Dogs and Cat 27 Flashcards
1
Q
Clinical signs of separation anxiety what are the main ones and 4 tips about identifying these patients
A
- Anorexia
- Housing soiling
○ Cats with mark and spray
○ Need to consider if owners issue? Can they actually soil? - Destructive
- Salivation/vomiting
- Vocalization
○ Generally occurs as a noise complaint
Clinical Signs-Tips to Remember
1. Signs will start before departure in most cases.
2. Signs usually occur within 20 minutes of owner departure.
3. Owners can gather a LOT of information via a webcam/ recording of their pet after their departure usually first 30 minutes.
4. The ‘Velcro’ dog - won’t let you go
5. nervous, excitable behavior in the consult room for over an hour
2
Q
What are some important history points that are important in behaviour consult
A
1) how many other pets - are there any issues with them
2) schedule - has this changed recently - new job, working more etc
3) have they had obedience training and are they crate trained - important with safe space
4) are there irritating behaviors occurring - breaks down the bone between owner and dog
5) any destructive behaviors - indicates separation anxiety
3
Q
When presented with a case that looks like separation anxiety what is the first step
A
Prerequisites- Veterinary w/up!!!
- Complete a full PE
- Further tests- bloods-haemogram and biochemistry, U/A, BP, C &S and possibly more may be required
- Neurological exam
- Species specific? - pain response - German shepherd may be able to radiograph elbows and hip
4
Q
What are the 10 main signs of separation anxiety
A
- Destruction
- Defecation
- Urination
- Loud disruptive vocalisation
- Licking and dermatological lesions
- Salivation/saliva straining
- Salivation without saliva straining
- Soft non disruptive vocalization
- Transient anorexia/pacing
- Withdrawal/freezing
5
Q
What is separation anxiety
A
- Separation= absent from owners OR able to hear / see owners however no access to them
- Anxiety= anticipation of a danger or threat to the individual. The threat may be real or imagined…feeling insecure/ unsafe.
6
Q
What are the 3 main areas behaviour is influences by and therefore target with treatment
A
- Genetics- Some animals are born with a mental disease. Statistically possibly 1 in 8 animals.
- Environment- some environments may predispose more than others to particular diseases.
- Learning- Learning starts from 2 weeks of age and continues through life.
○ Particularly between 8 and 16 weeks of age
7
Q
Behaviour modification in the treatment of separation anxiety
A
○ Create a Safe Space in the home-
§ Crates already exist- utilize them (Mat/crate)
§ Training in owners presence first
○ Short departures may be accepted
○ Lying down/ calm –always reward quietly
§ Also can do when they largely exhale
○ ‘Look-Sit-Stay’-relaxation program training, allows for longer periods of time away-Ajax stays longer on mat.
§ Get them into cognition zone
○ Decouple departure cues? - DOESN’T WORK
○ Never punish Ajax Punishment….
§ Increases anxiety
§ Impedes learning
§ Damages human bond
§ Welfare Concerns
§ Difficult to perform properly
§ Must be effective after 2-3 attempts- if not this becomes abuse!!!
8
Q
Environmental modification in the treatment of separation anxiety
A
1) Crate training/ mat training to encourage a safe space
§ Reduce visual triggers which include windows access in Ajax’s case.
§ Choose a quiet area
§ Corner space best
§ ‘All good things happen in the crate!’
□ Progression ->
§ NOT MORE THAN ONE DOG WITHIN
2) Dog appeasing pheromone (adaptil)
§ Collar (dog aggressive animals), spray (acute - vet visits, in the car, create - only 2-3 hours), diffuser (have to leave on) -> safe space
§ DAP/Adaptil do’s and don’ts
□ Diffuser- have switched on 24 hours for 2-3 months
□ Low to ground/ accessible- dog can lie down
□ Avoid plugging device under/ behind furniture
□ Spray- great for the ‘safe space’ or car trips
□ Collar- great for outside/ walks.
□ Collar- remove when swimming or bathing
9
Q
Medication in the treatment of separation anxiety is it needed, how effective, why used and the main one used
A
○ Is Necessary- damage to property and potentially to animals.
○ Patient improves 4 x faster in combination w Bmods than Bmods alone.
○ Anxiety& Separation
§ Anxiety is a true mental disorder of the brain. As vets we can offer treatment.
§ If your dog had diabetes would give it insulin?
○ Medication will reduce anxiety or arousal
○ Types
§ SSRI - Fluoxetine was implemented at 0.5mg/kg SID - STARTING DOSE
□ Prozac®/ Lovan®/Zactin® 20mg tablets from human pharmacy/ supplier.
□ effects serotonin metabolism and post synaptic receptors on the neuron
® Increase amounts of receptors for serotonin as well as increase amount of serotonin
10
Q
In terms of medication for separation anxiety what is the main one, when does effect start and what else may need to be used in some situations and why
A
1) Fluoxetine (SSRI) 4-8 weeks initial effect
- Requires at least 12 weeks to assess - FOR receptor to grow
- Maintain minimum 6 months-12 months
- Side Effects seen: - usually transient
○ Minimal- lethargy 3-4 days, reduced appetite
○ Soft stools 1-2 days.
○ Can we wait for 4 weeks ???
- Immediate medical attention required - CANNOT WAIT 12 WEEKS
2) Trazodone-SARI (serotonin antagonist and reuptake inhibition) was initiated at 3mg/kg once a day prior to Fluoxetine (check side effects)
§ Get tolerance - more give the more needed
○ Available via compounding pharmacy
11
Q
Monitoring of separation anxiety patients and medication
A
6 weeks - clinical signs - web cam seeing eating food or playing with toys while gone - good sign
every 12 months - blood work performed to ensure liver and kidney can handle the medication
Medication
- may need to be lifelong or could possibly wean off (some dogs keep the new receptors that is made from medication)
12
Q
What are 3 other medications that can use in separation anxiety cases and when use
A
- TCA’s- Clomipramine, Amitriptyline.
○ Useful for cases with additional compulsive disorders or neuropathic pain. - Anxiolytics-used in combination with
○ TCA’s/SSRI’s
○ Benzodiazepines-Alprazolam, Diazepam, Clonazepam- best used prior to departure - Clonidine- Noradrenergic blocker.
○ By blocking Noradrenergic stimulation in the brain, we reduce hyper-aroused states.
○ Dose rate 0.01-0.05mg/kg prn / bid.
§ need to give
○ Usually effective one hour pre required effect.
○ Side effects- mild sedation & lethargy, can reduce BP.
13
Q
define fear and phobia - what is the difference
A
- Fear- Normal response to a threatening stimulus
○ Protects
○ Important for survival - Phobia- A maladaptive fear response that is out of proportion to the stimulus / threat.
○ May endanger the animal
○ May endanger others
○ May generalize to other issues
○ May cause long term generalized anxiety
14
Q
What are the 2 main phobic behaviours
A
- Noise phobia- most commonly presented ○ Thunderstorms ○ Fireworks ○ Grand Prix Airshows - Contextual phobia ○ Veterinary Clinics!!! ○ Vet phobia ○ Car phobia ○ Men/ Men wearing hats
15
Q
noise phobia what can also have, what drug can predipose, when start and causes and what to do
A
- Dogs with noise phobia have a high probability of also having separation anxiety
- Administration of C/S (corticosteroids) is associated with increased reactivity to thunderstorms and noises
- Can start suddenly even over 6 years of age
- Strongly influenced by genetics- inherited fear responses
- Fears may generalize- noise to clouds, wind etc.
- Change in approach- soothe them don’t ignore them!
16
Q
What are some common clinical signs of phobic behaviours
A
- Panting
- Salivation
- Shaking
- Cowering
- Seeking out the owner -> 207% increase cortisol
- Restlessness
- Hypervigilance
- Vocalizing/ whining
17
Q
Treating noise phobia principles
A
- Get the animal away from the source of noise as best as possible. Bring your dog inside!!!
- Give your animal support and calm your dog by allowing him/ her to feel safe. Do not ignore the animal.
- DAP (dog appeasing pheromone) may be of use
- Thunder shirt may be of use
- Calming Cap may be helpful
18
Q
What has historically been used for medication for phobia and the 3 common ones used now
A
- Historically - ACP - NOT USED NOW, animals become more noise reactive
1) Anxiolytics - BZ
2) trazodone - SARI
Medications work best when used in combination with behaviour modification
3) zylkene - hit and miss
19
Q
BZ use in phobic animals what does it do, when give, what animals avoid in, positives and negatives and side effects
A
○ The BZ group are useful at treating intense situational anxieties
○ Short acting –if home, LA if away.
○ Best when administered before the noise event.
○ LA medications usually take a little longer to work/ take effect.
○ Amnesiac
○ Avoid with aggressive animals
○ Be aware of the side effects
§ Dysphoria -> NEED TO GIVE BIGGER DOSE - knock them cold better
§ Paradoxical effect of BZ’s
○ May require higher dose
○ Care in cats
○ Addictive substance
○ Not for long term use if frequent episodes
○ Can be used in combination with SSRI/TCA
20
Q
Trazodone use in phobic animals what is it, why used and dose effect seen in
A
○ SARI (serotonin antagonist and reuptake inhibition) very useful past few years and superseding the BZ’s due to fewer side effects.
○ From compounding Pharmacy
○ Off label
○ Usually see effect @ 2-3mg/kg
21
Q
Behaviour modification in phobic animals what does and doesn’t work
A
DON’T DO
- systemic desensitization - causes flooding, difficult to implement, required 15min for 30-60 days
- counter conditioning - impossible to implement and no appetite when stressed
- NEVER punish these animals - being phobic is feeling out of control
DO DO
- INSTEAD -> want to change response to stimulus from anxious to happy
○ Give high value treat every-time the noise happens, irrespective of the dog behaviour
○ Can be tricky
1. Create a safe space - crate/mat where the dog retreats to
2. DAP (dog appeasing pheromone)
3. Thunder shirt
22
Q
Euthanasia what need to consider
A
- Barbiturate usually most appropriate ○ Prior sedation? ○ Catheter? ○ Owner present? ○ At home or in clinic? § At home -> different behaviour ○ Disposal of body? ○ Payment? § Before or after
23
Q
What are the 5 main types of acquirement of immunity
A
- Passive
- Maternal
- Live / modified live = infectious
- Killed / inactivated = non-infectious
- Recombinant – nucleic acids, recombinant
24
Q
Passive immunisation what does it involve, examples and how common
A
- Administration of exogenous antibodies in serum or immunoglobulins against infectious agents
- E.g. in failure to colostral transfer (large animals)
- E.g. antisera in Parvo virus, (rarely done, EBM against it)
- Need a strong source
- Risk of transfusion reactions (serum)
- Not common in small animals
25
Maternal immunity and vaccination what is involved and what is important to consider, how does this influence vaccines
- Neonate protected for 6-16 weeks by passive transfer of immunoglobulins
- These antibodies have a variable half-life, specific for each disease
- Maternal antibodies can interfere with vaccination for first 8-12 weeks in most dogs
○ Which is why vaccinate at multiple time points -> unsure when maternal antibodies decline and at risk of disease
- Unpredictable degree of passive transfer in each individual
○ High MDA -> protected, can’t respond to vaccine till ≥ 12 weeks
○ Low MDA -> at risk, able to respond to vaccine earlier
26
Live or modified live (MLV)/attenuated vaccines what does it involve. example with pros and cons
- Produced by serial passage in tissue culture or unusual host passage
- Must replicate in host to stimulate immune response
- SC, intranasal (kennel cough - rapid and local - good for disease outbreak)
Pros
- Give good CMI and humoral response
○ Rapid, long duration
- Low antigenic mass required
- One dose generally required
- Cheap
- Almost never cause local reactions
Cons
- Risk for biological contamination - manufactory issue
- Easily inactivated by heat, chemicals - handling and storage is important
- Low risk but can revert to virulence (esp. immunosuppressed patient, pregnancy)
- Might insert into host genome
- Can cause immunosuppression (mild)
- Not possible in every patient
- Intranasal: sneezing
27
Non-infectious vaccines = killed or inactivated what is it, pros and cons - COMPARE WITH LIVE
- Inactivated, cannot revert to virulence
- Whole or subunit (part)
- No host replication required, can’t revert to virulence
- Contain adjuvants (local reactions / hypersensitivities)
- Often require two doses (slower / shorter duration of immunity unless adjuvant)
- Good choice in pregnant animals
- Rarely immunosuppressive
28
Recombinant vaccines how developed, what require and examples
- Develop by genetic engineering
- Produce in E.coli, yeast or insect cell lines
- Similar in efficacy to killed vaccines
- Require adjuvants
- Free of problems of insertion into the host genome or containing unwanted antigens.
- An example is the Leukogen® vaccine
29
What are some causes of vaccine failure and the most common ones - EXAM
- Interference of Maternal antibody in neonates*
○ Most common reason in neonates
- Poor handling or administration* (most common)
- Inactivation by temperature extremes, (MLV especially)
- Inactivation by chemicals - don't chemically alcohol swab the area
- Improper re-constitution of the vaccine
- Protective immune response not stimulated : CM vs. humoral
- Unable to respond due to immunosuppression fever, hypothermia, medications - avoid at this point
- Failure to complete initial vaccine course* (common)
- Exposure to highly virulent field strain
- Overwhelming pathogen exposure
- Incubating disease at time of vaccination
- Immunity waned
- Vaccine caused disease
- Manufacture failure (rare)
- Poor responder
30
What are some ways to avoid vaccine failure and the main ones
- Follow manufacturer’s temperature, dose, route and frequency recommendations
- UV protection
- Mix and use immediately (common)
- Don’t mix incompatible vaccines or give at same site drained by same LN (common)
- Don’t use chemically sterilized syringes, or local disinfectants (alcohol)
- Mix well if multidose vial
- Discard expired vaccines
- Avoid using in hypo/hyperthermia (common)
- Avoid anesthetized patients - HARDER TO RECOGNISE IF HAVE A NEGATIVE REACTION
○ Potentially immunosuppressed
- Care immune mediated disease (?EBM for this)
- Care pregnancy - AVOID LIVE VIRAL (common)
- Care patient with chronic disease / immunosuppression
31
What is the dose of vaccines
- Dosed as minimum immunizing dose
- Not as mg/mg or mg/m2 ect..'
- ALL GET THE SAME DOSE
32
Post-vaccinal complications and how common
- Hypersensitivity (Common with Bordetella vaccines)
- Clinical disease (rare) – MLV FCV (feline caliciviral), MLV FPV (feline parvovirus) < 6weeks, CDV
- Local reactions
- Systemic reactions
- Contamination, multidose (rare)
- Focal Granulomatous reactions
33
Modified live vaccine FPV what occurs when vaccinate the bitch/queen
Cerebellar hypoplasia
| - Shaking, tremors of kittens - can get better with age but will never be normal
34
What are the 5 main vaccine related diseases and how common
WEAK LINKS
1. Hypertrophic osteodystrophy?
2. Juvenile pyoderma?
3. Immune suppression (other disease?)
4. Autoimmunity, IMHA, IMTP and SLE?
5. Feline Injection Site Sarcoma - common one
35
Feline injection site sarcoma (FISS) what associated with, due to, site, diagnosis and prevention
- Association with Rabies and FeLV vaccines
- Possibly chronic inflammation due to Aluminum adjuvants causes malignant transformation
- Site (Shoulder blades) may also be an issue
○ Difficult to get margins on
- Frequency 1 in every 5,000 to 12,500 cats vaccinated - RARE
- Requires incisional biopsy for diagnosis
- Biopsy if
○ Mass present > 3 months post vaccination
○ Mass > 2 cm
○ Mass progressing after 4 weeks
- Benefits vaccine >> FISS
- Prevention
○ Use non-adjuvanted vaccines when possible
○ Avoid interscapular injections
○ Use other SC sites
§ Consider ease of Sx removal VS. operator safety
○ Vaccine at different sites, and record location
- Report FISS cases, national / manufacturer
36
What are the 4 main CORE dog vaccines and when give (regime)
1. Canine Distemper Virus (CDV)
2. Canine Adenovirus (CAV types 1 & 2)
3. Canine Parvovirus type 2 (CPV-2 and variants)
4. Rabies (if endemic) – killed vaccines with 3 year DOI (or repeat at 1 year if defined by local law)
When give
○ Puppy: (MLV (modified live vaccine), parenteral)
§ Core at 6-8 weeks of age
§ Then every 3-4 (2) weeks until 16 weeks of age or older
§ “Booster” at 6-12 months of age (or 26 weeks of age)
§ Then core every 3 (to 4) years - when used MLV
○ If dog > 16 weeks of age, single MLV, then every 3 years
37
What are the 2 non-CORE dog vaccines, when/how to give
(locally recommended) - low geographical risk
- Two main ones (makes up C5)
○ Bordetalla bronchiseptica
§ Life avirulent BB, intra-nasal
○ Parainfluenza
§ MLV CPiV
- When give/how give
○ Single intra-nasal dose from 3 weeks
○ Annual booster (or more often if high risk)
○ Both intra-nasal Greater local protection, more rapid
Or live avirulent BB PO – single dose from 8 weeks
- can also give parenteral - if aggressive
38
Seology testing in dogs to figure out when to vaccinate when would you use and why wouldn't you
```
- An alternative to 3-yearly boosters (CDV, CAV, CPV-2)
○ Non-core annual booster
- In-house test kits
- Validated
- More expensive than vaccination
○ Negative -> repeat vaccination
○ Positive -> vaccination not required
- Should we use serology?
○ After puppy vaccines
§ If clients really want to know if need to vaccinate
○ Shelters, infectious disease outbreaks
```
39
What are the 3 main CORE for cats and duration of immunity
1. Feline Panleukopenia (FPV) - long duration of immunity
2. Feline Herpes Virus – 1 (FHV-1) - short duration of immunity
3. Feline Calici Virus (FCV) - short duration of immunity
40
What are the 2 non-core cat vaccines, when would you give, regime and protection
- Feline Leukaemia Virus (FeLV) - social disease
○ Depends on lifestyle, local prevalence
○ Given twice 2-4 weeks apart, from 8 weeks of age, then annual boosters
○ Only if FeLV negative
- Feline Immunodeficiency Virus (FIV) - fighting prevalence
○ Depends on lifestyle, local prevalence
○ Given three times 2-4 weeks apart, then every year, from 8 weeks of age, then annual boosters
○ Variable protection - not all subtypes but best protection without keeping cats inside
○ Will result in Ab positive, and can interfere with FIV diagnosis
○ Only if FIV Ab negative prior to use
41
Cat vaccines when give as kitten, if first vaccine >16 weeks and booster
```
- Kitten
○ Core at 6-8 weeks of age, then every 2-4 weeks until 16 weeks or older
○ “First Booster at 6-12 months of age
- First vaccine > 16 week
○ Single MLV (modified live) FPV protective
○ 2 FHV-1/FCV doses 2-4 weeks apart
- Then Booster
○ High risk every year
○ Low risk every 3 years
```
42
Cat serology testing for vaccines, which done on, which correlate well and which don't
- In house Serology testing (FPV, FCV, FHV-1)
- Validated
- FPV antibodies correlate well with disease risk
○ Positive result -> Protected, vaccination not required
○ Negative result -> At risk, vaccination required
- Can help assess need for FPV booster, access vaccine success, role in disease outbreaks in shelters
- Same not true with FCV, FHV-1 - doesn't correlate well
○ Such testing for FCV and FHV-1 not recommended
43
What documentation is needed after a vaccination
- Record date (and when next due)
- Your name
- Vaccine name
- Lot / serial number
- Expiry date
- Manufacturer
- Site & route of administration - important for feline
- Informed consent
- Record adverse events – alerts for future visits
44
What are the 4 main questions to ask over the phone for a toxicity case
1) what is the possible poison
2) how long ago did it happen
3) what is the pet doing now
4) is there risk to people
45
Telephone advice for a toxicity case
- Make the situation safe
- Reduce further absorption of poison if possible
○ If contact wash the animal
- Bring animal to vet ASAP
- Bring packet/label of poison with animal
- Vomitus sample If appropriate
- Exercise care when advising emesis at home
- Use milk for corrosive ingestions
○ Protein - casein binds to areas of deficits
○ Only use acutely - only good for mouth and oesophagus not once in stomach
- Seizures - AVOID the mouth
46
What are the 6 general principles of toxicities
1. Establish vital signs
2. History and evaluation
3. Stop ongoing absorption
4. Give antidote if available
5. Increase toxin clearance
6. Supportive care - KEY TO MOST PATIENTS
47
Step 1 of toxicities stabilise 2 main steps, what is needed and what is seizuring patient
1) Physical exam - major body systems assessment
- Respiratory
- Cardiovascular
- Gastrointestinal
- Neurological
- Pupils
- Temperature
2) Stabilise vital signs
- Maintain respiration
○ Oxygen +/- intubation
○ PPV
- Maintain circulation
○ IV fluid, pressors
- Control CNS excitement
○ Seizing patient
§ Diazepam 0.5-1mg/kg - short effect
§ Midazolam 0.2-0.5 mg/kg - slightly longer effect
§ Levetiracetum 20-40mg/kg
○ If continuing to seizure
§ Propofol
§ Methocarbamol (muscle relaxants)
§ Guaifenesin (muscle relaxants)
- Control body temperature
48
In terms of history and evaluation of patient for toxicity what is involved - 3 things
1) history
2) physical exam
3) laboratory tests
49
In terms of history for toxin patient what need to ask
- When was the patient last seen normal?
- When was the last meal?
- Toxin access?
○ What is in garage - rat or snail bait
○ What is in the cupboard
- How long seizuring?
○ Is cerebral oedema an issue
- Rapidity of onset?
- Any changes at home (eg builders)?
- Owner exposure?
50
In terms of laboratory data during toxin case what initially get, and subsequent analysis with other testing
- INITIAL LAB TESTS:
○ PCV / TP
○ Glucose & Calcium (for an seizing animal)
○ Electrolytes
○ Urine
- COLLECT SAMPLES FOR SUBSEQUENT ANALYSIS
○ EDTA
○ Plasma/serum
○ Fluoro-oxalate
○ Citrate
○ URINE
- Other tests
○ Clotting tests - PT, APTT, activated clotting time (if don't have the others - LESS SENSITIVE (need to lose 80-85% of clotting factors to detect)
Urine toxicity screening - available at the chemist
- Detects presence of stimulants and /or sedatives but not quantity.
- Cocaine, Amphetamines, Barbituates, Benzodiazipines, Opioids, Cannibinoids (can give false negative), Methadone
51
What are the 5 main ways to prevent absorption during toxin case
a. Emesis
b. Gastric lavage
c. Enema
d. Cathartics and adsorbents
e. Washing skin or eyes
52
Emesis during toxin case what information can it give, when need to do it and when cannot perform
- Can be diagnostic - vomit up something the owners didn't give to dog - know it has gotten into something
- Within 3-4 hours of ingestion - depends on absorption time of the drugs as well
○ Most designed to be absorbed within an hour
○ CHOCOLATE - up to 8 hours can slow transit time and slow absorption
- Only if animal stable and ambulatory
○ DON'T WANT ASPIRATION PNEUMONIA
- Not if poison is corrosive or volatile
○ Zinc sulphide (farmers for mice - RARE) -> gas they let off when vomit can poison
○ Petrol -> if inhale cause damage to the lung
53
Emesis during toxin case how to perform (3 different options) and which species for each
○ Washing soda - NaCO3 - CATS first option
○ Apomorphine - tablet or injectable solution (subconjunctiva of the eye) - DOGS
§ Doesn't work as well in cats
○ Xylazine - CATS next option
§ Side effects - sedation
54
Gastric lavage during toxin case time frame, what requires and how to perform
- Best within 1-2 hours of ingestion
- Requires general anaesthetic
- Cuffed ET tube essential
- Two tube method works best - use warm water
○ One for flow in and one for flow out
- Until fluid runs clear then flip and do the same on the other side
- Can take an hour to perform
- Generally done with an enema
55
Enema during toxin case what to use, beware of, how often and what information can get
- Warm water best
- Beware of phosphate solutions
- Often need to repeat - allow the movement of food from proximal to distal
○ Every 3-4 hours
- Can be diagnostic
○ Identify plant material from the faecal contents
56
Cathartics and adsorbents what does each do, main one used
```
Cathartics
- Speed up GIT emptying
- Useful for solid poisons
- Use with activated charcoal generally
- Sorbitol 0.5g/kg PO
Adsorbents
- Activated charcoal (can get a combination with sorbitol)
○ Predisposes to vomiting
- 1-4g/kg q4-6
○ One dose enough?
- Kaolin
```
57
Topical exposure how to reduce toxin exposure
- Wash with a mild detergent
- Consider clipping
- Beware of hypothermia
- Beware of human exposure
58
In terms of supportive care what are the 3 main things could do
1) increase toxin clearnace via maintaining renal perfusion
2) medication - protectants, anti-emetics, anaglesics
3) Intravenous lipid emulsion
59
how to maintain renal perfusion during toxin case
- IV fluids
- Urinary catheter
- Monitor urine output
- Monitor urea , creatinine, electrolytes, PCV and TP
60
What medications needed for supportive care for toxin case
```
○ Gastrointestinal protectants - depends on case
§ Sucralfate - most common
§ Ranitidine
§ Omeprazole/pantoprazole
§ Misoprostol - NSAID toxicity
○ Antiemetics
§ Metoclopramide
§ Maropitant
○ Analgesics
```
61
Intravenous lipid emulsion what is it, indications and mechanism of action
- What is it?
○ Intralipid 20%
○ Soybean oil-based emulsion of long-chain triglycerides
- Indications
○ Local anaesthetic and other lipophilic drug toxicoses
§ Bupivicaine, lidocaine, propanolol, moxidectin, thiopentone
- Mechanism of action
○ Lipid sink effect
§ Lipid emulsion provides separate plasma compartment for lipophilic agents to partition into
□ Results in less free drug available to the tissues
62
dosing protocols for the intravenous lipid emulsion how need to give
○ 20% lipid formulation
○ Peripheral or central catheter
○ Strict asepsis- VERY IMPORTANT - bacteria love this stuff
○ Store unused portion in fridge (2-8°C), discard after 24h
63
When would you use intravenous lipid emulsion, what needs to be done first and potential adverse effects (main ones)
- Traditional therapy (over ILE) recommended if an effective therapy or antidote already exists (e.g. pyrethrin toxicity in cats)
- Important to maximise tissue perfusion and oxygenation before administration of ILE
○ ILE increases FFA concentration, may have negative inotropic effects, may induce cardiac arrhythmias in hypoxic myocardium
Potential adverse effects
a. Contamination
b. direct reaction - anaphylaxis
c. fluid overload
d. interference with laboratory tests
64
Ivermectin toxicity when generally occur, mechanism of action and clinical signs
- Chewed up container of ivermectin horse wormer found in backyard
- Binds chloride channels in the CNS, leads to influx of chloride ions, results in hyperpolarisation of the neuron
- Clinical signs: disorientation, ataxia, hyperaesthesia, hypersalivation, vocalisation, recumbency and coma
65
What is a possible additional treatment option for ivermectin toxicity and when wouldn't you use it
- Intralipid IV as per recommendations (doesn't work if collie)
P-glycoprotein (missing in collies)
- Expressed in the mammalian blood brain barrier (BBB)
- Functions as an efflux pump, prevents accumulation of high concentrations of macrolides in the brain tissue
66
CASE - Cat
- Permethrin dog flea treatment applied
- Severe muscle tremors 2-3h later, poorly responsive to diazepam
What treatment
- IV fluids at 2x maint, methocarbamol IV
| - IV intralipid as per recommendations (for 2h) followed by single dose of guaiphenesin IV
67
- Owner found chewed packet of 15mg meloxicam containing 7 tablets (human medication) on arrival home 3 hours ago
is that toxic dose? what treatment
- Up to 8mg/kg
- Yes!!
- IV fluids
- GIT protectants including misoprostal
- Activated charcoal only if takes in food
68
Pediatric what considered that and dietary need
○ Up to 6 months (small breed dogs)
○ Up to 12 months (large breed dogs)
○ Increased need for protein, energy, vitamins and minerals
○ No Ca supplementation if balanced diet! Needs Phosphorous
69
growth of small breed dogs (<10kg) how occurs and how relates with diet
○ Multiply birth weight by 20 times
○ Reach half adult weight at 3 months of age
○ Complete growth by 10 months
○ Short and intense growth phase - growth requirements at this point
70
large breed dogs (>25kg) growth period
○ Multiply birth weight by 70 times
○ Reach half adult weight at 5-6 months
○ Growth period may last up to 2 years (may be on puppy food for 2 months)
71
Maximum daily weight gain when reached, and sec reached fastest
○ Reached at about 3-4 months large breed and 5-6 months in giant breeds
§ Greater risk period of problems associated with growth
○ Small and medium dogs greatest increase in post weaning period
- Females reach maximum weight earlier than males
○ Especially large and giant breeds
72
cats and diet what is important to remember
Rarely get orthopaedic issues associated with growth
- Less breed variability in size
- Growth is mainly finished by 10 months of age
- Cats have specific nutritional requirements
- > Need following - OBLIGATE CARNIVORE - different to dogs
- Vitamin A, D
- Niacin (B3) and Pyridoxine (B6)
73
what diets/requirements needed for adult, senior, pregnancy and lactation
- Adults- well balanced
- Senior requirements:
○ > 7 yo????
○ Reduced protein, phosphorous, energy and sodium
○ Easier to prehend and chew
- Pregnancy
○ No increased requirement first 2/3 - increasing will actually make this worse
○ Moderate increase last 1/3
○ Calcium?
- Lactation
○ Greatest demand on energy
○ Requires 3-4 times maintenance
74
Metabolisable energy what is it and equation for dogs
```
- Amount required for body’s metabolism or Resting Energy Requirement (RER) ONLY
○ Done in hospital if not eating
- Dogs:
= 30 (BW) + 70 kcal/day OR
= 132 x BW^0.75 - more accurate
```
75
RER what equations for cats
- Less variation in body size/shape amongst breeds
- Cats: RER
= 100 x BW0.67 (lean)
= 130 x BW0.40 (overweight)
= 80 x BW (active) OR
= 70 x BW (inactive)
- Lactating queen = 5 x RER (or ad lib)
76
Daily energy requirement (DER) how to determine, examples and what need to be considerate of
```
DER = RER x conversion factor
DOGS
- Average desexed adult x1.6
- Geriatric x 1.4
- Obese prone x 1.4
- Weight loss x 1
- Gestation x 2-3
- Lactation ad lib
- Growth x 3-2
- Work x 2-8
CATS
- Average desexed adult x1.2
- Geriatric x 1.1
- Obese prone x 1
- Weight loss x 0.8
- Gestation x 1.5-2
- Lactation ad lib
- Growth x 2.5
In hospital interventional feeding no factor needed!
THESE ARE ESTIMATES - can be out 25% -> NEED TO FOLLOW UP - monitor weights and adjustment
```
77
What are the 3 main ways to assess nutritional qualities of food, how done and which is best - EXAM
1. As fed comparison
- Caution:
- Still need to quantify to be useful
2. On a dry matter (DM) basis
- Calculate the %age of a nutrient on a DM basis by:
- dividing the nutrient % on as fed basis by % dry matter (x 100)
3. Nutrients per kcal (metabolisable energy = ME) - BEST
- Use the amount ME/100 grams to calculate the amount food (in grams) that gives 100 kcal
- Then calculate the amount of nutrient per 100 kcal ME
78
- Does a 7.5% protein (20%DM) tinned diet deliver less or more protein than a 23% protein dry food (92%DM) to the pet?
○ 7.5/20 x 100 = 37.5% DM basis of tinned food
○ 23/92 x 100 = 25% protein on DM basis
- Recommended protein levels for adult dogs is 15-30% on DM basis - dry IS BEST
79
Dry food - 23% protein, 100 gram gives 370.5kcalME how to determine amount of metbaolisable energy per 100kcalME
```
○ How much food gives 100 kcal?
§ 100/370.5 x 100 = 27 grams
○ How much protein (gm) per 100 kcal?
○ % nutrient (23% protein) x amount food for 100 kcal (27)
= 6.21 grams
```
80
Define overweight and obesity
```
- Overweight
○ Exceeding optimal BW by 10-20%
○ Body condition score (BCS) (6)7/9
- Obesity
○ Exceeding optimal BW by >20%
○ Body Condition Score (BCS) (7)8/9
```
81
Cats how to determine whether overweight and risk factors
Body condition score
- 1-9 - 5 is ideal - Step up and down is difference of 10% in BW
5 - well proportioned, observe waist behind ribs, ribs palpable with slight fat covering, abdominal fat pad minimal
- Also should look at muscle mass - normal, mild muscle loss, moderate and severe muscle loss
Risk factors
- Age up to 10 years
- Domestic breeds
- Desexed cats
- Males
- Rural / semi-rural cats
82
Dogs how to determine whether overweight and risk factors
```
Body condition score, 1-9 - 4,5 ideal
- Also should look at muscle mass - normal, mild, moderate or severe loss
Risk Factors
- Overeating
- Reduced exercise
- Breeds?
- Beagles, Cockers, Goldens, Labs
- Female, neutered
- ↑ Age
- Drugs – pred, phenobarb
- Diseases – hypothyroidism, hyperA
```
83
Hypothyroidism how common, main cause and clinical signs (common and less common)
```
- Most common endocrinopathy in dogs? - MOST OVERDIAGNOSED (false positives)
Causes
- Congenital
- Acquired
○ Immune-mediated - most common (thyroid gland)
§ Breed predispositions
○ Atrophy
Clinical signs
- Most common:
○ Lethargy
○ Weight gain
○ Heat-seeking
○ Alopecia with thickened skin
○ Pyoderma
- Less common
○ Corneal lipid accumulation
○ Neurological deficits (peripheral)
○ Pancreatitis
○ Decreased cardiac function
○ Myxoedema coma
```
84
Hypothyroidism Diagnosis what are the things need to consider and 2 main types of tests to run
- Only test if you’re fairly sure the dog could have hypothyroidism - DON'T GO FISHING WILL GET FALSE POSITIVES
- Don’t test when the dog is unwell or receiving specific drugs-
○ Not an emergency diagnosis - if really sick - SOMETHING ELSE GOING ON
○ Non thyroidal illness = “Euthyroid sick syndrome”
1. Perform basic haematology and biochemistry
- Look for other diseases
- Supportive evidence includes:
○ Mild, normocytic, normochromic non-regenerative anaemia
○ High cholesterol
2. Perform thyroid function testing
- Options:
○ Total T4
○ Free T4 by dialysis
○ TSH
○ Thyroid panel
85
In terms of performing thyroid function testing what should you do
Start with cheapest and easiest
- Total T4
○ If normal, dog probably doesn’t have hypothyroidism - DON'T DO ANYTHING ELSE
○ If low, it could be hypothyroid - need further testing
Then move on
- free T4 (equilibrium dialysis) and thyroid stimulating hormone (TSH)
Thyroid panel - need to send overseas - can just confuse you more
86
If still usure after performing thyroid function testing what other tests can you do for hypothyroid diagnosis and which is best
- Ultrasound
- Scintigraphy - main one use to CONFIRM
- TSH response test
- Thyroid biopsy
- Treatment trial - look brighter even without T4 -> are they really hypoT - delay finding the actual disease
87
What is the treatment for hypothyroidism, what is important to do
- Levothyroxine
○ 0.02 mg/kg bid (max dose 0.8 mg)
○ Or in to or giant breeds use 0.5 mg/m2
- Assess response in 2-4 weeks (remove from treatment to help confirm diagnosis before put on lifelong therapy)
- Once controlled, swap to once daily and test every 6 months
88
Weight loss program what are the 4 elements
1. Recognition and Acceptance - of the owner
○ How do you feel fluffy wait is? - wait 10 seconds
§ If say yes larger than I would like - AWESOME
○ Ideal weight -> back when 1 or 2 (giant breed) years old is ideal
2. Diet
○ What to feed?
○ How much to feed?
○ How to feed?
3. Activity level of the pet
4. Compliance
○ Owner’s commitment
○ Regular rechecks
○ Long term weight management
89
why is being overweight a bad thing and how to phrase to owners
```
- Obesity linked to worsening of: - INSTEAD SAY - as losing weight THIS STUFF WILL GET BETTER
○ Lameness
○ Diabetes
○ Respiratory disease
○ Non allergic skin disease
○ Urinary disease
○ Pancreatitis
○ Increased anaesthetic risk
○ Reproductive failure/difficulties
```
90
How much to feed what are the 3 steps
1) calculate actual caloric intake
2) work out the desired caloric intake
3) choose diet -> diet modification is usually necessary
91
in terms of determining how much to feed how to calculate actual caloric intake
```
○ Diet history is important
○ Type of food and how much
§ Size of cup / bowl
○ Other sources of food
§ Other pets
§ Outdoor access
§ Treats
○ How is the food fed?
○ Exercise?
○ Food diary kept by owner may help
```
92
work out the desired caloric intake how done to determine how much to feed
○ Base that on the DER using current weight and weight loss factor
○ Base it on the DER for the goal weight using obese prone factor (1.2)
93
What is an ideal weight loss diet and what do they often have
```
○ Ideal Weight Loss Diet will:
§ Decrease the caloric intake
§ Reduce body fat
§ Maintain lean body mass
§ Stimulate satiety
§ Provide balanced nutrition long-term
§ Therapeutic weight loss diets have modified levels of nutrients with reduced calories
□ Modifications include
® Low fat
® Increased fibre levels - larger stools
® Increased protein
® Low carbohydrate
```
94
Diet modification of protein what can it do and what to change to
to help promote loss of fat while maintaining lean body tissue
- Protein also promotes satiety - with high fibre increases
- Diet with high protein shown to lose more fat and less lean tissue in dogs and cats
- >30% of the calories from protein (dogs)
- >45% of the calories from protein (cats)
95
How often feed on a weight losing diet and what diet suggest and how works
How often feed
- Multiple small meals during the day rather than a single large meal
○ Helps reduce begging and increases satiety
- Hill’s metabolic diet
○ Ad lib - Increases energy metabolism and provides appetite regulation
96
What is a realistic goal for weight loss diet and what can severe caloric restriction result in
- Loss of 1% of initial body weight per week
○ Client owned studies have achieved (0.38-0.85%per week)
- Severe caloric restriction (<60% DER) can be
○ Detrimental to behaviour
○ Promote loss of lean muscle mass rather than fat
○ Predispose to rebound weight gain later
97
Treats and excercise with weight loss diets
Treats?
- Allow for treats BUT
○ Define the treats
○ Include in the caloric intake
○ Max 10% of the daily caloric intake as usually not complete and balanced
- Keep pets out of the kitchen and dining areas during preparation and consumption of family meals
- Always give treats from the pets bowl to avoid begging
Exercise
- Encourage owners to increase their pets activity level
○ Build up the amount of exercise progressively
98
How to improve compliance with weight loss programs
○ Clinic based follow up program
○ After weight achieved need to stay on a long term weight management program to avoid rebound weight gain
○ Calorie restricted diet still needs amount monitored as uncontrolled access to a low calorie food will not maintain ideal body weight
99
Prevention of overweight dogs
- Controlled calories and close monitoring of weight and BCS from weaning
○ Puppy consults
- Long term
○ Portion control
○ Activity level
○ Indoor pets esp cats should not be fed ad lib
