bulldog with urethral blockage

Re: bulldog with urethral blockage

Gillian Mostyn — Sun, 11 Oct 2009 20:10:10 GMT

After doing all the diagnostics, and getting a clearer idea of the problem, I rang the client to tell them I would recommend transferring to our OOH provider as the dog required extensive care. Luckily they agreed but it died on the 5 minute journey!!!!

Re: bulldog with urethral blockage

Clive Ansell — Sun, 11 Oct 2009 11:09:26 GMT

[quote user="Gillian Mostyn"]

[quote user="Clive Ansell"]despite doing our best, and staying behind after hours (unpaid I hasten to add!) the clients are whinging about the costs and refusing to pay. [/quote]

Yeah - this case turned up at 6pm on friday, so we did get away a bit later than normal, and haven't been paid yet........we'll see.

[/quote]

Yes, my case rolled up just after 6pm on a Thursday, the practice is unmanned overnight and uses an OOH care facility. Because costs were an issue and the owners declined to use the OOH facility I reluctantly agreed to keep the case overnight and check on it from time to time, although ongoing monitoring would not be possible. Because the dog died, as predicted (It had been collapsed for 2 days!), the owners don't wish to pay claiming a poor standard of overnight care, despite the fact it died before the end of the (greatly extended) evening surgery. It seems they want a 21st century USA ER style of premium standard 24/7 care without having to pay for it.

Re: bulldog with urethral blockage

Gillian Mostyn — Sun, 11 Oct 2009 10:34:58 GMT

Many thanks for your replies - really appreciated. I have been beating myself up a bit cos I didn't do much to help it - but do feel a little better now.

[quote user="Clive Ansell"]despite doing our best, and staying behind after hours (unpaid I hasten to add!) the clients are whinging about the costs and refusing to pay. [/quote]

Yeah - this case turned up at 6pm on friday, so we did get away a bit later than normal, and haven't been paid yet........we'll see.

Re: bulldog with urethral blockage

Glen McIntosh — Sat, 10 Oct 2009 19:28:48 GMT

Thankyou for sharing this case with us. I had a similar case recently in a similar state of extremis. I took a slightly different approach to diagnositics - started with pcv/ghp first, then electrolytes after seeing the marked uraemia, no rads- it took me about the same time to reach the diagnosis but I still wasn't certain of the primary cause - eg renal failure vs uroperitineum.

I suspect that, like my case, this dog was in cardiogenic shock secondary to profound hyperkalaemia, from the uti obstruction/uroperiteneum. Along with this, a severe acidosis. This would have a severe effect on cardiac output and, along with the uraemia, resulted in the severe pulmonary oedema.

My assessment of this dogs most immeadiate life threatening problems would be the hypoxaemia, hyperkalaemia and acidosis all combining to produce a severe arrythmia. An ecg might have shown an biphasic qrs rythm etc.

Supplementary oxygenation/intubation if unconcious and IV calcium gluconate to antagonise the cardiac effects of the hyperkalaemia so as to restore cardiac output breifly to by a bit of time (a few minutes or so), before starting an iv insulin/dextrose regimen to drive pottasium into the cells. Sodium bicarb iv might also be useful as these cases.

If the dog survives this long, restablishing urine flow either by urinary catheterisation and/or abdominal drainage/peritoneal dialysis would be the next goal followed by diureseis via reasonably fast iv fluids and frusemide to get the pottasium levels down to just above high normal. Definative surgical repair of the bladder/obstruction could then follow when the animal was stable.

Of course all of this is in hindsight and I wish I could say that I managed to do all of the above and that the dog survived, I didn't and it didn't. I thought I could hear a normal heart rythm (despite a markedly elevated K ~ 11) so I pfaffed about with setting up insulin/dextrose. When I did finally set up the ecg I was just in time to witness a biphasic qrs complex convert within a minute into a ventricular fib and then asystole and cpr was unsuccessful. I had forgotten all about using calcium. Would this case have survived if I had remembered? Maybe, maybe not - its ph was about 6.8 on the initial sample.

But you live and you learn etc, so hopefully I am better prepared for the next one.

Re: bulldog with urethral blockage

Clive Ansell — Sat, 10 Oct 2009 19:17:58 GMT

It sounds like you did all you reasonable could, and I think I would have done the same as you; low volume fluids, survey rads and bloods for pcv, electrolytes and urea, crea, phos as a minimum. Abdomino and thoracocentesis may have been useful perhaps?. If a distended bladder were palpable or visible on rads, then cystocentesis to drain , but it sounds like the poor dog was in extremis and the end point would probably have been the same whatever you did.

I had a similar case in a 12 year old Chow Chow bitch about 2 months ago; it had been ill for a week and collapsed, almost in extremis, for 2 days on presentation. Survey rads showed there was a single large urolith blocking the urethra, urea, phos and crea through the roof, crea >1000, K+ about 8 -9 mMol. we drained the bladder via cystocentesis and started saline IVFT, but she died within the hour. slighly off topic - despite doing our best, and staying behind after hours (unpaid I hasten to add!) the clients are whinging about the costs and refusing to pay.