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Background Early recognition of acute kidney injury (AKI) is hindered by current definitions and use of traditional, insensitive markers. Hypothesis/objectives Urinary (u) activity of γ-glutamyl transpeptidase (GGT) and alkaline phosphatase (ALP), and concentrations of heat-shock protein 70 (HSP70) and interleukins (ILs) -6 and -18, are predictive biomarkers for AKI and survival. Animals Nonazotemic, hospitalized dogs (n = 118) and healthy controls (n = 20). Methods A prospective observational study. Nonazotemic dogs at risk of AKI were recruited and their urinary biomarker concentrations were measured at presentation. Serum creatinine (sCr) and symmetric dimethylarginine (sSDMA) were measured daily until discharge/death. Results The overall case fatality rate was 18.6%. Fifteen dogs (12.7%) developed AKI, which was associated with death (relative risk, 3.2; 95% confidence interval [CI], 1.57-6.55). All 5 urinary biomarkers were significantly higher in hospitalized dogs compared to controls, with minimal overlap. uHSP70/uCr, uGGT/uCr, and uIL-6/uCr at presentation were higher in dogs which later developed AKI. Areas under the receiver operator characteristic curve (AUROC) (95% CI) for the 3 biomarkers as predictors of AKI were 0.67 (0.51-0.83), 0.68 (0.55-0.81), and 0.78 (0.65-0.91), respectively. When they were categorically classified as elevated/normal, each additional elevated biomarker increased the odds for AKI (OR, 2.83; 95% CI, 1.23-6.52, P = .01). Agreement between sCr and sSDMA was poor (Cohen's kappa = .071). The AUROC of SDMA at presentation for AKI prediction was 0.73 (0.51-0.95). Conclusions and clinical importance Kidney injury was common, irrespective of subsequent worsening of azotemia or death. The predictive value of individual urinary biomarkers was reduced by moderate sensitivities and specificities. SDMA showed moderate discriminatory utility for AKI prediction, and often displayed discordant results with sCr.

Tracheal intubation (TI) is a common procedure that rarely entails life‐threatening complications. A 1.5‐year‐old female spayed cat presented with acute signs of respiratory distress 5 weeks after undergoing TI. Radiographs revealed a marked, segmental, tracheal narrowing. A hard, 5‐cm‐long, white‐yellowish tissue was identified and removed from the trachea, with subsequent resolution of clinical signs and radiographic changes. Microscopically, the tissue consisted of fibrin and lytic neutrophils, interspaced with optically empty cavities and a few remains of talcum powder and hair shafts. Consequently, a diagnosis of obstructive fibrinous tracheal pseudomembrane (OFTP) was made. A rare complication of TI in humans, OFTP should also be suspected in cats with respiratory distress, a history of TI and radiographic evidence of tracheal narrowing. Based on cases from other species and the cat described herein, the condition can be easily resolved with OFTP removal.

OBJECTIVES To evaluate the in vitro efficacy of specific Daboia (Vipera) palaestinae (Dp) antivenom or fresh frozen plasma (FFP) against Dp venom-induced hemostatic changes DESIGN: In vitro study. SETTING Laboratory of a university referral hospital. ANIMALS Five healthy dogs. INTERVENTIONS Rotational thromboelastometry (including recombinant tissue factor or kaolin activators [EXTEM and INTEM, respectively]) and conventional hemostatic tests were evaluated in citrated whole blood samples that underwent 4 treatments: (1) no additives (control); (2) 15 μg of Dp venom; (3) 15 μg of Dp venom and 10 μL of specific Dp antivenom; (4) 15 μg of Dp venom and 0.3 mL of FFP. A linear mixed-effects regression model was used to compare results between each treatment and the control. MEASUREMENTS AND MAIN RESULTS Dp-venom engendered statistically significant (P < 0.05) EXTEM changes in 8/17 variables, all indicative of hypercoagulability, which were negated by antivenom but not with FFP. Similarly, Dp-venom induced hypercoagulable, hyperfibrinolytic changes in 12 of 17 INTEM variables, of which only 5 of 12 were negated by antivenom but not with FFP. Fibrinogen concentration was decreased, and the activated partial thromboplastin time (aPTT) was shortened (P < 0.05 for both) in all treatments compared to the control. CONCLUSIONS This study demonstrated the ephemeral procoagulant phase of Dp envenomation for the first time. Many venom-induced thromboelastometric changes were reversed by specific antivenom but not with FFP. Prospective clinical studies are warranted to investigate whether the present findings translate to clinical efficacy.

OBJECTIVE To compare serum concentrations of histones and inflammatory markers in dogs with acute pancreatitis and healthy control dogs, investigate associations of these variables with coagulation test results and survival (vs nonsurvival) to hospital discharge, and examine the prognostic utility of clinical findings and routine laboratory and coagulation tests in affected dogs. ANIMALS 36 dogs. PROCEDURES Dogs with findings consistent with acute pancreatitis (n = 29) and healthy control dogs (7) were enrolled in a prospective, observational study. Serum concentrations of histones, interleukin (IL)-6, and tumor-necrosis factor-α were assessed for all dogs. Clinical (including ultrasonographic) findings, relevant history, routine laboratory and coagulation test results, and outcomes were recorded for dogs with pancreatitis. Variables were assessed to determine an association with outcome for affected dogs and hospitalization time for survivors; histone concentrations and markers of inflammation were compared among survivors, nonsurvivors, and controls. Correlation between quantitative variables was investigated. RESULTS Serum histone and IL-6 concentrations did not differentiate survivors (n = 23) from nonsurvivors (6); IL-6 concentrations in affected dogs were correlated with 1,2-o-dilauryl-rac-glycero glutaric acid-(6′-methylresorufin) ester lipase activity (rS = 0.436) and hospitalization time (rS = 0.528). Pancreatitis-associated peritoneal fluid, obtundation, and jaundice were more common, and serum bilirubin concentration, serum alanine aminotransferase and aspartate aminotransferase activities, and prothrombin and activated partial thromboplastin times were greater in nonsurvivors than in survivors. Thromboelastometric changes consistent with hypercoagulability were detected in survivors; hypocoagulability was detected in 2 nonsurvivors. CONCLUSIONS AND CLINICAL RELEVANCE Serum histone concentrations were not associated with presence of acute pancreatitis or outcome for affected dogs. Further research is needed to investigate the clinical and therapeutic implications of hypocoagulability, hepatocellular injury, and pancreatitis-associated peritoneal fluid in affected dogs. (Am J Vet Res 2021;82:701–711)

Background Urethral obstruction (UO) is a common complication of feline idiopathic cystitis (FIC). Robust treatment recommendations to prevent its recurrence are scarce. Objectives To evaluate meloxicam treatment for prevention of clinical recrudescence in male cats with obstructive FIC. Animals Fifty-one client-owned cats. Methods Prospective, randomized clinical trial. Every male cat with FIC-associated UO was deemed eligible for the study and was recruited during hospitalization. After discharge, cats were treated with phenoxybenzamine and alprazolam for 2 weeks, with (24 cats) or without (27 cats) low-dose meloxicam (0.025 mg/kg/day PO) and monitored for 6 months. Results Cumulative number (%) of cats with recurrent UO at 10 days, 1-, 2-, and 6-months after discharge was 1 (2%), 2 (4%), 4 (8%), and 8 (16%), respectively. Overall, 12 (24%) cats experienced signs of recurrent FIC within 6 months, with (8 cats) or without (4 cats) concurrent UO. No difference in the cumulative incidence of UO within 6 months was detected with addition of meloxicam (odds ratio [95% confidence interval], 0.63 [0.13-2.97]; P = .70). All cats were alive at 6 months. Conclusions and clinical importance No clinical benefit was detected with the addition of low-dose meloxicam to phenoxybenzamine and alprazolam treatment for 2 weeks after discharge. Nevertheless, this study was underpowered to identify potential differences, and its findings must be corroborated in larger studies.

Heatstroke (HS) is an acute, progressive life-threatening emergency. Animals, including military working dogs (IDFMWD), rapidly activate cytoprotective processes, e.g., heat shock proteins (HSPs) and antioxidative molecules, in response to heat stress. We hypothesized that serum HSPs (eHSP72) and oxidative stress markers would differ in IDFMWD with a history of HS compared with controls and thus could be used to detect susceptibility to recurrent HS. eHSPs concentration, oxidative stress markers, and systemic physiological parameters were studied in dogs with and without histories of HS, undergoing indoor or outdoor training. Treadmill physical performance tests (PPTs) were conducted indoors at 22 °C (groups C-I and HS-I) or outdoors under heat stress conditions of 36 °C; 60% humidity (groups C-O and HS-O). Pre-, immediately post-, and 45 min post-PPT heart rate (HR), respiratory rate, and rectal temperature (T(re)) were recorded in all dogs. Likewise, blood samples were collected and eHSP72, venous blood gas analysis, and lactate and creatine kinase activity (CK) were assayed. Serum uric acid (sUA) and total serum redox potential (TRP) were measured only in the indoor group. Immediately post-PPT under both environmental conditions, T(re), HR, eHSP, sUA, and TRP (only measured in indoor PPT) significantly (P

The effect of 30 days of β-alanine supplementation on neurophysiological responses of animals exposed to an acute heat stress (HS) was examined. Animals were randomized to one of three groups; exposed to HS (120 min at 40-41 °C) and fed a normal diet (EXP

Acute kidney injury (AKI) in cats is associated with high mortality, partially attributed to late recognition of the disease when using currently available markers. Feline chronic kidney disease (CKD) has a variable progression rate. This study aimed to evaluate the sensitivity and specificity of urinary heat shock protein-72 to urinary creatinine ratio (uHSP72:uCr) as a diagnostic and prognostic marker in feline AKI, and as a prognostic indicator in feline CKD. The study included 63 cats, divided into five groups: healthy controls (n=10), urethral obstruction (UO; n=7), CKD (n=15), AKI (16 cats) and acute decompensating CKD (ACKD; n=15). Median uHSP72:uCr (ng/mg) of healthy, UO, CKD, AKI and ACKD cats were 0.44 (range, 0.13-1.1), 1.96 (range, 0.64-11.9), 4.2ng/mg (range, 0.57-22.16), 3.2 (range, 0.42-10.91) and 7.0 (range, 1.2-20.96), respectively, and differed (P

Background Acute kidney injury (AKI) is common in dogs, but evidence of efficacy of its treatment is lacking. Objective To evaluate the efficacy of fenoldopam in the management of AKI. Animals Forty dogs with naturally occurring heatstroke. Methods Dogs were prospectively enrolled and divided into treatment and the placebo groups (fenoldopam, constant rate infusion [CRI] of 0.1 µg/kg/min or saline, respectively). Urine production (UP) was measured using a closed system. Urinary clearances were performed at 4, 12, and 24 hours after presentation to estimate the effect of fenoldopam on UP, glomerular filtration rate (GFR) and sodium fractional excretion (NaFE). Results At presentation, severity of heatstroke, based on a previously developed scoring system, was similar between the study groups, but was significantly worse in nonsurvivors compared with survivors. Fenoldopam administration was not associated with hypotension. Overt AKI was diagnosed, based on the International Renal Interest Society guidelines in 22/40 (55%) of the dogs. Overall, 14/40 dogs (35%) died, with no significant (P = .507) mortality rate difference between the fenoldopam (6/20 dogs; 30%) and placebo (8/20; 40%) groups. The proportion of dogs with AKI did not differ between the fenoldopam and the placebo groups (9/20; 45% versus 13/20; 65%, respectively; P = .204). There were no differences in UP, GFR, and NaFE between the fenoldopam and the placebo groups. Conclusion and clinical importance Fenoldopam CRI at 0.1 µg/kg/min did not have a clinically relevant effect on kidney function parameters in dogs with severe heatstroke-associated AKI.

Heatstroke results from a failure to dissipate accumulated heat during exposure to hot environments, or during strenuous physical exercise under heat stress. It is characterized by core body temperatures > 41°C, with central nervous system dysfunction. Functional morphology and thermoregulatory effectors differences between dogs and humans may require special heatstroke protective adaptations in dogs, however, the risk factors for developing heatstroke are similar in both. In dogs, these include hot, especially highly humid environments, excessive physical activity, obesity, large (>15 kg) body weight, being of certain breed (e.g., Labrador retrievers and brachycephalic breeds), upper airway obstruction and prolonged seizures. Lack of acclimation to heat and physical fitness decreases the survival of heat stroked dogs. At the systemic level, blood pooling within the large internal organs (e.g., spleen, liver) is a major contributor to the development of shock and consequent intestinal ischemia, hypoxia and endothelial hyperpermeability, commonly occurring in heatstroke patients. Evoked serious complications include rhabdomyolysis, acute kidney injury, acute respiratory distress syndrome and ultimately, sepsis and disseminated intravascular coagulation. The most common clinical signs in dogs include acute collapse, tachypnea, spontaneous bleeding, shock signs and mental abnormalities, including depression, disorientation or delirium, seizures, stupor and coma. In such dogs, presence of peripheral blood nucleated red blood cells uniquely occurs, and is a highly sensitive diagnostic and prognostic biomarker. Despite early, appropriate body cooling, and intensive supportive treatment, with no available specific treatment to ameliorate the severe inflammatory and hemostatic derangements, the mortality rate is around 50%, similar to that of human heatstroke victims. This review discusses the pathophysiology of canine heatstroke from a veterinarian's point of view, integrating new and old studies and knowledge.

Heatstroke is associated with systemic inflammatory response syndrome, leading to multiple organ dysfunction and death. Currently, there is no specific treatment decreasing hyperthermia-induced inflammatory/hemostatic derangements. Emerging studies indicate that histones leaking from damaged cells into the extracellular space are toxic, pro-inflammatory, and pro-thrombotic. We therefore hypothesize that serum histones (sHs) are elevated during heatstroke and are associated with the severity of the disease. Sixteen dogs with heatstroke and seven healthy controls were included in the study. Median serum histones (sHs) upon admission in dogs with heatstroke were significantly higher (P = 0.043) compared to that in seven controls (13.2 vs. 7.3 ng/mL, respectively). sHs level was significantly higher among non-survivors and among dogs with severe hemostatic derangement (P = 0.049, median 21.4 ng/mL vs. median 8.16 ng/mL and P = 0.038, 19.0 vs. 7.0 ng/mL, respectively). There were significant positive correlation between sHs and urea (r = 0.8, P = 0.02); total CO2 (r = 0.661, P = 0.05); CK (r = 0.678, P = 0.04); and prothrombin time (PT) 12 h post presentation (r = 0.888, P = 0.04). The significant positive correlation between sHs and other heatstroke severity biomarkers, and significant increase among severely affected dogs, implies its role in inflammation/oxidation/coagulation during heatstroke. sHs, unlike other prognostic and severity biomarkers in heatstroke, can be pharmacologically manipulated, offering a potential therapeutic target.

Objective To investigate hemostatic analyte abnormalities and their association with mortality in dogs with naturally occurring heatstroke. Design Prospective observational study. Setting University teaching hospital. Animals Thirty client-owned dogs with naturally occurring heatstroke. Interventions None. Measurements and Main Results Citrated and EDTA blood samples were collected at presentation and at 4, 12, 24, 36, and 48 hours postpresentation (PP). Hemostatic tests performed included platelet count, prothrombin and activated partial thromboplastin times (PT and aPTT, respectively), antithrombin activity (ATA), total protein C activity (tPCA), fibrinogen, and D-dimer concentrations. The overall survival rate was 60% (18/30 dogs). Older age, higher heart rate and rectal temperature at presentation, and time from onset of clinical signs to presentation were significantly associated with mortality. Hemostatic analytes at presentation were not associated with mortality. Prolonged PT and aPTT at 12–24 hours PP, lower tPCA at 12 hours PP, and hypofibrinogenemia at 24 hours PP were significantly (P < 0.05) associated with mortality. Increased D-dimer concentration and low ATA were common at all time points, but were not associated with mortality. The frequency of disseminated intravascular coagulation (DIC) increased in nonsurvivors throughout hospitalization, but the development of DIC was not associated with mortality. The number of abnormal coagulation disturbances during the first 24 hours was significantly higher in nonsurvivors (P = 0.04). Conclusions Hemostatic derangements are common in dogs with naturally occurring heatstroke. Alterations in PT, aPTT, tPCA, and fibrinogen concentrations appear to be associated with the outcome at 12–24 hours PP, exemplifying the need for serial measurement of multiple laboratory hemostatic tests during hospitalization, even when within reference interval on presentation. The development of DIC, as defined in this cohort, was not associated with mortality; however, nonsurvivors had significantly more coagulation abnormalities during the first 24 hours PP.

Objective To describe the use of an ultrasound-guided intracardiac xenotransfusion of canine packed red blood cells (pRBC) to the left ventricle of a severely anemic cat during cardiopulmonary resuscitation (CPR). Case Summary An 8-year-old previously healthy neutered female cat was presented with severe weakness after she had disappeared for 1 month. On presentation, the cat was in hypovolemic shock, laterally recumbent, and severely anemic with massive flea infestation. Within minutes of admission, the cat became agonal and suffered cardiopulmonary arrest. CPR was immediately initiated; however, attempts to gain IV access during CPR were unsuccessful. As the cat's blood type was yet unknown, 10 mL of canine pRBC was transfused directly into the left ventricular chamber using ultrasound guidance, as well as 0.02 mg/kg of epinephrine using a similar technique. The cat regained cardiac activity and once the jugular vein was cannulated it received 20 additional mL of canine pRBC intravenously. The packed cell volume and total plasma protein following the intracardiac transfusion were 0.09 L/L [9%] and 30 g/L [3.0 g/dL], respectively. Subsequent blood typing revealed the cat had type B blood. The cat was discharged 3 days post-CPR and was alive and doing well 3 months following discharge. New or Unique Information Provided This is the first reported case of ultrasound-guided intracardiac canine-to-feline xenotransfusion during CPR.

OBJECTIVES: The effect of 30-days of β-alanine (BA) supplementation on heat shock protein 70 (HSP70), inflammatory and neurotrophin responses in the hippocampus and hypothalamus of rats exposed to an acute heat stress was investigated. METHODS: Animals were randomized to either a control (CTL) group or BA supplementation (100mg·kg(−1)) group. All animal were fed a normal diet and only differed regarding supplementation. Following supplementation animals were either exposed to the heat stress (120 min at 40–41°C) or were unexposed. Following the acute heat stress, or at the end of the supplementation period, animals were harvested and their brains removed. Immunohistochemical technique was used to detect expression of HSP70, brain-derived neurotrophic factor (BDNF), cyclooxygenase-2 (COX2) and neuropeptide Y (NPY) in the hippocampus subregions and paraventricular nuclear (PVN) region of the hypothalamus. RESULTS: Three animals in CTL and one in BA did not survive the heat stress. Significant attenuation (P's

Heatstroke is often associated with acute kidney injury (AKI). The objectives of this study were to characterize the kidney damage occurring in canine heatstroke using routine and novel biomarkers and to assess their diagnostic and prognostic performance. Thirty dogs with naturally occurring heatstroke were enrolled prospectively. Blood and urine specimens were collected at presentation, at 4 h post-presentation and every 12 h until discharge or death. The glomerular filtration rate (GFR) and electrolyte fractional excretion (FE) at 4 h post-presentation were also calculated, based on urinary clearances. AKI was further characterized by evaluating urine neutrophil gelatinase-associated lipocalin/creatinine ratio (UNGAL), urine retinol-binding protein/creatinine ratio (URBP), urine C-reactive protein/creatinine ratio (UCRP) and urine protein to creatinine ratio (UPC). These biomarkers were compared to those for 13 healthy dogs. Thirteen dogs (43%) died and 17 (57%) survived. Median serum creatinine concentration at presentation was 1.69 mg/dL (range, 0.5-4.7 mg/dL), while concurrent GFR was markedly decreased (median 0.60 mL/min/kg; range, 0.00-3.10 mL/min/kg). Median Na fractional excretion was 0.08 (range, 0.01-0.41) and was an accurate predictor of AKI (area under curve 0.89; 95% confidence intervals 0.76-1.00). Median UPC at presentation was 4.8 (range, 0.4-46.0). Median UCRP, URBP and UNGAL were increased in all dogs with heatstroke, and were mean 232, 133, and 1213-fold higher than healthy control dogs, respectively. In conclusion, although AKI occurs invariably in dogs with heatstroke, it is often subclinical at presentation. Damage occurs in both the renal tubules and the glomeruli. Novel kidney function tests for the characterization of renal injury and its severity are superior to conventional markers and could be used to facilitate early diagnosis of AKI.

Heatstroke is a serious illness in dogs characterized by core temperatures above 41 °C with central nervous system dysfunction. Experimental heatstroke models have tried to correlate biomarker levels with the severity of the syndrome. Serum heat shock protein (eHSP70) levels were recently evaluated as a biomarker of heat tolerance and acclimation, their role as a marker of heatstroke is inconclusive. Here, we monitored eHSP70 levels in correlation with systemic biomarkers in 30 naturally occurring canine heatstroke cases. Thirty dogs diagnosed with environmental (33 %) or exertional (66 %) heatstroke admitted to hospital (0–14 h post-injury) were tested for biomarkers of organ damage and coagulation parameters. eHSP70 levels were measured upon admission and 4, 12, and 24 h later (T1, T2, and T3, respectively). No differences were found between exertional and environmental heatstroke cases. The eHSP profile demonstrated an inverted bell shape, with the lowest levels at the 12 h time point. A positive correlation between eHSP70, lactate, and aPPT was also noted at T2 in all the dogs in the study. Twenty-four h after presentation, eHSP70 levels returned to those measured upon admission, this change was only significant in the survivors. The obtained results suggest that eHSP72 level profile may be predictive of survival.

Objective To assess the effects of tranexamic acid (TA) on hematological, hemostatic, and thromboelastographic analytes in healthy adult dogs. Design Prospective study. Setting University teaching hospital. Animals Eleven healthy, staff-owned, adult dogs. Measurements and Main Results Dogs were administered TA as an IV bolus, followed by a 3-hour constant rate infusion (CRI). Complete blood count, prothrombin time, activated partial thromboplastin time, D-dimer, antithrombin, fibrinogen, and thromboelastography (TEG) were measured prior to, and immediately after TA administration. Vomiting occurred transiently in the first 2 treated dogs, immediately after 20 and 15 mg/kg IV boluses, but not during the CRI. In all other dogs the TA IV bolus dose was reduced to 10 mg/kg, and administered slower, and vomiting did not occur. All measured hemostatic and hematological analytes remained within their reference intervals, however, following TA treatment, significant decreases were recorded in prothrombin time, TEG R and A30 values, Hct, and hemoglobin concentration, while the TEG LY30 significantly increased. Conclusions Administration of TA as a slow IV bolus at 10 mg/kg, followed by a 10 mg/kg/h CRI over 3 hours to healthy dogs is safe; however, its effect on TEG A30, A60, LY30, and LY60 values was inconsistent with its expected anti-fibrinolytic properties.

Objective To develop a statistically-derived scoring system that can aid in severity assessment and outcome prediction for dogs with heatstroke. Design Retrospective study. Setting Veterinary teaching hospital. Animals One hundred twenty-six client-owned dogs diagnosed with heatstroke. Interventions None. Measurements and Main Results Logistic regression analysis was performed to identify clinicopathologic variables, available in the first 24 hours of hospitalization, which were associated with outcome (P ≤ 0.1). These were subjected to further analyses. In Model A, continuous variables were divided into quartiles, and logistic regression was performed to yield quartile-specific odds ratios (ORs) for the outcome. Model A was developed, assigning weighted values to each quartile, based on its corresponding OR for the outcome. An individual predictive score was calculated for each dog by summating all weighted values. Model B was a multivariable logistic regression model. Receiver operator characteristic (ROC) analyses were performed to assess models’ performance and to calculate sensitivity, specificity, and optimal cutoff points. The overall mortality rate was 53%. The total predictive score (Model A) was negatively and significantly (P < 0.001) associated with probability of survival. The areas under the ROC curve for Models A and B were 0.92 and 0.86, respectively. The optimal cutoff score for Model A was 35.0, corresponding to sensitivity of 93% and specificity of 86%, correctly classifying 90% of the cases. Conclusions and Clinical Relevance The proposed models are applicable, allowing objective assessment of the severity and prognosis of heatstroke in dogs; however, they should be validated further in an independent cohort, and used cautiously for assessment of individual cases.

The objective of the study was to review the veterinary literature for evidence-based and common clinical practice supporting the postoperative management of dogs with gastric dilatation and volvulus (GDV). GDV involves rapid accumulation of gas in the stomach, gastric volvulus, increased intragastric pressure, and decreased venous return. GDV is characterized by relative hypovolemic-distributive and cardiogenic shock, during which the whole body may be subjected to inadequate tissue perfusion and ischemia. Intensive postoperative management of the patients with GDV is essential for survival. Therapy in the postoperative period is focused on maintaining tissue perfusion along with intensive monitoring for prevention and early identification of ischemia-reperfusion injury (IRI) and consequent potential complications such as hypotension, cardiac arrhythmias, acute kidney injury (AKI), gastric ulceration, electrolyte imbalances, and pain. In addition, early identification of patients in need for re-exploration owing to gastric necrosis, abdominal sepsis, or splenic thrombosis is crucial. Therapy with intravenous lidocaine may play a central role in combating IRI and cardiac arrhythmias. The most serious complications of GDV are associated with IRI and consequent systemic inflammatory response syndrome and multiple organ dysfunction syndrome. Other reported complications include hypotension, AKI, disseminated intravascular coagulation, gastric ulceration, and cardiac arrhythmias. Despite appropriate medical and surgical treatment, the reported mortality rate in dogs with GDV is high (10%-28%). Dogs with GDV that are affected with gastric necrosis or develop AKI have higher mortality rates.

Vipera palaestinae is responsible for most envenomations in humans and domestic animal in Israel. Its venom has pro- and anticoagulant properties. Protein C is a major natural anticoagulant, preventing excess clotting and thrombosis. This study investigated protein C activity and its prognostic value, as well as several other hemostatic analytes in dogs (Canis familiaris) accidently envenomed by V. palaestinae. Protein C activity was compared between envenomed dogs and 33 healthy control dogs. Mean protein C was lower in dogs envenomed by V. palaestinae compared to controls (12.9% vs. 22.9%, respectively; P < 0.01). It was positively correlated with antithrombin activity (r = 0.3, P = 0.04), but not with other hemostatic analytes. The overall mortality rate was 13%, and at presentation no significant protein C activity difference was noted between survivors and non-survivors. A receiver operator characteristics analysis of protein C activity as a predictor of mortality had an area under the curve of 0.7 (95% confidence interval 0.52-0.87). A protein C cutoff point of 8% corresponded to sensitivity and specificity of 70% and 57%, respectively. Dogs diagnosed with consumptive coagulopathy (14%) tended to have lower protein C activity compared to others; however, their mortality did differ from that of other dogs. This is the first study assessing protein C activity in V. palaestinae victims. Decreased protein C activity in such dogs may play a role in formation of thrombosis and hemostatic derangement as well as inflammation in V. palaestinae envenomations.

Military working dogs in hot countries undergo exercise training at high ambient temperatures for at least 9 mo annually. Physiological adaptations to these harsh conditions have been extensively studied; however, studies focusing on the underlying molecular adaptations are limited. In the current study, military working dogs were chosen as a model to examine the effects of superimposing endurance exercise on seasonal acclimatization to environmental heat stress. The lymphocyte HSP70 profile and extracellular HSP70 were studied in tandem with physiological performance in the dogs from their recruitment for the following 2 yr. Aerobic power and heat shock proteins were measured at the end of each summer, with physical performance tests (PPTs) in an acclimatized room (22°C). The study shows that together with a profound enhancement of aerobic power and physical performance, hsp72 mRNA induction immediately post-PPT and 45 min later, progressively increased throughout the study period (relative change in median lymphocyte hsp72 mRNA first PPT, 4.22 and 12.82; second PPT, 17.19 and 109.05, respectively), whereas induction of HSP72 protein was stable. These responses suggest that cellular/molecular adaptive tools for maintaining HSP72 homeostasis exist. There was also a significant rise in basal and peak median optical density extracellular HSP at the end of each exercise test (first PPT, 0.13 and 0.15; second PPT, 1.04 and 1.52, respectively). The relationship between these enhancements and improved aerobic power capacity is not yet fully understood.

Objectives To assess the performance of a portable prothrombin time (PT) analyzer (CoaguChek-XS) in dogs. Animals Ninety-seven dogs composed of 20 healthy dogs, 45 ill dogs, and 32 ill dogs with altered coagulation. Procedures Samples were concurrently obtained and PT was measured using the CoaguChek-XS and an automated coagulation analyzer. Agreement between methods was assessed using Spearman's correlation and Bland–Altman analysis. Results The reference interval for PT using the CoaguChek-XS was 9.6–11.5 s. The CoaguChek-XS was easy to use, required a small volume of whole blood, and gave results within 1 min. The mean difference in PT between the 2 methods was 2.58 s (SD 3.10), and 94% of the samples fell within limits of agreement. The correlation was moderate, but significant (r = 0.35, P < 0.001). Sensitivity and specificity of the CoaguCheck-XS PT compared to analyzer PT were 92% and 56%, respectively, and increased to 95% and 77% on intent to treat basis. The coefficient of variance was 0.72%. The CoaguChek-XS identified all 8 dogs with anticoagulant rodenticide intoxication, although a discrepancy was noted from the analyzer results. In anemic dogs (PCV≤25%), the CoaguChek-XS did not display accurate results. Conclusions The CoaguChek-XS is a simple, user-friendly, highly precise PT analyzer. Results had moderate correlation and good agreement with a standard method. It can be used reliably for screening dogs when the PT is normal. However, when the CoaguChek-XS PT is prolonged or when the PCV is ≤25%, results should be confirmed using a standard method.

Objective To describe the clinical signs, clinicopathologic abnormalities, treatment, complications and outcome, and to identify risk factors for death in cats envenomed by Vipera palaestinae (Vp). Design Retrospective study. Setting Veterinary teaching hospital. Animals Eighteen client-owned cats envenomed by Vp. Interventions None. Measurements and Main Results All envenomations occurred during the hot season (May to October), mostly in young ( 40/min, 100%), lameness (78%), depression (71%), fang penetration marks (55%), hypothermia ( 220/min, 20%), and bradycardia (

Objective To describe the clinical course, outcome and success rate of 8 dogs with persistent pneumothorax treated with autologous blood-patch pleurodesis (ABP). Design Retrospective case series. Setting University teaching hospital Animals Eight client-owned dogs. Intervention Non-coagulated blood was aseptically collected from the jugular vein and injected immediately into the pleural cavity of dogs with persistent pneumothorax. Measurements and Main Results The procedure was successful in 7 of 8 dogs. The median duration of pneumothorax until the ABP was performed was 4 days (range 2–6 days). Pneumothorax resolved immediately after 1 treatment in 4 dogs. Pleurodesis was repeated once in 3 dogs, and twice in 1 case after which it resolved in 3 of the 4 dogs. Out of a total of 13 ABP procedures performed in 8 dogs, 5 (62.5%) were successful after 1 procedure and the success rate increased to 87.5% after additional procedures. One dog failed ABP and was euthanized 3 days later due to continued deterioration and a hospital acquired pneumonia. Mild to moderate complications occurred in 2 other dogs and resolved in both. Conclusions ABP is a simple, inexpensive, and relatively safe procedure which can be considered in dogs with persistent pneumothorax that have failed conservative or surgical management. Infections following ABP were documented in 2 of the 8 dogs and resolved in 1 dog.

Early recognition of acute kidney injury (AKI) is important, as therapy is potentially more efficacious if instituted early in the course of disease. Urinary heat shock protein-72 to urinary creatinine ratio (uHSP72/uCr) was assessed as a diagnostic and prognostic marker in AKI in dogs. Fifty-three dogs were enrolled in five groups: healthy controls (n=11), urinary tract infection (n=10), chronic kidney disease (CKD; n=11), AKI (n=13), and acute decompensating CKD (n=8). Urinary heat shock protein-72 to urinary creatinine ratio was highest in the AKI group (P0.001 when compared to the control and urinary tract infection groups, individually; P0.05 compared to each of the other two groups). The area under the curve (AUC) for the receiver operator characteristic (ROC) analysis of uHSP72/uCr to predict AKI, compared to the control group, was 0.97. A cutoff value of 0.20ng/mg corresponded to sensitivity and specificity of 100% and 82%, respectively. Urinary heat shock protein-72 to urinary creatinine ratio was significantly lower in dogs categorized as survivors vs. non-survivors of AKI; ROC AUC, 0.91 (95% confidence intervals, 0.74-1.0). Urinary heat shock protein-72 to urinary creatinine ratio is a potentially useful diagnostic and prognostic biomarker of AKI in dogs.

Objective To assess the efficacy of IV lidocaine in decreasing complication rate and improving the outcome in dogs with gastric dilatation volvulus (GDV). Design Prospective non-controlled study of 83 lidocaine-treated dogs with GDV compared to 47 untreated historical controls with GDV. Setting University veterinary teaching hospital. Animals One hundred and thirty client-owned dogs with naturally occurring GDV. Interventions Study group dogs were treated at presentation with lidocaine (2 mg/kg, IV bolus) followed by constant rate infusion (CRI) of 0.05 mg/kg/min for 24 h. Historical control dogs did not receive any lidocaine. Measurements and Main Results There were no group differences in age, body weight, time lag from onset of clinical signs to presentation, rectal temperature and pulse rate at presentation, and proportion of gastric wall necrosis. The proportions of cardiac arrhythmias and acute kidney injury (AKI) were significantly (P< 0.001 and P = 0.045, respectively) lower in the lidocaine group (10/83 [12%] versus 18/47 [38.3%] and 3/83 [3.6] versus 0/47). Median hospitalization time period was shorter (P = 0.05) in the lidocaine group compared to the controls (median 48 h; range 24–360 h versus median 72 h; range 24–144 h, respectively). Conclusion and Clinical Relevance Early treatment with IV lidocaine bolus, followed by CRI of lidocaine for 24 h post presentation decreased the occurrence of cardiac arrhythmias, AKI and hospitalization time period significantly in lidocaine-treated dogs with GDV compared to untreated historical controls. Due to the nonblinded, placebo-uncontrolled, nonrandomized nature of the current study, further evaluation of the efficacy of lidocaine in dogs with GDV is warranted.

This prospective study was conducted to evaluate the prevalence and severity of ocular lesions in dogs with anemia (packed cell volume < or =20%) and/or thrombocytopenia (platelet count

Eleven dogs with fatal heatstroke were examined grossly and histopathologically post mortem. All showed multi-organ haemorrhagic diathesis with coagulative necrosis. Hypaeremia and diffuse oedema were observed in the skin (eight dogs), lungs (11), brain (11) and bone marrow (one). Congestion of the splenic pulp (10 dogs) and hepatic sinusoids (nine) was also noted. Necrosis was observed in the mucosa of the small intestine (seven dogs), large intestine (eight), renal tubular epithelium (nine), hepatic parenchyma (eight) and brain neural tissue (four). The results showed that naturally occurring, fatal canine heatstroke induces acute multiple organ lesions affecting most body systems, and suggest that the more prevalent lesions include haemorrhagic diathesis, microthrombosis and coagulative necrosis. These are probable sequels of hyperthermia-induced disseminated intravascular coagulation and systemic inflammatory response syndrome, which lead to multi-organ dysfunction and death.

The records of five dogs diagnosed with spirocercosis-associated pyothorax were retrospectively reviewed. On admission, the most common clinical findings were weakness, anorexia, depression, dyspnoea and fever. All dogs had typical oesophageal Spirocerca lupi granulomas. Contrast thoracic radiography revealed contrast material leakage from the oesophagus into the pleural cavity in two dogs only. All dogs were medically treated with broad-spectrum antibiotics, repeated chest tube drainage and thoracic lavage, and four of the dogs were treated with doramectin. One dog was euthanased due to a concurrent non-related disease at the owners request while the remaining four survived. S. lupi infection should be included in the differential diagnoses of canine pyothorax in endemic areas. Conservative medical management of pyothorax with antihelmintic medication was shown to be effective in the treatment of S. lupi-associated pyothorax.

Summary Aspergillus terreus, normally a soil or plant saprophyte, causes disseminated systemic infection, involving primarily the skeletal and the cardiopulmonary system in humans and dogs.1, 2 We describe two cases of German shepherd dogs that were referred to Koret School of Veterinary Medicine Teaching Hospital with a history of anorexia and weakness. Case 1 suffered from neurological deficits, paraparesis and lumbar pain whereas case 2 suffered from unilateral uveitis and exophthalmus. Both dogs were treated symptomatically, but deteriorated progressively despite therapy and were therefore euthanised. Necropsy revealed disseminated aspergillosis, and numerous organs had multiple, miliary, white-yellow foci. Microscopically, these were identified as granulomas, containing fungal hyphae. Affected tissue included brain, heart, kidneys, spleen, lymph nodes and bones (case 2). Aspergillus terreus was isolated from different organs and from urine culture. We suggest that disseminated aspergillosis should be considered as a differential diagnosis in German shepherd dogs presenting with ocular disease, neurological deficits, spinal column pain, urinary system disorders, and radiographic evidence of skeletal and/or respiratory pathology.

The medical records of 54 dogs presented to the Hebrew University Veterinary Teaching Hospital and diagnosed with heat stroke were retrospectively reviewed. Data abstracted included history, clinical and clinicopathological signs at admission, treatment, disease progression, and outcome. Exertional and environmental heat stroke were present in 63% (34 of 54) and 37% (20 of 54) of the dogs, respectively, and 78% (42 of 54) were examined between June and August. The mean temperature and heat discomfort index in the particular days of heat stroke were significantly increased (P.001, P.001, respectively) compared with their corresponding average daily values. In 27 dogs the body temperature wasor = 41 degrees C (105.8 degrees F). Belgian Malinois (15%, odds ratio [OR] = 24, 95% confidence interval [CI95%] 8.2-64.5), Golden and Labrador Retrievers (21%, OR = 2.08, CI95% 0.95-4.2), and brachycephalic breeds (25%, OR = 1.7, CI95%], 0.81-3.21) were overrepresented, whereas small breeds (8 kg) were underrepresented (2%, OR = 0.08, CI95%, 0.002-0.48). Thrombocytopenia (45 of 54 dogs) and prolongation of the prothrombin (PT) and activated thromboplastin (aPTT) times (27 of 47 dogs) were recorded during hospitalization. Disseminated intravascular coagulation (P = .013) and acute renal failure (P = .008), diagnosed in 28 of 54 and 18 of 54 of the cases, respectively, were risk factors for death. The overall mortality rate was 50%. Hypoglycemia (47 mg/dL, P = .003), prolonged PT (18 seconds, P = .05), and aPTT (30 sec, P.001) at admission were associated with death. Serum creatinine1.5 mg/dL (P = .003) after 24 hours, delayed admission (90 minutes, P = .032), seizures (P = .02), and obesity (P = .04) were also risk factors for death. Heat stroke in dogs results in serious complications and high fatality rate despite appropriate treatment.

OBJECTIVES To assess the usefulness of clinical and clinicopathological parameters as prognostic markers of survival in dogs undergoing positive pressure ventilation. METHODS Retrospective study of case records of 58 client-owned dogs undergoing positive pressure ventilation. Dogs were divided into two groups; inadequate oxygenation due to pulmonary parenchymal disease (Group 1) and inadequate ventilation (Group 2). RESULTS Median duration of positive pressure ventilation was 30 (range 10 to 136) hours. Survival rate was 32% (19 dogs). Survivors were significantly younger (P

Background Pepsinogens are proenzymes secreted by gastric chief cells. In humans, their serum concentrations reflect gastric mucosal morphological and functional status. Objectives To evaluate serum canine pepsinogen-A (cPG-A), C-reactive protein (CRP), and canine pancreatic lipase immunoreactivity (cPLI) concentrations in dogs with gastric dilatation-volvulus (GDV). Animals Sixty-six dogs presented with GDV and 79 healthy controls. Methods Blood was collected prospectively, and records retrospectively reviewed. Results Median cPG-A concentration was higher in GDV dogs (median, 397 μg/L; range, 37–5,410) compared to controls (median, cPG-A 304 μg/L; range, 18–848; P = .07). Mortality rate in GDV dogs was 22.7%. In nonsurvivors of GDV, median cPG-A was higher compared to survivors (median, 746 μg/L; range, 128–5,409 versus median, 346; range, 36–1,575, respectively; P = .003). The proportion of dogs with increased cPG-A increased with gastric wall damage score (P = .007). An ROC analysis of cPG-A as a predictor of death showed an area under the curve (AUC) of 0.75, higher than lactate (AUC 0.66), and corresponded to a sensitivity and specificity of 53% and 88%, respectively. CRP was increased in 48 dogs (75%), cPLI was >200 μg/L in 26 dogs (39.4%) and >400 μg/L in 12 dogs (18.2%) but both analytes had no association with outcome. Conclusions Presurgical cPG-A concentration was positively and significantly associated with gastric wall lesion severity, but, based on ROC analysis, it was only a moderate outcome predictor. CRP and cPLI were commonly increased in dogs with GDV.

Aflatoxins, produced by Aspergillus spp., are toxic contaminants of stored grain. This study describes 50 dogs presented with foodborne aflatoxicosis. Common clinical signs included lethargy (78%), vomiting (76%), anorexia (74%), icterus (66%), depression (66%), melena (60%), haematuria (36%) and diarrhoea (36%). Common laboratory abnormalities included increased activities of aspartate aminotransferase (86%), alkaline phosphatase (84%) and alanine aminotransferase (79%), hypoantithrombinaemia (86%), prolonged prothrombin (PT, 82%) and activated partial thromboplastin times (aPTT, 80%), hyperbilirubinaemia (73%), hypocholesterolaemia (60%) hypoalbuminemia (47%) and thrombocytopenia (42%). Non-survivors had longer PT and aPTT and lower antithrombin (P0.001) at presentation compared to survivors (23.8s vs.10.5; 37.9 vs.17.6s and 5% vs. 54%, respectively). Hyperbilirubinaemia (56.6 μmol/L) and albumin concentration32.5 g/L at presentation were risk factors for mortality (P0.0001). Common complications included disseminated intravascular coagulation (58%), hepatic encephalopathy (35%) and acute kidney injury (4%). The mortality rate was 68%, suggesting that dogs with aflatoxicosis have poor prognosis.

Background: Heatstroke in dogs is often fatal and is associated with a high prevalence of secondary complications. Peripheral nucleated red blood cells (NRBC) occur in dogs with heatstroke, but their association with complications and the outcome is unclear. Hypothesis: Peripheral NRBC are common in dogs with heatstroke and have prognostic significance. Animals: Forty client-owned dogs with naturally occurring heatstroke. Methods: Prospective, observational study. Dogs were followed from presentation to discharge or death. Serum biochemistry and coagulation tests were performed at presentation. CBC and evaluation of peripheral blood smears were performed at presentation and every 12 hours. The relative and the absolute NRBC numbers were calculated. Results: Presence of NRBC was observed in 36/40 (90%) of the dogs at presentation. Median relative and absolute NRBC were 24 cells/100 leukocytes (range 0–124) and 1.48 × 103/μL (range 0.0–19.6 × 103/μL), respectively. Both were significantly higher in nonsurvivors (22) versus survivors (18) and in dogs with secondary renal failure and DIC versus those without these complications. Receiver operator curve analysis of relative NRBC at presentation as a predictor of death had an area under curve of 0.92. A cut-off point of 18 NRBC/100 leukocytes corresponded to a sensitivity and specificity of 91 and 88% for death. Conclusions and Clinical Importance: Relative and absolute numbers of peripheral NRBC are clinically useful, correlate with the secondary complications, and are sensitive and specific markers of death in dogs with heatstroke, although they should never be used as a sole prognostic indicator nor should they replace clinical assessment.

Objective—To determine clinical features, outcome, risk factors for death, and efficacy of IV administration of lidocaine as a prophylactic treatment for ischemic reperfusion injury in gastric dilatation and volvulus (GDV) in dogs. Design—Retrospective case series. Animals—112 dogs with GDV. Procedures—Data pertaining to breed; time lag to admission; clinical, clinicopathologic, and surgical findings; lidocaine treatment; and postoperative complications were assessed for association with outcome. Results—German Shepherd Dogs (28.6%) and Great Danes (17%) were significantly over-represented. Risk factors for death included time lag (≥ 5 hours vs < 5 hours) from onset of clinical signs to admission (46.0% vs 11.3%), rectal temperature (≤ 38°C vs > 38°C [< 100.4°F vs > 100.4°F]) at admission (40.0% vs 14.9%), presence or absence of ARF (67.0% vs 23.3%), presence or absence of suspected gastric wall necrosis (59.3% vs 16.0%), and untreated gastric wall necrosis, compared with treated gastric wall necrosis (100% vs 47.6%). Overall mortality rate was 26.8%; no significant differences were detected in mortality rate or postoperative complications between dogs that received lidocaine IV prior to surgical intervention (52.0%) and dogs that did not (48.0%). Mean ± SD hospitalization time was longer in the lidocaine treatment group (3.5 ± 1.9 days vs 2.5 ± 1.4 days). Conclusions and Clinical Relevance—Presence of the identified risk factors should warrant aggressive treatment. Lidocaine treatment was not associated with mortality rate or postoperative complications, but was associated with prolonged hospitalization time.

The pine processionary moth (Thaumetopoea wilkinsoni) is an insect of medical significance in the eastern Mediterranean. This report describes three exposure cases in dogs due to ingestion of this moth's caterpillars in Israel. All three dogs were observed in direct contact with caterpillars or pinecones in infested gardens. The disease course and progression of signs were acute in all three cases, and included vomiting and severe tongue swelling. Physical examination findings included hyperthermia, tachypnoea, respiratory distress, cyanosis and tongue oedema, labial angioedema, ptyalism, bilateral submandibular lymphadenomegaly and conjunctivitis. Severe tongue necrosis and sloughing of its distal portion occurred 2-5 days after admission to the hospital. All dogs recovered and were discharged within 2-7 days of admission. Two staff members, attending one of the dogs, experienced an itchy rash and wheals on their arms, wrists and necks. To the best of our knowledge, this should be the first report of severe oral lesions and tongue necrosis due to contact with T. wilkinsoni caterpillars.

THE plastic explosive composition C-4 is commonly known as RDX (Royal Defence Explosive) for its main component. RDX is a white, crystalline powder used as an explosive substance for police, military or civilian purposes. The active ingredient of RDX is cyclonite or hexogen; its chemical formula is cyclotrimethylenetrinitramine or hexahydro-1,3,5trinitro-1,3,5-triazine (Harrell-Bruder and Hutchins 1995). There are few reports of RDX intoxication; reports of RDX intoxication in military personnel (Goldberg and others 1992, Harrell-Bruder and Hutchins 1995, Hett and Fichtner 2002) and civilians (Woody and others 1986) have documented generalised seizures, headaches, nausea, vomiting, hyperexcitability, haematuria and petechial rash. Reported cases of animal intoxication are rare (Berry and others 1983, De Cramer and Short 1992, Gogal and others 2003). While handling explosives during training, police or military working dogs may be exposed to RDX, and may therefore suffer intoxication (Berry and others 1983). Pets and wild animals may be exposed to residues of RDX by ingesting contaminated soil or water (Nipper and others 2001, Gogal and others 2003). The main reported clinical signs of exposure in dogs include generalised convulsions, muscle fasciculation, salivation, vomiting, tachypnoea, dyspnoea and hyperexcitability (Dilley and others 1982, Berry and others 1983, De Cramer and Short 1992). This short communication describes a case of general tonic-clonic seizures, transient blindness and hepatic insult, with full recovery, following the ingestion of RDX by a police working dog. A three-year-old, entire, female labrador retriever police working dog, weighing 25 kg, was referred to the Koret School of Veterinary Medicine Teaching Hospital, Israel, with facial twitches and hypersensitivity, 60 minutes after ingesting a small fragment, described to be the size of a grain of rice, of RDX during training. The dog had been exposed to RDX at least once a week during 14 months of training before this incident, with no apparent adverse effects. The trainer had administered two 30 ml doses of 3 per cent hydrogen peroxide, 15 minutes apart, orally to the dog in order to induce vomiting, and it was referred to the veterinary hospital. White material that was suspected to be RDX residue was observed in the vomitus. On admission, the dog was panting and had a normal body temperature (39·0°C) and pulse (132 bpm). Clinical examination revealed pale mucous membranes and central nervous system (CNS) signs that included facial twitches, confusion and hyperexcitability. For initial emergency management, lactated Ringer’s solution was administered intravenously at a rate of 5 ml/kg/hour. Pretreatment haematology and serum biochemistry were unremarkable. The urine specific gravity was 1·035 and blood casts were seen in the urinary sediment. Thirty minutes after admission, the dog collapsed, exhibited tonic-clonic generalised seizures and became cyanotic. It received 6 mg/kg diazepam (Assival; Biogal) and 12 mg/kg propofol (Diprofol; Taro) intravenously until the seizures ceased. In addition, the dog was given 4 mg/kg phenobarbital (Luminal; Quimica) intramuscularly. An endotracheal tube was placed and the dog received positive-pressure ventilation. Gastric lavage was performed, and white matter that resembled the matter noted by the referring police trainer in the vomitus was seen. After lavage, 1 g/kg activated charcoal was administered through the gastric tube. During the next five hours the dog suffered four more episodes of generalised seizures while anaesthetised; each time it received 0·4 mg/kg propofol intravenously and a constant-rate intravenous infusion of diazepam at 10 mg/100ml 0·9 per cent saline, at a rate of 2 ml/kg/hour, to stop the seizures. Analysis of the arterial blood gases, performed four hours after the dog’s arrival, when it was on 100 per cent oxygen, revealed a pH of 7·32, PO2 of 440·3 mmHg, PCO2 of 42 mmHg and bicarbonate concentration (cHCO3 –) of 21·8 mmol/l. The dog was treated with 5 mg/kg cimetidine (Tagamet; GlaxoSmithKline) administered intravenously every eight hours to protect the gastrointestinal tract from the toxin, 1 mg/kg furosemide (Fusid; Biogal) intravenously every six hours to enhance renal clearance of the toxin, and 8 mg/kg thiamine (Bimeda) intramuscularly every 24 hours to protect the CNS from insult. A urinary catheter was placed to monitor the output of urine, and 25 mg/kg ampicillin (Penibrin; Biochemie) was administered intravenously every eight hours to prevent urinary tract infection. Approximately eight hours after the dog’s arrival at the hospital, oedema developed on its muzzle, around the eyes and in all four limbs. Successive blood tests revealed that the total solids decreased from 70 g/l on arrival to 40 g/l (reference range 54 to 78 g/l). To treat the developing hypoproteinaemia, the dog received 10 ml/kg fresh frozen plasma at a rate of 5 ml/kg/hour. This was followed by administration of hydroxyethyl starch (HAES-steril; Fresenius Kabi) at a rate of 1 ml/kg/hour. Several attempts to disconnect the dog from anaesthetic were unsuccessful, resulting in renewed generalised seizures. The dog remained on anaesthetics for a total of approximately 24 hours. When recovering from anaesthesia, the dog exhibited transient blindness and had no menace response for a period of approximately 12 hours. The pupillary light response and palpebral reflex were intact in both eyes. Over the following 48 hours the dog progressed to complete clinical recovery. Routine blood biochemistry, conducted at the hospital’s laboratory 24 hours after the dog was admitted, revealed a low albumin concentration of 20·4 g/l (reference range 28·3 to 38·3 g/l) and slight hyperbilirubinaemia (24·62 μmol/l, reference range 0·34 to 9·23 μmol/l). Two days later, bilirubin increased to 105·17 μmol/l, alkaline phosphatase (AP) was elevated (975 iu/l, reference range at 37°C 4 to 140 iu/l, ) alanine aminotransferase (ALT) increased to 166 iu/l (reference range at 37°C 5 to 103 iu/l) and aspartate aminotransferase (AST) increased to 136 iu/l (reference range at 37°C 9 to 47 iu/l). Because of the biochemical evidence of hepatic insult, the dog was supplemented with 2 mg/kg vitamin K, administered orally every 24 hours, 4·5 mg/kg zinc sulphate (Avazinc; Rekah) orally every 12 hours as an antioxidant, and 1·25 ml multivitamins (Duphafral Multi; Fort Dodge) administered intramuscularly every 24 hours. The dog was discharged four days after it had been admitted. Four days later, complete blood chemistry, conducted in a different (government) laboratory, revealed an albumin concentration of 29 g/l (reference range 26 to 40 g/l), AP 1614 iu/l (reference range at 37°C 13 to 190 iu/l), ALT 485 iu/l (reference range at 37°C