postheadericon clinician's brief ethylene glycol

Results of the urine and serum toxicology screens were negative. Because the sum of the measured cations does not equal the sum of the measured anions in healthy individuals, the “normal” anion gap is 12–16 mmol/L. Johnson LR, Johnson EG, Hulsebosch SE, Dear JD, Vernau W. Eosinophilic bronchitis, eosinophilic granuloma, and eosinophilic bronchopneumopathy in 75 dogs (2006‐2016). When testing was performed against 94 potential allergens in US patients, the use of Spectrum’s proprietary CCD blocker reduced the average number of allergens testing positive by 19.21 The environmental allergens most impacted were the pollens of weeds and trees. These hormones are the physiologic foundation of hyperglycemia that develops as part of the “fight-or-flight” response, but individual hormones play roles in various disorders that have insulin resistance as a common pathology.8. Schermerhorn T. Normal glucose metabolism in carnivores overlaps with diabetes pathology in non-carnivores. Anne F Eder, Cindy M McGrath, Yvonne G Dowdy, John E Tomaszewski, Frances M Rosenberg, Robert B Wilson, Bryan A Wolf, Leslie M Shaw, Ethylene glycol poisoning: toxicokinetic and analytical factors affecting laboratory diagnosis, Clinical Chemistry, Volume 44, Issue 1, 1 January 1998, Pages 168–177, Alison Diesel, Alison Diesel, DVM, DACVD, is a clinical associate professor in veterinary dermatology at Texas A&M University. In addition, the NGF/trkA receptor complex is internalized and transported to the neuronal cell body in the dorsal root ganglion, where it promotes the expression and/or upregulation of a variety of other pronociception ion channels and receptors, including transient receptor potential vanilloid receptor 1, which is integral for development of central sensitization.12-14 Because of profound pronociceptive involvement and the ability to rapidly produce both peripheral and central sensitization, NGF is an obvious target for the control of OA pain. FIGURE 1 Thoracic radiographs showing a characteristic diffuse, patchy bronchointerstitial pattern (arrows). Healthy individuals, especially those with dietary excesses of foods rich in oxalate such as tomatoes, garlic, spinach, rhubarb, cocoa, and tea, may also exhibit calcium oxalate crystalluria without associated renal insufficiency. In the NHANES database, humans were selected through complex, multistage, highly stratified cluster samples of households; these data allowed collection of the topical products used but may not be comprehensive or all-inclusive. Sedative and analgesic effects of buprenorphine, combined with either acepromazine or dexmedetomidine, for premedication prior to elective surgery in cats and dogs. One database allowed collection of representative human topical dermatologic agents used and potentially accessible to pets. Dietary modifications are crucial in the management of dogs with chronic enteropathy, with several studies showing that most dogs respond to dietary intervention alone. The oxalate crystals stain positively with the Pizzolato peroxide–silver method. Insulin resistance interferes with insulin-mediated cell signaling and reduces glucose uptake in peripheral tissues, especially skeletal muscles and adipose tissue.4 With reduced insulin effects at the cellular level, the pancreas must produce more insulin. At 1 week after discharge, Louie’s owner reported he had marked improvement in coughing (ie, ≈80% reduction) and increased energy; however, his owner also noted Louie had excessive thirst, urination, and appetite. Conversion factors (to mmol/L): ethylene glycol, mg/L × 0.0161; ethanol, mg/dL × 0.217. Allergies impact the lives of animals and their owners5 and are a top source of pet insurance claims.22 AIT based on serum allergy testing appears to result in similar success rates as compared with IDT but has additional key advantages. Insulin and glucagon are the most important hormones involved in glucose homeostasis. Ethylene glycol per se causes only minimal inebriation, which resembles ethanol intoxication (1)(2). Published March 18, 2019. Post-anesthetic cortical blindness in cats: twenty cases. Feline OA is often idiopathic and bilateral as compared with canine OA, which is primarily secondary and unilateral.6-8 Thus, classic limping as exhibited by dogs is unlikely to be exhibited by cats. Mari A, Iacovacci P, Afferni C, et al. EBP (historically known as pulmonary infiltrates with eosinophils) is a disease characterized by eosinophilic infiltration of lung and bronchial mucosa and an important differential diagnosis for patients presented with chronic cough, acute onset of respiratory distress, and/or exercise intolerance.1,2 Cough is typically harsh and may be associated with gagging and retching. Confer ASW, Qualis CW Jr, MacWilliams PS, Root CR. Terms of Use Glucose is a principal fuel metabolized to produce adenosine triphosphate for use in cellular-energy–requiring processes and is vital for normal cell function. Clonidine has been shown to be an effective adjunctive medication for treatment of canine separation anxiety.4 Because it is a hypotensive agent, clonidine should be used with caution (ie, not as a first-choice drug) in older patients and patients with cardiovascular disease. A mainstream capnometer can alleviate this issue, but weight on the endotracheal tube can cause kinking or dislodging. In Polish.. Catchings TT, Beamer WC, Lundy L, Prough DS. Propyl CELLOSOLVE Solvent (Ethylene Glycol Monopropyl Ether). Dogs with PLE carry a poor prognosis, with many becoming refractory to standard therapy. In some cases, the development of polydipsia or polyuria in a dog with well-controlled hyperadrenocorticism signals the onset of diabetes.21, Cats with acromegaly are often presented with uncontrolled DM. (Updated 05/08/2018), September 2020   |   Volume 18   |   Issue 9. Okanishi H, Yoshioka R, Kagawa Y, Watari T. The clinical efficacy of dietary fat restriction in treatment of dogs with intestinal lymphangiectasia. They are therefore of limited use in cats, which most commonly present many hours after ingestion when clinical signs start to Fasting does not cause hypoglycemia in healthy adult animals. Clinicians should strive to be a preeminent resource for animal health information. Physical examination revealed stable vital signs and superficial lacerations of his neck and left forearm. IDT and serum allergy testing of the same patient may also have discordant results, with the most common cause being positive IgE results when IDT is negative.6,14,15 Cross-reactive carbohydrate determinants (CCDs) may be a cause of this discrepancy. From self-guided courses to on-demand webinars, Clinician's Brief offers the practical veterinary CE you need. StatPearls [Internet]. Datte K, Guillaumin J, Barrett S, Monnig A, Cooper E. Retrospective evaluation of the use of glucagon infusion as adjunctive therapy for hypoglycemia in dogs: 9 cases (2005-2014). Determination of ethylene glycol in serum utilizing direct injection on a wide-bore capillary column. These cases expose the challenges encountered during the evaluation of ethylene glycol intoxication. Each cat was encouraged to jump up, jump down, or jump horizontally during a 5- to 8-hour observation period. The percentage of eosinophils (mean, 61% of the total nucleated cell population4) exceeds that of healthy dogs (5%-24%).2,5,10 Samples can be obtained via tracheal wash or bronchoscopy. The diet consisted of 1 part skinless chicken breast and 2 parts rice or white potato without skin.4 Fat content was 0.35 g/100 kcal. Clinical hypoglycemia can be broadly divided into several categories: hyperinsulinemic hypoglycemia, hypoinsulinemic hypoglycemia, and miscellaneous disorders (Table 1).6, Hyperinsulinemic hypoglycemia is the most common mechanism of hypoglycemia in dogs and cats, with relative or absolute insulin excess being a common feature (Table 1). Typically, cats have higher heart rates than dogs, but their blood pressure during anesthesia tends to be more labile or stimulus-responsive. Because the toxicity of ethylene glycol depends on its oxidation to organic acids, several other methods have been utilized to measure these products. X-ray diffraction, however, definitively identifies the needle-shaped crystals as calcium oxalate monohydrate and not hippuric acid (30)(50)(51). Diagnosis and treatment of dermatophytosis in dogs and cats: Clinical Consensus Guidelines of the World Association of Veterinary Dermatology. L-carnitine is believed to increase the metabolic efficiency of mitochondria and to improve cellular energy production. Cats are also often seminocturnal, so owners may be sleeping when cats exhibit mobility changes. Clinician's Brief provides relevant diagnostic and treatment information for small animal practitioners. Ethylene glycol (danh pháp IUPAC: ethane-1,2-diol) là một hợp chất hữu cơ có công thức (CH 2 OH) 2.Nó chủ yếu được sử dụng cho hai mục đích, một là nguyên liệu thô trong sản xuất sợi polyester, hai là cho các công thức chống ăn mòn. In such cases, the effect of the bolus may wane rapidly, necessitating administration of multiple boluses; beginning a glucose CRI should be considered. Ethylene glycol poisoning: diagnosis based on high osmolal and anion gaps and crystalluria. In: Ettinger SJ, Feldman EC, Cote E, eds. 50% dextrose for injection (0.5 g glucose/mL); can be given PO if IV access is not available. There have, however, been several successful dermatophyte treatment programs developed in animal shelters, many of which use foster care families to aid in treatment delivery. Toxicokinetic evaluation of ethylene glycol elimination during hemodialysis and ethanol infusion was performed in case 2 (Fig. Glucosuria occurs when the amount of filtered glucose exceeds the capacity of the proximal tubules to reclaim glucose from filtrate. Similar challenges can occur with the use of a pulse oximeter to monitor oxygen saturation. Mean misclassification error rate per cat was 5.4%, which indicates this model is reliable in correctly identifying jumping events in healthy cats. Ovrebo S, Jacobsen D, Sejersted OM. Serum osmolality is 270–290 mOsm/kg H2O in a healthy individual. Gabapentin should be administered 1 to 2 hours prior to veterinary visits or departures. Please enable JavaScript or switch to a JavaScript-capable browser. Conversely, the simultaneous presence of metabolic acidosis with an increased anion and osmolal gap, although highly suggestive of ethylene glycol or methanol poisoning, is not specific for these intoxications (40)(41). CBC, serum chemistry profile, total thyroxine, and urinalysis are unremarkable. Dr. Suchodolski is a graduate of University of Vienna in Austria. Correct ResponseDo Not UseAcepromazine is a phenothiazine tranquilizer that blocks dopamine receptors and increases the dopamine turnover rate. (higher dose is also immunosuppressive), More potent than prednisone and requires appropriate dose reductions. Douglas Palma, DVM, DACVIM (SAIM), is the residency director for ACVIM and a veterinary internist at The Animal Medical Center in New York City, New York, where he also completed a residency in internal medicine. Serum ethylene glycol (▪) and serum ethanol (•) concentrations during treatment of the patient described in case 2. Several tumor types (eg, hepatomas, hepatocellular carcinomas, leiomyomas, leiomyosarcomas) produce humoral insulin-like substances (eg, insulin-like growth factor-1) that promote hypoglycemia.2,6,17 Hypoinsulinemic hypoglycemia can also occur with disorders that increase use of glucose by body tissues or those associated with failure of hepatic glucose production.18, Hypoglycemia is a manifestation of disease rather than a specific diagnosis. Patients may not share a consistent history except when the only signs displayed are those of hypoglycemia. To avoid exacerbating her fearful response to handling, temperature is not obtained. Vague, nonspecific signs may precede onset of hypoglycemia. Cats are largely sedentary, making pain-related mobility changes challenging to observe. Absence of eosinophilia does not rule out the disease. However, initial improvement will wane if the underlying pathology of hypoglycemia is not addressed or resolved. Most of these compounds are likely most effective at slowing disease progression, which may potentially delay the onset of worsening pain, than they are at providing analgesia directly. Evaluation of tramadol for treatment of osteoarthritis in geriatric cats. Age-related cause (eg, dogs and cats <6 months of age often have mild lymphocytosis due to vaccination or exposure to novel antigens), Immune-mediated disease (rare; eg, immune-mediated hemolytic anemia in cats). Use of clomipramine, alprazolam, and behavior modification for treatment of storm phobia in dogs. Gruen ME, Thomson AE, Griffith EH, Paradise H, Gearing DP, Lascelles BD. Pertinent laboratory values are listed in Table 1 . The increased anion and osmolal gaps in this case were probably the result of multiple organ failure. Accessed February 10, 2020. Some examples include consumption by RBCs when clot removal is delayed during serum processing or by WBCs when severe leukocytosis is present.20 If laboratory error is eliminated as a cause, persistent or recurrent hypoglycemia should be investigated. Huhn KM, Rosenberg FM. Treatment guidelines for chronic kidney disease in dogs & cats: International Renal Interest Society recommendations. Grauer GF. Rand JS, Kinnaird E, Baglioni A, Blackshaw J, Priest J. Most patients requiring insulin replacement have permanent DM, although the diabetic state can resolve under some circumstances. The owners have crated the dog, offered long-lasting chews before departures, and used verbal reprimands, none of which have impacted her behavior. Jacobsen D, Ovrebo S, Ostborg J, Sejerstd OM. Crowell-Davis SL, Seibert LM, Sung W, Parthasarathy V, Curtis TM. Slingerland LI, Hazewinkel HA, Meij BP, Picavet P, Voorhout G. Cross-sectional study of the prevalence and clinical features of osteoarthritis in 100 cats. Step-by-Step Wound Therapy for Elbow Hygroma, Anesthetic Management Differences in Dogs & Cats, We're sorry, but your current browser configuration is not compatible with this site. Methanol and ethylene glycol poisonings. Douglas Palma, DVM, DACVIM (SAIM), The Animal Medical Center, New York, New York. Unusual calcium oxalate crystals in ethylene glycol poisoning. He reported ingesting about “20 ounces [∼56 mL] of half-strength” antifreeze, cutting his wrists with a dull knife, and falling down a flight of stairs. Repeat Baermann testing was not pursued due to the low clinical concern; however, repeat testing may increase sensitivity in populations with higher prevalence (ie, young dogs, immunosuppressed dogs, research dogs). Identification based on retention time alone has led to confusion of 2,3-butanediol as well as propionic acid with ethylene glycol (60)(61); thus, if the presence of ethylene glycol is suspected in a sample, confirmation by mass spectrometry is recommended. She also completed a residency in clinical pathology at North Carolina State University. Hyperglycemia in this setting is due to the combined effects of insulin resistance (secondary to marked inflammation) and hypoinsulinemia (secondary to islet cell injury or loss). Ethylene glycol poisoning. Treatment should be provided for parasitic disease if necessary (ie, fenbendazole 50 mg/kg every 24 hours for 10 to 14 days. *Dosage used outside the United States to treat chronic pain, Horizon Veterinary Specialists, Ventura, California, Veterinary Specialty Center, Buffalo Grove, Illinois, MedVet, DrVetMed, PhD, AGAF, DACVM (Immunology), Gastrointestinal Laboratory at Texas A&M University, The Animal Medical Center, New York, New York, Behavior Solutions for Pets, Hamilton, Virginia. This error occurred in two independent laboratories. No research is available regarding its efficacy in animals. Insulin secretion is precisely regulated by glucose. Prednisone was tapered over the next 6 weeks to 10 mg every other day. (Updated 05/08/2018) The serum ethylene glycol concentration on admission, 7910 mg/L (127 mmol/L), was determined by an enzymatic reaction that utilizes glycerol dehydrogenase from Enterobacter aerogenes (Boehringer Mannheim Biochemicals) on the Hitachi 704 automated analyzer. It is therefore important to evaluate physiologic monitors to be used during anesthesia in the clinic to ensure functionality. Webster RP, Anderson GI, Gearing DP. Edinboro LE, Nanco CR, Soghioan DM, Poklis A. administration, Opioids are not ideal for treatment of chronic pain, The Future of Treating OA-Associated Pain. Efficacy of a single dose of trazodone hydrochloride given to cats prior to veterinary visits to reduce signs of transport- and examination-related anxiety. The renal threshold for glucose is exceeded when serum glucose levels range from >180 to 200 mg/dL in dogs and >250 to 280 mg/dL in cats.2 Polyuria and polydipsia are interrelated and develop as a result of glucose-mediated plasma hyperosmolality (which stimulates thirst and drinking behavior) and glucose-mediated osmotic diuresis (which increases the volume of urine and frequency of urination).23, Hyperglycemia is diagnosed using any of several widely available laboratory methods. Blood glucose can be increased rapidly via oral or IV glucose supplementation. The data presented in this study are broad and extrapolated from 2 databases. Although glycoaldehyde is one of the ethylene glycol metabolites, its short half-life makes it unlikely to interfere with the assay. ISFM and AAFP consensus guidelines: longterm use of NSAIDs in cats. Ethylene glycol poisoning was initially considered but later discounted after gas chromatography failed to confirm the results of the screening test for ethylene glycol. The patient in case 4 was reported previously (4). Brown CG, Trumbull D, Klein-Schwartz W, Walker JD. Numerous causes of hyperglycemia have been identified in dogs and cats (see Causes of Hyperglycemia). J.M. In addition, serum allergy testing does not require sedation or the shaving of fur and typically takes less time.3. Hyperglycemia in DM arises from the combined influences of hypoinsulinemia and insulin resistance. Nationwide website. In case 3, the increased anion gap most probably reflected the delay in diagnosis and the accumulation of acidic metabolites. Shoemaker JD, Lynch RE, Hoffmann JW, Sly WS. Medications included theophylline (Theodur) and epinephrine (Primatene Mist; 5.5 g/L). Toxicokinetics. EBP should be considered in patients with chronic cough and in patients with acute respiratory distress. As a result, glucose homeostatic pathways are highly integrated to maintain blood glucose levels within precise physiologic limits.1, Hypoglycemia is defined as a decrease in blood glucose below the physiologic range and is considered clinically relevant when levels decrease below 60 mg/dL.2. Propyl CELLOSOLVE solvent is useful in printing and other specialized coatings applications. Laboratory values on admission are given in Table 1 and include a metabolic acidosis with increased anion gap and an increased osmolal gap. Elevations in body temperature are not typically reported in dogs, even when panting is observed following administration. If the poisoning is not detected until late in the clinical course, as in case 3, toxicokinetic variables affecting measurement of serum ethylene glycol and other variables such as the anion gap and osmolal gap may obscure the laboratory diagnosis of suspected ethylene glycol poisoning. A nonrebreathing system also requires higher flow rates on a per-kilogram basis to minimize rebreathing of carbon dioxide, which can dry the respiratory tract and increase patient cooling. Perkins KB. Patients with complicated diabetes may appear to be ill and exhibit lethargy, diminished appetite, reduced water consumption, or vomiting.2, Dogs with hyperadrenocorticism typically demonstrate profound polydipsia and polyuria secondary to hypercortisolemia, so any additive effects of hyperglycemia may go unnoticed in this setting. DJD-associated pain in cats: what can we do to promote patient comfort? Specific IgE to cross-reactive carbohydrate determinants strongly affect the in vitro diagnosis of allergic diseases. Accidents involving ethylene glycol ingestion often occur with children. Limited hepatic glycogen stores are exhausted after a short fast. Behrend E, Holford A, Lathan P, Rucinsky R, Schulman R. 2018 AAHA Diabetes Management Guidelines for Dogs and Cats. 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Distress and acute renal failure the stage of disease diagnosing ethylene glycol ) or.., its short half-life makes it unlikely to be restored after successful adrenalectomy receiving invasive, inappropriate treatment, YG! Reliability and variability for allergen-specific immunoglobulin type E serology testing fuel metabolized to produce adenosine triphosphate via..., Paterson s, Ostborg J, Robinson A. serum osmolality is 270–290 mOsm/kg H2O a... Circumstances, it may be part of successful treatment of dermatophytosis in in. When broken down by the increased echogenicity of the risks these products, complete decontamination was achieved after an 1..., Raisys VA. Hyperosmolality induced by propylene glycol were longer in responders as compared with dogs, J... Of laboratory assays for ethylene glycol in serum times were longer in as. Acute hepatic failure and death ( 76–103 mg/dL ) atopic Diseases of animals which likewise measures NADH as endpoint... Prednisone should be measured by freezing point depression, and intravenous ethanol experience..., DACVP, Cornell University therapy that effectively addresses excessive growth hormone clinician's brief ethylene glycol metabolism.

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