2. Immune-Mediated Thrombocytopenia
Signalment: 11yo, female neutered Shitzu
Presentating Problem: Referral for blood transfusion due to blood results from
referring vet CBC: HCT 0.26, WBC increased @ 27.6, Neutrophilia 19.3,
increased bands @ 9%, Monocytosis @ 3.0, 4 Nucleated RBCs/100 WBCs,
marked severe Thromobocytopaenia @ 4. Evidence of regeneration on
smear with ansiocytosis and polychromasia. Toxic changes on smear with
basophilic cytoplasm. No platelet clumps on smear.
Clinical Examintion:
• HR 132, RR 44- ↑ inspiratory with expiratory push, temp 37.9 °C, MMs pale
pink, CRT <1s, pulses ↓ width and height.
• Marked ecchymoses over ventral abdomen, inner thighs,
forearms and over jugular venipuncture
• Scleral haemorrhage.
• Melena.
• Petechiation on gums
3. Investigations and Results:
• Venous blood gas- ↑ lactate at 4.6 (0.6-2.5)
• Manual PCV- 11
• Slide agglutination- Negative
• Abdo U/S- Sliding of the pleural line indicates the lack of air between the visceral and
parietal pleural
Diagnosis: Severe Thrombocytopenia. Level consistent with Immune-Mediated
Thrombocytopenia.
Treatment Options:
• Stabilisation
• Blood transfusion
• Immunosuppressive dose of prenisolone
• Euthanasia
Outcome: Humane euthanasia with IV pentobarbitone.
4. Snake Envenomation
Signalment: 6yo, male neutered Kelpie x
Presenting Problem: Snake envenomation treated with 1 vile of anti-venom
by referring vet, severe respiratory weakness, prolonged activated clotting
time, epileptic seizure treated with valium by referring vet.
Clinical Examination:
• HR 104, RR 26- paradoxical pattern, reduced chest wall effort, temp
38.9°C, MMs pink, CRT 1s, pulses tall and synchronous.
• Mentation paralysed/sedated.
• Dilated pupils.
• Port wine coloured urine suspect myoglobinuria.
• LMN weakness.
Investigations and results:
• SpO2- 95-99% on O2 supplementation via face mask
• ECG- sinus rhythm
• Blood Pressure- systolic = 161, diastolic = 112, MAP = 128
Outcome: Human euthanasia with IV pentobarbitone.
5. Pharyngeal Foreign Body
Signalment: 7yo, male entire, German Shepherd Dog
Presenting Problem: Noted to be repeatedly retching and
struggling to breathe at home, owner called the Emergency
Service and was advised that he should be seen urgently in case
this was a possible GDV/dilatation. He presented in difficulty and in
a brief history it emerged that his rubber Kong ball had gone
missing.
Clinical Examination:
• HR 164, RR 60- increased effort with URT noise, obstructive as
red ball seen in pharynx, temp 39.6°C, MMs injected, CRT <1s,
normal pulses.
• Further examination not performed due to finding respiratory
obstruction and requiring immediate treatment.
Treatment and Procedures:
• IV catheter placed and anaesthesia induced with 2mg/kg
Alfaxalone
• Ball removed manually with great difficulty from pharynx- hole
in Kong allowed dog to breathe.
• 0.2mg/kg Dexamethasone SC to reduce inflammation
Outcome: Dog observed for 3 hours after removal of FB to ensure
no ill effects, including neurogenic pulmonary oedema occurred
before being discharged.
6. Progressive LMN Weakness
Signalment: 6yo, male neutered, Staffordshire Bull Terrier
Presenting problem: Dyspnoeic, progressive LMN muscle weakness resulting in
tetraparesis. Tested for Toxoplasma at referring vet, titres were mildly elevated
(IgG and IgM), and treatment with Clindamycin was initiated with no
improvement. Progressive difficulty swallowing and breathing in last 2 days.
Clinical Examination:
• HR 140, RR 112- panting, paradoxical abdominal motion, temp 38.5°C,
MMs pink, CRT 1.5s.
• Abdomen mildly tympanic- suspect aerophagia.
• Tetraparetic, patellar reflexes absent.
Investigations and Results:
• Venous blood gas and electrolyes- no abnormalities
Outcome: Hospitalised overnight to monitor for respiratory deterioration as
owner warned may require ventilation. Referred to Neurology Service next
day but deteriorated further and so humane euthanasia performed.
7. Cat Bite Abscess
Signalment: 4yo, female neuter, Domestic Short Hair
Presenting Problem: Lethargic and uninterested in food. Owner heard cat
fight previous day.
Clinical Examination:
• HR 200, RR 20, temp 39.8°C, MMs pink, CRT 1s.
• Multiple cat scratches found on hind quarters.
• 0.5mm skin flap over right hip
• Puncture wound on left hip- ambulatory, no swelling
• Painful left hind foot on palpation.
Investigations and Results:
• Clipped hair around puncture wound and skin flap, flushed with 0.9%
saline
• Investigated left hind foot under buprenorphine- revealed small scratches
but no puncture wounds.
Outcome: Discharged with Amoxicillin and Clavulanic Acid 62.5mg PO BID
for 5 days and Buprenorphine 0.06mg PO q8hrs for 1 day.
8. Chocolate Ingestion
Signalment: 10yo and 13yo, male entire, Staffordshire Bull Terrier X’s
Presenting Problem: Empty 200g bar of milk chocolate but unsure which dog, or if both,
ate it. Toxic dose is 40mg/kg. The chocolate was ingested no more than 4 hours before
presentation.
Clinical Examination: Neither of the two dogs were showing clinical signs of toxicity. All
vital parameters were within normal limits except for the HR of the younger dog which
was 124bpm.
Treatment:
• Both dogs were given 0.5 tablets of Apomorphine conjunctively to induce emesis.
• The younger dog vomited within 5mins of administration and vomited up 7cmx3cm
piece of hard plastic. Further vomiting prevented by washing the eye with cool
water as risk of possible other FB causing damage.
• Emesis was not induced with 0.5 tabs in older dog so further 0.25 tabs given into
conjunctiva. Again, no emesis induced so administer 0.3mg Apomorphine IV.
Emesis was induced and the dog vomited up chocolate. 1.25mg of
Metaclopramide was administered to resolve nausea. No activated charcoal
given due to being slightly sedate.
Outcome: Both dogs were discharged. The owner was advised of risks of chocolate
toxicity include vomiting, diarrhoea and seizures. If concerned then to come back
immediately.
9. Diabetic Collapse
Signalment: 13yo, female neutered, Spotted Mist
Presenting Problem: Diagnosed as diabetic in July ‘14. Owner returned home to find
her collapsed and unreposnsive. Diabetes had never been fully controlled. Been
receiving increasing insulin doses starting at 1IU BID up to 4IU BID in the last 2 weeks.
Clinical Examination:
• HR 210, RR 12, temp 33.6°C, MMs pale pink, CRT 2s, pulses tall and narrow.
• Recumbant gait. Dull, minimally responsive mentation. Marked mydriasis.
Mucoid diarrhoea.
Stabilisation:
• IV catheter placed in right cephalic- 2.5ml of 50% dextrose diluted in 50% 0.9%
saline adminstered IV.
• Fed 1.5 tins of a/d food.
Investigations and Results:
• Venous blood gas- poor sample
• Blood glucose on glucometer- 1.1mmol/L
Treatment:
• Hospitalise- continuously monitor blood glucose Q2-4h
• If blood glucose >15mmol/L administer 2IU Glargine
Outcome: Discharged with instructions to administer 2IU of Glargine in the morning
only as blood glucose falls to 7mmol/L at its nadir. Consultation with Medicine Service
in one week.
10. Snake Envenomation
Signalment: 14yo, female neutered, Domestic Short Hair
Presentation: Owner found immobile 1 hour before presentation and immediately
brought to emergency department as recognised signs of snake envenomation.
Clinical Examination:
• HR 204- greadeII/III systolic heart murmur, intermittent gallop, RR 32- increased
paradoxical motion, temp 36.9°C, MMs pink, CRT 1.5s, pulses short and narrow
• Non-ambulatory tetraparesis, alert but minimally responsive due to
neuromuscular weakness
• Bilateral mydriasis and absent PLRs
• Bladder ½ full- expressed: orange tinged urine
Investigations and Results:
• Snake Venom Detection Kit- strongly positive for tiger snake
• Venous Blood Gas- metabolic acidosis although lactate has come down. PH
7.24, pCO2 45.5, SBE -7.3mmol/L, HCO3 18.8, Lactate 2mmol/L
Stabilisation
• Given one vial of tiger-brown antivenom (diluted in 40mls saline) IV immediately.
Premedicated with 5mg chlorpheniramine IV.
11. Treatment:
• 0.8mg of Methadone IV Q4h
• Lacrilube in both eyes Q2h- developed corneal ulcer on R eye
• Premedication with chlorphenamine 5g IV
• 2nd vial of tiger-brown antivenom
Outcome: Hospitalised in ICU due to developing cellulitis. An oesophageal tube was placed
and feed started on 1/3 of recommended energy requirement. Case still active.
12. Elbow Abscess
Signalment: 7yo, male neutered, Neapolitan Mastiff
Presenting Problem: Lame on left forelimb but is weight bearing. Owners
noticed swelling around left elbow and so gave 150mg of Carprofen.
Owners did not witness any trauma. Has a history of reduced eyesight
and receiving treatment for with Tricin BID.
Clinical Examination:
• HR 112, RR 16- grunting and snoring, temp 40.9°C in consult, 39.5°C 1
hour later (probably due to Carprofen), MMs pink, CRT 1.5s, strong
pulses.
• Discomfort on L FL but weight bearing. Swelling around L elbow
extending down to foot. Swelling is soft and does not seem painful
on palpation
• Flakey skin and lots of sores around pressure points on limbs.
• Submandibular lymphadenopathy likely secondary to infection
• Abscess ruptured from elbow in consult room. Large volume of
bloody purulent fluid leaked from left forelimb following rupture.
Investigations and Results-:
• CBC- leukocytosis
• PCV/TP- 42/78
• Venous Blood Gas- all values within normal limits
13. Treatment:
• IV catheter in L saphenous
• Methadone 10mg Iv Q4h
• Wound flushed with 1L 0.9% sterile saline
• IV antibiotics cephazolin 22mg/kg q8
• IVFT with Hartmann’s at 820ml/hr (4x maintenance)
• FNA of elbow revealed turbid serosanguinous fluid- multiple RBS and degenerate
WBCs but no bacteria
• Culture of fluid from abscess
Outcome: Discharged home with Cephalexin 2000mg PO q12, Tramadol 200mg PO Q8h
and advice on how to minimise pressure sores by ensuring that the bed is padded. An
appointment was made with the local vet for continuing treatment and monitoring. The
owners were informed hat they would be contacted with the pending microbiology
results regarding which long term antibiotic they would be administering.
14. Metaldehyde Toxicity
Signalment: 13yo, female neutered, Staffordshire Bull Terrier
Presenting Problem: Ingested metaldehyde up to 5 hours previous to
presentation and showing mild clinical signs of toxicity. Prior to presentation,
owner advised by referring vet to give a handful of soda crystals to induce
vomiting in dog- owner gave golf ball size of soda crystals and dog vomited
large amount of green metaldehyde. The dog was then given a second golf
ball size of soda crystals which did not induce vomiting.
Clinical Examination:
• HR 180, RR panting, temp 38.7°C, MMs injected, CRT 1s, pulses short and
narrow.
• Able to stand but falling into sternal
• Comfortable on abdominal palpation, no free fluid
• Mild muscle tremors.
Investigations and Results:
• PCV/TP- 50/75
• Electrolytes- Na+ 148 mmol/L, K+ 3.7 mmol/L, Cl 114 mmol/L, Ca2+(i) 1.32
mmol/L
15. Treatment:
• Apomorphine IV to try and induce faster emesis but no emesis induced so given
2 SC injections of apomorphine but no vomit produced
• 10mg metaclopramide SC and 4mg ondasterone IV to prevent emesis before
surgery
• Anaesthetic induction with methadone and alfaxalone- initial apnoea but then
stable throughout
• Enema revealed large amount of green thick paste like material consistent with
metaldehyde occasional mucoid discharge with blood fleck.
• Gastric lavage reveal small amount of green tinged water with occasional thick
saliva. Repeat enema after gastric lavage due to further thick green paste like
material passed.
• IVFT Hartmann’s at 4ml/kg/hr
• Pantoprazole 20mg/kg slow IV
• Metronidazole 160mg IV
• Methocarbamol 400 mg IV - administered once and seemed to resolve persisting
tremors; not needed subsequently
Outcome: Discharged home for further supportive care since eating well and no
Further clinical signs of metaldehyde toxicity. Discharged with omeprazole.
Readmit if clinical signs recur or other symptoms occur.
16. Vomiting
Signalment: 2yo, female neutered, Pug X
Presenting Problem: 2D history of lethargy, reduced appetite and vomiting.
There was no access to toxins and no recent change of diet. Not recently
wormed.
Clinical Examination:
• HR 128, RR 32- referred URT noise due to restricted nasal airflow, temp 38.2°C,
MMs pink and moist, CRT 1s.
• On abdominal palpation it was relaxed and no foreign bodies were
palpable. There was no distension of the intestines palpable nor was pain
elicited.
Differentials:
• Primary gastroenteritis
• Foreign body
• Bacterial/viral/fungal infection
• Pancreatitis
Treatment:
• 0.5ml SC Maropitant
• Drontal
• GI probiotic
17. Outcome:
• Discharged and owner told to monitor for continuation of vomiting or deterioration
clinically. Dog readmitted later that evening as continued to vomit through
Maropitant.
• An abdo U/S was performed with no abnormalities found and so she was admitted to
the hospital for further monitoring.
• After 2 days in ICU there was no marked improvement and she was neither eating nor
drinking and so was put on IVFT 2x maintenance.
• The dog was discharged the next day with advice on feeding a bland diet and
administering omeprazole. The owner was also given advice on watching for
deterioration once Maropitant wore off.
18. Cycad Ingestion
Signalment: 5yo, female neutered, Dachshund X
Presenting Problem: Owner witnessed dog eating cycad root 3 hours prior
to arrival. Confirmed picture of cycad fern with onwer. Dog also ate BBQ
fat. Dog vomited at least 7 times in 2 hours but only foam was produced.
No diarrhoea or other clinical signs.
Clinical Examination:
• HR 120, RR 24, temp 38°C, MMs pink, CRT 2s, tall and narrow pulses.
• No pain on abdo palpation, nausea evident
Assessment:
• Eaten cycad root with current GI signs evident - risk include acute
hepatic failure and poor prognosis.
• Pancreatitis risk re: fat ingestion
Stabilisation:
• Elected to induce emesis given potentially fatal side effects of Cycad
ingestion. Administered 1 apomorphine tablet sub-conjunctival in right
eye. Produced 6-8 vomits which were clear in nature, some bile staining
in later vomits. Eye then washed until clear with water
• Reversed with IV ondansetron and Maropitant as reluctant to given
metoclopramide in case significant cycad root ingested and risk of FB
• IVFT with Hartmann’s at 5ml/kg/hr with 20mmol/L KCl
• Given 1g activated charcoal
19. Diagnostics:
• PCV/TP : 42 / 64 serum clear in nature
• VBG: PH 7.444 pco2 30.8 SBE -2.6 Lactate 3.2 >> post vomiting Glucose 5.0, Na 148 K
3.4 Cl 118 Ca 1.34
• CBC : WNL
• BIOCHEM : All WNL except elevated lipase @ 2427
• PT 13 sec APTT 70 sec ( fast)
Treatment:
• Hartmann’s at 5ml/kg/hr supplemented with KCl 20mmol/L
Outcome: Discharged home as no concerning clinical signs and no hepatopathy
associated with cycad ingestion. Owner told to monitor for deterioration or change in
behaviour.
20. Collapsed Rabbit
Signalment: 7wk old, male entire, Miniture Lop
Presenting Problem: Acute onset weakness and dull, not been witnessed to eat,
drink or defecate. One of six rabbits bred by owners. Live outside in aviary on
concrete floor bedded with hay.
Clinical Examination:
• HR 280, RR 176, temp 38.8, MMs pink, CRT 1s, strong pulses.
• Lying down in sternal with occasional head tilt to right
• Able to pull hind legs under him into normal position from stretched out
position. However this reaction was greatly delayed
• Faecal pellets felt in abdomen, no gas distension, no GI sounds and no pellets
passed in journey to emergency department nor during examination.
Investigations and Results:
• Blood glucose- 9.1mmol/L
Stabilisation:
• Panacure 20mg/kg dose PO
• 40ml subcut 0.9% NaCl (warmed)
• 5kg dose of meloxicam once a day (0.3 mg/kg sid PO)
• Critical care mix 5ml Q2h
21. Outcome: The rabbit was discharged home for supportive care feeding Critical Care mix Q2h and
advised to make an appointment with rabbit specialist if not passed any faeces overnight.
Rabbit readmitted due to progressive weakness and being unable to syringe feed at home. The rabbit
had critical care mix stuck in his mouth and was very limp.
Clinical Examination:
• HR 120, RR 60- short very shallow resps, minimal chest excursion, temp 39.4°C, MMs cyanotic
• Recumbent, not moving, obtunded
• On abdo palp intestines hard and full, no gaseous distension
• Tongue hanging out of mouth unable to swallow food or spit it out
Stabilisation:
• Removed food from mouth with damp swab
• 24G IV catheter in ear vein
• 10ml IV bolus of Hartmann’s
• Flow by oxygen
Final Outcome: Owners elected for humane euthanasia by IV pentobarbitone. Declined PM due to
wanting body back. Owners advised to monitor other rabbits closely for signs of illness.
22. Glaucoma
Signalment: 17yo, male neutered, Australian Silky Terrier X
Presenting Problem: Twitching left eye, clear serous discharge from it. 3 year history of
discolouration in both eyes but has had no other medical problems. No history of
trauma and not receiving any medication. Owner reports that the dog has lost depth
but is not bumping into objects.
Clinical Examination:
• HR 88, RR 24 MMs pink, CRT 1s, pulses strong, grade 3 systolic heart murmur
• Both eyes were cloudy and discoloured, previously diagnosed cataracts present in
both eyes. Serous discharge from left eye and repeated blinking. Painful on
palpation. Anterior luxation of lens in left eye.
Investigations and Results:
• Tonometer- IOP of left eye= 67, IOP of right eye =12
Treatment:
• Tropicamide- attempt to dilate pupil (pressure reduced from 65 down to 25),
• Dexamethasone 0.1% topical q4
• Methadone 0.2mg/kg IV q4-6
• Atropine used to try and further dilate the pupil to allow posterior movement of the
lens. This was not successful
Outcome: Hospitalised overnight in order to monitor IOP and administer medication.
Within 24 hours the anterior luxated lens resolved and moved back into posterior
chamber. Pilocarpine 1% applied to left eye Q8hrs to keep pupil constricted now that
lens has moved into posterior chamber.
23. Jugular Transection
Signalment: 10yo, female entire, Jack Russell Terrier
Presenting Problem: Dog attack, severed right jugular vein that bled profusely.
Clinical Examination:
• HR 114, RR 20, temp 36.7°C decreasing rapidly, MMs pale pink, CRT 2s, weak pulses
• Right jugular vein exposed and oozing blood
• Obtunded and recumbent
• 2cm laceration to right jugular groove, 2cm laceration (full thickness skin, not
extending beyond) and a puncture to dorsal neck and a small puncture
lateroventral to L eye
Stabilisation:
• IV catheter placed in left saphenous vein, methadone 1mg IV. A 100ml, 200ml and a
final 100ml bolus of LRS were administered over the first hour of treatment - raising
blood pressure (MAP) to the mid 50's. This period extended into the surgical period.
• Blood transfusion: 86ml of packed RBC's (Positive, not cross-matched) given with 0.9%
NaCl over 2 hours. First 25ml given in 15 minutes, second given over 30 minutes
Investigations and Results:
• Blood Pressure- MAP 66 rapidly falling to 30’s
• PCV/TS: 14/30
• Blood gas: pH 7.022, pCO2 54.6, SBE -15.5, Lactate 9.6, Glucose 7.6
• Electrolytes: Na 147, K 3.5, Cl 120, Ca 1.29
24. Treatment:
• Anaesthesia induced with 10mg alfaxalone and a size 6 ET tube placed. Maintained on
isoflurane
• Cranial end of R jugular vein identified and isolated and ligated with 4x 2/0 monoplus
ligatures
• Caudal end could not be located but no obvious haemorrhage
• Loose material debrided away
• Penrose drain placed
• Surgical site was flushed with 250ml 0.9% saline
• Ticarcillin
• Pantoprazole
• IVFT with Hartmann’s supplemented with KCl 30mmol/L
Outcome: Transferred to General Practice for continued monitoring and supportive care.
