VetEmCRIT Rounds: A Chat about Fibrinolysis

During these rounds, two Diplomates of American College of Veterinary Emergency and Critical Care (Laura Cole and Rachael Birkbeck) are discussing a post-operative bleeding in a dog that underwent an anal sacculectomy and sublumbar lymph node removal. Drs. Cole and Birkbeck talk about physiology and pathophysiology of fibrinolysis as well as DIC, viscoelastic testing and the reasons why hemorrhagic cavitary effusions do not clot.

Dr. Birkbeck’s review paper on hyperfibrinolysis in dogs and cats can be found here.

Understanding Stats When Reading a Scientific Paper

In this post, I want to underscore the importance of understanding a statistical analysis section when reading any scientific paper, especially in veterinary medicine where the peer-review process of statistical analysis is not always as strict as in human medicine.

Obviously, it is impossible to cover the entire statistical analysis course in this post, and I am by no means a statistician. However, I will give you an example of choosing a wrong statistical test leading to a completely wrong interpretation of the results of a clinical study. My goal is to ignite your interest and curiosity with respect to statistical analysis, and I plan to continue posting similar articles in the future.

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Approach to Hyponatremia in Dogs and Cats

This post presents diagnostic and therapeutic approaches to canine and feline patients with hyponatremia. As we all remember, the plasma sodium concentration represents a ratio of plasma sodium content to the water content. As a result, the plasma sodium concentration depends heavily on water balance. Therefore, hyponatremia may develop secondary to either excess of free water in the body or lack of sodium ions relatively to the free water. Also, it is helpful to remember that plasma sodium concentration is the key determinant of plasma osmolality, and the majority of hyponatremic patients will have low plasma osmolality. However, this is not always the case. For example, patients with hyperglycemia or those who received mannitol may develop hyponatremia in conjunction with high plasma osmolality caused by excessive glucose concentration or the presence of other osmotically active substances (e.g. mannitol). Hyponatremic patients with normal plasma osmolality typically have spurious hyponatremia (aka pseudohyponatremia).

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Approach to Hypernatremia in Dogs and Cats

Hypernatremia is defined as a serum sodium level above the reference range. It is a relatively infrequently encountered electrolyte disturbance in dogs and cats. In one retrospective study (Ueda et al. 2015), 5.7% dogs and 8.0% cats were diagnosed with hypernatremia. It was associated with increased case fatality rates in this population of patients. Understanding hypernatremia requires a comprehension of body fluid compartments, as well as concepts of the preservation of normal body water balance. The animal body maintains a normal osmolality between 280 and 310 mOsm/kg via Arginine Vasopressin (AVP), thirst, and the renal response to AVP; dysfunction of all three of these factors can cause hypernatremia (Mushin et al. 2016). In this post, I present a step-by-step approach to the hypernatremia in canine and feline patients. Further reading is recommended to deepen understanding of the physiology and pathophysiology of sodium and water balance.

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