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BackgroundProphylactic gastropexy has been promoted as a means of preventing gastric volvulus during gastric dilatation and volvulus (GDV) syndrome. Little is known about the impact of gastropexy on gastrointestinal transit time.HypothesisLaparoscopic-assisted gastropexy (LAG) will not alter gastrointestinal transit times when comparing gastric (GET), small and large bowel (SLBTT), and whole gut transit times (TTT) before and after surgery.Animals10 healthy client-owned large-breed dogs.MethodsProspective clinical trial. Before surgery, all dogs underwent physical examination and diagnostic evaluation to ensure normal health status. Dogs were fed a prescription diet for 6 weeks before determination of gastrointestinal transit with a wireless motility capsule. LAG was then performed, and dogs were fed the diet for 6 additional weeks. Measurement of transit times was repeated 6 weeks after surgery.ResultsTen dogs of various breeds at-risk for GDV were enrolled. No complications were encountered associated with surgery or capsule administration. There were no significant differences in GET 429 [306-1,370] versus 541 [326-1,298] (P = 0.80), SLBTT 1,243 [841-3,070] versus 1,540 [756-2,623] (P = 0.72), or TTT 1,971 [1,205-3,469] versus 1,792 [1,234-3,343] minutes (median, range) (P = 0.65) before and after LAG.Conclusions and clinical importanceAn effect of LAG on gastrointestinal transit time was not identified, and wireless motility capsule can be safely administered in dogs after LAG.

This study compared the frequency and severity of postoperative (postop) hypoxemia and hypercarbia in healthy dogs receiving butorphanol (BU) versus hydromorphone (HY). All dogs were admitted for neutering and proved normal on physical examination, CBC, creatinine, and preoperative (preop) arterial blood gas (ABG). Dogs received 0.02 mg kg[sup -1] acepromazine and 0.01 mg kg[sup -1] glycopyrrolate, with 0.4 mg kg[sup -1] BU (BU dogs, n = 10) or 0.2 mg kg[sup -1] HY (HY dogs, n = 10) IM preop. Despite BU and HY being equipotent on a per weight basis, they are not necessarily equianalgesic. Therefore, clinically accepted dosages of BU and HY were used. Anesthesia was induced with 2–4 mg kg[sup -1] thiopental boluses IV to effect, and maintained with isoflurane (ISO) and O[sub 2] . A catheter was placed in the dorsal metatarsal artery. The POET agent monitor with proximal endotracheal side-stream sampling measured end-tidal Fe[sup ′][sub ISO] and CO[sub 2] . The Fe[sup ′][sub ISO] was targeted between 0.9 and 1.5% and the ETCO[sub 2] between 30 and 45 mm Hg using PPV or IPPV. An intraoperative (intraop) ABG was obtained during stage III anesthesia 10–30 minutes prior to extubation. The BU dogs received 0.4 mg kg[sup -1] BU and HY dogs 0.1 mg kg[sup -1] HY IM prior to extubation. Post-extubation, an ABG, HR, RR, temperature, pulse quality, MM color, CRT, and nonblinded pain/sedation scores were obtained by the primary investigator at 10 minutes, 30 minutes, 1, 2, 3, and 4 hours. Anesthesia time, age, and weight for BU dogs were 119 ± 36.3 minutes, 1.9 ± 2.7 years, and 24.1 ± 8.4 kg and for HY dogs 170 ± 64.7 minutes, 0.93 ± 0.77 years, and 21.5 ± 10.3 kg, respectively. Student's t -test was used for statistical analysis on normally distributed data and the sign rank test on the A-a gradient data. Statistical significance was assigned for values of p < 0.05. Data are reported as mean ± SEM. In the HY... [ABSTRACT FROM AUTHOR]

Background: Working dogs exposed to narcotics might require reversal in the field., Objective: To explore the pharmacokinetic and pharmacodynamic effects of naloxone administered intramuscularly (IM) or intranasally (IN) to reverse fentanyl sedation in working dogs., Animals: Ten healthy, working dogs aged 1.7 ± 1 year and weighing 26 ± 3 kg., Methods: In this randomized, controlled cross-over study dogs received either 4 mg of naloxone IN or IM 10 minutes after fentanyl (0.3 mg IV) administration. Sedation was assessed at baseline and 5 minutes after fentanyl administration, then at 5, 10, 15, 20, 25, 30, 60 and 120 minutes after reversal with naloxone. Blood samples for naloxone detection were obtained at 0, 5, 10, 30, 60 and 120 minutes. Pharmacokinetic parameters and sedation scores were compared between IM and IN naloxone groups., Results: There was a significant increase in sedation score from baseline (0.25 [-4 to 1] IM; 0 [-2 to 1] IN) after fentanyl administration (11 [5-12] IM; 9.25 [4-11] IN), followed by a significant reduction at 5 (0.5 [-0.5 to 1.5] IM; 1.25 [-1.5 to 4.5] IN) through 120 minutes (-0.5 [-2 to 1] IM; 0 [-4.5 to 1] IN) after reversal with naloxone. Route of administration had no significant effect on sedation score. Maximum plasma concentration was significantly lower after IN administration (11.7 [2.8-18.8] ng/mL IN, 36.7 [22.1-56.4] ng/mL IM, P < .001) but time to reach maximum plasma concentration was not significantly different from IM administration., Conclusion and Clinical Importance: Although IM administration resulted in higher naloxone plasma concentrations compared to IN, reversal of sedation was achieved via both routes after administration of therapeutic doses of fentanyl., (© 2023 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.)

Objective: To examine weight estimations by veterinarians, veterinary nurses, and veterinary students to determine the accuracy of weight estimation in a veterinary emergency department. Secondary objectives included an initial evaluation of how body condition score (BCS), hair coat length, and hospital position of the estimator impacted accuracy of weight estimation., Animals: 101 dogs and 28 cats that presented to the emergency department from October 17, 2017, to September 3, 2019., Procedures: A written form was prospectively distributed to veterinarians, veterinary nurses, and veterinary students asking them to estimate a patient weight. Additional information about the patient, including estimated hair length and BCS, was recorded., Results: As dogs' weights increased, all estimators underestimated the patients' weight. As BCS increased, dogs' weights were underestimated by veterinary students. Longer hair coat statistically significantly impacted accurate weight estimation in dogs. In cats, as BCS increased, veterinarians and veterinary nurses overestimated patient weight. Only 32% (32/101) and 20% (6/28) of weight estimations in dogs and cats, respectively, were within 10% of the patient's actual weight., Clinical Relevance: Veterinarians, veterinary nurses, and veterinary students may not be reliable estimators of patient weight in the emergency department, especially with overweight animals. Prompt measurement of weight, if possible, is important for appropriate patient care.

Objective: To determine the severity of nasopharyngeal collapse in brachycephalic dogs before and after corrective airway surgery., Animals: Twenty-three brachycephalic dogs (21 with clinical signs referrable to the upper airway) and nine clinically normal nonbrachycephalic dogs (controls)., Methods: Dogs were evaluated with fluoroscopy awake and standing with the head in a neutral position. The magnitude of nasopharyngeal collapse was measured as the maximum reduction in the dorsoventral dimension of the nasopharynx during respiration and expressed as a percentage. Brachycephalic dogs were anesthetized, the airway evaluated, and corrective upper airway surgery (alaplasty, staphylectomy, sacculectomy, tonsillectomy) was performed. A cohort (n = 11) of the surgically treated brachycephalic dogs had fluoroscopy repeated a minimum of 6 weeks after surgery., Results: Median preoperative reduction in the dorsoventral dimensions of the nasopharynx was greater in brachycephalic dogs (65%; range: 8-100%) than in controls (10%; range: 1-24%, p = .0001). Surgery did not improve the reduction in dorsoventral diameter of the nasopharynx during respiration in brachycephalic dogs (n = 11) postoperatively (p = .0505)., Conclusion and Clinical Significance: Nasopharyngeal collapse was a common and sometimes severe component of brachycephalic airway obstruction syndrome in the cohort of dogs evaluated. The lack of significant postoperative improvement may represent a type II error, a failure to adequately address anatomical abnormalities that increase resistance to airflow, or inadequate upper airway dilator muscle function in some brachycephalic dogs., (© 2022 American College of Veterinary Surgeons.)

Objective: To evaluate preoperative diagnostics in dogs with gastrointestinal foreign body (GIFB) obstruction and to identify clinical variables associated with the performance of simple enterotomy (EO) versus enterectomy (EC)., Design: Retrospective case control study from October 2013 to January 2016., Setting: Veterinary Teaching Hospital., Animals: Eighty-two client-owned dogs diagnosed at the time of surgery with GIFB obstruction., Measurements and Main Results: Data were collected from medical records regarding history, initial physical examination, clinicopathologic testing, diagnostic imaging, and surgical reports. Based on univariate analysis, dogs that required EC were ill (P < 0.0001) and anorexic (P = 0.0007) for a longer duration; had a higher vomiting severity score (P = 0.005); and had worse perfusion parameters (mucous membrane color [P = 0.028] and quality [P = 0.032], poorer pulse quality [P = 0.0015], relatively lower blood pressure [P = 0.0328], greater heart rates [P = 0.0011]). Dogs undergoing EC were more likely to have altered peritoneal detail on radiographs (P = 0.0014; odds ratio [OR] = 25.5; 95% confidence interval [CI]: 2.4, 275.7) and echogenic peritoneal effusion on ultrasound (P = 0.0101; OR = 12.5; 95% CI: 1.3, 120.9), compared to the EO group. Heart rate (adjusted P = 0.028; OR = 1.07; 95% CI: 1.0, 1.1) and vomiting severity score (adjusted P = 0.028; OR = 5.6; 95% CI: 1.2, 26.1) maintained significance after multiple logistic regression., Conclusions: Multiple factors in the preoperative clinical evaluation were different between dogs undergoing EO versus EC for GIFB obstruction. However, many of these variables become insignificant with multiple logistic regression. The presence of an increased heart rate or increased vomiting severity score at presentation was independently associated with undergoing enterectomy. Prospective studies with greater number of animals are warranted to validate these results., (© Veterinary Emergency and Critical Care Society 2021.)

Objectives: The objective of the study was to identify whether venous blood gas (VBG) variables may serve as a predictor of inflammatory lower airway disease (ILAD) in cats presenting with respiratory distress. A secondary objective of this study was to compare the diagnostic utility of patient signalment, history and physical examination findings, as compared with VBG variables., Methods: The medical records of cats presenting with respiratory distress secondary to ILAD (54 cases) and non-ILAD (121 controls) were retrospectively reviewed., Results: No admission VBG variables were predictive of a final diagnosis of ILAD. Comparatively, multivariable analysis identified a history of a cough ( P <0.001), increased respiratory rate ( P  = 0.001), the presence of an abdominal component to respiration ( P  = 0.007) and the absence of pleural effusion ( P <0.01) to be independently associated with a final diagnosis of ILAD. Cats with a history of a cough and an abdominal component to respiration had 7.86 and 5.81 greater odds of being diagnosed with ILAD, respectively. Cats with pleural effusion had 7.43 lower odds of having this final diagnosis. For every 10 breaths/min increase in respiratory rate, cats had 1.48 greater odds of being diagnosed with ILAD. Cats diagnosed with ILAD had a survival rate of 94% (95% CI 84-99%) vs 61% (95% CI 51-70%) for non-ILAD controls ( P <0.001)., Conclusions and Relevance: The results of this study found patient history and physical examination findings to be more useful predictors of a final diagnosis of ILAD in comparison with VBG variables at presentation. A history of a cough, an abdominal component to respiration and a lack of pleural effusion were found to be significant predictors of this diagnosis. Further investigation into the role of respiratory rate in ILAD is warranted.

Objective: To compare systolic blood pressure measured by Doppler (SBP) taken from the coccygeal artery versus common digital branch of the radial artery in cats with normal and poor perfusion parameters., Design: Prospective, observational study., Setting: University Teaching Hospital., Animals: Eighty-five cats presenting to the emergency service for which prior emergency treatment was not received and a blood pressure was indicated on triage., Interventions: Systolic blood pressure was measured by Doppler using the radial and coccygeal arteries. Cats were categorized as having normal or poor tissue perfusion based on physical examination., Measurements and Main Results: Agreement was poor between coccygeal and radial SBP overall with absolute and relative bias (95% limits of agreement) of 23 (-51 to 96) mm Hg and 16% (-38% to 69%), respectively. In cats with poor perfusion, the agreement was absolute bias = 28 mm Hg and relative bias = 22% and with normal perfusion absolute bias = 22 mm Hg, and relative bias = 12%. The median (interquartile range) coccygeal SBP was significantly different from the radial SBP 141 (50) mm Hg versus 120 (45) mm Hg, P < 0.001. In multivariate linear regression, heart rate was negatively associated with coccygeal SBP (r 2  = 0.088, P = 0.049), and pale mucous membrane color (P = 0.034) and poor pulse quality (P = 0.007) were independently associated with lower radial SBP (r 2  = 0.18)., Conclusions: Median coccygeal SBP is significantly greater than radial SBP in sick cats with both normal perfusion and hypoperfusion. Agreement between coccygeal and radial SBP is poor in cats and cannot be used interchangeably. As clinically significant differences exist between sites, the authors recommend obtaining SBP from both sites initially and choosing to monitor and trend changes with the one site that correlates most with physical examination findings., (© Veterinary Emergency and Critical Care Society 2021.)

Background: Feline Dermatitis Extent and Severity Index (FEDESI) and Scoring Feline Allergic Dermatitis (SCORFAD) are scales used to assess lesion severity in cats with allergic dermatitis. Interobserver reliability has not been assessed for either., Hypothesis and Objectives: To determine interobserver reliability for FEDESI and SCORFAD, and the relationship between lesion scores and pruritus., Animals: Thirty-eight cats presenting for pruritus., Methods and Materials: Each cat's lesions were scored by two observers at each visit using both FEDESI and SCORFAD (n = 117 paired observations). Spearman's rho was calculated to assess correlation between scales and between each scale and the owner-reported pruritus Visual Analog Scale (pVAS). Concordance correlation coefficients were calculated between observers for each scale, and Bland-Altman plots were used to visually represent the relationship between paired scores., Results: FEDESI and SCORFAD were strongly positively correlated with one another (rho = 0.84, P < 0.001). Each scale showed fair correlation with pVAS (rho = 0.42, P < 0.001; rho = 0.38, P < 0.001, respectively). There was good concordance between observers for both scales, with a correlation coefficient of 0.77 for FEDESI and 0.80 for SCORFAD [intraclass correlation coefficient (ICC) 95%, confidence interval (CI) 0.69-0.83; ICC 95%, CI 0.72-0.86, respectively]. Median lesion score was low (FEDESI 20; SCORFAD 4), which may improve interobserver reliability., Conclusions and Clinical Importance: There is good interobserver reliability for both FEDESI and SCORFAD. FEDESI and SCORFAD are positively correlated with one another and with pVAS. These findings support use of both scales in clinical research and assessment., (© 2021 ESVD and ACVD.)

Objective: To prospectively compare the effectiveness and any adverse effects of apomorphine administered SC or IV for induction of emesis in dogs., Animals: 42 client-owned dogs., Procedures: Dogs for which emesis induction was deemed appropriate by the attending clinician were prospectively randomized to receive apomorphine (0.03 mg/kg [0.01 mg/lb]) either SC (n = 20) or IV (22). Data collected included whether emesis was successfully induced, time from drug administration to emesis, number of emetic events, and adverse events (eg, sedation, protracted vomiting, or other)., Results: Of the 20 dogs given apomorphine SC, 16 (80%) vomited. Of the 22 dogs given apomorphine IV, 18 (82%) vomited. With regard to route of administration, the number of dogs in which emesis was induced did not differ significantly. Median time to the first emetic event was 13.5 minutes (range, 3 to 32 minutes) in the SC treatment group and 2 minutes (range, 1 to 5 minutes) in the IV treatment group; the difference was significant. There was no significant difference in the number of emetic events or frequency of adverse events between the 2 groups., Conclusions and Clinical Relevance: Apomorphine administered SC or IV reliably induced emesis in dogs. Compared with SC administration of apomorphine, the time from drug administration to emesis associated with IV administration was significantly shorter, a finding that has clinical importance.

Objective: To investigate whether decompressive cystocentesis (DC) safely facilitates urethral catheterization (UC) in cats with urethral obstruction (UO)., Animals: 88 male cats with UO., Procedures: Cats were randomly assigned to receive DC prior to UC (ie, DC group cats; n = 44) or UC only (ie, UC group cats; 44). Abdominal effusion was monitored by serial ultrasonographic examination of the urinary bladder before DC and UC or before UC (DC and UC group cats, respectively), immediately after UC, and 4 hours after UC. Total abdominal effusion score at each time point ranged from 0 (no effusion) to 16 (extensive effusion). Ease of UC (score, 0 [easy passage] to 4 [unable to pass]), time to place urinary catheter, and adverse events were recorded., Results: No significant difference was found in median time to place the urinary catheter in UC group cats (132 seconds), compared with DC group cats (120 seconds). Median score for ease of UC was not significantly different between UC group cats (score, 1; range, 0 to 3) and DC group cats (score, 1; range, 0 to 4). Median change in total abdominal effusion score from before UC and DC to immediately after UC was 0 and nonsignificant in UC group cats (range, -5 to 12) and DC group cats (range, -4 to 8). Median change in effusion score from immediately after UC to 4 hours after UC was not significantly different between UC group cats (score, -1; range, -9 to 5) and DC group cats (score, -1; range, -7 to 5)., Conclusions and Clinical Relevance: DC did not improve time to place the urinary catheter or ease of UC in cats with UO.

Objectives: To evaluate the potential association between signalment, history and physical examination findings and elevated renal and hepatic blood values before non-steroidal anti-inflammatory drug administration in dogs. Secondary objectives were to investigate clinicopathologic differences between dogs that were and were not prescribed a non-steroidal anti-inflammatory drug., Materials and Methods: Medical records of 81 dogs that underwent renal and hepatic blood value screening before drug administration via a non-steroidal anti-inflammatory drug blood panel were reviewed retrospectively. Patient signalment, history and physical examination findings were recorded., Results: Six (7%) dogs had an elevated blood urea nitrogen, 2 (2%) dogs had an elevated creatinine, 24 (30%) dogs had an elevated alanine aminotransferase, 29 (36%) had an elevated aspartate aminotransferase and 14 (17%) had an elevated alkaline phosphatase. Forty-five (56%) dogs had an elevation in at least 1 renal or hepatic blood value. Dogs less than 8 years of age and with a longer duration of clinical signs were less likely to have an elevated renal or hepatic blood value. Dogs with elevated hepatic blood values were less likely to be prescribed a non-steroidal anti-inflammatory drug; however, this was not true for elevated renal parameters alone., Clinical Significance: The results of this preliminary study suggest that blood value screening before non-steroidal anti-inflammatory drug administration may be important for dogs greater than 8 years of age. Hepatic enzyme elevations may play a greater role in clinical decision making in comparison to renal parameters., (© 2020 British Small Animal Veterinary Association.)

Objective: To evaluate the difference in the rectal-interdigital temperature gradient (RITG) between dogs that were presented to an emergency room with clinical signs of shock compared to those without signs of shock, and if this gradient can be used as a diagnostic marker for shock., Design: Prospective, single center, observational study conducted from 2014 to 2015., Setting: University veterinary teaching hospital., Animals: Twenty dogs with a clinical diagnosis of shock and 60 dogs without a clinical diagnosis of shock (controls)., Measurements and Main Results: Upon presentation to the emergency room and prior to intervention, measurements of rectal temperature, interdigital temperature, ambient temperature, systemic markers of perfusion (capillary refill time [CRT], heart rate [HR], respiratory rate [RR], Doppler blood pressure [DBP], and venous plasma lactate concentration), and venous blood gas analytes were recorded. Dogs were initially determined to be in shock by the attending clinician, and post hoc inclusion criteria were applied. Shock was defined as abnormalities in ≥3 of the 6 following criteria: HR > 120/min, RR > 40/min, CRT > 2 seconds, rectal temperature <37.8°C (100.0°F), venous plasma lactate concentration >2.5 mmol/L, or DBP < 90 mm Hg. Animals with circulatory shock had a significantly increased RITG. An increased RITG was also correlated with individual perfusion parameters including prolonged CRT (ρ = .353, P = 0.0013), tachycardia (ρ = .3485, P = 0.0015), decreased DBP (ρ = -0.6162, P = 0.0003), and shock index (ρ = 0.6168, P = 0.0003). Receiver operator curve analysis indicated a RITG cutoff point of 11.6°F had 90% specificity for the diagnosis of shock (area under the curve = 0.7604)., Conclusions: The RITG in this study was associated with a diagnosis of shock and therefore may serve as a diagnostic marker of circulatory shock. Future studies with larger sample sizes to validate the use of temperature gradients and other peripheral perfusion abnormalities as diagnostic and monitoring tools are warranted., (© Veterinary Emergency and Critical Care Society 2020.)

Objective: To assess the accuracy of focused cardiac ultrasound (FOCUS) and point-of-care N-terminal proBNP assay in the emergency setting for differentiation of cardiac from noncardiac causes of respiratory distress in cats., Design: Prospective diagnostic accuracy study between 2014 and 2016., Setting: Emergency room at an urban university teaching hospital., Animals: Forty-one client-owned cats presenting for evaluation of respiratory distress., Interventions: Emergency clinicians made an initial diagnosis of noncardiac or cardiac cause of respiratory distress based on physical examination (PE) findings and history. The diagnoses were updated after performing FOCUS and point-of-care N-terminal B-type natriuretic peptide (POC-BNP). Reference standard diagnosis was determined by agreement of a board-certified cardiologist and critical care specialist with access to subsequent radiographs and echocardiograms., Measurements and Main Results: Forty-one cats were enrolled. Three cats with incomplete data and 1 cat with an uncertain reference standard diagnosis were excluded. The remaining 37 cats were used for analysis: 21 cardiac and 16 noncardiac cases. The ratio of left atrial to aortic root diameter (LA:Ao) measured by FOCUS was significantly correlated with LA:Ao measured by echocardiography (R = 0.646, P < 0.0001). Emergency clinicians correctly diagnosed 27 of 37 (73.0%), yielding a PE positive percent agreement = 76.2% (95% CI, 52.8-91.8%) and negative percent agreement = 68.8% (95% CI, 41.3-89.0%). Five noncardiac and 5 cardiac cats were misdiagnosed. Post FOCUS, overall percent agreement improved to 34 of 37 (91.9%), with positive percent agreement = 95.2% (95% CI, 76.2-99.9%) and negative percent agreement = 87.5% (95% CI, 61.7-98.5%). The POC-BNP yielded an overall percent agreement = 32/34 (94.1%), positive percent agreement = 100% (95% CI, 82.4-100.0%), and negative percent agreement = 86.7% (95% CI, 59.5-98.3%) in differentiating cardiac versus noncardiac cases., Conclusions: FOCUS evaluation of basic cardiac structure and LA:Ao by trained emergency clinicians improved accuracy of diagnosis compared to PE in cats with respiratory distress. FOCUS and POC-BNP are useful diagnostics in the emergent setting., (© Veterinary Emergency and Critical Care Society 2020.)

High-grade canine mast cell tumours (HG-MCT) have a high rate of locoregional relapse. In this study, dogs with HG-MCT treated with radiation therapy (RT) were retrospectively evaluated to determine the benefit associated with treating the locoregional lymph nodes (LNs). Forty-two dogs were included. Variables assessed for association with overall survival (OS) and progression-free survival (PFS) included WHO stage, tumour location and size, LN irradiation (prophylactic, therapeutic or none), LN treatment (yes or no), LN status at RT (metastatic or nonmetastatic) and RT intent (definitive vs palliative). Lower-stage disease at irradiation was significantly associated with prolonged median PFS (425 vs 125 days for stage 0 vs 1-4), and OS (615 vs 314 days for stage 0 vs 1-4). Having any LN treatment and definitive RT were both significantly associated with prolonged OS. In order to evaluate the role of LN irradiation, dogs were divided into subgroups: (a) stage 0 at irradiation with no LN treatment (n = 14), (b) stage 0 at irradiation with prophylactic LN irradiation (n = 6), (c) stage 0 at irradiation but previously stage 2 (n = 5) and (d) stage >0 at irradiation (n = 17). Prophylactic LN irradiation significantly prolonged PFS (>2381 vs 197 days; group B vs A). Interestingly, dogs that were stage 2 and had LN treatment (C) had prolonged OS vs dogs with negative LNs and no LN treatment (A) (1908 vs 284 days; P = .012). This study confirms that prophylactic and therapeutic LN irradiation in dogs with HG-MCT is beneficial and improves outcome., (© 2019 John Wiley & Sons Ltd.)

Background: It has long been speculated that sterile granulomatous dermatitis and lymphadenitis (SGDL) occurs in adult dogs. However, only three published case reports exist., Hypothesis/objectives: To describe clinical presentation, identify breed predispositions, and assess treatment and outcomes of adult dogs with the histopathological diagnosis of SGDL., Animals: Included are 90 dogs with biopsies submitted to a veterinary teaching hospital with a histopathological diagnosis consistent with SGDL, from 2004 to 2018, of which 35 had medical records available for review., Methods: Data were analysed retrospectively from histopathology submission forms, medical records, surveys and telephone calls. Scoring systems were created to aid statistical analysis of outcomes., Results: Havanese dog (P < 0.0001), Australian shepherd dog (P < 0.0001), Irish setter (P < 0.0001), Dachshund (P = 0.0002), bichon frise (P = 0.0003) and Maltese dog (P = 0.004) were significantly over-represented breeds. The median age at onset was 1,292 days (3.54 years). Dogs up to five years of age were significantly over-represented (P < 0.01). Of 35 dogs with medical records available for review, the median treatment duration was 60 days and the median time to remission 28 days. Remission status was not established for five dogs but the remaining 30 dogs reached remission. Nineteen dogs remained in complete remission. Recrudescence occurred in 11 dogs (median follow-up 60 days)., Conclusions and Clinical Importance: This study shows a close parallel in clinical appearance, histopathological results and clinical behaviour, of both adult and juvenile onset SGDL; therefore, SGDL should be considered as a differential diagnosis for dogs of all ages., (© 2019 the European Society of Veterinary Dermatology and the American College of Veterinary Dermatology.)

Objective: To investigate the efficacy and safety of the caudal epidural technique in cats with urethral obstruction (UO)., Design: Prospective, double-blinded, randomized, sham-controlled study., Animals: Eighty-eight male cats with UO., Interventions: Thirty cats randomized to bupivacaine epidural (BUP), 28 cats to bupivacaine-morphine epidural (BUP/MOR), and 30 cats to sham epidural (SHAM)., Measurements and Main Results: Time to perform the epidural and efficacy of the epidural was assessed by evaluation of tail and perineal responses. The amount of propofol for urinary catheterization and time to administration of rescue analgesia (buprenorphine) was recorded. Cats were monitored for epidural complications. The median time to perform the epidural was 2 min (range, 0.2-13 min and range, 0.5-13 min), with an epidural success rate of 70%. The median amount of propofol administered for urinary catheterization was significantly less in the BUP (2.1 mg/kg; range, 0-7.5 mg/kg) and MOR/BUP cats (1.85 mg/kg; range, 0-8.6 mg/kg) as compared to SHAM cats (4 mg/kg; range, 0-12.7 mg/kg) (P = 0.006, P = 0.0008, respectively). The median time to administration of rescue analgesia was also significantly longer in the BUP (10 h; range, 2-32 h) and MOR/BUP cats (10 h; range, 4-45 h) as compared to SHAM cats (4 h; range, 2-36 h) (P = 0.0026, P = 0.0004, respectively). There were no recognized complications related to the epidural., Conclusion: Caudal epidural appears to be safe, may reduce the amount of IV anesthesia needed to facilitate urinary catheterization, and can be used to provide long-term analgesia in the hospital., (© Veterinary Emergency and Critical Care Society 2020.)

Objective: To evaluate survival and associated risk factors when utilizing an outpatient treatment protocol for treatment of canine parvovirus (CPV) performed in a shelter-based low-cost urban clinic., Design: Retrospective study., Setting: Pennsylvania Society for the Prevention of Cruelty to Animals., Animals: Ninety-five CPV positive dogs presented between June 1 and July 31, 2016. Owners elected for outpatient care when inpatient care was not financially feasible and the dog was considered medically stable for outpatient care., Interventions: None., Measurements and Main Results: Of the 95 CPV positive dogs, 79 (83%) survived treatment. Logistic regression indicated that an increasing number of days with clinical signs prior to treatment and an increase in percent body weight during treatment were significantly associated with survival (odds ratio [OR], 3.15, P = 0.020; and OR, 1.29, P = 0.027, respectively). Hypothermia upon presentation (T < 37℃) was negatively associated with survival (OR, 0.002; P = 0.002)., Conclusions and Clinical Relevance: The survival rate of this clinic suggests that an outpatient program may be a potential alternative treatment to inpatient care. Longer duration of clinical signs prior to treatment and an increase in percent body weight during treatment appear to be associated with increased survival outcomes, while hypothermia on presentation appears to be associated with decreased survival outcomes., (© Veterinary Emergency and Critical Care Society 2020.)

Objective: To report the gross and histopathological postmortem findings of the urinary tract and compare them to clinical severity of disease in cats with urethral obstruction (UO)., Design: Retrospective, observational, descriptive study., Setting: University teaching hospital., Animals: Fourteen cats from 2000 to 2014 with UO that had a complete postmortem examination., Interventions: None., Measurements and Main Results: Bladder lesions were moderate-severe in 10 of 14 (71%) and mild in 4 of 14 (29%) cats. Bladder lesions were diffuse in 8 of 14 (57%), multifocal in 3 of 14 (21%), and focal in 3 of 14 (21%) cats. Lymphocytic cystitis was noted in 11 of 14 cats (78%), and neutrophilic cystitis was noted in 10 of 14 (71%) bladders. Urethral lesions were moderate-severe in 4 of 14 (29%), mild in 4 of 14 (29%), and no urethral lesions were identified in 6 of 14 (43%) cats. Ureteral lesions were mild in 1 of 14 (7%), and no ureteral lesions were identified in 13 of 14 (93%) cats. There were moderate-severe histopathological renal lesions in 5 of 14 cats (36%), mild renal lesions in 6 of 14 (43%), and no renal lesions were identified in 3 of 14 cats (21%). Renal lesions were multifocal in 10 of 14 (71%) and regional in 1 of 14 cats (7%). In the kidneys, the most common inflammatory infiltrate was lymphoplasmacytic. The severity of urethral lesions was not associated with the severity of bladder lesions (P = 1.0). Hyperkalemia paralleled the severity of bladder (P = 0.02) and renal lesions (P = 0.04). An association between the severity of bladder lesions and degree of azotemia could not be determined due to small sample size and removal of the most azotemic cats., Conclusions: Substantial renal and urinary bladder inflammatory lesions were found in cats with UO. The severity of these findings paralleled the severity of blood potassium concentrations., (© Veterinary Emergency and Critical Care Society 2020.)

Objective: To determine whether focused cardiac ultrasound (FOCUS) performed by emergency and critical care (ECC) specialists or residents in training improves differentiation of cardiac (C) versus non-cardiac (NC) causes of respiratory distress in dogs compared to medical history and physical examination alone., Design: Prospective cohort study (May 2014 to February 2016)., Setting: University hospital., Animals: Thirty-eight dogs presenting with respiratory distress., Interventions: FOCUS., Measurements and Main Results: Medical history, physical examination, and FOCUS were obtained at presentation. Emergency and critical care clinicians, blinded to any radiographic or echocardiographic data, categorized each patient (C vs NC) before and after FOCUS. Thoracic radiography (within 3 h) and echocardiography (within 24 h) were performed. Percent agreement was calculated against a reference diagnosis that relied on agreement of a board-certified cardiologist and ECC specialist with access to all diagnostic test results. Reference diagnosis included 22 dogs with cardiac and 13 dogs with noncardiac causes of respiratory distress. In 3 dogs a reference diagnosis was not established. Prior to FOCUS, positive and negative percent agreement to detect cardiac causes was 90.9% (95% CI, 70.8-98.9) and 53.9% (25.1-80.8), respectively. Overall agreement occurred in 27 of 35 dogs (77.1%). Two C and 6 NC cases were incorrectly categorized. Following FOCUS, positive and negative percent agreement to detect cardiac causes was 95.5% (77.2-99.9) and 69.2% (38.6-90.9), respectively. Overall agreement occurred in 30 of 35 dogs (85.7%). Three dogs with discrepant pre-FOCUS diagnoses were correctly re-categorized post-FOCUS. One C and 4 NC cases remained incorrectly categorized. No correctly categorized dogs were incorrectly re-categorized following FOCUS. The proportions of dogs correctly classified pre- versus post-FOCUS were not significantly different (P = 0.25)., Conclusions: FOCUS did not significantly improve differentiation of C vs NC causes of respiratory distress compared to medical history and physical examination alone., (© Veterinary Emergency and Critical Care Society 2020.)

Objectives: To report the incidence of and risk factors for development of recurrent secondary septic peritonitis (RSSP) in dogs. To report the outcome of dogs treated surgically for RSSP., Design: Retrospective study., Setting: University teaching hospital., Animals: One hundred forty-nine client-owned dogs treated surgically for secondary septic peritonitis (SSP)., Interventions: None., Measurements and Results: The medical records database was searched for dogs that underwent surgery to treat SSP. Of 149 dogs that met the inclusion criteria, 15 (10.1%) dogs developed RSSP following surgery and 134 (89.9%) did not. Dogs with RSSP had significantly lower albumin prior to the first surgery to treat secondary septic peritonitis (SPsx1) (median 18 g/L [1.8 g/dL] vs 22 g/L [2.2 g/dL], P = 0.005) and significantly higher PCV prior to SPsx1 (median 52% vs 45%, P = 0.028). Dogs with septic peritonitis of gastrointestinal (GI) origin were significantly more likely to develop recurrent peritonitis than those with sepsis from a non-GI source (odds ratio [OR], 4.4, 95% CI: 0.95-20, P = 0.041). Of dogs with sepsis of GI origin, those with sepsis due to a foreign body were significantly more likely to develop RSSP than those with GI sepsis from a non-foreign body cause (OR, 7.2, 95% CI: 1.6-43, P = 0.0018). Of the 15 dogs in the RSSP group, 8 were euthanized without further treatment. Relaparotomy was performed in the remaining 7 cases; 3 of these (42.9%) survived., Conclusions: There was a 10.1% rate of RSSP following SPsx1. Preoperative albumin was significantly lower and preoperative PCV was significantly higher in dogs that developed recurrence. Dogs with GI sepsis were at increased risk of recurrence and, among dogs with GI sepsis, the presence of a foreign body was an additional risk factor for recurrence., (© Veterinary Emergency and Critical Care Society 2020.)

Objective: To assess effects of basal-bolus insulin treatment (BBIT) with lispro and neutral protamine Hagedorn (NPH) insulins, compared with NPH insulin alone, on serum fructosamine concentration (SFC) and postprandial blood glucose concentration (BGC) in dogs with clinically well-controlled diabetes mellitus and postprandial hyperglycemia fed a high insoluble fiber-content diet., Animals: 6 client-owned dogs with diabetes mellitus., Procedures: Blood samples were collected for BGC and SFC measurement in hospitalized dogs just before feeding and routine SC NPH insulin administration (time 0); samples were collected for BGC measurement every 30 minutes for 2 hours, then every 2 hours for up to 10 additional hours. Postprandial hyperglycemia was identified when BGC 30 minutes after insulin administration exceeded BGC at time 0 or the 1-hour time point. For BBIT, owners were instructed to continue NPH insulin administration at the usual dosage at home (q 12 h, with feeding) and to administer lispro insulin (0.1 U/Kg, SC) separately at the time of NPH injections. Two weeks later, SFC and BGC measurements were repeated; results at the start and end of the study were compared statistically., Results: Median SFC was significantly higher at the start (400 μmol/L) than at the end (390 μmol/L) of the study. Median 1-hour (313 mg/dL) and 1.5-hour (239 mg/dL) BGC measurements at the start of the study were significantly higher than those at the end of the study (117 and 94 mg/dL, respectively)., Conclusions and Clinical Relevance: In this sample of dogs with well-controlled diabetes mellitus, addition of lispro insulin to an existing treatment regimen of NPH insulin and dietary management significantly decreased postprandial BGCs. Further study of BBIT for dogs with diabetes mellitus is warranted.

Objectives: Constipation is a common complaint in cats presenting to the emergency room and can become a frustrating recurrent condition. Despite widespread anecdotal reports of risk factors for constipation, at the time of writing there have been no studies supporting these associations or assessing treatment outcomes. The aim of this study was to identify risk factors in the signalment, history, physical examination and clinicopathologic findings of cats presenting to the emergency room for constipation. In addition, we aimed to assess factors contributing to the success or failure of enemas administered to these cats., Methods: A medical record search identified 189 cats with a diagnosis of constipation/obstipation that were treated and discharged by the emergency service at an academic veterinary hospital. Data regarding signalment, medical history, physical examination and clinicopathologic findings, as well as treatments performed, were recorded. Ninety-nine cats presenting to the emergency room for other reasons were identified as controls. Statistical analysis was performed to assess risk factors for constipation, as well as success/failure of enema treatments., Results: Older, overweight cats and cats with chronic kidney disease or previous episodes of constipation were found to be at increased risk of constipation ( P <0.0001, P = 0.0004, P = 0.0046 and P <0.0001, respectively). Ionized calcium levels were significantly higher in constipated cats, though varied significantly within the cohort ( P = 0.0133). Cats noted to be painful on abdominal palpation were less likely to defecate following an enema. Adjunctive treatments (fluids, laxatives) increased the likelihood of a successful enema but were not statistically significant., Conclusions and Relevance: Older, overweight cats with a history of constipation or chronic kidney disease are more likely to present for constipation. Further studies are needed to determine the most appropriate treatment protocol in an urgent care setting.

Objective: To describe the frequency of renal tubular vacuolization (RTV) as a surrogate of osmotic nephrosis and assess hyperosmolar agents as predictors of RTV severity., Design: Retrospective study (February 2004-October 2014)., Setting: Veterinary teaching hospital., Animals: Fifty-three client-owned, critically ill dogs that had a postmortem examination., Interventions: None., Measurements and Main Results: The frequency, severity, and location of RTV were determined in small group of critically ill dogs postmortem. Logistic regression was performed to assess cumulative 6% HES (670/0.75) and mannitol dose as predictors for RTV severity with presenting serum creatinine concentration, cumulative furosemide dose, and duration of hospitalization as covariates. RTV was noted in 45 (85%) of 53 critically ill dogs and was most commonly located to the medullary rays (68%). Cumulative 6% HES (670/0.75) dose (P = 0.009) and presenting serum creatinine concentration (P = 0.027) were significant predictors of RTV severity. For every 1 mL/kg increase in 6% HES (670/0.75) dose that a dog received, there was 1.6% increased chance of having more severe RTV (OR 1.016; 95% CI 1.004-1.029). In addition, for every 88.4 μmol/L (1 mg/dL) increase in presenting serum creatinine, there was a 22.7% increased chance of having more severe RTV (OR 1.227; 95% CI 1.023-1.472). Cumulative mannitol (P = 0.548) and furosemide (P = 0.136) doses were not significant predictors of RTV severity., Conclusion: In a small group of critically ill dogs, there was a high frequency of RTV identified on postmortem examination. Administration of 6% HES (670/0.75) and presenting serum creatinine concentration were significant predictors of RTV severity. Larger prospective studies are needed to determine the etiology and significance of RTV in dogs., (© Veterinary Emergency and Critical Care Society 2019.)

Objective: To describe postobstructive diuresis (POD) in cats undergoing surgical placement of ureteral stents or subcutaneous ureteral bypass systems for treatment of ureteral obstruction in cats and to identify factors associated with duration and maximum severity of POD., Design: Retrospective case series., Animals: 37 client-owned cats with ureteral obstruction treated between August 2010 and December 2014., Procedures: Medical records were reviewed, and data extracted included signalment, history, results from physical examinations and clinical laboratory analyses, treatment, urine output, and outcome. Data were evaluated to identify factors associated with POD duration and maximum severity, alone or in combination., Results: Serum concentrations of creatinine, potassium, phosphorus, and BUN before surgery positively correlated with duration and maximum severity of POD. Absolute changes in serum concentrations of creatinine, potassium, and BUN from before surgery to after surgery positively correlated with POD duration. Cats with anuria before surgery had longer POD than did other cats; however, there was no difference in POD duration or maximum severity with unilateral versus bilateral ureteral obstruction. Thirty-four of 37 (92%) cats survived to hospital discharge, which was not associated with whether ureteral obstruction was unilateral or bilateral. Azotemia resolved in 17 of the 34 (50%) cats that survived to hospital discharge., Conclusions and Clinical Relevance: Results of the present study indicated that several factors were associated with POD duration and maximum severity, alone or in combination, and that with intensive management of fluid and electrolyte derangements, regardless of the extent of the original azotemia, a high percentage of cats survived to hospital discharge.

OBJECTIVE To assess the utility of ultrasonography to detect the cause and location of ureteral obstruction in cats and to identify factors associated with agreement between ultrasonographic and surgical findings. STUDY DESIGN Retrospective case series. ANIMALS 71 cats. PROCEDURES Medical records were searched to identify cats that had ureteral obstruction diagnosed ultrasonographically and that subsequently underwent exploratory laparotomy. Patient signalment, ultrasonographic findings, interventions performed, and surgical findings were recorded. Cause and location of ureteral obstruction as assessed by ultrasonography were compared with surgical findings. Sensitivity, specificity, and positive predictive value of ultrasonography for detection of ureteroliths and strictures were calculated. Statistical analysis was performed to identify factors associated with agreement between ultrasonographic and surgical findings. RESULTS There was significant, moderate agreement between ultrasonographic and surgical findings for the cause and location of ureteral obstruction. Signalment variables, ureter affected (left vs right), and presence of retroperitoneal effusion were not associated with this agreement. Sensitivity was 98% and 44%, specificity was 96% and 98%, and positive predictive value was 98% and 88% for detection of ureteroliths and strictures, respectively, by ultrasonography. CONCLUSIONS AND CLINICAL RELEVANCE Ultrasonography was highly sensitive for detection of ureteroliths that caused ureteral obstruction but was considerably less sensitive for detection of ureteral strictures in the study population. Future prospective studies are needed to determine the role of advanced imaging in assessing cats with ureteral abnormalities. (J Am Vet Med Assoc 2019;254:710-715).

Importance: Veterinarians are a subset of opioid prescribers., Objective: To assess the quantity and trends in prescribing and dispensing of several different opioids in the past 11 years in a large veterinary hospital in Philadelphia, Pennsylvania., Design, Setting, and Participants: This cross-sectional study inventoried all opioid tablets and/or patches dispensed or prescribed by veterinarians practicing in a multispecialty academic veterinary teaching hospital in Philadelphia for small animals and species, such as rabbits, birds, and reptiles, from January 1, 2007, through December 31, 2017. Prescribing data were obtained from all veterinarians who wrote a prescription for opioids by reviewing detailed pharmacy records of controlled substances for the study period. Data included all opioids dispensed, or prescribed to animals (patients) undergoing evaluation at the center or being followed up as outpatients by the veterinarians in the hospital. Statewide veterinarian prescribing data were used for comparison. Data were analyzed from December 24, 2017, through May 15, 2018., Main Outcomes and Measures: The trend in administration and prescribing of 4 specific opioid analgesics (codeine sulfate, hydrocodone bitartrate, and tramadol hydrochloride tablets as well as fentanyl citrate patch) during the 11-year study period. The individual opioids were converted to morphine milligram equivalents (MME) for comparison., Results: The study included 134 veterinarians (70.9% women) with 366 468 patient visits. During the study period, the hospital veterinarians prescribed 105 183 689 tablets of tramadol, 97 547 tablets of hydrocodone, 38 939 tablets of codeine, and 3153 fentanyl patches to dogs (73.0%), cats (22.5%), and exotic animals (4.5%). Overall, MME use increased 41.2%, whereas visits increased by 12.8%. The comparison data for Pennsylvania revealed a predominance of hydrocodone use (688 340 tablets prescribed), although data were not available for comparison with tramadol because it is a Schedule IV drug., Conclusions and Relevance: Results of this study suggest that the large, increasing volume of opioids prescribed at 1 veterinary teaching hospital highlights concerns parallel to those about excessive opioid prescribing in humans. The extent to which these data may represent similar volumes of prescriptions from the general veterinary practices and hospitals across the United States is suggested by the accompanying Pennsylvania state data. These findings highlight an opportunity to assess the risk of veterinarian opioid prescriptions to safeguard public health.

Background: Ureteral stent and subcutaneous ureteral bypass (SUB) placement are commonly used for managing ureteral obstructions. Urinary tract infection (UTI) is a recognized complication., Objectives: To determine postoperative incidence of positive urine cultures in cats undergoing ureteral stent and SUB placement and to identify risk factors associated with positive urine cultures., Design: Retrospective study., Animals: Forty-three cats that underwent 48 surgical events., Procedures: Medical records were reviewed. Cats were included if urine cultures were performed before and after surgery. Variables were compared to identify risk factors., Results: Urine cultures were positive postoperatively pre-discharge in 5/20 (25%) cats. Median duration of follow-up post-discharge was 209 days (range, 11-2184 days), with a total of 143 urine cultures performed in cats post-discharge. Of these, 16 (11%) were positive in 12/48 (25%) cats. Nine different bacteria were identified; Enterococcus spp. (n = 8) predominated as monomicrobic or mixed infections. In 14/16 instances of positive urine cultures, affected cats had lower urinary tract signs, signs of pyelonephritis or both. Cats that received antibiotics postoperatively were significantly less likely to have a positive urine culture compared to those that did not (odds ratio, 0.2, 95% confidence interval, 0.05, 0.8, P = 0.02). Chronic kidney disease, renal implant type and postoperative urinary catheterization were not associated with positive urine cultures., Conclusions and Clinical Relevance: Postoperatively, occurrence of positive urine cultures was similar to previous reports. Subclinical bacteriuria was less common than UTI. Postoperative urinary catheterization has been speculated to increase risk of bacteriuria, but this was not the case in this cohort., (© 2018 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.)

Objective: To determine whether the partial pressure of end-tidal carbon dioxide (PetCO 2 ) could predict return of spontaneous circulation (ROSC) in patients with cardiopulmonary arrest (CPA) undergoing CPR., Design: Prospective observational study., Setting: Two private specialty referral hospitals., Animals: Thirty-five client-owned dogs and cats in CPA in which CPR was performed and pertinent data recorded on a purpose-made form., Interventions: None., Measurements and Main Results: PetCO 2 was recorded at 1-minute intervals during CPR. Hospital, animal, arrest, and outcome variables were also reported in the Utstein style where possible. Twelve animals (7 dogs and 5 cats) achieved ROSC; 4 of these (2 dogs and 2 cats) had sustained ROSC, of which 1 dog was discharged alive. Patients that achieved ROSC had significantly higher initial PetCO 2 (P = 0.0083), peak PetCO 2 (P < 0.0001), average PetCO 2 (P < 0.0001), and ΔPetCO 2 (difference between last and first recorded PetCO 2 ; P = 0.0004) than patients not resuscitated. The PetCO 2 accurately discriminated between ROSC and failure to achieve ROSC at minutes 3, 4, 5, 6, 7, and 8 of CPR with area under the receiver operating characteristic curve of 0.926, 0.967, 0.938, 0.933, 0.956, and 1.00, respectively. The optimal cutoff PetCO 2 was 18 mm Hg (2.4 kPa), with a sensitivity of ≥80% and a specificity of ≥95% at minutes 3, 4, 5, 6, and 8, correctly classifying 91-100% of cases., Conclusions: The results of this small study support previous recommendations to monitor PetCO 2 during CPR and suggest that PetCO 2 during CPR may be useful for determining the probability of ROSC. Absolute values and trends of PetCO 2 may assist clinicians and owners in making decisions for pets with CPA., (© Veterinary Emergency and Critical Care Society 2018.)

OBJECTIVE To test for an association between indwelling urethral catheter placement in cats with urethral obstruction (UO) and the short-term (30-day) risk of recurrent urethral obstruction (RUO). DESIGN Prospective cohort study. ANIMALS 107 client-owned male cats with UO. PROCEDURES Owners were offered standard care for their cats, including hospitalization, placement of an indwelling urethral catheter, IV fluid therapy, and other supportive treatments (inpatient group). One-time catheterization and outpatient care were offered (outpatient group) if standard care was declined. Data regarding signalment, measures of metabolic compromise and urinalysis findings at enrollment, catheterization-related variables, and supportive treatments of interest were collected. Risk of RUO ≤ 30 days after urethral catheter removal was determined for the outpatient vs inpatient group by OR and 95% confidence interval calculation. Other variables were compared between cats that did and did not develop RUO with Fisher exact and trend tests. RESULTS 91 cats completed the study; 19 (5/46 [11%] inpatients and 14/45 [31%] outpatients) developed RUO. Risk of RUO was significantly greater for cats of the outpatient group (OR, 3.7; 95% confidence interval, 1.2 to 11.4). Among inpatients, increasingly abnormal urine color at the time of catheter removal was significantly associated with RUO. No other significant associations were identified. CONCLUSIONS AND CLINICAL RELEVANCE Hospitalization and indwelling catheterization significantly reduced the risk for RUO ≤ 30 days after treatment for the population studied. Results suggested that removal of an indwelling catheter before urine appears grossly normal may be associated with development of RUO. One-time catheterization with outpatient care was inferior to the standard care protocol but was successful in many cats and may be a reasonable alternative when clients cannot pursue standard care.

Objective: To assess the association between peripheral pulse palpation and Doppler-derived systolic blood pressure (SBP) measurement in dogs presenting to an emergency service., Design: Prospective observational study., Setting: University veterinary teaching hospital., Animals: Ninety-three dogs that were presented to the emergency service. Dogs were eligible for inclusion in the study if a physical examination and a SBP measurement were performed prior to any interventions., Interventions: None., Measurements and Main Results: Both the femoral pulse quality and dorsal metatarsal pulse quality were digitally palpated and assessed as either strong, weak, or absent. The mean SBP in all dogs was 139 mm Hg (± 39 mm Hg). Seventeen (17/93; 18%) dogs were hypotensive with a SBP < 90 mm Hg (range, 40-88 mm Hg). The median SBP was not significantly different between dogs in the absent and present femoral pulse groups (P = 0.120) but the median SBP was significantly different between absent and present metatarsal pulse groups (P = 0.002). Dogs with absent metatarsal pulses were 7.6 times more likely to be hypotensive with a SBP < 90 mm Hg (OR, 7.6; 95% CI, 1.8-32) as compared to dogs with palpable metatarsal pulses. The sensitivity of absent metatarsal pulses to diagnose hypotension (SBP < 90 mm Hg) was 33% (95% CI, 10-65%) and the specificity was 94% (95% CI, 86-98%)., Conclusions: Absent metatarsal pulses are highly specific in the diagnosis of hypotension. However, dogs with palpable metatarsal pulses can still be hypotensive. Dorsal metatarsal pulse palpation is useful during triage assessment of dogs presenting to an emergency service, though it should not be used as the only indicator of a dog's cardiovascular stability and should not replace an actual blood pressure measurement., (© Veterinary Emergency and Critical Care Society 2018.)

Objective: To describe problems noted during central venous jugular catheter (CVJC) placement, conditions associated with unsuccessful catheterization, and CVJC maintenance complications., Design: Prospective observational study from September 2014 to September 2015., Setting: University veterinary teaching hospital., Animals: Twenty-seven dogs and 20 cats hospitalized in a veterinary ICU. Patients were excluded if previously hospitalized with a CVJC or lacked sufficient data., Interventions: None., Measurements and Main Results: Ninety-one percent of indwelling CVJCs were placed successfully (43/47, 95% CI: 80%, 98%). Procedural-related difficulties that resulted in the inability to place a CVJC totaled 18/63 (28.6%, 95% CI: 18%, 41%) and included the inability to puncture the vessel (10), hematoma (6), malposition (1), and dislodgement (1). Procedural complications occurred in 24/47 patients (51%, 95% CI: 36%, 66%) and included cardiac dysrhythmias (13), hematoma (6), CVJC placement failure (4), and malposition (1). Risk factors associated with multiple catheterization attempts included increased age (7.5 years [± 4.2] vs 10.6 years [± 4.1], P = 0.04), smaller size (8.0 kg [0.6-51.9 kg] vs 4.4 kg [2.6-6.8 kg], P < 0.01) and thinner body condition score (median 5/9 [2/9-9/9] vs 4/9 [2/9-7/9], P = 0.04). The risk factor associated with dysrhythmias was smaller patient size (6.8 kg [2.6-51.9 kg] vs 4.8 kg [0.6-29.5 kg], P = 0.04). Eighteen indwelling complications occurred in 14 patients and included mechanical obstruction (7), skin irritation (6), malposition (4), and inflammation (1). Risk factors for indwelling complications included longer dwell time (5 days [2-30] vs 3 days [1-10], P < 0.01) and the administration of an irritant medication (P = 0.02)., Conclusions: Complications were documented in the placement and maintenance of CVJCs in critically ill patients with a low incidence of life-threatening sequelae. Risk factors associated with both unsuccessful CVJC placement and indwelling CVJC complications were identified., (© Veterinary Emergency and Critical Care Society 2018.)

OBJECTIVE To compare dialysate sodium concentration and patient plasma sodium concentration of dogs during intermittent hemodialysis treatments. SAMPLE 211 intermittent hemodialysis treatments performed on 40 client-owned dogs for the management of dialysis-dependent uremia. PROCEDURES Medical records were reviewed to determine the plasma sodium concentration of each dog before and after routine hemodialysis treatments. Associations between detected changes in plasma sodium concentration and dialysate sodium concentration were evaluated by use of Spearman rank correlations and linear regression analysis. RESULTS Significant linear correlations were found between the dialysate sodium concentration and patient sodium concentration. The starting dialysate-to-patient sodium gradient was associated with the strongest correlation to the change in patient sodium concentration at the end of the dialysis session. Modest correlations existed between the dialysate sodium concentration and postdialysis patient sodium concentration as well as between the predialysis dialysate-to-patient sodium gradient and postdialysis dialysate-to-patient sodium gradient. CONCLUSIONS AND CLINICAL RELEVANCE The dialysate sodium concentration was correlated with the patient sodium concentration in dogs, and the dialysate-to-patient sodium gradient could be used to further refine this association to predict the postdialysis patient sodium concentration and potentially manage dysnatremia during hemodialysis. Prospective studies should be performed to determine how these associations can be used to correct aberrations as well as to avoid unwanted alterations in patient sodium concentrations.

Background: There are conflicting reports of plasma lipoprotein lipid content in dogs with diabetes mellitus (DM)., Objectives: To determine lipoprotein lipid content of plasma of dogs with DM by spectrophotometry and ultracentrifugation; to compare lipoprotein lipid content in diabetic and healthy dogs; and to quantify apolipoprotein B-100 (ApoB) in dogs with DM., Animals: 22 dogs with DM and 9 healthy dogs., Methods: Cross-sectional study. Triglyceride (TG), total cholesterol (TC), and high-density lipoprotein cholesterol (HDL-C) concentrations were measured by spectrophotometry. Very low-density lipoprotein cholesterol (VLDL-C) and low-density lipoprotein cholesterol (LDL-C) concentrations were calculated after ultracentrifugation. Non-HDL-C cholesterol was calculated by subtracting HDL-C from TC. ApoB was quantified by ELISA. The Mann-Whitney test was used for comparison of median lipoprotein concentrations, and Spearman's correlation was used to assess associations between ApoB and lipoprotein fractions., Results: All values are reported in mg/dL. Median TG (122), TC (343.5), HDL-C, (200), VLDL-C, (27) LDL-C (68), non-HDL-C (114), and ApoB (320) were significantly higher in dogs with DM, compared to healthy dogs (57, 197, 168, 12, 16, 31, and 258, respectively, P-values 0.0079, <0.001, 0.029, 0.011, <0.001, <0.001, 0.025, respectively). A significant association was found between ApoB and LDL-C (Spearman's rho = 0.41, P = 0.022) and between ApoB and non-HDL-C (Spearman's rho = 0.40, P = 0.027)., Conclusions and Clinical Importance: Dyslipidemia of dogs with DM is characterized by pronounced increases in LDL-C and non-HDL-C concentrations, although all lipoprotein fractions are significantly increased. Knowledge of specific lipoprotein fraction alterations in dogs with DM can enhance treatment options for diabetic dyslipidemia in dogs., (Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.)

OBJECTIVE To compare the effect of blood collection by a push-pull technique from an indwelling IV catheter versus direct venipuncture on venous blood gas values before and after administration of alfaxalone or propofol to dogs. DESIGN Prospective randomized clinical study. ANIMALS 30 healthy client-owned dogs that weighed ≥ 10 kg (22 lb) and were anesthetized for elective surgical procedures. PROCEDURES All dogs were premedicated with methadone (0.5 mg/kg [0.2 mg/lb], IM), and 20 to 30 minutes later, anesthesia was induced with either alfaxalone (1 to 3 mg/kg [0.5 to 1.4 mg/lb], IV to effect; n = 15) or propofol (2 to 6 mg/kg [0.9 to 2.7 mg/lb], IV to effect; 15). Immediately prior to premedication and after anesthesia induction, paired blood samples were collected from the cephalic veins; 1 by direct venipuncture and 1 by use of a push-pull technique from a 20-gauge catheter. All blood samples underwent venous blood gas analysis immediately after collection. Results were compared between sample collection techniques before and after anesthesia induction and between anesthesia induction protocols. RESULTS All results were within established reference ranges. For many variables, statistically significant but clinically irrelevant differences were detected between samples collected by direct venipuncture and those collected by the push-pull technique but not between the 2 anesthesia induction protocols. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated the push-pull technique was an acceptable method for collection of blood samples from dogs for venous blood gas analysis that could be used instead of direct venipuncture for patients with patent IV catheters.

Objective: To determine the prevalence and risk factors for veterinary acute lung injury (VetALI) and veterinary acute respiratory distress syndrome (VetARDS), assess mechanical ventilation settings and patient outcomes, and to evaluate the relationship of clinical diagnoses with necropsy findings., Design: Retrospective study., Setting: University teaching hospital., Animals: Twenty-four dogs and 5 cats with a clinical diagnosis of VetALI or VetARDS. Control population includes 24 dogs and 5 cats with a clinical diagnosis of respiratory disease other than VetALI or VetARDS., Interventions: None., Measurements and Main Results: VetALI and VetARDS were diagnosed in 3.2% of dogs and 1.3% of cats presenting to the ICU. Systemic inflammatory response syndrome was the most common inciting condition (16/24 dogs, 2/5 cats), followed by vomiting and subsequent aspiration of gastric contents (9/24 dogs), sepsis (5/24 dogs, 3/5 cats), multiple transfusions (4/24 dogs), trauma (3/24 dogs), and adverse drug reactions (1/24 dogs, 1/5 cats).  None of these conditions were found to be significantly associated with a risk of development of VetALI or VetARDS when compared to controls. Twelve dogs (50%) and 4 cats (80%) underwent mechanical ventilation for a median duration of 18 hours in dogs (range: 6-174 h) and 15.5 hours in cats (range: 6-91 h). Overall, 3/29 patients survived to discharge including 2/24 dogs and 1/5 cats. Necropsy results were available for 8/22 dogs and 3/4 cats. A total of 6/8 dogs (75%) dogs and 3/3 (100%) cats met the histopathologic criteria for diagnosis of VetALI or VetARDS., Conclusions: VetALI and VetARDS can cause life-threatening respiratory distress in dogs and cats necessitating mechanical ventilation in 50% of dogs and 80% of cats in this study. These diseases are associated with a poor clinical outcome and a high rate of humane euthanasia., (© Veterinary Emergency and Critical Care Society 2017.)

Thoracic radiographs are used as a screening tool for dogs and cats with a variety of disorders that have no clinical signs associated with thoracic structures. However, this practice has never been supported by an evidence-based study. The objective of this retrospective observational study was to determine if certain canine and feline populations have a higher proportion of radiographic abnormalities, and whether any of these abnormalities are associated with patient hospitalization and outcome. Patients were excluded if current or previous examinations revealed evidence of primary respiratory or cardiac disease, malignant neoplasia, or an abnormal breathing pattern consistent with pulmonary pathology. Any notable thoracic change in the radiology report was considered important and evaluated in this study. One hundred and sixty-six of these included patients were dogs and 65 were cats. Of the 166 dog radiographs evaluated, 120 (72.3%) had normal thoracic radiographs, while 46 (27.7%) had radiographic abnormalities. Of the sixty-five cats included, 36 (55.4%) had normal radiographs, while 29 (44.6%) had abnormal radiographs. Canine patients with abnormal radiographs had a significantly higher lactate level (P-value 0.0348) and feline patients with abnormal radiographs had a significantly lower packed cell volume (P-value 0.012). A large proportion of patients that had screening thoracic radiographs (32.5%) had documented abnormalities, but a relatively low percentage (6.5%) of our total population had their clinical plan changed as a consequence of detection of these abnormalities. Findings indicated that abnormal screening thoracic radiographs are more likely in dogs with an elevated lactate and cats with anemia, or a low normal hematocrit., (© 2017 American College of Veterinary Radiology.)

Objective: To determine if shock index (SI) would increase following blood donation and if it would be a more sensitive assessment of acute blood loss as compared with heart rate (HR), blood pressure, and plasma lactate., Design: Prospective study., Setting: University teaching hospital., Animals: Twenty client-owned clinically normal dogs., Interventions: Peripheral venous blood measurements and blood donation., Measurements and Main Results: Data were collected at 3 time points: prior to donation (T pre ), immediately after donation (T 0 ), and 10 minutes following completion of donation (T 10 ). HR and systolic blood pressure (SBP) were recorded and used to calculate SI at time points T pre , T 0 , and T 10 . Packed cell volume (PCV), total plasma protein (TPP), and plasma lactate were evaluated from a peripheral venous blood sample at T pre and T 10. The mean SI was significantly increased at both time points following blood donation as compared to baseline (SI pre = 0.88 ± 0.19 vs SI 0 = 1.17 ± 0.21 vs SI 10 = 1.12 ± 0.25 (P = 0.0002 and 0.0003, respectively). Following blood donation, the mean SBP was significantly lower (SBP pre = 149 ± 24 mm Hg, SBP 0 = 118 ± 20 mm Hg; P = 0.0001, SBP 10 = 133 ± 21 mm Hg; P = 0.011). The mean HR was not significantly different at T 0 but was significantly increased at T 10 (HR pre = 128 ± 21/min, HR 0 = 136 ± 25/min, P = 0.193; HR 10 = 146 ± 29/min, P = 0.003). There was no significant difference in mean PCV (PCV pre = 50 ± 4%, PCV 10 = 48 ± 4%, P = 0.08). The mean TPP and plasma lactate were significantly different following donation but still within the reference interval (TPP pre = 6.8 ± 0.4 g/dL, TPP 10 = 6.4 ± 0.4 g/dL, P = 0.0014; Lac pre = 1.7 ± 0.7mmol/L, Lac 10 = 1.9 ± 0.8 mmol/L, P = 0.04). A receiver operating characteristic (ROC) analysis comparing area under the curve (AUC) for SI, HR, and SBP at T 0 and T 10 compared to T pre found that SI (AUC at T 0 : 0.858, CI: 0.730, 0.984 AUC at T 10 : 0.769 CI: 0.617, 0.921) was a better indicator of blood loss than SBP at both T 0 (AUC 0.165, CI: 0.0384, 0.292, P < 0.0001) and T 10 (AUC 0.288, CI: 0.124, 0.451, P < 0.001) and better than HR at T 0 (AUC 0.574, CI: 0.392, 0.756, P < 0.001). An SI cut-off of 1.064 was 80% specific and 85% sensitive at T 0 for detecting blood loss., Conclusions: An SI > 1.0 is a sensitive and specific tool for detecting acute small volume blood loss in healthy dogs., (© Veterinary Emergency and Critical Care Society 2017.)

Objective: To describe patient characteristics, treatment, and outcome in male cats with urethral obstruction (UO) and fluid overload (FO), and to determine risk factors for the development of FO., Design: Retrospective case-control study from 2002-2012., Animals: Eleven client-owned cats with UO that developed respiratory distress secondary to suspected FO and 51 control cats with UO without FO., Interventions: None., Measurements and Main Results: Medical records of cats with UO and FO were identified. FO was defined as the development of respiratory distress secondary to pleural effusion or pulmonary edema while receiving IV fluids. To identify risk factors for FO, variables for cats that developed FO were compared with variables from a randomly selected control group of unaffected UO cats during the same time period. Variables analyzed included patient signalment, previous medical history, serum biochemical data, respiratory rate, cardiac auscultation abnormalities, admission systolic blood pressure, intravenous fluid administration, thoracic imaging, treatment, duration and cost of hospitalization, and outcome. Echocardiogram identified heart disease in 5/6 cats with FO. Cost (2.9 times as much) and median duration of hospitalization (4.1 vs 1.8 days) were significantly greater in cats with FO. Cats with FO were more likely to have received a fluid bolus (odds ratio [OR]: 5.1; 95% confidence interval [CI]: 1.3, 20, P = 0.014), developed a heart murmur (OR: 4.5; 95% CI, 1.1-18, P = 0.028) or a gallop sound (OR: 75; 95% CI, 8.1-694, P < 0.0001)., Conclusions: FO is a possible complication of the treatment of UO. The administration of a fluid bolus on presentation, and the development of a heart murmur or gallop sound during treatment were the most clinically useful risk factors identified. The development of FO is associated with significant increases in both the cost and length of hospitalization, but was not associated with increased mortality., (© Veterinary Emergency and Critical Care Society 2017.)

Objective: To determine whether prazosin administration following urethral obstruction (UO) reduces the risk for recurrent urethral obstruction (rUO) or lower urinary tract signs, and to document adverse effects associated with prazosin use in cats., Design: Double-blinded, prospective, interventional study., Setting: University teaching hospital., Animals: A population of 47 consecutive male cats with UO not associated with urinary tract calculi >2 mm in diameter., Interventions: Cats were randomized to receive either prazosin (0.25 mg/cat PO q 12 h, n = 27) or placebo (n = 20) for 1 month following UO., Measurements and Main Results: Cats were monitored for rUO, severity of lower urinary tract signs, and medication adverse effects during hospitalization and through weekly conversations with the owner during the 1- month study period and once more at 6 months following discharge. There was no difference in the rUO rate among cats that received prazosin or placebo prior to hospital discharge (2/26 (7%) versus 1/19 (5%), P = 1.00), during the 1- month medication period (4/26 (15%) versus 3/18 (17%), P = 0.776), or at 6 months following treatment for UO (7/19 (37%) versus 4/13 (31%), P = 0.811). There was no difference in the severity of lower urinary tract signs reported by the owners at the 1-, 2-, 3-, or 4-week follow-up periods among the cats in either group (P = 0.62, 0.68, 0.33, 1.00, respectively). Reported adverse effects from prazosin administration included lethargy, ptyalism, diarrhea, anorexia, and malodorous stool., Conclusions: Although our study results failed to find a difference in the incidence of rUO and severity of lower urinary tract signs among cats receiving prazosin and those receiving placebo, these study results should be interpreted cautiously as our study was underpowered to identify such differences. Larger placebo-controlled, prospective studies are needed to determine the clinical utility of prazosin in prevention of rUO., (© Veterinary Emergency and Critical Care Society 2017.)

OBJECTIVE To evaluate the outcome for cats with benign ureteral obstructions treated by means of ureteral stenting and to compare the outcome for these cats with outcome for a historical cohort of cats treated by means of ureterotomy only. DESIGN Prospective study with historical cohort. ANIMALS 62 client-owned cats with benign ureteral obstructions, including 26 cats treated with ureteral stenting and 36 cats previously treated with ureterotomy. PROCEDURES Data were recorded prospectively (ureteral stent cases) or collected retrospectively from the medical records (ureterotomy cases), and results were compared. RESULTS Cats treated with ureteral stents had significantly greater decreases in BUN and serum creatinine concentrations 1 day after surgery and at hospital discharge, compared with values for cats that underwent ureterotomy. Six cats in the ureteral stent group developed abdominal effusion after surgery, and cats in this group were significantly more likely to develop abdominal effusion when a ureterotomy was performed than when it was not. Cats that developed abdominal effusion after surgery were significantly less likely to survive to hospital discharge. Cats that underwent ureteral stenting were significantly more likely to have resolution of azotemia prior to hospital discharge than were cats that underwent ureterotomy alone. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that cats with benign ureteral obstructions treated with ureteral stenting were more likely to have resolution of azotemia prior to hospital discharge, compared with cats undergoing ureterotomy alone. Results of ureteral stenting were encouraging, but further investigation is warranted.

Background: Acute kidney injury (AKI) is a common problem in small-animal patients and carries a guarded prognosis with substantial morbidity and mortality, particularly in oligoanuric dogs. Fenoldopam, a selective dopamine agonist, has been shown to increase urine output in healthy dogs and cats; however, the mechanism of action is unknown., Hypothesis/objectives: To evaluate the effect of fenoldopam infusion on glomerular filtration rate (GFR) and fractional excretion of sodium (FeNa) in healthy dogs., Animals: Ten healthy, privately owned dogs., Methods: Randomized, crossover design with negative control. Ten healthy dogs were given fenoldopam diluted in 5% dextrose (D5W) as a continuous IV infusion of 0.8 μg/kg/min for 5 hours and a control infusion of D5W alone, 7 days apart. Glomerular filtration rate was measured by exogenous iohexol clearance, beginning 1 hour after the start of the fenoldopam infusion. Fractional excretion of sodium (FeNa) was measured before and after the infusion. Glomerular filtration rate and change in FeNa were compared between treatment days., Results: Fenoldopam infusion resulted in a significantly increased (P = .0166) GFR (median GFR, 3.33 mL/min/kg) in healthy dogs compared with D5W infusion (median GFR, 2.71 mL/kg/min). Fenoldopam also resulted in a significantly increased (P = .0148) FeNa (mean change, 0.106), whereas infusion of D5W alone did not (mean change, 0.016)., Conclusions and Clinical Importance: In healthy dogs, fenoldopam significantly increased GFR and FeNa compared with infusion of D5W alone. No adverse effects were seen., (Copyright © 2016 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.)

Background: β-hydroxybutyrate (BOHB) concentrations have not been quantified in dogs with acute pancreatitis (AP)., Objective: The aim of this study was to investigate BOHB concentrations in dogs with AP., Animals: A total of 154 client-owned dogs without DM., Methods: Prospective clinical study. Dogs were enrolled into 1 of 3 groups: AP, sick without an AP diagnosis, or fasted. Dogs were diagnosed with AP (44) if they had vomiting or anorexia, and either ultrasonographic findings consistent with AP or increased pancreatic lipase. Sick dogs without AP (68) had vomiting or anorexia but a diagnosis of AP was either not suspected or was excluded based on ultrasonographic findings or a normal pancreatic lipase. Dogs without anorexia or vomiting that were fasted for over 10 hours for a procedure were also enrolled (42). BOHB was measured on whole blood with a portable ketone meter. The Kruskal-Wallis test was performed to compare BOHB in the 3 groups. Pair-wise comparisons were performed using the Mann-Whitney test and Bonferroni corrected P-values are reported., Results: Median BOHB concentration was significantly higher in dogs with AP (0.3 mmol/L, range 0-2.9 mmol/L) compared to sick dogs without AP (0.20 mmol/L, range 0-0.9 mmol/L, P = .007) and fasted dogs (0.1 mmol/L, range 0-0.4 mmol/L, P = .0001). Median BOHB concentration was significantly higher in sick dogs without AP compared to fasted dogs (P = .0002)., Conclusions and Clinical Importance: In dogs without DM, BOHB is significantly higher in dogs with AP compared to other dogs. The diagnostic utility of this finding remains to be investigated., (Copyright © 2016 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.)

Objective: To describe the incidence of the development of anemia, the number of phlebotomies performed daily, the approximate volume of blood withdrawn, the transfusion requirements and their association with duration of hospitalization and survival to discharge in critically ill cats., Design: Retrospective study from January 2009 to January 2011., Setting: University teaching hospital., Animals: Cats hospitalized in the intensive care unit (ICU) for >48 hours., Interventions: None., Measurements and Main Results: Medical records of cats hospitalized for >48 hours in the ICU were examined. Of the 45 cats included, 60% (27/45) were not anemic upon admission to the ICU. Of these, 74.1% (20/27) developed anemia during their ICU stay. Development of anemia was associated with a longer duration of hospitalization (P = 0.002) but not with survival (P = 0.46). Fourteen cats (31.1%; 14/45) received one or more packed red blood cell transfusions and had significantly longer ICU stays (P < 0.001). Transfusion requirements were not associated with survival (P = 0.66). The median number of phlebotomies per day for all cats in the ICU was 3 (range 1-6). This was significantly associated with the development of anemia (P = 0.0011) and higher transfusion requirements (P = 0.16) in the 14 cats that received a transfusion. The estimated volume phlebotomized was significantly (P < 0.001) greater in cats that required a transfusion (median volume 3.32 mL/kg/ICU stay) compared to cats that did not require a transfusion (median volume 1.11 mL/kg/ICU stay) but was not associated with survival to discharge (P = 0.84)., Conclusions: Development of anemia necessitating blood transfusions is common in critically ill cats and leads to significantly longer duration of ICU hospitalization. Iatrogenic anemia from frequent phlebotomies is an important cause for increased transfusion requirement. Fewer phlebotomies and other blood conserving strategies in these patients may help reduce the incidence of anemia and decrease transfusion requirements, as well as result in shorter hospital stays., (© Veterinary Emergency and Critical Care Society 2015.)