Reggie, a 4 year old female spayed Pug cross, presented to our hospital for heat stroke. The following is a summary of what happened with Reggie once she entered our hospital.
The clients reported that Reggie had been accidentally locked out on a patio for several hours with no shade or water; the temperature that day was 100F. When the owners came home and found Reggie, she was panting heavily and was unresponsive. The owners took Reggie into the shower in effort to cool her down, and then brought her to the hospital.
There were several abnormalities found on Reggie’s initial physical exam. Her body temperature upon arrival was 108.9 (despite cooling efforts by the owners); she was not responsive to sound or touch; her pupils were dilated and unresponsive to light; her heart was beating very fast and her pulses were decreased. At this early stage, Reggie was determined to be in hypovolemic shock, suffering from severe dehydration, and showing signs of cerebral edema (swelling of the brain).
Emergency treatment was initiated immediately: an IV catheter was placed and a bolus of fluids was given, oxygen was delivered via flow-by, and external cooling measures were started. Within 20 minutes of arrival, we had lowered Reggie’s body temperature to 102.3 (normal). The IV fluids helped resolve the shock, as well as start the long process of rehydration. Reggie was given medication to decrease the swelling in her brain; she became more responsive and aware of her surroundings, however, she appeared to be blind. Reggie was hospitalized in an oxygen cage and a treatment plan was made to treat her current and impending problems.
Heat stroke causes injury to the cells of the body, which can result in multiple organ failure, and often death. The following is a summary of the organ systems that were affected, and the treatment given to Reggie over the three days that she was hospitalized.
Damage to the GI tract – Reggie developed severe, bloody diarrhea, indicating that the cells lining her GI tract had been damaged. We started Reggie on broad spectrum antibiotics (to protect her from bacteria that may be crossing from her damaged GI tract into her bloodstream) and GI protectants. After a brief period of fasting, Reggie was started on an oral electrolyte solution to provide nutrition to the cells lining the GI tract.
Clotting abnormalities – Reggie developed petechial (pinpoint) hemorrhages, indicating that she was having problems clotting her blood. Reggie was given a plasma transfusion to provide clotting factors, and her blood was monitored regularly. During her stay, Reggie’s platlet count dropped to a dangerously low level, which put her at risk for spontaneous bleeding.
Heart damage – Continuous monitoring of Reggie’s EKG showed an abnormal rhythm, indicating possible damage to her heart muscle. The arrhythmia was not severe enough to warrant treatment other than supportive care and continued monitoring.
Liver damage – Reggie’s liver enzymes were moderately elevated, but she did not develop signs of liver failure. She was started on medications to help support and protect her liver.
After three days of intensive care, Reggie was doing much better; her sight returned, she was brighter, her bloody diarrhea had improved and she was eating on her own. Her platlet count remained very low and she was still at risk for spontaneous bleeding. Reggie was discharged to her family with several medications, including antibiotics and GI and liver protectants. The family was instructed to provide strict exercise restriction to reduce the risk of any trauma that could cause bleeding. Reggie was to follow up with her regular veterinarian to monitor her blood to be sure that her platlet count was improving and that her organs were continuing to function; she was also to have a recheck EKG.
A follow up phone call to Reggie’s family found that she was active and doing well, and was not showing any signs of bleeding or organ failure.
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