OUTPATIENT PARVOVIRUS: DOES IT WORK? DR. JUSTINE A. LEE, DVM, DACVECC, DABT
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5 GOALS Treatment of the canine parvovirus patient is aimed towards fluid therapy, antibiotic therapy, nutritional support, gastrointestinal support, supportive care, and monitoring. Specific goals of pediatric medicine include temperature control, fluid therapy, nutritional support (with the goal of weight gain), and control of infectious disease and parasites. In the more critically ill pediatric patient, goals should be focused on the following 3H’s: Hypovolemia/Hydration, Hypothermia, and Hypoglycemia. Hypovolemia/Hydration One of the most common causes of neonatal hypovolemic shock is dehydration, which can occur quickly in these small patients due to gastrointestinal losses or higher fluid requirements; therefore, aggressive fluid therapy is warranted because these small patients can deteriorate quickly. For neonates, maintenance fluid requirements are 120-180 ml/kg/ day, while for pediatric patients, fluid requirements range from 60-100 ml/kg/ day. 5,6 In critically ill pediatric patients, fluid therapy for shock must initially be given by IV (or intraosseous) route. Intraperitoneal or SQ routes are not adequate due to slower absorption and, ideally, should not be used in the critically ill, dehydrated, or hypovolemic patient. In severely dehydrated or hypovolemic patients, initial shock doses of a balanced crystalloid such as 30-45 ml/kg should be used. Serial assessment should be done after the bolus to reassess response and
to evaluate the need for further fluid resuscitation. Potassium and dextrose supplementation typically is required, and careful monitoring of blood glucose and electrolytes is warranted. Lastly, colloids can be used in pediatric patients; however, keep in mind that puppies have a lower colloid osmotic pressure (COP) than adult dogs. 7 If necessary, a colloid (e.g., Hetastarch, 1 mL/kg/H; VetStarch, 2 mL/kg/H) can be used to keep colloid osmotic pressure above 15 mm Hg. Hypothermia In pediatric patients, careful temperature regulation and awareness of normal homeostatic temperatures is imperative. Normal rectal temperature in the first week of life is 96° + 1.5°F (35.6° + 0.7°C), 98.6° - 100°F (37-38.2°C) in the second and third week of life, and by 7 weeks of age, reach normal adult levels. 8 Hypothermia can lead to bradycardia and intestinal ileus. Hypoglycemia aggravated by anorexia, vomiting, diarrhea, dehydration, and infection. Ideally, IV dextrose boluses should be used (0.5-1.0 g/kg or 0.5-1.5 ml/ kg IV of 50% dextrose, diluted 1:2- 1:3) preferentially over oral dextrose. Isotonic fluids supplemented with 2.5-5% dextrose as a CRI can also be used (i.e., not D5W); however, caution should be used to prevent over-supplementation as prolonged hyperglycemic can result in worsening Young patients are prone to hypoglycemia, which can be
of dehydration via osmotic diuresis (due to puppies having insulin insensitivity). Antimicrobial therapy In general, beta lactam antimicrobials are considered the safest choices in young, growing puppies. If possible, avoid chloramphenicol, aminoglycosides, tetracyclines, and drugs like clindamycin that undergo enterohepatic cycling. Metronidazole can be used, but dose interval should be prolonged. Finally, quinolones have been shown to result in cartilage lesions in puppies and should be used only with the benefit outweighs the risk and ideally avoided altogether in growing, large breed dogs. (continued)
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