Rethinking Fluids - Replacement, Maintenance, Overload and Tolerance with Dr Alexandra Pfaff

Simon is joined by Professor Kelly Tart from the Universityof Minnesota to discuss “Lorazepam reduces recurrence of urethral obstruction in male cats: a prospective, randomized, double-blinded, placebo-controlled study.” https://avmajournals.avma.org/view/journals/javma/aop/javma.26.01.0045/javma.26.01.0045.xmlThe study prospectively enrolled 80 cats following their first urethral obstruction and randomised them to receive oral lorazepam or placebo for one month. Five cats receiving placebo re-obstructed, compared with none receiving lorazepam, alongside encouraging findings regardingowner-reported lower urinary tract signs.We discuss the rationale behind the study, trial design, recurrence and lower urinary tract signs, reported adverse effects, and how to interpret the results. Finally, we ask the important clinical question: is the evidence strong enough to change how we manage cats after urethral obstruction?

Why is the severe anaphylaxis patient actually unstable, and how do you treat it? This was a fascinating discussion with Dr Ryan Smith about his group’s study on dogs with severe anaphylaxis that did not receive early epinephrine as part of their management. We cover those 49 cases, basic physiology, hepatic rupture and the protocol that Dr Smith and his team use. That protocol is available as supporting information to the study itself here: Canine Anaphylaxis Patients Receiving Late Epinephrine or No Epinephrine: 49 Cases (2019–2023) https://onlinelibrary.wiley.com/doi/10.1111/vec.70102 Other articles also mentioned: Evaluation of hemostatic derangements associated with canine anaphylaxis and the relationship to syndrome severity https://onlinelibrary.wiley.com/doi/10.1111/vec.13345 Acute hepatic rupture causing hemoperitoneum in a dog with anaphylaxis https://onlinelibrary.wiley.com/doi/10.1002/vms3.1391 Clinical characteristics of two-hundred thirty-two dogs (2006-2018) treated for suspected anaphylaxis in Perth, Western Australia https://onlinelibrary.wiley.com/doi/10.1111/avj.13114

Here we have two amazing educators in Bobbi Conner DACVECC and Alex Blutinger DACVECC to discuss CPR orders, client presence in CPR events and tactics to help navigate these situations. How do you decide when to stop, or if we should even have started?! The studies we covered: Evaluation of Client Communication Regarding Cardiopulmonary Resuscitation and Do-Not-Resuscitate Orders: A Survey Study https://onlinelibrary.wiley.com/doi/10.1111/vec.70064 Evaluation of a Cardiopulmonary Resuscitation Video Decision Aid for Pet Owners https://onlinelibrary.wiley.com/doi/10.1111/vec.70070 Outcome prediction in dogs admitted through the emergency room: Accuracy of staff prediction and comparison with an illness severity stratification system for hospitalized dogs https://onlinelibrary.wiley.com/doi/10.1111/vec.13350 You can (and should) listen to more from Bobbi on The Veterinary Journal Club and Discussions podcast: https://podcasts.apple.com/gb/podcast/veterinary-journal-club-discussions/id1478755748

Here we discuss the role of antimicrobials in dogs with pyometra - how, or even if we need to use them. Anna Ylhäinen a doctoral researcher and clinician from the University of Helsinki Veterinary Teaching Hospital who recently published the following study with her team: Placebo is non-inferior to postoperative antimicrobial treatment in uncomplicated canine pyometra – A double-blinded randomized controlled trial. The Veterinary Journal. Open access. https://www.sciencedirect.com/science/article/pii/S1090023325001534 We also discussed further work from Anna and her team: Bacteria associated with canine pyometra and concurrent bacteriuria: A prospective study https://www.sciencedirect.com/science/article/pii/S0378113524003845

When to use, or rather, when not to use any peri-operative antimicrobials at all. Here we discuss the ENOVAT guidelines on surgical antimicrobial prophylaxis. There is a huge capacity for impact here by following and disseminating these guidelines. If you’re on board already, listen and spread the word. If you’re not converted yet, listen in and see what you think. At the end Fergus asks for your help in submitting cases with E. coli in their bile for an observational study he is actively recruiting for. The guidelines: European Network for Optimization of Veterinary Antimicrobial Therapy (ENOVAT) 2025 guidelines for surgical antimicrobial prophylaxis in dogs and cats. https://onlinelibrary.wiley.com/doi/10.1111/jsap.70072 Resources we mentioned: IVEG International Veterinary Evidence Based Guidelines Centre (IVEG) - University of Copenhagen https://iveg.ku.dk/ European Network for Optimization of Veterinary Antimicrobial Therapy (ENOVAT) guidelines for antimicrobial use in canine acute diarrhoea. https://www.sciencedirect.com/science/article/pii/S1090023324001473 ENOVAT website: https://enovat.eu Canine Cruciate Registry https://ccr.rcvsknowledge.org/ Fergus Allerton e-mail address for contributing biliary tract infections to the study: [email protected] Retrospective evaluation of surgical site infection after open splenectomies with and without perioperative prophylactic antibiotic coverage https://www.thieme-connect.com/products/ejournals/abstract/10.1055/a-2105-3593

In this we discuss the peculiarities of cats falling out of windows – what we can expect to find and how we might manage them. Think chest tubes, cardiac rupture, traumatic pancreatitis and a nostalgic dose of physics. Vicente was lecturing on this topic at IVECCS in San Diego, sees plenty of these cases in Valencia, Spain and has a particular interest in traumatic coagulopathies. There are some great articles listed below for your interest. If you find these useful, a quick star rating really helps these conversations reach more vets who might also enjoy them. Articles: High-rise syndrome in cats and dogs. JVECC 2022 https://onlinelibrary.wiley.com/doi/10.1111/vec.13206 High-rise syndrome in cats (part 1): epidemiology and risk factors. JFMS 2025 https://journals.sagepub.com/doi/10.1177/1098612X251334091 High-rise syndrome in cats (part 2): injury patterns and survival rate. JFMS 2025 https://journals.sagepub.com/doi/full/10.1177/1098612X251334096 Pancreatic rupture in four cats with high-rise syndrome. JFMS 2012 https://journals.sagepub.com/doi/10.1177/1098612X11431527 Retrospective evaluation of traumatic pneumomediastinum in dogs and cats (2005–2022): 52 cases. JVECC 2024 https://onlinelibrary.wiley.com/doi/epdf/10.1111/vec.13384 Recommended recumbency to avoid insertional complications during small-bore wire-guided thoracostomy tube placement in cats-a cadaver study. BMC Veterinary Research 2024 https://link.springer.com/article/10.1186/s12917-024-04301-7

Here we discuss how best to use fluid therapy in our critical patients – specifically, the concepts of fluid stewardship, hidden fluids, replacement versus maintenance fluids, sodium load and when fluid overload can happen. Dr Alexandra Pfaff has been building a fluid stewardship team and recently authored a study entitled: Retrospective Evaluation of Risk Factors and Outcome in Dogs With and Without Fluid Overload During Hospitalization in the journal of veterinary internal medicine. https://onlinelibrary.wiley.com/doi/10.1111/jvim.70132 The International Fluid Academy https://www.fluidacademy.org/

This study documents a higher frequency of seronegative myasthenia gravis dogs than was previously thought to be the case and discusses a classification approach that is likely to be built on over time. An Vanhaesebrouck as lead author joins Abbe Crawford to discuss - so you’re in excellent hands to learn more about myasthenia gravis. Case Series of Canine Myasthenia Gravis: A Classification Approach With Consideration of Seronegative Dogs https://onlinelibrary.wiley.com/doi/10.1111/jvim.70113

“Anesthesia safety is less about picking the ‘correct’ drug combination, and more about how you take care of and stabilise the patient…” Join myself and Dr Lydia Love as we discuss the 2025 Small Animal Anesthesia and Sedation Monitoring Guidelines, specifically thinking how we can improve the care of our ICU and ER patients. We cover all sorts: hypothermia, sedation vs anesthesia, recovery, cases such as urethral obstruction and septic peritonitis, locoregional anaesthesia and plenty more! For reference The American College of Veterinary Anesthesia and Analgesia Small Animal Anesthesia and Sedation Monitoring Guidelines 2025 https://www.vaajournal.org/article/S1467-2987(25)00071-6/fulltext Coccygeal epidural with local anesthetic for catheterization and pain management in the treatment of feline urethral obstruction https://onlinelibrary.wiley.com/doi/10.1111/j.1476-4431.2010.00609.x

In this episode we welcome Dr Lauren Minter and Professor Deborah Silverstein to discuss: -Factors associated with tracheostomy decannulation failure in dogs with BOAS -When to attempt decannulation of these dogs -Tracheostomy tube dislodgement -Complications of suctioning -Recurrent obstructive fibrinous pseudomembranes. See this report here: https://onlinelibrary.wiley.com/doi/10.1111/jvim.14650 …all in relation to their original study entitled “Factors that may be associated with tracheal decannulation failure in dogs requiring temporary tracheostomy after upper airway surgery for brachycephalic obstructive airway syndrome” https://onlinelibrary.wiley.com/doi/10.1111/vec.13453 Also see a recent related study here: Retrospective evaluation of the outcomes of advanced airway management in intubated patients with brachycephalic obstructive airway syndrome: 52 cases (2010-2020), https://onlinelibrary.wiley.com/doi/10.1111/jsap.13907 covering specifically those dogs with BOAS that require emergency intubation. Happy listening and reading!