Veterinary ECC Small Talk

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Listeners' Questions on Fluid Therapy Jan 02, 2015

Show notes

There are some well know standard principles of fluid therapy with different approaches to the treatment of hypovolaemia and dehydration. Regardless of the indication, individual patients may have additional problems or considerations that should influence our fluid therapy approach. In this episode I respond to questions sent in by listeners with respect to findings that should influence our fluid therapy approach - pulmonary contusions and heart murmurs. I then go on to discuss the role of and approach to fluid therapy in patients exposed to renally excreted nephrotoxins.

Click Here For Your FREE Copy of the Transcript of this Episode

For online training material on Parenteral Fluid Therapy and Hypovolaemia, Shock and Dehydration, CLICK HERE.

Christmas Hazards for Dogs and Cats Dec 19, 2014

Show notes

Do you see dogs and cats exposed to poisons around the festive period? Sure you do! There are many potential poisons and other hazards to which dogs and cats are more likely to be exposed during the Christmas period. In this episode I discuss some of them in detail - chocolate, grapes/raisins/currants/sultanas, xylitol - and mention a variety of others to remind you of the high level bits of essential information.

As mentioned in the episode, if you would like a one-page summary of the general approach to tremorgenic neuromuscular toxins (e.g. from mouldy food), please click the link below and follow the instructions:

Click Here For a 1-Page Summary of the General Approach to Tremorgenic Toxins

Nutritional Management of Acute Pancreatitis Dec 05, 2014

Show notes

This episode focuses on the nutritional management of acute pancreatitis in dogs and cats answering questions such as:

When should we be providing nutrition to dogs and cats with acute pancreatitis?
Should we be using enteral or parenteral nutrition?
Should we be using post-pyloric jejunal feeding or is oral or gastric feeding okay?

The episode is largely based around the following clinical practice review article:

Jensen KB, Chan DL. Nutritional management of acute pancreatitis in dogs and cats. J Vet Emerg Crit Care 2014. 24(3):240-250.

As mentioned in the episode, if you would like a FREE copy of some general notes on acute pancreatitis in dogs and cats that cover more than 'just' the nutritional aspects, please click the link below and follow the instructions:

Get your FREE copy of notes on acute pancreatitis

In the episode I also mention a blog post on syringe feeding which you can find HERE.

One paragraph from the paper that I read out in the episode and promised to include here was as follows:

“The traditional approach to AP centered on the premise that withholding food would reduce pancreatic autodigestion by decreasing pancreatic stimulation and enzyme release. However, the pathogenesis of pancreatitis more likely involves premature intracellular activation of proteolytic enzymes rather than pancreatic stimulation. Avoidance of feeding as a means to decrease pancreatic stimulation may be unwarranted and could lead to malnutrition and impaired gastrointestinal barrier function. Lack of enteral nutrition results in the loss of normal physiologic intestinal motility, is associated with intestinal villus atrophy, and compromises intestinal mucosal blood flow. If sustained, the lack of enteral nutrition could lead to a compromise of local immunoglobulin and biliary salt production with consequent disruption of normal internal bacterial flora and gastrointestinal barrier function. It also has been demonstrated in experimental rodent models and in people with naturally occurring disease that exocrine pancreatic secretion actually decreases during pancreatitis and that the decrease is more pronounced with increasing severity of inflammation. The practice of withholding food for several days from the time of initiation of therapy may prove detrimental as a period of anorexia often precedes the initial clinical presentation to veterinarians in patients with AP. Implementation of nutritional support may be critical for successful management of patients with AP.”

And the list of summary points from the paper is as follows:

There is increasing evidence supporting the important role of early EN (ideally within 48 h of diagnosing pancreatitis) in positively impacting outcome in patients with AP.
Nutritional support is an integral and key aspect of the successful management of AP.
The use of enteral feeding in veterinary medicine is now considered to be safe, effective, and well-tolerated in severe AP.
Enteral nutrition is less expensive than parenteral feeding and helps to maintain gastrointestinal mucosal function, and therefore is likely to have a beneﬁcial inﬂuence on the disease course.
Use of NG, nasoesophageal, jejunal, and oesophagostomy feeding tubes is effective and safe in dogs and cats and should be used unless speciﬁc contraindications are identiﬁed. There is no evidence at this time to support the superiority of post-pyloric jejunal feeding over oral or gastric feeding.
The optimal enteral diet for patients with AP has not been identiﬁed, but diets commonly used for convalescing dogs and cats can be used.
Avoidance of enteral diets with high fat content does not appear to be necessary in the majority of patients.
Despite the growing evidence that EN can be used effectively in the management of patients with AP, there may still be patients that require some form of PN until sufﬁcient EN can be tolerated.
And of course we have the usual and completely reasonable conclusion that future veterinary studies investigating feeding routes, dietary composition, and optimal timing of nutritional support in AP are warranted.

Fluid Choice in Tomcat Urethral Obstruction (Blocked Cats) Nov 21, 2014

Show notes

Cats with urethral obstruction ("blocked cats") can present in a state of shock with moderate-to-severe hypoperfusion and should receive adequate fluid resuscitation with bolus therapy as needed using an isotonic crystalloid solution before worrying about relieving the obstruction. Blocked cats may have clinically significant hyperkalaemia and can also be severely acidaemic. With this in mind, does it matter whether we use 0.9% sodium chloride or a more balanced solution such as Hartmann's solution (buffered lactated Ringer's solution, compound sodium lactate), Normosol-R or Plasmalyte 148? This is discussed in detail in this podcast and a paper from the veterinary literature presented.

A summary of the podcast including the reference for the paper discussed can be found on the Veterinary ECC Small Talk website HERE.

If you are interested in taking a presentation and acquiring some course notes describing in detail an approach to the overall management of blocked cats, please visit the website HERE.

Intravenous Lipid Emulsion as an Antidote Nov 07, 2014

Show notes

Intravenous lipid emulsion (ILE) (e.g. Intralipid 20%) has been used for some time and is being used more and more as an antidote for certain toxins in both human and veterinary medicine. How does it work? What is the evidence base for its use? What poisons should we consider using it for in dogs and cats? These are amongst some of the questions that I discuss in this episode of the podcast.

Listen to this episode to find out more and feel free to share your thoughts on the main website or via social media.

** To get your FREE copy of some notes on intravenous lipid emulsion visit the Veterinary ECC Small Talk website HERE **

I would be very grateful if you could also take the time to rate and/or review these podcasts! Thank you!

Antibiotics in Canine Acute Haemorrhagic Diarrhoea Oct 21, 2014

Show notes

Canine acute haemorrhagic diarrhoea is a common presentation in small animal veterinary practice and often these patients present as emergencies. Aside from fluid therapy and other medical treatments, antibiotics are often prescribed. But is this appropriate in all cases? Should all dogs with acute haemorrhagic diarrhoea receive antibiotics? Listen to this episode to find out more and feel free to share your thoughts on the main website or via social media.

Show notes for this episode can be found HERE

I would be very grateful if you could also take the time to rate and/or review these podcasts! Thank you!

Introduction Oct 21, 2014

Show notes

An introduction to the Veterinary ECC Small Talk podcast, bringing the small animal veterinary Emergency and Critical Care (ECC) small talk and jibber jabber!

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