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Therapy Protocols for Acute Hemorrhagic Diarrhea Syndrome in a Dog

Britt Thevelein, DVM, DACVECC, University of Georgia

Internal Medicine

|September 2022|Peer Reviewed

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THE CASE

Rosie, a 4-year-old, 11-lb (5-kg) spayed Yorkshire terrier, is presented 12 hours after an episode of hematemesis followed by hemorrhagic diarrhea. She is hyporexic and increasingly lethargic. There is no known history of toxin exposure or dietary changes. Vaccinations, heartworm, and flea and tick preventives are current. 

On presentation, Rosie is dull, tachycardic (180 bpm), and tachypneic (80 breaths per minute) with weak femoral pulses, pale pink mucous membranes, and a prolonged capillary refill time of 3 seconds. She is estimated to be 7% dehydrated. Rectal temperature is 99.1°F (37.2°C), and frank blood is present on the thermometer. 

Physical examination findings suggest hypovolemic shock, and immediate stabilization measures are initiated. An IV catheter is placed, and a bolus of lactated Ringer’s solution (LRS; 400 mL/hour [20 mL/kg IV over 15 minutes]) is administered with a fluid pump. The remainder of the physical examination is unremarkable except for mild abdominal discomfort without distension. Cardiothoracic auscultation is normal. 

Abdominal radiograph and thoracic point-of-care ultrasound results are normal. Blood pressure measured via Doppler is 75 mm Hg. A blood gas and electrolyte panel reveal moderate metabolic acidosis with respiratory compensation and severe hyperlactatemia (Table 1). Packed cell volume (PCV) and total solids (TS) are 65% and 5.5 g/dL, respectively. Electrocardiogram reveals sinus tachycardia.

 

TABLE 1

SELECTED VALUES FROM THE BLOOD GAS & ELECTROLYTE PANEL

Value Result  Reference Interval
PCV (%) 65 37-55
TS (g/dL) 5.5 5.4-7.1
pH 7.25 7.36 ± 0.02
Partial pressure of carbon dioxide (mm Hg) 30 43 ± 3
Base deficit (mmol/L) -3 –1 ± 1
Bicarbonate (mmol/L) 16 23 ± 1
Lactate (mmol/L) 5.6 0.5-2
Potassium (mEq/L) 4.8  3.9-4.9
Sodium (mEq/L) 142 140-150
Chloride (mEq/L) 111 109-120
Glucose (mg/dL) 72 65-112
Values outside the reference interval are bold.

What are the next steps?

THE CHOICE IS YOURS …

CASE ROUTE 1

You suspect acute hemorrhagic diarrhea syndrome (AHDS), but the pet owner declines further diagnostics due to financial concerns and requests conservative treatment and supportive care.

CASE ROUTE 2

You suspect acute hemorrhagic diarrhea syndrome (AHDS) and pursue further diagnostics.

References

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

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