ObjectivesTo determine whether administration of intravenous hydrocortisone is a safe and effective alternative treatment in comparison to the traditional treatment with prednisolone/dexamethasone in dogs presenting with Addisonian crisis; and to assess if there is any advantage of the former over the latter in normalisation of electrolyte imbalances and in hospitalisation length in these dogs.MethodsMedical records of client-owned dogs with hypoadrenocorticism were retrospectively reviewed. Time until normalisation of sodium and potassium concentration, intravenous fluid needs over the first 24 h and hospitalisation length were compared between hydrocortisone and prednisolone/dexamethasone treated dogs.ResultsTwenty-five dogs met the inclusion criteria; 13 received hydrocortisone and 12 prednisolone/dexamethasone. Intravenous hydrocortisone was well-tolerated but failed to prove superiority in terms of time to normalisation of sodium and potassium concentration. Interestingly, potassium normalised in all dogs prior to discharge, but sodium did not in 1/11 hydrocortisone and 5/9 prednisolone/dexamethasone treated dogs with initial hyponatraemia (p = 0.05). Hydrocortisone treated dogs, however, had more electrolyte re-checks [hydrocortisone treated dogs, median (range): 4 (2–16); prednisolone/dexamethasone treated dogs: 2 (0–6); p = 0.001]. There was no difference in intravenous fluid needs over the first 24 h but hydrocortisone treated dogs had longer hospitalisation [hydrocortisone: 81 (45–309) h; prednisolone/dexamethasone: 52 (22–138) h; p = 0.01].Clinical SignificanceIntravenous hydrocortisone is well-tolerated and safe, but no clear additional benefit over traditional glucocorticoid replacement could be identified. Also, it might result in longer hospitalisation time and more intensive monitoring.
Induction of a hypocoagulable state is imperative in the treatment of feline arterial thromboembolism. Publications in human medicine report the use of enoxaparin intravenously in selected cases. The aim of our retrospective study was to report the regain of perfusion, short-term outcome, and complications of cats treated with a novel intravenous enoxaparin protocol (1 mg/kg bolus injection followed by 3 mg/kg/day continuous infusion) combined with oral clopidogrel administration. The secondary aim was to report the monitoring of enoxaparin with anti-Xa activity. There were 36 cats included. The probability of reaching limb reperfusion was significantly (p = 0.0148) higher with anti-Xa activity within or above the target range compared to results below the target range (19/21, 90% versus 11/20, 55%). The complications observed were acute kidney injury (15/36, 42%), hemorrhage (2/36, 6%), and neurological signs (6/36, 17%). The most common causes of death/euthanasia were cardiac instability, acute kidney injury, neurological abnormalities, and limb necrosis. The hospital discharge rate was 83% (10/12) for single limb and 29% (7/24) for dual limb thrombosis; the difference was significant (p = 0.0039). The median hospitalization time for the survivors was 119.5 (95–480) h. Our study supports the use of intravenous continuous rate infusion of enoxaparin in combination with oral clopidogrel for cats with aortic thromboembolism. We report similar discharge rates and lower hemorrhage rates than previously reported with thrombolytic treatment.
ZusammenfassungDie kanine Leishmaniose ist eine Infektionskrankheit, die zunehmend an Bedeutung gewinnt, da auch in Deutschland der Hauptvektor der Leishmaniose vorkommt und Einzelfälle autochthoner Infektionen beschrieben sind. Der Artikel fasst aktuelle Informationen über Therapie und Prävention der Leishmaniose zusammen. Kürzlich wurden bei Hunden, die unter Allopurinoltherapie ein Rezidiv der Erkrankung erlitten, Allopurinol-resistente Leishmania-infantum-Stämme gefunden. Daher werden alternative Langzeittherapien erforderlich. Auch die Ergebnisse aus Langzeitstudien zur Effizienz von Miltefosin im Vergleich zu Megluminantimonat können die Wahl des leishmaniziden Therapeutikums beeinflussen. Eine Vielzahl verschiedener Repellenzien steht zur Übertragungsprophylaxe zur Verfügung. In Europa sind zwei Impfstoffe für Hunde zugelassen, um das Risiko einer aktiven Infektion und den Schweregrad der klinischen Erkrankung zu reduzieren.
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