The Collapsing Puppy

You are presented with an 8 week old male Maltese terrier with a short history of diarrhoea and collapse. What next …

First, Let's start with the major body systems:

Important points about collecting a thorough history and carrying out a good physical exam: 1. Signalment, 2. History, 3. Systematic physical exam

Major Body System Assessment:

Cardio: 1. Mucus membrane colour, 2. Capillary refill time, 3. Heart rate, 4. Pulse quality, 5. Auscultation 6. Arrthymia

• Resp: 1. Respiratory rate, 2. Breathing sounds, 3. Cyanosis, 4. Respiratory effort…

• Neuro: 1. Altered mentation, 2. Cranial nerves 3. Posture,

Good questions keep coming in!

Some physical exam findings …

Lots of tweets about more blood work but what in particular? It is important to remember exactly which blood tests we want to do and why, so we need some specific tests…

Good point! Puppy should have some fluids. Lots of tweets about dextrose fluid therapy. By what route do we adminster the fluids? Orally or IV? Any other routes and how easy is this to do? What affects the decision?

Maintenance rate for pups is higher 3-4 ml/kg as higher % of total body water

Links to InPractice reviews of fluid therapy in small animals – Issue 1 & Issue 2

Lots of really good differential diagnoses tweeted: metabolic storage disease, hepatic disease, parvo, parasites, toxins, starvation, hepatoportal shunt, intussusception, glucagon deficiency, foreign body, sepsis, hypoadrenocorticism, insulinoma, growth hormone deficiency, hypersensitivity, hunting dog hypoglycaemia

These pups need 2-3 days on IV fluid therapy with glucose supplementation to build up glycogen stores, frequent quality puppy food & education of owners.

Juvenile hypoglycaemia in puppies and kittens
• Puppies and kittens have smaller liver and muscle mass (decreased glycogen stores) and a larger brain (increased glucose utilisation) in proportion to their body size, they are at greater risk of developing hypoglycaemia than adult dogs & cats. (also seen in toy breeds)
• Inadequate glycogen stores are the most common cause of hypoglycaemia in puppies.
• Hypoglycaemia, hypothermia and dehydration occur quickly when a puppy or kitten is not adequately feeding. Treatment involves fluid therapy, glucose supplimentation & warming. This can be accomplished by administering warmed dextrose isotonic fluids subcutaneously or intravenously, depending upon the severity of the condition. Also treat concurrent infections.
• In general, the majority of puppies and kittens diagnosed with hypoglycaemia were only mildly affected & responded well to treatment.

Excellent work guys! I hope you enjoyed the session – it was really good fun. Best of luck in your revision. See you all next week for poisons and toxicology!