Claire R. Sharp

Introduction
There is limited published information on iron toxicosis in dogs, and it is unclear if dogs follow the four stages of progression as in humans. The objective of this retrospective case series was to describe the clinical course and treatment of dogs presenting after iron EDTA ingestion.

Methods
Cases were retrieved through an electronic medical records search at three veterinary teaching hospitals and three private referral hospitals in Australia. Non-parametric descriptive statistics are reported.

Results
61 dogs met the inclusion criteria. The most common iron-containing product ingested was iron EDTA molluscicide (60/61), with only one dog ingesting iron EDTA plant fertilizer. Notably, 20 out of 61 dogs (32.8%) had no clinical signs before presentation. Vomiting without blood was the most common clinical sign (21), followed by lethargy (16), diarrhea without blood (15), ataxia/weakness (12), and signs consistent with abdominal pain (10). Abdominal pain was the most common physical examination finding (21), followed by dehydration (10). Forty dogs underwent some form of gastrointestinal decontamination. The median pre-chelation serum iron concentration was 61.3 μmol/L (Min–Max 9–356, n = 40), while the median post-chelation concentration was 14.7 μmol/L (5.72–44, n = 22). Overall, 10 dogs were managed as outpatients, while 51 dogs were treated as inpatients. Inpatient treatments included desferoxamine (43), gastroprotectants (41), antiemetics and/or prokinetics (36), analgesia (24), and hepatoprotectants (4). The most common protocol for desferoxamine administration was a continuous intravenous infusion at 15 mg/kg/h (n = 27); other dogs received 40 mg/kg intramuscularly (n = 13). Two dogs had an anaphylactic reaction to an inadvertent bolus of desferoxamine, while two had allergic reactions possibly related to desferoxamine. Two dogs developed neutropenia, and one developed acute respiratory distress syndrome, possibly as a result of desferoxamine treatment. Overall, 91.8% of dogs survived to discharge. One dog died during hospitalization, experiencing cardiac arrhythmias, shock, and cardiac arrest despite treatment. When considering the stage of iron toxicoses, 16/61 (26.2%) dogs never developed clinical toxicosis, 44 dogs (72.1%) had evidence of Stage 1 clinical signs, 4 dogs (6.6%) also had evidence of Stage 2 clinical signs, and 19 dogs (31.1%) progressed to Stage 3 clinical signs. No dogs had Stage 4 clinical signs (delayed gastrointestinal stricture). A single case was euthanized for acute hepatic failure upon re-presentation after initial survival to discharge.

Conclusion
Iron EDTA toxicosis has a good prognosis in dogs following prompt treatment, but severe organ damage, including hepatic and cardiovascular dysfunction, can occur. Additionally, desferoxamine was well tolerated when administered according to published protocols, but potentially fatal adverse effects can occur.

Introduction
The use of rivaroxaban, an oral direct factor Xa inhibitor, has only been described in a small number of publications in cats. The study objective was to describe the use of rivaroxaban in a large population of hospitalised cats.

Methods
Cases were retrospectively identified from June 2017 to July 2024 at seven veterinary specialty hospitals. Any cat prescribed rivaroxaban was eligible for inclusion. Data extracted from the medical records included signalment (age, sex, breed), body weight, reason for commencing rivaroxaban, dose and duration of rivaroxaban, concurrent anticoagulant and antiplatelet therapies, potential rivaroxaban adverse effects, and outcome. Non-parametric descriptive statistics are reported.

Results
In total, 66 cats were included. Median rivaroxaban dose was 2.5 mg (Min-Max 1.25–10, Q1-Q3 2.5–5.0), equal to 0.73 mg/kg/day (Min-Max 0.28–1.87, Q1-Q3 0.53–1.0). A total of 36 cats (54.5%) were within the suggested dose range of 0.5–1 mg/kg/day of the Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE) guidelines, 14 (21.2%) were below, while 16 (24.2%) were above. Median duration of rivaroxaban was 26.5 days (Min-Max 0–442, Q1-Q3 2–60), although followup was variable. The indication for rivaroxaban administration was confirmed thrombosis (48, 72.7%), strong clinical suspicion of thrombosis (6, 9.1%), and prophylaxis (12, 18.2%). Most thrombi were arterial, including aortic thromboembolism affecting both pelvic limbs (25/54 cats with thrombosis, 46.3%), arterial thrombosis affecting a single limb (16, 29.6%), and cardiac chamber thrombus (7, 13%). Cardiac disease was the most common thrombosis risk factor (53/66, 80.3%). Other CURATIVE defined risk factors included immune-mediated haemolytic anaemia in four cats (6.1%) and sepsis in one cat. Other thromboprophylaxis administered included clopidogrel in 58 cats (87.9%), dalteparin in 8 cats (12.1%), and aspirin in 4 cats (6.1%). Potential adverse effects prompting rivaroxaban discontinuation included one case each of vomiting, a cerebrovascular accident, gastrointestinal bleeding, and haemorrhagic pleural effusion. Forty-five cats (68.2%) survived to hospital discharge, 14 (21.2%) were euthanised, two (3%) died, and five (7.6%) were taken home against medical advice.

Conclusion
Rivaroxaban was well tolerated in a large population of cats, predominantly prescribed for arterial thrombosis associated with cardiac disease.

Introduction
Prokinetics are used to treat gastrointestinal (GI) dysmotility in critically ill dogs but there have been no published studies characterizing their use. The objective of this multi-institutional retrospective cohort study was to describe the use of the prokinetics erythromycin and metoclopramide in dogs hospitalized in two institutions. We hypothesized that there would be change over time and differences between institutions in the use of erythromycin and metoclopramide.

Methods
Dogs for inclusion were identified by fee code searches for injectable erythromycin and metoclopramide in the electronic medical record systems of The Animal Hospital at Murdoch University and Western Australian Veterinary Emergency and Specialty Hospital for the years 2018 and 2023. 75 cases from each hospital in each year were selected for inclusion from the search results using a formal randomization procedure to yield a total case number of 300. Data collected for each dog included signalment, diagnosis, reason(s) for starting prokinetics, the injectable prokinetic(s) used, frequency, and doses. Chi square or Fisher’s exact tests were used as appropriate to compare the proportions of dogs receiving metoclopramide alone, erythromycin alone, or both prokinetics in 2018 and 2023, the proportions of dogs receiving metoclopramide or erythromycin as sole prokinetics between the two institutions, and the proportions of dogs receiving a single prokinetic versus dual prokinetics between the two institutions.

Results
Primary GI diseases accounted for the majority of the diagnoses. The most common reasons for starting a prokinetic were vomiting, an imaging diagnosis of ileus, prophylaxis following abdominal surgery, and regurgitation. Metoclopramide was administered as a sole prokinetic in the majority of dogs, fewer cases received erythromycin alone, or both prokinetics. Use of metoclopramide alone decreased from 2018 to 2023, with more dogs receiving erythromycin alone or both prokinetics in 2023. There were also significant differences in prokinetic use between institutions.

Discussion
Prospective studies to investigate the effectiveness and safety of metoclopramide and erythromycin as prokinetics in dogs are warranted.

Objective:
The aim of this report is to raise awareness of the risk of oxidant-induced erythrocyte injury, including Heinz body (HB) anemia, in critically ill dogs by describing the condition in five dogs receiving constant rate infusions of propofol.

Case summary:
This case series describes five dogs with suspected propofol-induced HB anemia undergoing mechanical ventilation (MV) for lower motor neuron disease. Four of the five dogs were treated for tick paralysis (Ixodes holocyclus) and one was treated for suspected eastern brown snake (Pseudonaja textilis) envenomation. Propofol constant rate infusions were administered as part of total intravenous anesthesia. All five dogs became anemic, and a complete blood count and blood smear interpretation by a specialist clinical pathologist confirmed the presence of oxidative red blood cell injury (eccentrocytosis and HBs). The duration of MV ranged from 76 to 131 h, with HBs identified within 47–96 h of commencing propofol. All five dogs survived to discharge, with one dog requiring a blood transfusion.

Discussion:
While propofol-induced HB anemia is a recognized phenomenon in cats, to the author’s knowledge, this is the first case series detailing multiple occurrences in dogs. Veterinarians should be aware of the risk of propofol-induced oxidative erythrocyte injury in dogs receiving prolonged infusions of propofol, and consider risk mitigation by using propofol as part of multiagent intravenous anesthesia, keeping dose rates as low as possible, and daily monitoring of blood smears and red blood cell indices.

Objective
To discuss the definitions of sepsis in human and veterinary medicine.

Design
International, multicenter position statement on the need for consensus definitions of sepsis in veterinary medicine.

Setting
Veterinary private practice and university teaching hospitals.

Animals
Dogs and cats.

Interventions
None.

Measurements and Main Results
Sepsis is a life-threatening condition associated with the body's response to an infection. In human medicine, sepsis has been defined by consensus on 3 occasions, most recently in 2016. In veterinary medicine, there is little uniformity in how sepsis is defined and no consensus on how to identify it clinically. Most publications rely on modified criteria derived from the 1991 and 2001 human consensus definitions. There is a divergence between the human and veterinary descriptions of sepsis and no consensus on how to diagnose the syndrome. This impedes research, hampers the translation of pathophysiology insights to the clinic, and limits our abilities to optimize patient care. It may be time to formally define sepsis in veterinary medicine to help the field move forward. In this narrative review, we present a synopsis of prior attempts to define sepsis in human and veterinary medicine, discuss developments in our understanding, and highlight some criticisms and shortcomings of existing schemes.

Conclusions
This review is intended to serve as the foundation of current efforts to establish a consensus definition for sepsis in small animals and ultimately generate evidence-based criteria for its recognition in veterinary clinical practice.

This report describes a suspected case of paraneoplastic syndrome of inappropriate antidiuretic hormone (SIADH) in a 5-year-old male entire Australian Kelpie associated with a gastric adenocarcinoma. The dog had a history of chronic vomiting and presented with hyponatraemia, hypokalaemia, hypochloraemia and increased urinary sodium. Computed tomography identified the presence of a gastric tumour and histopathology confirmed a pyloric gastric adenocarcinoma. Removal of the tumour via a Billroth I procedure resulted in rapid resolution of electrolyte derangements. The dog was still alive six months postoperatively with no recurrence of either SIADH or tumour at the time of publication.

•Cause: Viruses of the family Paramyxoviridae; genera Morbillivirus (feline morbillivirus [FeMV], canine distemper virus [CDV], Henipavirus (including Hendra virus [HeV] and Nipah virus), and the newly named Rubulavirus (previously paramyxovirus; mumps virus [MuV]).

•First Described: FeMV was first described in China in 2012. CDV was first described in France in 1905. HeV was first isolated in Queensland, Australia in 1994. Nipah virus was first identified in humans in Malaysia in 1999. MuV was first described in 410 bc (Hippocrates).

•Affected Hosts: Domestic cats (FeMV); large wild Felidae, dogs and other Canidae, Procyonidae (raccoons, pandas), Mustelidae (ferrets, mink, skunks, otters), nonhuman primates (CDV); horses, humans, flying foxes (reservoirs), domestic cats (experimental infection only), guinea pigs (experimental), dogs (HeV); pigs, humans, fruit bats (reservoirs), domestic cats, dogs (Nipah virus); humans, dogs, cats (MuV).

•Geographic Distribution: Asia, Europe, North and South America (FeMV); northeastern Australia (HeV); Malaysia, Singapore, Bangladesh, India (Nipah virus); worldwide (MuV).

•Route of Transmission: Oronasal contact with virus in secretions or excretions, droplet nuclei, and large particle aerosol transmission. Major Clinical Signs: Paramyxoviruses cause infections of the CNS, and respiratory and urinary tracts. FeMV has been implicated in chronic kidney disease in cats, but its clinical significance remains unclear. Natural infections of dogs with HeV have been rare and subclinical. Natural infections of dogs and cats with Nipah virus are also rare, but death and severe respiratory signs have been described. MuV can cause parotitis with salivary gland enlargement.

•Differential Diagnoses: These include other causes of infectious respiratory disease; parasitic respiratory disease; toxins such as lead and ethylene glycol; other causes of infectious meningoencephalitis. Differential diagnosis for mumps include other causes of parotitis such as immune-mediated disease.

•Human Health Significance: FeMV is not known to infect humans. HeV and Nipah virus cause serious infections of humans with high mortality. Mumps is a serious infection of humans but largely controlled by vaccination; periodic outbreaks still occur. Dogs and cats do not appear to be important in transmission of these viruses to humans.

Objectives: To compare the hemostatic characteristics of cold-stored whole blood (CSWB) from non-greyhound dogs (NGD) and greyhound dogs (GD) over 42 days of storage, notably, platelet closure time (PCT) (NGD only), manual platelet count (PLT) (GD only), ellagic acid (INTEM) and tissue factor activated (EXTEM) rotational thromboelastometry, prothrombin (PT) and activated partial thromboplastin time (aPTT), fibrinogen concentration (FIB), and the activities of factors (F) FII, FV, FVII, FVIII, FIX, FX, FXIII antigen (FXIII:Ag), and von Willebrand factor antigen (vWF:Ag).

Design: Whole blood from 10 NGD and 10 GD, was refrigerated in CPD blood bags at 4 degrees C for 42 days. Blood was analyzed before refrigeration (day 0) and at day 1 (d1), 3, 5, 7, 10, 14, 17, 21, 24, 28, 31, 35, 38, and 42. Multivariate linear mixed effects models were created to evaluate coagulation parameters over time and compare NGD and GD. Data are summarized as estimated marginal means with 95% confidence intervals. Significance was set at P < 0.05.

Results: The PCT for all NGD CSWB was above the device limit by d7. The PLT for GD CSWB did not change during storage. The mean alpha-angle for INTEM and EXTEM decreased to < 50% of baseline at d38 and d31 for NGD, and d31 and d17 for GD CSWB. The mean maximum clot firmness (MCF) for INTEM and EXTEM reduced to < 50% of baseline at d42 and d28 for both GD and NGD. PT and aPTT for NGD and GD increased over time. For NGD CSWB, the mean FVIII and vWF:Ag activities decreased to < 50% of baseline at d7 and d28, respectively, and FIB reached 0.982 g/dL by d24. For GD CSWB, FVIII, FXIII:Ag and FV activities decreased to < 50% of baseline by d3, d38, and d38, respectively, and FIB was 0.982 g/dL at baseline. Alpha-angle and MCF for both INTEM and EXTEM, and activities for FII, FV, FIX, FXIII:Ag were significantly lower, and vWF:Ag was significantly higher overall in GD CSWB compared with NGD. A significant difference in the pattern of change over time was detected between NGD and GD in EXTEM alpha-angle, INTEM and EXTEM MCF, FII, and FVIII activities.

Conclusions: The in vitro viscoelastic parameters of GD and NGD CSWB declines over 42 days, but numerous hemostatic parameters (INTEM and EXTEM alpha-angle and MCF, activity of FII, FV, FV, FVII, FIX, FX, FXIII:Ag, vWF:Ag, and FIB) remain within 50% of baseline for more than 14 days. CSWB from GD compared to NGD has reduced hemostatic activity overall, but a similar pattern of decline for most parameters over time.

Red blood cell (RBC) transfusion is associated with recipient inflammation and infection, which may be triggered by excessive circulating iron. Iron chelation following transfusion may reduce these risks. The aim of this study was to evaluate the effect of deferoxamine on circulating iron and inflammation biomarkers over time and in vitro growth of Escherichia coli (E. coli) following RBC transfusion in dogs with atraumatic hemorrhage. Anesthetized dogs were subject to atraumatic hemorrhage and transfusion of RBCs, then randomized to receive either deferoxamine or saline placebo of equivalent volume (n = 10 per group) in a blinded fashion. Blood was sampled before hemorrhage and then 2, 4, and 6 h later. Following hemorrhage and RBC transfusion, free iron increased in all dogs over time (both p < 0.001). Inflammation biomarkers interleukin-6 (IL6), CXC motif chemokine-8 (CXCL8), interleukin-10 (IL10), and keratinocyte-derived chemokine (KC) increased in all dogs over time (all p < 0.001). Logarithmic growth of E. coli clones within blood collected 6 h post-transfusion was not different between groups. Only total iron-binding capacity was different between groups over time, being significantly increased in the deferoxamine group at 2 and 4 h post-transfusion (both p < 0.001). In summary, while free iron and inflammation biomarkers increased post-RBC transfusion, deferoxamine administration did not impact circulating free iron, inflammation biomarkers, or in vitro growth of E. coli when compared with placebo.

A 14-y-old, castrated male, diabetic, domestic longhaired cat was presented for investigation of anemia. General examination revealed widespread cutaneous erythematous macules and patches. Hematology and bone marrow aspiration revealed severe regenerative anemia and marked erythroid hyperplasia, respectively. Low numbers of intermediate-to-large, atypical lymphocytes were observed in the blood smear and bone marrow aspirates. Various imaging modalities demonstrated a diffuse pulmonary bronchial pattern, multifocal mural thickening of the urinary bladder, splenomegaly, and mild tri-cavitary effusion. Skin biopsies and cytologic examination of the pleural effusion demonstrated round-cell neoplasia consistent with lymphoma. Autopsy confirmed disseminated T-cell lymphoma, mostly affecting the urinary bladder, stomach, lymph nodes, and interscapular subcutis and muscles. Angiocentrism and nerve infiltration were present. The cutaneous erythematous patches, characterized by perivascular neoplastic lymphocytic infiltrates and angiodestruction, were a manifestation of the disseminated lymphoma in this cat, similar to the lesions reported in humans affected by angioimmunoblastic T-cell lymphoma.