The following morning, the patient had peripheral edema, icteric mucous membranes, abdominal pain, and prominently enlarged popliteal lymph nodes. The following medications were administered: S-adenosylmethionine with silybin (Denamarin Nutramax Laboratories, Lancaster, South Carolina, USA), 20 mg/kg BW, PO, q24h, famotidine (Famotidine APP Pharmaceuticals, Shaumburg, Illinois, USA), 1 mg/kg BW, IV, q24h, maropitant (Maropitant citrate Zoetis, New York, New York, USA), 1 mg/kg BW, SC, q24h, vitamin K 1 (Vitamin K1 Phoenix Pharmaceutical), 3 mg/kg BW, SC, q12h, and ampicillin sodium/sublactam sodium (Ampicillin sodium/sublactam sodium AuroMedics Pharma, Dayton, New Jersey, USA), 22 mg/kg BW, IV, q8h. Joseph, Missouri, USA), 2 mL/L, and a crystalloid (Normosol R Hospira, Lake Forest, Illinois, USA) bolus of 65 mL/kg body weight (BW) followed by a rate of 5.4 mL/kg BW per hour. The dog was treated with intravenous fluids containing vitamin B complex (Vitamin B complex Phoenix Pharmaceutical, St. Treatment recommendations made by the APCC included intravenous fluid therapy with vitamin B complex supplementation, anti-emetics, abdominal pain control, N-acetylcysteine or S-adenosylmethionine (SAM-E) if the patient was not vomiting.
The most common side effects of acute joint supplement toxicity included moderate to severe gastroenteritis, elevated liver enzymes, and prolonged clotting times. An abdominal ultrasound was recommended but declined.Ī consulting veterinarian at the ASPCA Animal Poison Control Center (APCC) was contacted and indicated several cases of liver failure had been associated with joint supplement overdosage in recent years. The most significant abdominal radiographic finding was generalized loss of serosal detail. Urinalysis revealed a urine specific gravity (USG) of 1.033, a pH of 7.5, proteinuria (3+), bilirubinuria (3+), and hematuria (2+). A blood sample sent to a reference laboratory showed the alanine aminotransferase (ALT) markedly elevated at 14 950 U/L (RR: 12 to 118 U/L), prolonged prothrombin time (PT) of 18.5 s (RR: 5.5 to 12 s), and a normal activated partial thromboplastin time (aPTT) of 22.5 s (RR: 10 to 25 s). Serum chemistry abnormalities included moderately elevated alkaline phosphatase (ALKP = 509 U/L RR: 23 to 212 U/L), mildly elevated total bilirubin (tBil) at 30.8 μmol/L (RR: 0.0 to 15.4 μmol/L), and mildly elevated lipase at 1997 U/L (RR: 200 to 1800 U/L). The CBC abnormalities included moderate hemoconcentration at 59%, mild neutrophilia at 13.88 × 10 3/μL (RR: 2.0 to 12.0 × 10 3/μL), mild basophilia at 0.10 × 10 3/μL (RR: 0.00 to 0.10 × 10 3/μL), and a decreased mean corpuscular hemoglobin concentration at 293 g/L (RR: 300 to 375 g/L). Diagnostic tests included a complete blood (cell) count (CBC), serum biochemistry, coagulation parameters, abdominal radiographs, and urinalysis. Upon presentation to the critical care service, approximately 16 h after ingestion, the patient’s physical examination findings were unchanged. Blood tests showed markedly elevated hepatocellular enzymes and moderately elevated bilirubin levels. Melena was present on rectal examination. On examination, the patient was quiet but responsive, cardiothoracic auscultation was normal, and abdominal palpation was unremarkable. The patient was presented to the veterinarian approximately 10 h after ingestion with a chief complaint of vomiting, inappetence, and lethargy. The estimated doses of glucosamine and chondroitin sulfate ingested were 2173 mg/kg body weight (BW) and 217 mg/kg BW, respectively. A 5-year-old, spayed female, Bernese mountain dog ingested approximately 200 joint supplement chews (Joint MAX Triple Strength Pet Health Solutions, Union City, California, USA).
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