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: 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.

Lab testing:

pcv/tp: 22/5.0 >35/>6
Prothrombin time: >220 seconds 12 – 17 seconds
Pulse oximeter ~85% >95%

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.

SateviaDiagnosis: Anticoagulant rodenticide toxicity with resultant hemothorax (bleeding into the chest cavity).

Prognosis: Guarded to poor due to ongoing hemorrhage and late stage of toxicity.

Treatment: An intravenous catheter was placed on arrival and oxygen therapy was instituted. Following approval of necessary care by the owners, a plasma transfusion was started. We administered a total of 20mls of fresh frozen plasma intravenously (provides important clotting factors to stop the ongoing hemorrhage). Vitamin K1 was also administered during the plasma transfusion (antidote).

SateviaApproximately 4 hours after presentation, the puppy was observed becoming progressively dyspneic suggesting that too much blood had accumulated within the chest cavity to allow normal lung inflation. The pulse ox was 88% (measurement of oxygen concentration in the blood) on room air but dyspnea was also observed with supplemental oxygen.

Thoracocentesis was performed (placing a needle into the chest to remove the blood) and approximately 35mls of blood was removed from each side of the chest. We attempted to collect blood in an anticoagulant for possible auto-transfusion (transfusing the same blood back into the animal) but the blood clotted. Breathing immediately improved but mucous membranes were becoming pale again.

PCV/TP: 11/3.5

Due to the quantity of blood removed from the chest and the subsequent severe anemia observed, a whole blood transfusion was administered (60mls) intravenously. Mucous membrane color improved and “Satevia” was upgraded to stable condition by 8am the next morning. No further problems were observed. The Animal Hospital of Rowlett continued to provide oxygen and monitor the breathing through the day. “Satevia” was discharged later that afternoon with a prescription of vitamin K1 capsules.

SateviaMechanism of toxicity: The agent in the rat poison (brofidacoum, warfarin, others) selectively bind to vitamin K receptors in the liver and prevents the production of specific clotting factors. Without these factors, we will eventually see some area of uncontrolled hemorrhage. The areas of bleeding can be into the chest cavity, abdomen, stomach, urine, eyes or from a small cut or bruise. If all bleeding is internal, the only signs observed might be difficulty breathing, pale gums and lethargy. Hemorrhage will be fatal unless treated in the initial stages of bleeding.

Discussion: Unfortunately, anticoagulant rodenticide toxicity is a fairly common ailment observed at the emergency clinic. The rat poison is readily found and eaten by curious pets with bleeding signs developing ~3 days after ingestion. The PT test can quickly confirm any suspected exposures by measuring the efficiency of the clotting system. If the PT is significantly prolonged and exposure is possible, a presumed diagnosis can be made.
“Satevia” was already bleeding on arrival so blood product transfusions were necessary to stop the bleeding. Plasma provides clotting factors and proteins for those animals and whole blood also provides red blood cells. Vomiting and activated charcoal are of little use by this time because the toxin has already being digested and absorbed. The antidote (vitamin K1) is administered in high concentrations for the next 2-3 weeks to overwhelm the binding sites in the liver thus pushing the toxin compounds off the receptor sites in the liver. This allows the liver to make the much needed cloting factors again. If the vitamin K1 is discontinued too early, the signs could re-develop. This duration of action of the toxin depends on which exact compound was in the product. Some components will have effects lasting several weeks and others may only last a week or so.

Treatment options:
Acute ingestion (owner recognizes the ingestion within the first few hours)
Prognosis: good/excellent
1. Decontaminate - induce vomiting.
2. Prevent absorption - administer activated charcoal
3. Administer antidote - vitamin K1
4. Confirm prolonged PT and baseline PCV/TP.

> 3 days ingested (often presenting with an ongoing critical hemorrhage)
Prognosis: guarded/poor
1. Plasma and/or blood transfusions
2. Administer antidote.
3. Possible thoracocentesis if severe hemothorax encountered.

Important Facts:

Keep all poisons away from areas that are even remotely accessable to pets or children.
If your pet ingests a poison, call your veterinarian or local emergency facility and inform immediately.
Not all poisons should be vomited; please call your veterinarian first before inducing vomiting at home.
Bring the packaging of the poison with you so your veterinarian can read the ingredient list.

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.

Read more ...

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.

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