Specialist: Dr Adam Mugford BVetMed MVetMed DACVECC MRCVS, Board-Certified Emergency and Critical Care Specialist
Tell had been diagnosed with an open pyometra one month earlier. She was represented to London Vet Specialists collapsed, and a ruptured pyometra with septic peritonitis was confirmed with ultrasound, abdomenocentesis and in-house cytology. Stabilisation via rapid goal-directed therapy, and exploratory laparotomy with ovarian hysterectomy and abdominal lavage was performed. Monitoring was aided by continuous ECG, serial invasive blood pressure measurement and lactate measurement.
36 hours post operatively, Tell had acute onset dyspnoea with severe hypoxaemia. Her SpO2 was 80%, and bilateral nasal cannulae were placed to allow continuous administration of oxygen therapy at a concentration of 40-60 %. Serial arterial blood gas sampling via arterial catheter placement and repeated thoracic radiography confirmed the presence of severe aspiration pneumonia. Rapid respiratory fatigue occurred, with paO2 56 mmHg (reference 300 mmHg) and pCO2 57 mmHg. Management via mechanical ventilation was discussed with Tell’s owners.
At this time however she slowly began to make progress . Ileus was managed with CRI of metoclopramide and analgesia provided with fentanyl and lidocaine infusions. Early enteral nutrition was provided via naso-oesophageal tube placement.
During ongoing recovery, Tell developed significant hyperglycaemia, which was managed using an insulin constant rate infusion. Evidence of acute kidney injury was detected by serial creatinine monitoring and fluid therapy for a significant polyuria was guided by in-dwelling urinary catheter placement. After 11 days, Tell was weaned from oxygen therapy and successfully discharged, with insulin therapy, however a fructosamine level was within reference range.
In consultation with board-eligible Internal medicine clinician Amy Lam, insulin antagonism due to progesterone excess as a result of the pyometra was suspected. Regular ongoing monitoring and adjustment of insulin therapy by Amy allowed rapid diabetic remission and after only 6 weeks insulin therapy was discontinued.
Dr Mugford is happy to discuss the referral and appropriate transport of any dyspnoeic case that may require long term oxygen therapy and investigation.