5y Lab, haemorrhagic diarrhoea and blood in urine, blindness etc

Re: 5y Lab, haemorrhagic diarrhoea and blood in urine, blindness etc

mariette asselbergs — Mon, 08 Dec 2014 22:36:49 GMT

Would the owners let you do a PM? Then you could check the lungs for lungworm. If you hold them under the tap worms will rinse out and you can look at them under the microscope. I had a 10 week old pup dead on arrival "from choking on his food", but with bright red blood in his mouth. The owner had other dogs so I could convince them to let me have a look and they were very grateful to know for sure that they needed to treat their other dogs and not leave toys and drinking bowls out in the garden etc.

Mariette

Re: 5y Lab, haemorrhagic diarrhoea and blood in urine, blindness etc

Andrew Kent — Fri, 05 Dec 2014 21:03:44 GMT

Hi Charlotte,

Sorry to hear about the outcome of the case - these cases that deteriorate so quickly are difficult to contend with. I think there are lots of possible differentials for these signs - coagulopathy, infectious disease, acute kidney injury etc. Probably we will never know!

Andy

Re: 5y Lab, haemorrhagic diarrhoea and blood in urine, blindness etc

Graham Bilbrough — Fri, 05 Dec 2014 21:00:38 GMT

Yes, EDTA plasma is suitable. If you call the lab, and there is sufficient sample, they will be happy to add the test.

Thanks

Re: 5y Lab, haemorrhagic diarrhoea and blood in urine, blindness etc

Charlie Lyon — Fri, 05 Dec 2014 19:58:42 GMT

There are a lot of dykes/ditches around the Fens and therefore rats. I have seen facebook posts from the local area about lepto cases so there may be a trend but don't know til results come. No jaundice that we noted but his sclera were red from blood sub conjunctival! Graham would edta plasma be suitable as have sent that to idexx already for lepto test?

Re: 5y Lab, haemorrhagic diarrhoea and blood in urine, blindness etc

ruths — Fri, 05 Dec 2014 18:05:44 GMT

Sorry- there is bilirubin in the second test. -)) can't edit or retract posts -))

Re: 5y Lab, haemorrhagic diarrhoea and blood in urine, blindness etc

ruths — Fri, 05 Dec 2014 18:02:59 GMT

The SG wAs 1.038 so I don't think there was any renal damage- it looks like the kidneys were concentrating urine so the raised bun and crest could be from pre renal issues. Bun is raised in hge I think. There was no bilirubinaemia either I think... The lepto cases I've seen have all been really yellow and their kidneys were shot too. I may be missing some, tho.

Re: 5y Lab, haemorrhagic diarrhoea and blood in urine, blindness etc

Bob Russell — Fri, 05 Dec 2014 17:35:50 GMT

It is the season for Idiopathic cutaneous and renal glomerular vasculopathy. Any history of wounds especially muzzle or distal limbs? Too late for this dog (and symptoms are not classic) but worth adding to any dd list where there is severe acute renal damage.

Re: 5y Lab, haemorrhagic diarrhoea and blood in urine, blindness etc

Robin Grimmer — Fri, 05 Dec 2014 17:28:17 GMT

How about lead poisoning?

Re: 5y Lab, haemorrhagic diarrhoea and blood in urine, blindness etc

Graham Bilbrough — Fri, 05 Dec 2014 17:05:25 GMT

Do you have any serum or plasma left in a fridge? You could submit to IDEXX Wetherby and they will run the Angio Detect test for you.

Thanks

Graham

Re: 5y Lab, haemorrhagic diarrhoea and blood in urine, blindness etc

ruths — Fri, 05 Dec 2014 16:35:51 GMT

I hate to hijack your thread, but why is lepto higher than lungworm here? The dog didn't have a thrombocytopenia and so this wasn't haemorrhage due to lack of platelets. And there were no petechiae noted.

Re: 5y Lab, haemorrhagic diarrhoea and blood in urine, blindness etc

ruths — Fri, 05 Dec 2014 16:30:35 GMT

Yes- bleeding from a number of sites really makes me think it was clotting related. I wondered if it could be rat bait too. Lungworm is a great pretender - I would expect lung changes, but maybe this was an odd one. You can do a faecal smear test ( not very sensisitve but fast) or bauhermann faecal flotation too. What a tricky and depressing case -((

Re: 5y Lab, haemorrhagic diarrhoea and blood in urine, blindness etc

Charlie Lyon — Fri, 05 Dec 2014 15:33:04 GMT

uSG 1.038 sorry. We have sent off blood and urine for lepto as well and don't have a lungworm snap test. Haven't seen it yet in my practice in North cambs

Re: 5y Lab, haemorrhagic diarrhoea and blood in urine, blindness etc

Charlie Lyon — Fri, 05 Dec 2014 15:28:49 GMT

Unfortunately he died this morning. He did seem to improve a little after fluids and iv antibiotics but then deteriorated again. Electrolytes were normal. Did an index extended profile with cpli included. Wouldn't there be signs in the lungs on xR if it were lungworms as they weren't very exciting apart from small heart which we put down to dehydration? USG was 1.38 after we have spun the urine - was blood in urine rather than haemolytic type urine so must have been some sort of coagulopathy/DIC. Sad case to go downhill so quickly

Re: 5y Lab, haemorrhagic diarrhoea and blood in urine, blindness etc

Anthony Dennison — Fri, 05 Dec 2014 08:48:02 GMT

[quote user="Andrew Kent"]did your bloods include electrolytes? And these were normal?[/quote]

Are you thinking Addisons?

Re: 5y Lab, haemorrhagic diarrhoea and blood in urine, blindness etc

Andrew Kent — Fri, 05 Dec 2014 08:12:20 GMT

Hi Charlotte, agree with much already said and will try to add more a bit later, but just a query -did your bloods include electrolytes? And these were normal? Andy

Re: 5y Lab, haemorrhagic diarrhoea and blood in urine, blindness etc

Anthony Dennison — Fri, 05 Dec 2014 00:05:16 GMT

I would agree along the lines of lepto or coagulopathy. Worth a snap lungworm test? Also a lepto MAT titre or PCR (the latter takes longer however). Get some penicillins in as soon as samples have been taken and doxycycline 5mg/kg BID.

We had a case like this, unfortunately despite our best efforts he died after 48 hours. Good luck.

If there are any other dogs in the house or in contact dogs may be worth getting a sample from them also?

Re: 5y Lab, haemorrhagic diarrhoea and blood in urine, blindness etc

ruths — Thu, 04 Dec 2014 23:39:16 GMT

What was the urine SG? You need to rule out renal vs pre renal azotaemia. And yes to the bedig being the biggest problem- rodenticides? Lungworm? Other causes of prolonged clotting? Chase this first I think

Re: 5y Lab, haemorrhagic diarrhoea and blood in urine, blindness etc

Christopher Saul — Thu, 04 Dec 2014 19:48:13 GMT

Just a few thoughts. Sorry if there's any typos.. I'm doing this on my phone on the move.

Have you run PT/APTT? Sounds like a coagulopathy. Do check the BP - I very much doubt it but you need to eliminate massive hypertension.

If you cannot refer and assuming these are high then a fresh frozen plasma transfusion is indicated. If you phone the pet blood bank in Leicestershire they will often be able to courier you some, even out of hours. I agree lepto is a possibility so barrier nursing is important, and of course early IV antibiotics (after having taken your samples) . Appropriate IV fluid therapy is vital as is management of electrolyte and acid-base disturbances. Place a foley, both to help minimise your exposure to urine but also to allow you to manage 'ins' and 'outs' . Keep an eye on blood pressure

Michael's right to mention lungworm. Though lepto is higher on the differential list you can't eliminate lungworm either, so definitely cover for this also

Hope this helps

Re: 5y Lab, haemorrhagic diarrhoea and blood in urine, blindness etc

Louise6732 — Thu, 04 Dec 2014 18:32:20 GMT

I think lepto would be high on my differentials list, espec with high renal values.

Re: 5y Lab, haemorrhagic diarrhoea and blood in urine, blindness etc

Michael Woodhouse — Thu, 04 Dec 2014 17:26:05 GMT

Coagulopathy - lungworm until disproved.