What could I have done different? a vomiting dog.

Re: What could I have done different? a vomiting dog.

Mark Holmes — Mon, 30 May 2011 16:08:50 GMT

[quote user="Michael Woodhouse"]

[quote user="Claire Edgington"]Her heart rate was normal at presentation[/quote]

If heart rate was normal despite PCV 66%, tachy membranes and treacle like blood that has to be an inappropriate physiological response.

Addisons?

[/quote]

I have to say I think addisons is a good consideration. I have seen some look truely awful. I generally keep it a ready differential in any unexepected (ie age/history) azotaemic dog. Its a shame you didn't have electrolytes available.

Re: What could I have done different? a vomiting dog.

Michael Woodhouse — Mon, 30 May 2011 14:26:16 GMT

[quote user="Claire Edgington"]Her heart rate was normal at presentation[/quote]

If heart rate was normal despite PCV 66%, tachy membranes and treacle like blood that has to be an inappropriate physiological response.

Addisons?

Re: What could I have done different? a vomiting dog.

Claire Edgington — Mon, 30 May 2011 09:41:21 GMT

Thanks everyone. I did think in hindsight that I should have whacked the fluids up. Her heart rate was normal at presentation and she passed normal faeces in the hospital. I'll just have to scratch this one down to learning curve.....

Re: What could I have done different? a vomiting dog.

Gillian Mostyn — Sun, 29 May 2011 22:37:31 GMT

If I have a young dog that has not kept anything at all down for more than a day, not passed any faeces at all and nothing obvious diagnosed, I tend to go for ex-lap at a fairly early stage. You do get the odd case where you find nothing but in my experience there's something in there to see........and remove!!! You do get some stoic dogs who have truly awful twists and blockages and it is amazing how little pain they seem to show) In these types of cases I also find xrays of limited value unless you are looking for a specific disease process/radio-opaque FB - see something - go in - see nothing - go in...!!! If I was better at abdominal ultrasound then I'd reach for that though......

Re: What could I have done different? a vomiting dog.

Andrew Kent — Sun, 29 May 2011 18:43:10 GMT

What was her heart rate when you first saw her? I'd agree that potentially a higher initial fluid rate may have been indicated but it may not have made much of a difference.

I think ultrasound may have been useful as if something like a perforation or peritonitis this would have been evident.

An acute pancreatitis is certainly possible in which case plasma may have helped.

Ultimately this is all academic because if the deterioration was that rapid it is very unlikely that the outcome would have been any different.

Andy

Re: What could I have done different? a vomiting dog.

Utlendigur — Sun, 29 May 2011 18:38:15 GMT

Pancreatitis or early stage of some sort of really nasty enterotoxic gastroenteritis were my first guesses too. Other things I wondered about were addisons, peritonitis, torsion of some sort, FB, intussusception...You say the abdominal contents weren't clear on xray - does that mean there was fluid present - if so abdomenocentesis is often helpful. I'd second the suggestion of increased fluids too. If something looks very dehydrated/very high PCV I often put them on shock doses for a short time until they look better then drop the rate downv to 2-3xm.

I had a similar situation a few years ago. Fit early middle aged spaniel which presented with pyrexia and mild tachypnoea/hyperpnoea. Chest Xray had mild alveolar pattern but noad. No response to antibiotics and then started vomiting - also no faeces for several days. Bloods (in house biochem + pcv only - always happens on Fri evenings..) fairly normal apart from dehydration, reduced ALB + mild liver enz rise. No response to fluids/symptomatic tx, and was getting toxic, developing severe abdo pain, vomiting more frequently. Xray non diagnostic as minimal tissue contrast and no ultrasound available. The dog was getting worse rapidly and in pain, the owners didn't want pts and we are >1hr from referral centre (and I didn;t want to risk them crashing off the road if the dog keeled over in the car) so I ex lapped it as a last resort in case it was FB/peritonitis. Died UGA but the guts were just totally flaccid and dilated - looked like sausage skins full of fluid - but no obstruction. It just appeared to be some sort of ileus.

Re: What could I have done different? a vomiting dog.

Michael Woodhouse — Sun, 29 May 2011 18:23:45 GMT

I would have given more fluids Vetergesic and Cerenia. If you'd got as far as knocking the dog out I may have started the ex lap to see what was going on even if as a goodwill gesture never charged the owner. What was the heart rate like? If I have a reasonable sized dog - will give first litre of fluids full bore, then titrate to HOUR and CRT.

Re: What could I have done different? a vomiting dog.

Kate Richardson — Sun, 29 May 2011 17:54:49 GMT

Acute necrotising pancreatitis? Some form of enterotoxaemia? Perforating FB? Any of the previous with secondary DIC/SIRS? In hindsight maybe a higher initial fluid rate, but given she was reasonably bright, I would probably have gone with 2-3 x m as well. But given how quickly she deteriorated and died, I suspect it would have been unlikely to have made much difference.