Lake Ray Hubbard
Emergency Pet Care Center

was established in Rowlett in 1997 by a local group of veterinarians to provide high quality emergency and critical care on nights, weekends, and holidays... more

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Signalment: 6 1/2 YR NM DSH

JackHistory: ~2wk history of lethargy; owners now reporting loss of appetite, vomiting and vocalizing when picked up. Hx of feline asthma. Becomes stressed while owners are out of town. Current meds include prednisolone and amoxicillin.

Exam: Presented lethargic, ~8-10% dehydrated, unkempt hair coat, occasional vocalizations, mild gingivitis, tender on abdominal palpation, wt loss.

Diagnostics: Normal WBC on CBC (later elevated to 23k), elevated liver values (ALT 473 U/L), hypokalemia (3.2 mMOL/L), hypophosphatemia (3.0 mg/dl), mild hyperbilirubinemia (1.0 mg/dl) and severe hyperglycemia (425 mg/dl) observed on chemistry analysis. UA revealed concentrated urine (sg 1.044) with severe glucosuria (500 mg/dl) and severe ketonuria. Bilirubin initially normal but elevated to 4.2mg/dl 3 days after admission.

Diagnosis: Diabetic Ketoacidosis

Treatment: Following rehydration, a central venous catheter was placed to facilitate blood sugar rechecks. The blood glucose was monitored every 2 hours while a constant rate infusion of insulin was administered. Antibiotics were administered and electrolytes (and phosphorus) were supplemented in the IV fluids. Jack was discharged the following morning and taken to his regular veterinarian for further care. Force feeding was attempted with the regular veterinarian over the next 2 days but was found to be insufficient for Jacks nutritional requirements. Jack was re-admitted to LRH for esophagostomy tube placement and in conjunction with the Animal Diagnostic Clinic, received around the clock intensive care. Episodes of breathing difficulty were noted on readmission but was suspected to be related to the history of asthma. Radiographs were consistent with allergic bronchitis. Bronchodialators were added to treatment plan and an esophageal feeding tube was placed to assist in providing the much needed nutrients for Jack’s recovery. Once Jack became more stable, he was started on an more longer acting insulin (glargine). Jack gained his appetite back and was eventually discharged 11 days after the original diagnosis with a lifelong requirement for injectable insuilin.

Discussion: Diabetic Ketoacidosis (DKA) is a life threatening disease that occurs as a complication of diabetes from a prolonged deficiency of insulin. The purpose of insulin is to “drive” glucose into the cells so that it may be utilized as an energy source. When cells lack sufficient amounts of glucose, the body shifts to an alternate form of metabolism that results in formation of ketone bodies. Stress hormones have also been implicated in promoting the ketone body production and together will lead to metabolic acidosis (elevated pH of the blood). Hyperglycemia (high blood glucose) eventually leads to dehydration by promoting diuresis by the kidneys.

Signs: Presenting symptoms include polyuria (increased urinations), polydipsia (increased drinking), weight loss, vomiting, weakness, mental dullness, and collapse. Initially with diabetes, a voracious appetite is sometimes recognized in the face of weight loss. DKA often occurs in older male cats (>8yrs) and middle age female dogs (~7-9yrs). Pets can often present with concurrent disease processes such as pancreatitis, urinary tract infections, skin infections, kidney disease, etc..

Diagnosis: Hyperglycemia (blood sugar often >400 mg/dl), glucosuria (glucose in urine) and ketonuria (ketones in urine).

JackTreatment: Intravenous fluid therapy, electrolyte supplementation and eventually insulin therapy are provided around the clock to correct the metabolic derangements. The goal is to convert the DKA patient into a more stable diabetic situation that can be managed as an outpatient. CRI (constant rate infusion) insulin is started once the hydration level of the pet has improved. Central venous lines are placed to facilitate ease of monitoring the blood glucose and electrolytes as samples can often be needed every 1-2 hours for several days. Newer technology is becoming available that will allow us to continuously monitor the body glucose levels. Nutritional support is often necessary and may require esophagostomy or a gastric tube placement. These tubes provide a manner in which to administer the much needed nutrition to promote a more rapid return of normal energy metabolism. These tubes are tolerated quite well and can also be used at home during the recovery process.

24-hour critical care facilities are best utilized for managing these cases due to the constant requirement of medical attention and monitoring.

Prognosis: DKA is a manageable complication but often requires several days of continuous intensive care and hospitalization. Most DKA patients are discharged ~5-7 days after diagnosis unless some other disease process complications are encountered such as kidney failure, liver disease or pancreatitis. Once discharged, the pet will be placed on daily insulin injections which are quite easy to administer for most pets. The regular veterinarian will often request weekly checkups for the first month as the pet’s insulin needs are fine tuned.

Footnote: On a very sad note... Jack developed pulmonary histoplasmosis (fungal pneumonia) the following year and passed away on May 3rd, 2007.

All of us at LRH feel very fortunate to have been able to spend just a fraction of his life with him. With the hours all of us spent with Jack added up…he really found a way into all of our hearts. He remained quite vocal in the ICU throughout his stay (obviously had a lot of things to say to us) and his very unique personality remained quite evident even during his most ill moments. We will miss you Jack.

What's New

Dr. Lynn Britton - VRCEDVRCED welcomes Dr. Lynn Britton to our staff.  Dr. Lynn Britton’s areas of surgical expertise include wound management and reconstruction, fracture repairs, cranial cruciate ligament disease, and intervertebral disc disease while utilizing the latest in medical technology ...

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Dr. Carmen WooleyWe are pleased to announce that Dr. Carmenn Woolley has joined our practice as a Staff Internist and is currently accepting small animal internal medicine referrals from your veterinarian. Dr. Woolley graduated from Oklahoma State, completed her residency requirements at Cornell University, and is board certified by the American College of Veterinary Internal Medicine. She has received advanced training in the diagnosis and treatment of serious medical problems including those which affect major organ systems such as the heart ...

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From a Technician's Perspective

Emergency practice is completely different from the day practice. The animals in the hospital are usually very sick or severely injured. You become so close to the animals because your primary job is to care for them. You know that each animal is part of a family and it is up to you to get them back home.

At the beginning of each day I review cases, make sure that every animal in the hospital is as comfortable as possible and has everything it needs. I get the hospital ready for any emergency that could arrive. When the doorbell rings the day begins...

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The following article appeared in The Dallas Morning News.

ROWLETT - Bud had crawled home bleeding from what looked like buckshot wounds.

Coco had stopped eating and was barely generating enough body heat to stay alive.

Whiskers had parvo so severe that he couldn't stand, and Ozzy was starting to show parvo symptoms.

Just a typical weekend at the Lake Ray Hubbard Emergency Pet Care Center, the only 24-hour, seven-day-a-week "animal ER" in the Rockwall-Rowlett area and one of only a handful in North Texas.

By Monday, the furry patients would have stolen staffers' hearts and taxed their skills. As in human hospitals, there would be long, uncertain waits, some ending in relief, others in sorrow.

At first glance, Coco appeared to be an old piece of fleece someone had left in the corner of the incubator. But a tap on the glass brought up the 15-week-old toy poodle's head to see what had disturbed his nap.

Owner Lupe Zepeda of Rowlett said his older poodle had been scaring the puppy away from food and water at home. Eventually, the pup had stopped eating altogether. When he arrived at the clinic Saturday morning, Coco was near death...

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More Interesting Stories

Interesting Case

LaylaSignalment: 4 YR FS DSH

History: “Layla” was an adult stray cat, wandering the neighborhood when she was taken in by her good hearted owner. For the first two years in her new home “Layla” was healthy and received regular veterinary care. Layla’s owner began to notice weight loss and then blood tinged urine outside the litter box. At that time, “Layla” also began hiding and avoiding all attention. “Layla” was taken to her regular veterinarian where her blood work revealed anemia. It was suspected that she had a blood borne parasite or an autoimmune disorder, immune mediated hemolytic anemia (IMHA). She was prescribed the antibiotic Doxycycline and a vitamin supplement. Her owner observed labored breathing and increasing lethargy the following morning, “Layla” was referred to the ER.

Exam: She presented depressed with fair pulses, pale mucus membranes and increased bronchovesicular sounds in dorsal lung fields.

Diagnostics: The CBC revealed anemia (Hct 14%) and thrombocytopenia (62 K/uL). Hyperbilirubinemia (0.8 mg/dL) and hyperglycemia (266 mg/dL) were noted on the chemistry analysis.

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DieselHistory:  Diesel presented with facial swelling redness and hives on his chest and abdomen.  His owner stated that he was outside for approximately 1 hour, and noted the swelling after 30 minutes. Owner gave him a bath the he began rubbing his face.  Diesel began developing hives on the car ride to the clinic. The family’s yard is small and in a residential area, and they are not aware of any toxins or abnormal items that he could have ingested.  Diesel had had no recent changes in his diet, no flea products applied, and no vomiting.  He has no history of allergies or any other medical issues. He is also current on vaccinations and takes a monthly heartworm preventative.

Exam:  All of the abnormalities found were associated with Diesel’s skin.  He had generalized red skin (erythema) which was most pronounced on his head/neck, and swelling (angiodema) which was primarily affecting his face.  He was itchy (pruritic) and also had hives (urticaria).  Otherwise Diesel appeared to be a normal Boston Terrier.

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DeetsSignalment: 4YR, intact male, Belgian Sheepdog

History: Acute onset of abdominal discomfort noticed by owner several hours prior to presentation. “Deets” had been seen crouching in a “praying” posture and also was acting unusual. No retching, vomiting or diarrhea had been observed and there had been no history of dietary indiscretion.

Exam: Mucous membrane color was slightly muddy, femoral pulses reduced, and very mild stomach distension was observed on abdominal palpation. Hydration status was normal and “Deets” was very alert and active in the examination room.

Diagnostics: CBC, chemistry analysis, and electrocardiogram were normal. Radiographs revealed abnormal gas accumulation with compartmentalization in the stomach suggesting gastric distension and volvulus...

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SateviaSignalment: 3 month old, Chihuahua

History: Acute onset of weakness and lethargy. Owners also observed difficulty breathing (dyspnea).
Exam: Tachypnea (rapid breathing), pale mucous membranes, weak, lethargic, muffled heart sounds bilaterally.

Upon further discussion with the owners, it was found that the puppy had eaten rat bait poison approximately 3 days prior to presentation.The owners believed that the poison was an anticoagulant.

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Signalment: 6 1/2 YR NM DSH

JackHistory: ~2wk history of lethargy; owners now reporting loss of appetite, vomiting and vocalizing when picked up. Hx of feline asthma. Becomes stressed while owners are out of town. Current meds include prednisolone and amoxicillin.

Exam: Presented lethargic, ~8-10% dehydrated, unkempt hair coat, occasional vocalizations, mild gingivitis, tender on abdominal palpation, wt loss.

Diagnostics: Normal WBC on CBC (later elevated to 23k), elevated liver values (ALT 473 U/L), hypokalemia (3.2 mMOL/L), hypophosphatemia (3.0 mg/dl), mild hyperbilirubinemia (1.0 mg/dl) and severe hyperglycemia (425 mg/dl) observed on chemistry analysis. UA revealed concentrated urine (sg 1.044) with severe glucosuria (500 mg/dl) and severe ketonuria. Bilirubin initially normal but elevated to 4.2mg/dl 3 days after admission.

Read more ...