Iatrogenic magnesium overdose: 2 case reports

Objective: To describe the clinical manifestations and treatment of hypermagnesemia and the potential drug errors that can lead to iatrogenic electrolyte toxicities. Summary: We report 2 cases of iatrogenic intravenous (IV) magnesium (Mg) overdose. Both cases developed extreme cardiovascular and neurologic symptoms consisting of vomiting, hypotension, bradycardia, flaccid paralysis, and severe mental depression. Diagnosis was made based upon serum ionized Mg levels (3.47 mmol/L; reference range: 0.43–0.58 mmol/L for Case #1; and 4.64 mmol/L; reference range: 0.42–0.55 mmol/L for Case #2). Each animal was treated with 0.9% NaCl for diuresis and IV calcium gluconate. Within 24 hours, the cardiovascular and neurologic status of both animals, as well as the serum Mg concentration, had normalized. Each animal was discharged with no complications. Both animals had been hospitalized for critical illness and had developed hypomagnesemia that was being treated with Mg sulfate infusions. The cause for the hypermagnesemia was due to miscalculations in treatment orders that led to erroneously administered Mg‐containing solutions. Confusing drug labels and varying units of measurement can lead to erroneous miscalculations, especially in critically ill patients that receive multiple IV infusions. New information provided: This is the first case report of iatrogenic Mg overdose in veterinary medicine. These 2 cases had a good clinical outcome with prompt recognition and supportive care.     

Determination of plasma lysosomal enzyme activity and its relationship to severity of injury following blunt vehicular trauma in dogs

Objective: To determine plasma β‐d ‐glucuronidase (βG) activity in the first 4 hours following injury in dogs struck by a motor vehicle, and to evaluate whether the degree of enzyme activity is correlated with the severity of injury. Design: A prospective clinical study. Setting: Veterinary Medical Teaching Hospital. Animals: Thirteen client‐owned dogs that were presented to the Veterinary Hospital of the University of Pennsylvania between June and August 1999 for blunt vehicular trauma. Ten healthy student and staff‐owned dogs served as controls. Interventions: None. Measurements: Plasma was analyzed for βG enzyme activity at the time of presentation (n=13), and 1 and 4 hours (n=7) following presentation to the Emergency Service for blunt vehicular trauma. The results were compared with enzyme activity from healthy controls evaluated serially over 4 hours. Fluorometric analysis using 96‐well microtiter plates was used to perform the enzyme assays. The relationships between presentation (n=13) and 4 hours (n=7) of enzyme activity and 3 indices of metabolic and physical disturbance (serum pH, serum lactate and Animal Trauma Triage (ATT) score) at the time of presentation were also investigated. Main results: Of the 13 dogs, 7 fulfilled the inclusion criteria for comparison of enzyme activity of the trauma over time. A statistically significant difference in βG activity was found in the trauma group (mean 75.6±10.4 U) at 4 hours following presentation compared with controls (mean 48.0±6.4 U). This difference was suggested by 1 hour following presentation (trauma group, mean 70.4±10.9 U; control group, mean 49.8±5.5 U), although it did not reach statistical significance. Thirteen dogs fulfilled the inclusion criteria for comparison of only presentation enzyme activity with trauma severity score, serum lactate, and serum pH. No statistically significant relationship was found between the βd ‐glucuronidase activity and the presenting ATT score, serum lactate concentration, or serum pH at either presentation or 4 hours, although the power of these analyses was low. Conclusions: These results demonstrate that the activity of βG, a lysosomal enzyme, increases significantly in the systemic circulation in dogs 4 hours following blunt trauma. Additional research to include more severely injured dogs, a larger number of dogs, and to follow the course of injury for a longer period of time would be beneficial to further characterize βG activity following blunt trauma.     

Association of hyponatremia and hyperglycemia with outcome in dogs with congestive heart failure

Objective: To evaluate plasma sodium and glucose concentrations in dogs with congestive heart failure (CHF) prior to treatment and evaluate the differences between survivors and non‐survivors. Design: Retrospective study. Animals: Fifty‐nine dogs with CHF prior to receiving cardiac medication. Interventions: None. Measurements and main results: The mean plasma sodium concentration in dogs with CHF was below the reference range (144–156 mmol/L) and significantly lower (P=0.009) in non‐survivors (141±6 mmol/L) compared with survivors (147±4 mmol/L). The mean plasma glucose concentration was above the reference range (76–117 mg/dL) and significantly higher (P=0.004) in non‐survivors (128±52 mg/dL) compared with survivors (100±13 mg/dL). Forty‐four percent of non‐survivors had concurrent low plasma sodium and high plasma glucose concentrations, whereas no survivors had both abnormalities (P<0.0001). Conclusions: Lower plasma sodium and higher plasma glucose are associated with a worse outcome in dogs with CHF.     

C-reactive protein concentrations in canine acute pancreatitis

Objective: To determine if C‐reactive protein (CRP) concentration is elevated in spontaneously occurring canine acute pancreatitis (AP), and to measure changes in CRP during the course of hospitalization. Design: Prospective study. Setting: Tufts University School of Veterinary Medicine Foster Hospital for Small Animals. Animals: Sixteen client‐owned dogs with AP and 16 healthy controls. Interventions: Blood samples were obtained from the AP group on the day of diagnosis (Day 1), and on Days 3 and 5, unless the dog died or was discharged from the hospital. Blood was obtained from the control dogs once. Measurements and main results: Serum CRP was measured using a commercial immunoassay for each dog with AP and for healthy controls. Day 1 CRP concentrations were significantly higher in the AP group (56.1±12.7 μg/mL) compared with controls (2.8±1.3 μg/mL; P<0.001). For the 7 dogs that had samples collected on all 3 days, the mean CRP concentrations decreased significantly (P=0.043) over the 5 days of measurement. Of the 16 dogs with AP, 14 were discharged from the hospital and 2 were euthanized. Conclusions: Serum CRP concentrations were elevated in this group of 16 dogs with spontaneously occurring AP. In the 7 dogs that had measurements on all 3 days, the mean CRP concentration decreased from the day of diagnosis to the measurement made 5 days later.     

Hypernatremia secondary to homemade play dough ingestion in dogs: a review of 14 cases from 1998 to 2001

Objective: To correlate the sodium chloride dosage and the serum sodium concentration to clinical signs, to determine if the dosage of homemade play dough (and, therefore, sodium chloride) is the most reliable way to predict clinical signs and prognosis, and to review previously reported treatment options. Design: Retrospective case series. Animals: Fourteen dogs with a history of homemade play dough ingestion. Procedure: Cases were examined for each animal's signalment including body weight, age, approximate amount of play dough ingested, the estimated sodium chloride dosage, clinical signs, serum sodium concentration, and outcome when available. The literature was reviewed to determine pathophysiology and treatment regimens. Results: Twelve of 14 dogs (86%) that ingested homemade play dough showed clinical signs. Vomiting (9 of 14, 64%), polydipsia, and seizures (4 of 14 each, 29%) were the most common signs followed by polyuria, tremors (3 of 14 each, 21%), and hyperthermia (2 of 14, 14%). The lowest calculated dosage associated with objective clinical signs was 1.9 g/kg. Seizures were reported in all animals with serum sodium levels greater than 180 mEq/L. Conclusions and clinical relevance: Homemade play dough ingestion can be a serious and life‐threatening problem. Many factors can contribute to the toxicity of homemade play dough. This study indicates that the serum sodium concentration is a more reliable indicator of the clinical course of the toxicity rather than the amount of play dough and, therefore, the dosage of sodium chloride ingested. Treatment should be based on a clinical evaluation of the patient and laboratory results, and consists of controlling seizures, reducing serum sodium concentrations slowly, and supportive care.     

Computed tomographic anatomy of the canine cervical vertebral venous system

Computed tomographic (CT) venography of the cervical vertebral canal was performed in six, clinically normal, adult mixed-breed dogs from 14 to 23 kg. After dogs were euthanized and saline perfused, a gelatin and iothalamate mixture was injected into the right external jugular vein. Contiguous, 4-mm-thick CT images were obtained with dogs in sternal recumbency. Dogs were kept in the same position as for the CT scan and frozen to approximately -8 degrees C. All post-contrast CT images were analyzed using similar bone window and level settings. Additional multiplanar reformatted dorsal images were obtained in all dogs. The frozen cadavers were sectioned through the cervical region extending from the occiput to T1 at approximately 8-mm intervals. The frozen sections were then compared with the CT images. The CT appearance of the normal cervical vertebral venous system was described and illustrated. Components such as the internal vertebral venous plexus, interarcuate veins, intervertebral veins, and vertebral veins were clearly identified on the CT images.