Kenneth J. Drobatz

White Blood Cell Count and the Sodium to Potassium Ratio to Screen for Hypoadrenocorticism in Dogs

BACKGROUNDnAbnormal sodium to potassium (Na:K) ratios can raise suspicion for hypoadrenocorticism (HA). Although dogs with HA usually have normal leukograms, their white blood cell counts may be useful in screening for HA.nnnOBJECTIVESnTo examine the utility of combining the Na:K ratio with white blood cell counts to screen for HA in hospitalized dogs requiring fluid treatment administered i.v..nnnANIMALSnFifty-three dogs with confirmed HA and 110 sick dogs confirmed not to have HA.nnnMETHODSnRetrospective, case-control study. Dogs were included if they were hospitalized and administered fluids i.v., had a complete blood count and measurement of serum Na and K concentrations. HA was diagnosed using an ACTH stimulation test, or ruled out by measurement of basal serum cortisol concentration.nnnRESULTSnThe receiver operating characteristic (ROC) curve for the lymphocyte count was not significantly different from the ROC curve of the Na:K ratio (P = .55). The ROC curve for the model combining the Na:K ratio and lymphocyte count was superior for identifying dogs with HA compared to the Na:K ratio (P = .02) or lymphocyte count (P = .005) alone. At the 100% sensitivity cutoff, lymphocyte count was more specific for detection of HA than Na:K (P < .001).nnnCONCLUSIONS AND CLINICAL IMPORTANCEnA combination of the Na:K ratio and lymphocyte count provides a better screening test for HA compared to the Na:K ratio or lymphocyte count alone. At 100% sensitivity, the lymphocyte count is a more specific test for HA than the Na:K.

Evaluation of cytokines and hormones in dogs before and after treatment of diabetic ketoacidosis and in uncomplicated diabetes mellitus.

In human beings, diabetes mellitus (DM) and diabetic ketoacidosis (DKA) are recognized as proinflammatory states and dysregulation of cytokines has been linked to some potentially fatal complications. Cytokine profiles of dogs with DM or DKA have not been reported. The objectives of this study were to compare cytokine and hormone concentrations in dogs with DKA before and after resolution of ketoacidosis, to compare these concentrations before treatment of DKA to those measured in dogs with uncomplicated DM and healthy dogs, and to compare concentrations in dogs with uncomplicated DM to those measured in healthy dogs. 27 dogs were included in this prospective clinical study. 18 dogs had naturally-occurring disease (9 DKA and 9 DM) and 9 dogs were healthy. Serum GMCSF, IL-2, IL-4, IL-6, IL-7, CXCL8, IL-10, IL-15, IL-18, IFNγ, IP-10, TNFα, Monocyte Chemoattractant Protein-1 (MCP-1), Keratinocyte Chemoattractant (KC), glucagon, leptin, adiponectin, and resistin were assayed using Milliplex MAP Canine kits.(2)(,)(3) IL-18, resistin, and GMCSF concentrations were significantly higher in dogs with DKA before treatment compared to after resolution of ketoacidosis. CXCL8, MCP-1, KC, and resistin were significantly higher in DKA dogs compared to healthy controls, and KC was also significantly higher in DKA compared to DM dogs. Additionally, CXCL8 and MCP-1 were significantly higher in dogs with DM compared to healthy controls. Significant differences were not detected in concentrations of the other measured analytes, including glucagon. It is concluded that IL-18, resistin, GMCSF, and KC may be involved in the pathogenesis of canine DKA, and their importance in this pathogenesis may be as great as that of glucagon. Dysregulation of CXCL8 and MCP-1 may be involved in the pathogenesis of DM in dogs.

Preoperative evaluation and management of the emergency surgical small animal patient.

The initial management and stabilization of the emergency surgical patient is challenging. A consistent systematic evaluation of the four major body systems, determination of the underlying cause, and aggressive stabilization before surgery can optimize the outcome.

Retrospective evaluation of hyperosmolar hyperglycemia in 66 dogs (1993-2008).

Objectives nTo clinically characterize a large group of dogs with the hyperosmolar hyperglycemic state (HHS) and to determine whether 2 HHS subgroups, dogs with hyperosmolar ketonuric (HK) diabetes mellitus (DM) and dogs with hyperosmolar nonketonuric (HNK) DM were clinically different from one another. n nDesign nRetrospective study. Records of 1,250 diabetic dogs that were examined between January 1993 and July 2008 were reviewed in order to identify dogs with HHS. Inclusion required a calculated serum osmolality ≥325 mOsm/kg, with or without ketonuria. n nSetting nUniversity teaching hospital. n nAnimals nSixty-six dogs with HHS including 34 dogs with HK, 25 dogs with HNK, and 7 dogs with unclassified HHS. n nInterventions nNone. n nMeasurements and Main Results nHHS was diagnosed in 5% of dogs with DM. HK and HNK dogs were similar to one another in regard to most historical, physical examination, and clinicopathologic variables as well as outcome. Sixty-two percent of dogs with HHS survived to discharge from the hospital. Poor outcome of HHS dogs was associated with abnormal mental status (P = 0.03) and a low venous pH (P = 0.045). Dogs with HK were significantly more likely to have acute pancreatitis (P = 0.046), higher body temperature (P = 0.006), higher WBC count (P = 0.01), and a shorter duration of clinical signs (P = 0.02) compared to dogs with HNK. Dogs with HNK had significantly higher BUN and creatinine concentrations (P = 0.0002 and P = 0.008, respectively) and higher calculated osmolality (P = 0.001) compared to dogs with HK. n nConclusions nHHS is a rare condition in which poor outcome is associated with abnormal mental status and low venous pH. Among dogs with HHS, the subgroup of dogs with HK has significantly more acute pancreatitis, shorter duration of clinical signs, and higher body temperature and WBC count compared to dogs with HNK, whereas dogs with HNK have more azotemia and higher calculated osmolality compared to dogs with HK.OBJECTIVESnTo clinically characterize a large group of dogs with the hyperosmolar hyperglycemic state (HHS) and to determine whether 2 HHS subgroups, dogs with hyperosmolar ketonuric (HK) diabetes mellitus (DM) and dogs with hyperosmolar nonketonuric (HNK) DM were clinically different from one another.nnnDESIGNnRetrospective study. Records of 1,250 diabetic dogs that were examined between January 1993 and July 2008 were reviewed in order to identify dogs with HHS. Inclusion required a calculated serum osmolality ≥325 mOsm/kg, with or without ketonuria.nnnSETTINGnUniversity teaching hospital.nnnANIMALSnSixty-six dogs with HHS including 34 dogs with HK, 25 dogs with HNK, and 7 dogs with unclassified HHS.nnnINTERVENTIONSnNone.nnnMEASUREMENTS AND MAIN RESULTSnHHS was diagnosed in 5% of dogs with DM. HK and HNK dogs were similar to one another in regard to most historical, physical examination, and clinicopathologic variables as well as outcome. Sixty-two percent of dogs with HHS survived to discharge from the hospital. Poor outcome of HHS dogs was associated with abnormal mental status (P = 0.03) and a low venous pH (P = 0.045). Dogs with HK were significantly more likely to have acute pancreatitis (P = 0.046), higher body temperature (P = 0.006), higher WBC count (P = 0.01), and a shorter duration of clinical signs (P = 0.02) compared to dogs with HNK. Dogs with HNK had significantly higher BUN and creatinine concentrations (P = 0.0002 and P = 0.008, respectively) and higher calculated osmolality (P = 0.001) compared to dogs with HK.nnnCONCLUSIONSnHHS is a rare condition in which poor outcome is associated with abnormal mental status and low venous pH. Among dogs with HHS, the subgroup of dogs with HK has significantly more acute pancreatitis, shorter duration of clinical signs, and higher body temperature and WBC count compared to dogs with HNK, whereas dogs with HNK have more azotemia and higher calculated osmolality compared to dogs with HK.

Manual of Trauma Management in the Dog and Cat: Drobatz/Manual of Trauma Management in the Dog and Cat

PREFACE. ACKNOWLEDGMENTS. CONTRIBUTOR LIST. 1. GLOBAL APPROACH TO THE TRAUMA PATIENT (Kenneth J. Drobatz). 2. TRIAGE AND PRIMARY SURVEY (Matthew W. Beal). 3. SHOCK IN THE TRAUMA PATIENT (Rebecca S. Syring). 4. MONITORING OF THE TRAUMA PATIENT (Dana L. Clarke and Andrew J. Brown). 5. ANESTHESIA AND ANALGESIA FOR THE TRAUMA PATIENT (Benjamin M. Brainard and Lindsey Culp-Snyder). 6. TRAUMA ASSOCIATED THORACIC INJURY (Matthew W. Beal). 7. TRAUMATIC BRAIN INJURY (Rebecca Syring). 8. TRAUMA ASSOCIATED PERIPHERAL NERVE INJURY (Jessica Snyder). 9. TRAUMATIC SPINAL INJURY (Daniel Fletcher). 10. URINARY TRACT TRAUMA (Merilee F. Costello). 11. TRAUMA ASSOCIATED ABDOMINAL PARENCHYMAL ORGAN INJURY (Andrew J. Brown, Charles S. McBrien, and Stephen J. Mehler). 12. TRAUMA ASSOCIATED BILIARY TRACT INJURY (Phillip Mayhew). 13. TRAUMA ASSOCIATED BODY WALL AND TORSO INJURY (Phillip Mayhew and William Culp). 14. TRAUMA ASSOCIATED GASTROINTESTINAL INJURY (Phillip Mayhew and William Culp). 15. TRAUMA ASSOCIATED OCULAR INJURY (Deborah C. Mandell). 16. TRAUMA-ASSOCIATED MUSCULOSKELETAL INJURY TO THE HEAD (Alexander M. Reiter and John R. Lewis). 17. TRAUMA-ASSOCIATED SOFT TISSUE INJURY TO THE HEAD AND NECK (John R. Lewis and Alexander M. Reiter). 18. TRAUMA ASSOCIATED MUSCULOSKELETAL INJURY TO THE APPENDICULAR SKELETON (Stephen J. Mehler). 19. TRAUMA ASSOCIATED MUSCULOSKELETAL INJURY TO THE PELVIS, SACRUM AND TAIL (Lauren May and Stephen J. Mehler). 20. BITE WOUND TRAUMA (David Holt). 21. TRAUMA ASSOCIATED AURAL INJURY (William Culp and Phillip Mayhew). INDEX.

Retrospective evaluation of risk factors and outcome predictors in cats with diabetic ketoacidosis (1997–2007): 93 cases

Objectives nTo determine risk factors and outcome predictors in cats with diabetic ketoacidosis (DKA). n nDesign nRetrospective study. Inclusion in the DKA group required blood glucose concentration > 13.9 mmol/L (250 mg/dL), venous pH < 7.35, and urine or serum acetoacetate concentration greater than 1.5 mmol/L (15 mg/dL). Signalment and weight were recorded in all cats with uncomplicated diabetes mellitus (DM) without DKA and in all other nondiabetic cats examined during the study period. Clinicopathologic variables, concurrent disorders, and initial insulin intravenous (IV) continuous-rate infusion (CRI) concentration of 1.1 or 2.2 U/kg/240 mL bag of 0.9% NaCl, were examined for a possible association with outcome. n nSetting nUniversity teaching hospital. n nAnimals nNinety-three cats with DKA, 682 cats with uncomplicated DM, and 16,926 cats without DM or DKA. n nInterventions nNone. n nMeasurements and Main Results nCats with DKA were younger (median age 9.4 years; range, 1–17.9 years) than cats with uncomplicated DM (median 11.6 years; range 0.7–19.5 years, P < 0.0003). Siamese cats were overrepresented in the DKA group compared to the uncomplicated DM or nondiabetic group (P = 0.038 and P = 0.01, respectively). Poor outcome (defined as death due to disease or by euthanasia) in 36 cats with DKA (39%) was associated with increased initial creatinine, BUN, total serum magnesium, and total bilirubin concentrations (P = 0.007, P = 0.005, P = 0.03, P = 0.03, respectively). Cats treated with a higher concentration of insulin were less likely to have a poor outcome compared to cats treated with a lower concentration of insulin (odds ratio 0.14, 95% confidence interval 0.02–1.16, P = 0.02). n nConclusions nCats with DKA are more likely to be Siamese than cats with uncomplicated DM. Poor outcome of cats with DKA is associated with increased initial creatinine, BUN, total magnesium, and total bilirubin concentrations. Good outcome was associated with a higher concentration of IV insulin CRI.OBJECTIVESnTo determine risk factors and outcome predictors in cats with diabetic ketoacidosis (DKA).nnnDESIGNnRetrospective study. Inclusion in the DKA group required blood glucose concentration > 13.9 mmol/L (250 mg/dL), venous pH < 7.35, and urine or serum acetoacetate concentration greater than 1.5 mmol/L (15 mg/dL). Signalment and weight were recorded in all cats with uncomplicated diabetes mellitus (DM) without DKA and in all other nondiabetic cats examined during the study period. Clinicopathologic variables, concurrent disorders, and initial insulin intravenous (IV) continuous-rate infusion (CRI) concentration of 1.1 or 2.2 U/kg/240 mL bag of 0.9% NaCl, were examined for a possible association with outcome.nnnSETTINGnUniversity teaching hospital.nnnANIMALSnNinety-three cats with DKA, 682 cats with uncomplicated DM, and 16,926 cats without DM or DKA.nnnINTERVENTIONSnNone.nnnMEASUREMENTS AND MAIN RESULTSnCats with DKA were younger (median age 9.4 years; range, 1-17.9 years) than cats with uncomplicated DM (median 11.6 years; range 0.7-19.5 years, P < 0.0003). Siamese cats were overrepresented in the DKA group compared to the uncomplicated DM or nondiabetic group (P = 0.038 and P = 0.01, respectively). Poor outcome (defined as death due to disease or by euthanasia) in 36 cats with DKA (39%) was associated with increased initial creatinine, BUN, total serum magnesium, and total bilirubin concentrations (P = 0.007, P = 0.005, P = 0.03, P = 0.03, respectively). Cats treated with a higher concentration of insulin were less likely to have a poor outcome compared to cats treated with a lower concentration of insulin (odds ratio 0.14, 95% confidence interval 0.02-1.16, P = 0.02).nnnCONCLUSIONSnCats with DKA are more likely to be Siamese than cats with uncomplicated DM. Poor outcome of cats with DKA is associated with increased initial creatinine, BUN, total magnesium, and total bilirubin concentrations. Good outcome was associated with a higher concentration of IV insulin CRI.

Clinical approach to toxicities.

Toxicities are a common presenting complaint in the emergency department. This article discusses the clinical approach to the poisoned patient from the initial telephone call by the owner to presentation, management, and monitoring of the patient in the emergency department. Topics discussed include telephone triage, diagnosis, management, and monitoring of the poisoned patient.