QUARTERLY BEAT / OCTOBER 2023 ///
/// QUARTERLY BEAT / OCTOBER 2023
when we are not aware of their coagulation status. You will be able to gain information about the patient’s status by running a chemistry, complete blood count (CBC), packed cell volume (PCV), electrolytes, blood gases, prothrombin time (PT), and partial thromboplastin time (PTT). Even if we do not see abnormalities in these values on presentation, it is very helpful to have a baseline so we can continue to monitor trends. Clinicopathologic changes seen with heatstroke may include increases in serum hepatic and renal values, hyperlactatemia, hypoglycemia, thrombocytopenia, hemoconcentration, and prolonged PT/PTT. Electrolyte abnormalities can also be seen with heatstroke, including hypernatremia, hyperkalemia, or hypokalemia. Fluid therapy is warranted with heatstroke patients. A balanced, isotonic crystalloid should be used. Dextrose supplementation (2.5-5%) may be warranted, depending on what the blood glucose levels are; these should be frequently checked and adjusted as appropriate. The use of colloids should be limited to severe hypoproteinemic patients. The use of plasma transfusions may be warranted if the patient is coagulopathic (e.g., prolonged PT/PTT, etc.). Cooling the patient should be done in a controlled manner. Using a fan, placing cold wet towels between the inguinal region, placing the patient on a cool treatment table, or utilizing room-temperature intravenous fluids can help. We want to avoid submersion in an ice-cold bath or direct ice packs as these may cause peripheral vasoconstriction and lead to further damage by shunting all the patient’s warm blood to their vital organs. Temperature should be monitored at least every 5 minutes and active cooling efforts should stop once you reach a temperature of approximately 103.5 0 F/39.7 0 C. The body may continue to cool once active cooling is stopped, resulting in significant hypothermia. Monitoring Patients suffering from heatstroke require intensive nursing care and close monitoring. You should be continually assessing the patient’s perfusion, hydration status, blood glucose, lactate, blood gases, blood pressure, urine production, vitals, ECG, and mentation. Nursing care is a big part of managing these patients as they are often non-ambulatory and time intensive. Prognosis Patients suffering from heatstroke have a mortality rate of 40-50%. Unfortunately, even despite aggressive supportive care, the prognosis may be grave. Quick and aggressive care is imperative to achieve the best outcome. It is often the secondary complications such as SIRS, sepsis, MODs, and DIC that lead to death or euthanasia.
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HEATSTROKE IN DOGS: A LIFE- THREATENING EMERGENCY by Dr. Erik Zager, DACVECC
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SHOCK TÉRMICO (HEAT STROKE) by Dr. Mariana Pardo, BVSc, MV, DACVECC (Spanish only) • HEATSTROKE FOR VETERINARY TECHNICIANS by Amy Newfield, CVT, VTS (ECC) References • Bruchim Y. (2018, September 25-28). Management of heat stroke in the dog. World Small Animal Veterinary Associates Congress, Singapore. • Bruchim Y. et al. (2006). Heat Stroke in Dogs: A Retrospective Study of 54 Cases (1999-2004) and Analysis of Risk Factors for Death. Journal of veterinary internal medicine / American College of Veterinary Internal Medicine. 20. 38-46. 10.1111/j.1939-1676.2006.tb02821.x. • Bruchim, Y., Ginsburg, I., Segev, G. et al. Serum histones as biomarkers of the severity of heatstroke in dogs. Cell Stress and Chaperones 22, 903–910 (2017). https://doi.org/10.1007/s12192-017-0817-6 • Bruchim,Y. Horowitz, M, Aroch,I. (2017). Pathophysiology of heatstroke in dogs-revisited, Temperature, 4(4) 356-370. DOI: 10.1080/23328940.2017.1367457 • Bruchim, Y., Kelmer, E., Cohen, A., Codner, C., Segev, G. and Aroch, I. (2017), Hemostatic abnormalities in dogs with naturally occurring heatstroke. Journal of Veterinary Emergency and Critical Care, 27: 315-324. https://doi. org/10.1111/vec.12590 • Bruchim, Y. Loeb, E. Saragusty,J. Aroch, I. (2009). Pathological findings in dogs with fatal heatstroke. J. Comp. Path. 140. 97-104. doi:10.1016/j. jcpa.2008.07.011 • Bruchim, Y., Segev, G., Kelmer, E. et al. Hospitalized dogs recovery from naturally occurring heatstroke; does serum heat shock protein 72 can provide prognostic biomarker?. Cell Stress and Chaperones 21, 123–130 (2016). https://doi.org/10.1007/s12192-015-0645-5 • Cray, C., Zaias, J., & Altman, N. H. (2009). Acute phase response in animals: a review. Comparative medicine, 59(6), 517–526. • Hall, E. Carter, A. Chico, G. Bradbury, J. Gentle, L. Barfield, D. O’Neill, D. (2022). Vet. Sci. 9(5) 231. https://doi.org/10.3390/vetsci9050231 • Iba, T. Helms, J. Levi, M. Levy, J. (2022) The role of platelets in heat-related illness and heat induced coagulopathy. Thrombosis Research. https://doi. org/10.1016/j.thromres.2022.08.009 • Johnson, S. McMichael, M. White, G. (2006) Heatstroke in small animal medicine: a clinical practice review. Journal of Veterinary Emergency and Critical Care. 16(2). 112-119. doi:10.1111/j.1476-4431.2006.00191.x • Mazzaferro, E. (2015, May 15-18). Treatment of Hyperthermia and Heat- Induced Illness. World Small Animal Veterinary World Congress. Bangkok, Thailand. • Romanucci, M., & Salda, L. D. (2013). Pathophysiology and pathological findings of heatstroke in dogs. Veterinary medicine (Auckland, N.Z.), 4, 1–9. https://doi.org/10.2147/VMRR.S29978 • Segev, G. Aroch, I. Savoary, M. Kass, P. Bruchim, Y. (2015). A novel severity scoring system for dogs with heatstroke. Journal of Veterinary Emergency and Critical Care. 25(2) 240-247. doi: 10.1111/vec.12284 • Tabor,B. Heatstroke in Dogs. Today’s Veterinary Practice 2014; 4(6), 50-56. • Tracy, A. Lynch, A. Messenger, K. Vaden, S. Vigani, A. (2020). Use of extracorporeal therapy in a dog with heatstroke. Journal of Veterinary Emergency and Critical Care. 32(4) 512-519. https://doi.org/10.1111/ vec.13169ww
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