Clinical Exposures: Uterine rupture in an 18-month-old toy poodle - Veterinary Medicine
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Clinical Exposures: Uterine rupture in an 18-month-old toy poodle


VETERINARY MEDICINE


POSTOPERATIVE CARE

The patient recovered quickly and without complications from anesthesia. The dog was given intravenous lactated Ringer's solution at twice the maintenance rate and continued to receive intravenous sodium ampicillin every eight hours and buprenorphine intramuscularly as needed for pain. The dog's hematocrit, which was rechecked by using the capillary tube technique, was 24% with a total protein concentration of 8 g/dl. The dog was transferred to the local emergency clinic for continued overnight care.

The emergency clinician reported that the dog did not vomit overnight but had continual diarrhea and inappetence. Its hematocrit remained stable at 24%, and it was normothermic throughout the night, with an average rectal temperature of 100 F (37.8 C).

Once adequate hydration had been achieved, gentamicin (2 mg/kg intravenously every 24 hours) was empirically initiated to target gram-negative bacteria. An in-house canine pancreas-specific lipase test (Snap cPL Test—Idexx) was performed at the emergency clinic, and the results were abnormal, indicating pancreatitis. The patient was transferred back to the presenting hospital the next morning for continued care.

FOLLOW-UP DIAGNOSTIC TESTS

On re-examination, the dog was quiet, alert, and responsive. Its temperature was 100 F (37.8 C), and its mucous membranes were light pink with a capillary refill time of < 2 sec. A blood sample submitted to Antech Diagnostics revealed that the patient's hematocrit had increased to 30%, the amylase activity was increased (2,271 IU/L; reference range = 290 to 1,125 IU/L)—most likely because of pancreatic inflammation—and the lipase activity was normal (537 IU/L; reference range = 77 to 695 IU/L). All other serum chemistry profile results were normal.

Unfortunately, the patient continued to have bouts of vomiting and diarrhea throughout the day. The dog was given maropitant citrate (Cerenia—Pfizer Animal Health) (1 mg/kg) and famotidine (0.7 mg/kg) subcutaneously every 24 hours, and 2.5% dextrose was added to the intravenous fluids. A fecal examination was submitted to Antech Diagnostics for centrifugal flotation and revealed no abnormalities. The patient remained inappetent, so canned food was administered as a slurry through an oral syringe.

DISCHARGE

Because of financial constraints, the owners elected to take the patient home after 32 hours of hospitalization despite its inappetence. The previously described medications were discontinued, and at discharge, amoxicillin trihydrate-clavulanate potassium (17 mg/kg orally every 12 hours for 14 days), metronidazole (13.5 mg/kg orally every 12 hours for 14 days), and tramadol (1.7 mg/kg orally every eight hours for five days) were prescribed. The owners were instructed to feed the dog chicken and rice or another bland diet and to seek a veterinary evaluation if the patient's condition worsened.

The following morning, the patient was reportedly much brighter and alert and eating chicken and rice with no vomiting or diarrhea. Over the next several days, the dog's condition continued to improve, and by postoperative day 5, the owners reported the dog's appetite and behavior were normal, and it began eating commercial dog food again.

CULTURE RESULTS

The uterine bacterial culture yielded light growth of Escherichia coli, Proteus mirabilis, and Enterococcus species, and the Mycoplasma species culture yielded no growth in 14 days. The E. coli and Enterococcus species exhibited sensitivity to amoxicillin-clavulanate, and P. mirabilis exhibited intermediate sensitivity. These results became available when the patient was at home and showing no signs of illness. It was determined that the bacterial growth may have been an ascending infection associated with the patient's open cervix during parturition. No change in antibiotic therapy was recommended.


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Source: VETERINARY MEDICINE,
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