Biomedical subjects
Publications and source records attributed to M Schaer.
Differential diagnoses for hyponatremia with concurrent hyperkalemia should include hypoadrenocorticism. Renal failure, chylothorax, and gastrointestinal tract disorders may also cause abnormally low serum sodium:potassium ratios. The ACTH stimulation test is the gold standard for diagnosis of hypoadrenocorticism.
OBJECTIVE: To determine whether healthy dogs given high doses of methylprednisolone sodium succinate (MPSS) develop gastrointestinal tract ulcers and hemorrhage. ANIMALS: 19 healthy male hound-type dogs. PROCEDURE: Dogs were assigned randomly to intravenously receive high doses of MPSS (30 mg/kg of body weight, initially, then 15 mg/kg 2 and 6 hours later, and, subsequently, every 6 hours for a total of 48 hours; n = 10) or an equal volume of saline (0.9% NaCl) solution (9). Gastroduodenoscopy was performed before and after treatment. Endoscopic evidence of gross hemorrhage in the cardia, fundus, antrum, and duodenum of each dog was graded from none (0) to severe (3), and a total stomach score was calculated as the sum of the regional gastric scores. Number of ulcers were recorded. The pH of gastric fluid and evidence of occult gastric and fecal blood were measured. Food retention was recorded. RESULTS: Gastric hemorrhage was evident in all dogs after MPSS administration and was severe in 9 of 10 dogs but not visible in any dog after saline treatment. Occult gastric blood was detected more commonly (9/10 vs 2/9), median gastric acidity was greater (pH 1 vs pH 3), and food was retained more commonly (7/10 vs 1/9) in the stomach of MPSS-treated dogs. CONCLUSIONS AND CLINICAL RELEVANCE: High doses of MPSS cause gastric hemorrhage in dogs. All dogs treated with high doses of MPSS should be treated with mucosal protectants or antacids to prevent gastric hemorrhage.
OBJECTIVE: To determine whether administration of misoprostol prevents gastric hemorrhage in healthy dogs treated with high doses of methylprednisolone sodium succinate (MPSS). ANIMALS: 18 healthy hound-type dogs of both sexes. PROCEDURE: All dogs were given high doses of MPSS (30 mg/kg of body weight, initially, then 15 mg/kg 2 and 6 hours later, and, subsequently, q 6 h for a total of 48 hours) IV. Dogs were assigned randomly to receive concurrent treatment with misoprostol (4 to 6 microg/kg, PO, q 8 h; n = 9) or an empty gelatin capsule (9). Gastroduodenoscopy was performed before and after treatment. Hemorrhage was graded from none (0) to severe (3) for each cardia, fundus, antrum, and duodenum. A total stomach score was calculated as the sum of the regional stomach scores. Food retention was recorded, and pH of gastric fluid was determined. Gastric and fecal occult blood was measured. RESULTS: Gastric hemorrhage was evident in all dogs after MPSS administration, and its severity was similar in both groups. Median total stomach score was 6 for misoprostol-treated dogs and 5.5 for dogs given the gelatin capsule. Difference in gastric acidity, frequency of food retention, and incidence of occult blood in gastric fluid and feces was not apparent between the 2 groups. CONCLUSIONS AND CLINICAL RELEVANCE: Administration of misoprostol (4 to 6 microg/kg, PO, q 8 h) does not prevent gastric hemorrhage caused by high doses of MPSS. Alternative prophylactic treatment should be considered.
The surgical needs of the diabetic dog and cat parallel those affecting the general pet population. Most minor procedures can be managed in which the patient is admitted and discharged on the same day with special measures being taken to avoid the consequences of excess insulin administration. Those diabetic patients in need of major surgical procedures, however, require meticulous medical management and an intensive care environment. This article describes how the specific needs of the diabetic surgical patient can be provided effectively.
A 35 year old primigravida with a triplet pregnancy developed polyuria and epigastric pain in the 31st week of pregnancy. During that week, emergency cesarean section was performed due to evidence of liver disease and imminent fetal hypoxia. Three girls were delivered who were healthy apart from transient neonatal respiration distress syndrome. Following surgery, the mother developed HELLP syndrome with hemolysis, increased transaminases and thrombocytopenia. She also developed diabetes insipidus with daily urine outputs of up to 7000 ml and poor response to desmopressin. Both the HELLP syndrome and the diabetes insipidus resolved spontaneously within ten days. In pregnant patients with right upper quadrant pain, HELLP syndrome or acute fatty liver of pregnancy should be considered. The association of diabetes insipidus with acute fatty liver of pregnancy is an established, but rare phenomenon. As far as is known, this is the first report of a patient presenting with a combination of HELLP syndrome and diabetes insipidus. Patients with HELLP syndrome have a good prognosis, if the diagnosis is early and the pregnancy terminated at the right time. With close supervision further pregnancies are possible.
Modified choledochoduodenostomy and gastrojejunostomy were used successfully to treat extensive duodenal ulceration and perforation in a dog. Concomitant pyometra, simultaneously managed by ovariohysterectomy, may have predisposed the dog to stress ulceration. Choledochoduodenostomy was performed by transplantation of the entire common bile duct and associated major duodenal papilla to a more distal duodenal location. An indwelling choledochostomy tube was used to stent the anastomotic site, externally divert bile flow, and allow postoperative cholangiography. Early postoperative complications included presumed metronidazole-induced neurotoxicosis, choledochostomy tube obstruction, and pancreatitis, all of which resolved within 2 weeks. The dog was clinically normal and medication (ranitidine and sucralfate) was discontinued 35 months later.
The clinician's knowledge about total body water distribution and the appropriate choice of fluids for treatment can have an important effect on the eventual outcome of his or her patients. The ability to calculate fluid deficits and to compute infusion rates appropriately is an essential aspect of top-quality patient care. The principles of fluid therapy that were provided in this article should provide one with a logical and practical means for prescribing fluid treatments.
Septic shock is a life-threatening condition that results from the combined effects of bacteria and the host's chemical mediators of inflammation. Of particular detriment is the hyperdynamic and hypodynamic vasomotor instability that severely compromises the patient prior to the onset of overt bacteremia. The principles of therapy include (1) a prompt diagnosis, (2) removing the source of sepsis, (3) maintaining normal blood pressure through the use of parenteral fluids and inotropes, (4) selecting the appropriate antimicrobial agent, and (5) stringent patient monitoring. Sometimes, despite the optimal use of diagnostic tests and high-quality treatment, the prognosis remains guarded to grave.
Idiopathic pleural effusion was diagnosed in a 4-year-old female Poodle. Treatment included giving low doses of furosemide for 5 months and giving low doses of prednisone that eventually were given on alternate days and discontinued 16 months after initial evaluation. Idiopathic pleural effusion in this dog was eosinophilic. The clinical importance and diagnostic value of this finding were not determined. In man, idiopathic pleural effusions have a high correlation with eosinophilic pleural effusions.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Concurrent diabetes mellitus and hyperadrenocorticism were diagnosed in 30 dogs over a 2-year period. Clinical signs included polyuria, hepatomegaly, polyphagia, abdominal distension, truncal alopecia, anorexia, and vomiting. Because of the similar clinical and laboratory findings for hyperadrenocorticism and diabetes mellitus, hyperadrenocorticism was initially overlooked in some dogs. Insulin resistance, characterized by high daily insulin requirements, developed in the diabetic dogs with untreated hyperadrenocorticism. Therapy with o,p'-DDD resulted in precipitous declines in insulin requirements. By lowering the dosage of o,p'-DDD and supplementing with glucocorticoids during the o,p'-DDD loading period, serious hypoglycemia was avoided. Control of coexisting hyperadrenocorticism lessened the severity of the diabetes mellitus, but insulin therapy remained a necessity in all dogs.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.