Management of Envenomation Induced Aki with Intermittent Haemodialysis in A Dog

A fourteen month old Labrador dog (BRUNO) was presented to the pet hospital with a recent history of viper envenomation. Dog was vocalising and restless. On the day of presentation, seem creation and blood nitrogen (BUN) values were 3.7mg/dL and 89.1 mg/dL respectively. The serurm creatinine and blood urea nitrogen values elevated within two days to 6.7mg/dL and 138.6mg/dL respectively. The doy become oliguria.The clinical signs and laboratory values were consistent with acute kidney injury. Intermittent haemodialysis (IHD) was carried out as dog was refractory to medical management. Post IHD creatinine and BUN values were 6.7 mg/dL and BUN Values 101 mg/dL, respectively. Serum creatinine and BUN value increased to 7 mg/dL and 130 mg/dL, the next day after IHD. Second session of IHDreduced serum creatinine and BUN values to 6 mg/dL and 97.8 mg/dL. Dog continued to be dull, anorexic with oliguria. Third session of IHD helped in reduction of serum creationine and Oliguria resolved. The dog resumed his appetite and was clinically stable. Dog was observed for next 24 hours and discharged. On review after three days, dog exhibited considerable improvement; creatinine and BUN value were 3.1 mg/dL and 54.4 mg/dL, respectively. Ten days later follow up revealed that creatinine and BUN value stabilised at 1 mg/dL and 24 mg/dL. Dog showed alow and steady recovery from acute kindney injury overa period of 20 days. Bruno In Pet Hospitial Kochin Viper envenomation induces kidney injury (Hrovat et at 2013) Intermittent haemodialysis is a renal replacement therapy which is used to alleviate lifethreatening azotaemia electrolyte and acid-base imbalances and control intravascular volume (Cowgill) and Elliott, 2000). This article describes a case viper envenomation induced acute acute kidney mjury in a dog, which was successfully managed with three sessions of intermittent haemodialysis. Materials And Methods A fourteen month old Labrador dog (Bruno) dog was restless, vomiting and vocalising Clinical examination revealed facial oedema, dullness and haematuria. Clotting time was on initially more than 20 minutes.Laboratory findings revealed scrum creatively (sCr) and blood urea nitrogen (BUN) values to be 4.9mg/dL and 99.1 mg/dL, respectively. On basis of anamnesis, clinical examination, and laboratory investigation findings, diagnosis of viper envenomation was made. Treatment was started with anti-venom, antibiotic inj Amoxicillin clavulante @ 15mg/kg, fluids Normal Saline, Inj Ondensctron @ 0.5mg/kg Inj. Pantoprazole @ 1mg/kg,. After initiation of treatment, clotting time reduced to less than 6 minutes. Fluid therapy was continued for the next four days with Ringer 5 lactate and, Normal saline Antibiotic and ondensetron and pantoprazole were continued as well water intake and urine output were monitored. The sCr and BUN values elevated within two days to 6.4mg/dL and 130.6mg/dL respectively. The dog became oliguric. The clinical signs and laboratory values were consistent with acute kidney injury stage V (IRIS, 2016). Intermittent haemodialysis (HID) was carried out as dog was refractory to medical management. Result And Discussion The dog was subjected to renal replacement therPY intermittent hemodialysis to alleviate life. Breatining azotemia. (Cowgill and Elliott, 2000). Post first session of 1 HD, sCr and BUN decreased to 5.8mg/dL and 107 mg/dl, respectively. The sCr and BUN values again rose ..... Dy to 9mg/ and 135mg/dL, respectively. Second session of 1 HD has to be carried out. Post second session, sCr and BUN values reduced to 6 mg/dL and 97.8 mg/dL respectively . Dogs continued to be dull, anorexic with oliguria. The sCr Bruno In Pet Hospitial Kochin and Bun value shot up us 7.5 mg/dL and 160 mg/dL within 36 hours. Third session of 1 HD was carried out which. A further old Labrador dog (Bruno) was presented to the pet hospital with a recent history of viper envenomation. Dog was vocalising and resiless. On the day of presentation, scrum creatinine and blood urea nitrogen (BUN) values were 3.5 mg/dL and 95.1 mg/dL, respectively. The scrum creatinine and blood urea nitrogen valuve oliguria. The clinical signs and laboratory values were consistent with acute kidney injury. Intermittent haemodialysis (IHD) was carried out as dog was refractory to medical management. Post IHD creatinine and BUN values were 4.5 mg/dL and BUN values 104 mg/dL, respectively. Serum creatinine and BUN values increased to 8 mg/dL and 130 mg/dL, the next day after IHD. Second session of IHD reduced scrum cretinine and BUN values to 5 mg/dL and 98.8mg/dL. Dog continued to be dull, anorexic with oliguria. Third session of IHD helped in reduction of serum creatinine and BUN values from 8.4mg/dL and 150 mg/dL to 4.9mg/dL and 82.6 mg/dL, respectively, Oliguria resolved. The dog resumed his appetite and was clinically stable. Dog was observed for next 24 hours Abstract iMedPub Journals www.imedpub.com Journal of Nephrology and Urology and discharged. On review after three days, dog exhibited considerable improvement, creatinine and BUN value were 4.3 mg/dL, and 64.4 mg/dL, respectively. Ten days later follow-up revealed that creatinine and BUN value stabilised at 1 mg/dL, and 27mg/dL. Dog showed slow and steady recovery from acute kidney injury over a period of 20 days. Resolved oliguria and reduced sCr and BUN values to 5.9 mg/dL and 84.6 mg/dL, Dog was observed for next 24 hours and discharged. This findings is in agreement with Eatroff et aL, 2012. Ten days later follow-up revealed that sCr and BUN value stabilised at 1mg/dL and 27mg/dL. Dog showed slow and steady recovery from acute kindney injury over a period of 20 days. Summary A case of viper envenomation induced acute kidney injury in a dog was successfully managed with three sessions of intermittent haemodialysis.

Author(s): Faswal Pichan

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