Julien Guillaumin

Epsilon aminocaproic acid for the prevention of delayed postoperative bleeding in retired racing greyhounds undergoing gonadectomy.

OBJECTIVE To evaluate the effects of epsilon aminocaproic acid (EACA) on the prevalence of postoperative bleeding in retired racing Greyhounds (RRG), and to assess its effects on selected thrombelastography (TEG) and fibrinolysis variables. STUDY DESIGN Double-blinded, prospective, randomized study. METHODS 100 RRG had elective ovariohysterectomy or orchiectomy and were administered EACA or placebo for 3 days after surgery. TEG variables were analyzed preoperatively and 24, 48, and 72 hours after surgery. RESULTS Thirty percent (15/50) of RRG in the placebo group had delayed postoperative bleeding starting 36-48 hours after surgery compared with 10% (5/50) in the EACA group (P = .012). On the TEG variables, the slopes for R and K time were significantly different between treatment groups (P <.05); the R and K time decreased over time in the EACA group after surgery whereas they increased in the placebo group. The angle, maximal amplitude (MA), and G slopes were also significantly different between treatment groups (P = .001, .001, and .006, respectively). The angle, MA, and G increased postoperatively over time in the EACA group and decreased in the placebo group. All these changes are supportive of hypercoagulability associated with EACA administration. CONCLUSION Postoperative administration of EACA significantly decreased the prevalence of postoperative bleeding in RRG undergoing surgery by increasing the clot strength.

Effects of hematocrit and red blood cell-independent viscosity on canine thromboelastographic tracings

It is well established that hematocrit (Hct) influences whole blood thromboelastography (TEG) tracings. Previous studies showed hypercoagulable TEG tracings in anemic patients despite clinical expectations that anemia often prolongs bleeding. TEG is a viscoelastic assessment of clot kinetics, and Hct is the main determinant of whole blood viscosity. TEG changes in anemia may be an in vitro artifact due to Hct effect on blood viscosity rather than true in vivo changes in hemostasis. The effect of changes in whole blood viscosity on TEG independent of Hct is not well understood.

Extracorporeal renal replacement therapy and blood purification in critical care.

Objective To review indications methods of renal replacement therapies (RRT) and practical considerations for the creation of a RRT program. Data Sources Current human and veterinary literature review with a focus on advanced renal physiology and clinical experience in RRT and acute/chronic kidney diseases. Data Synthesis Renal replacement therapies encompass intermittent hemodialysis, continuous renal replacement therapy as well as some “hybrid” techniques. Each method of RRT has practical and theoretical advantages but currently there is no evidence that one technique is superior to the other. Conclusions RRT is a valuable therapeutic tool for treatment of acute kidney injury and chronic kidney disease. The implementation of an RRT program needs to take into consideration multiple parameters beyond the choice of an RRT platform.

Successful outcome in a dog with neurological and respiratory signs following smoke inhalation.

OBJECTIVE To report the case management of a patient with smoke inhalation complicated by neurological impairment, carboxyhemoglobinemia, acute respiratory distress syndrome (ARDS), upper airway obstruction, aspiration pneumonia, and bacteremia. CASE SUMMARY A 1.5-year-old male intact Beagle presented shortly after being involved in a household fire. Upon arrival the dog was diagnosed with ARDS and demonstrated acute neurological signs (eg, obtundation and seizures). Treatment included mechanical ventilation, temporary tracheostomy, and intensive supportive care. During hospitalization, the dog suffered multiple complications including prolonged neurological abnormalities, aspiration pneumonia, and bacteremia. The dog recovered over a 16-day period. NEW OR UNIQUE INFORMATION PROVIDED This is the first description of extensive management of a patient suffering both neurological and respiratory complication due to smoke inhalation, and details the steps that were taken to achieve a successful outcome.

Disorders of Sodium and Water Homeostasis.

This review article discusses normal and abnormal sodium balance in small animals. The terms and concepts central to understanding normal sodium and water balance are presented as well as of the physiology of body fluid compartments and the movement of fluid between those compartments. As dysnatremia is a very common disorder across the spectrum of critically ill patients, the main focus of the article is to present several clinical examples of both acute and chronic hypernatremia and hyponatremia and their practical, clinical management.

Retrospective evaluation of the use of glucagon infusion as adjunctive therapy for hypoglycemia in dogs: 9 cases (2005-2014).

OBJECTIVE To describe the use of glucagon infusion for adjunctive treatment of hypoglycemia in dogs. DESIGN Multicenter retrospective case series. SETTING One university and 1 private veterinary referral hospital. ANIMALS Dogs were included if they were hospitalized and received glucagon therapy for hypoglycemia, defined as blood glucose concentration (BG) <60 mg/dL. A total of 9 dogs were included from September 2005 to May 2014. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The medical record for each eligible case was reviewed. Data recorded included signalment, presenting complaint, underlying disease process, presenting BG, BG after dextrose supplementation, BG before glucagon administration, maximum BG while receiving glucagon, and BG after discontinuation of glucagon, if available. Adverse reactions to glucagon and outcome of case were recorded if available. The most common causative disease was insulinoma (n = 7). Median serum glucose concentration on presentation was 30 mg/dL (20-41 mg/dL). The median bolus of glucagon was 50 ng/kg followed by a median maximum dose of a glucagon CRI of 15 ng/kg/min. The mean time period on glucagon CRI until normoglycemia (defined as BG > 60 mg/dL) was 7 hours. All hypoglycemic patients had improvement of BGs when glucagon was added. Statistically significant differences (P < 0.05) were found between BG measurements on glucagon CRI compared to BG at presentation, BG after dextrose, and BG prior to glucagon with a Friedman statistic of 17.3. A CRI was found to effectively increase the BG without recurrence of hypoglycemia after weaning. The majority of patients (5/9) survived to discharge. CONCLUSION Glucagon CRI was accompanied by an increase in BG in hypoglycemic dogs. Glucagon CRI appears to be a safe method and can be readily utilized in most practice settings.Objective To describe the use of glucagon infusion for adjunctive treatment of hypoglycemia in dogs. Design Multicenter retrospective case series. Setting One university and 1 private veterinary referral hospital. Animals Dogs were included if they were hospitalized and received glucagon therapy for hypoglycemia, defined as blood glucose concentration (BG) <60 mg/dL. A total of 9 dogs were included from September 2005 to May 2014. Interventions None. Measurements and Main Results The medical record for each eligible case was reviewed. Data recorded included signalment, presenting complaint, underlying disease process, presenting BG, BG after dextrose supplementation, BG before glucagon administration, maximum BG while receiving glucagon, and BG after discontinuation of glucagon, if available. Adverse reactions to glucagon and outcome of case were recorded if available. The most common causative disease was insulinoma (n = 7). Median serum glucose concentration on presentation was 30 mg/dL (20–41 mg/dL). The median bolus of glucagon was 50 ng/kg followed by a median maximum dose of a glucagon CRI of 15 ng/kg/min. The mean time period on glucagon CRI until normoglycemia (defined as BG > 60 mg/dL) was 7 hours. All hypoglycemic patients had improvement of BGs when glucagon was added. Statistically significant differences (P < 0.05) were found between BG measurements on glucagon CRI compared to BG at presentation, BG after dextrose, and BG prior to glucagon with a Friedman statistic of 17.3. A CRI was found to effectively increase the BG without recurrence of hypoglycemia after weaning. The majority of patients (5/9) survived to discharge. Conclusion Glucagon CRI was accompanied by an increase in BG in hypoglycemic dogs. Glucagon CRI appears to be a safe method and can be readily utilized in most practice settings.

Effect of disrupted mitochondria as a source of damage-associated molecular patterns on the production of tumor necrosis factor α by splenocytes from dogs

OBJECTIVE To evaluate the effects of damage-associated molecular patterns (DAMPs) derived from disrupted mitochondria on canine splenocytes and other immune cells. SAMPLES Liver, spleen, and bone marrow samples obtained from 8 cadavers of healthy research Beagles that had been euthanized for other purposes. PROCEDURES Mitochondria were obtained from canine hepatocytes, and mitochondrial DAMPs (containing approx 75% mitochondrial proteins) were prepared. Mitochondrial DAMPs and the nuclear cytokine high-mobility group box protein 1 were applied to splenocytes, bone marrow-differentiated dendritic cells, and a canine myelomonocytic cell (DH82) line for 6 or 24 hours. Cell culture supernatants from splenocytes, dendritic cells, and DH82 cells were assayed for tumor necrosis factor α with an ELISA. Expression of tumor necrosis factor α mRNA in splenocytes was evaluated with a quantitative real-time PCR assay. RESULTS In all cell populations evaluated, production of tumor necrosis factor α was consistently increased by mitochondrial DAMPs at 6 hours (as measured by an ELISA). In contrast, high-mobility group box protein 1 did not have any independent proinflammatory effects in this experimental system. CONCLUSIONS AND CLINICAL RELEVANCE The study revealed an in vitro inflammatory effect of mitochondrial DAMPs (containing approx 75% mitochondrial proteins) in canine cells and validated the use of an in vitro splenocyte model to assess DAMP-induced inflammation in dogs. This experimental system may aid in understanding the contribution of DAMPs to sepsis and the systemic inflammatory response syndrome in humans. Further studies in dogs are needed to validate the biological importance of these findings and to evaluate the in vivo role of mitochondrial DAMPs in triggering and perpetuating systemic inflammatory states.

A Quick Reference on Hypernatremia

Hypernatremia most commonly is associated with water loss in excess of sodium or salt gain (typically associated with restriction of access to water). Most of the signs of hypernatremia arise from the central nervous system; the more rapid the development of hypernatremia, the more severe the neurologic signs are likely to be. Anorexia, lethargy, vomiting, muscular weakness, behavioral changes, disorientation, ataxia, seizures, coma, and death have been identified in dogs and cats with hypernatremia and hypertonicity.

Comparison of platelet function and viscoelastic test results between healthy dogs and dogs with naturally occurring chronic kidney disease

OBJECTIVE To compare platelet function and viscoelastic test results between healthy dogs and dogs with chronic kidney disease (CKD) to assess whether dogs with CKD have platelet dysfunction and altered blood coagulation. ANIMALS 10 healthy control dogs and 11 dogs with naturally occurring CKD. PROCEDURES Blood and urine were collected once from each dog for a CBC, serum biochemical analysis, urinalysis, and determination of the urine protein-to-creatinine ratio, prothrombin time, activated partial thromboplastin time, plasma fibrinogen concentration, and antithrombin activity. Closure time was determined by use of a platelet function analyzer and a collagen-ADP platelet agonist. Thromboelastography (TEG) variables (reaction time, clotting time, α angle, maximum amplitude, and global clot strength [G value]) were determined by use of recalcified nonactivated TEG. Platelet expression of glycoprotein Ib (GPIb; receptor for von Willebrand factor), integrin αIIbβ3 (αIIbβ3; receptor for fibrinogen), and P-selectin (marker for platelet activation) was assessed by flow cytometry. RESULTS Compared with healthy control dogs, the median closure time was prolonged, the median maximum amplitude and G value were increased, and the median clotting time was decreased for dogs with CKD. Platelet expression of both αIIbβ3 and P-selectin was also significantly increased for dogs with CKD, compared with that for control dogs. Platelet expression of GPIb, αIIbβ3, and P-selectin was not correlated with closure time or any TEG variable. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that dogs with CKD frequently had evidence of platelet dysfunction and hypercoagulability that were not totally attributable to alterations in platelet surface expression of GPIb, αIIbβ3, and P-selectin.

Analysis of the first-time pass rate of the American College of Veterinary Emergency and Critical Care certifying examination (2010-2015): Pass rate of the ACVECC certifying examination

OBJECTIVES To disseminate information regarding the annual pass rates for the American College of Veterinary Emergency and Critical Care (ACVECC) certifying examination. To compare the first-time pass rates (FTPR) of ACVECC residents trained in academic and private practice settings. DESIGN Retrospective study. SETTING ACVECC examination. ANIMALS None. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Anonymized ACVECC examination performance data from 2010-2015 inclusive were analyzed. Overall pass rates and FTPR were calculated for all candidates and categorized by type of residency training program. The overall pass rate for all candidates was 64.3%. The median pass rate for the 6-year period was 63.8% [IQR 59.3-67.3%]. The FTPR for residents trained in academic programs was significantly higher than for residents trained in private practice (77.1% vs 47.2%, P < 0.0001). When residents were subdivided by species-focus of training program, there was no significant difference between academic versus private practice training programs for large-animal candidates (P = 0.2), but there remained a significant difference between residency training programs for small-animal candidates (P < 0.0001). CONCLUSIONS Between 2010 and 2015 residents trained in academic training programs were significantly more likely to pass the ACVECC certifying examination compared to those trained in private practice training programs. The causes of this difference are uncertain, are likely multifactorial and warrant further investigation.