. Following thyroidectomy the dog became hypocalcemic and required supplementation with calcitriol and calcium carbonate. During the following 2 years, attempts to reduce the supplementation resulted in hypocalcemia. The dog died from renal failure with no evidence of thyroid carcinoma.     

Hypercalcemia in a dog: a challenging case

An 18-month-old, spayed female, mixed-breed dog was referred for investigation of persistent hypercalcemia. After extensive diagnostic evaluation, a tentative diagnosis of occult lymphosarcoma (LSA) was made and the dog was euthanized. At necropsy, infection with Heterobilharzia americana was diagnosed. In endemic areas, schistosomiasis should be included in the differential diagnosis of hypercalcemia, and a fecal examination should be performed in every dog with a hypercalcemia of unknown origin.     

Parathyroid hormone-related protein (PTHrP) produced by dog lymphoma cells

Parathyroid hormone-related protein (PTHrP) was investigated in a canine lymphoma case with hypercalcemia by means of immunoradiomentric assay (IRMA) and molecular analysis. The plasma calcium level of the patient dog was 13.7 mg/dl. The PTHrP concentration examined by IRMA was 6.1 pmol/L in the plasma sample from the dog, but it was undetectable (< 1.1 pmol/L) in plasma samples from 4 lymphoma cases without hypercalcemia or 5 normal dogs. The PTHrP concentration examined in the culture supernatant of the lymphoma cells from this case was 1.3 pmol/L, whereas those of the lymphoma cells from a lymphoma case without hypercalcemia was undetectable. PTHrP mRNA was clearly detected not only in the lymphoma cells from this dog with hypercalcemia but also in lymphoma cells from 4 lymphoma cases without hypercalcemia and 2 canine lymphoma cell lines.