Successful management and recovery following severe prolonged starvation in a dog

Khoo, Alison; Taylor, Susan; Owens, Tammy J.

doi:10.1111/vec.12878

Cited by 12 publications

(10 citation statements)

References 20 publications

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“…Two case series have documented hypophosphatemia associated with the treatment of diabetes mellitus and DKA in six dogs and two cats (8,9). Hypophosphatemia has also been reported in dogs with refeeding syndrome and in hyperparathyroidism (11,30). In the present study, hypophosphatemia was most frequently seen in dogs with cancer, musculoskeletal disorders, and disease of the neurologic and gastrointestinal systems.…”

Section: Discussionsupporting

confidence: 64%

Hypophosphatemia in Dogs With Presumptive Sepsis: A Retrospective Study (2008–2018)

et al. 2021

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Background: In humans with sepsis, hypophosphatemia is a marker of illness severity and a negative prognostic indicator. Hypophosphatemia has not been previously investigated in dogs with sepsis, however. This study aimed to estimate the prevalence of hypophosphatemia in dogs, the prevalence of presumptive sepsis in dogs with hypophosphatemia, the prevalence of hypophosphatemia in dogs with presumptive sepsis and the association between outcome and hypophosphatemia in dogs with presumptive sepsis.Methods: Electronic medical records of the Cornell University Hospital for Animals from 2008–2018 were queried to identify all dogs with hypophosphatemia and all dogs with presumptive sepsis. Hypophosphatemia was defined as a serum phosphate concentration <2.7 mg/dL. Sepsis was presumed where ≥2 of 4 systemic inflammatory response syndrome (SIRS) criteria were satisfied associated with a documented or highly suspected infection. Variables were assessed for normality using the D'Agostino-Pearson test. Continuous variables were compared between groups using the Mann-Whitney U test. Differences in frequency between categorical variables were analyzed using contingency tables, calculation of Fisher's exact test or Chi2 and estimation of odds ratios.Results: In the study period, 47,992 phosphate concentration measurements from 23,752 unique dogs were identified. After eliminating repeat analyses, the period prevalence of hypophosphatemia on a per dog basis over the 11-year study period was 10.6% (2,515/23,752). The prevalence of presumptive sepsis within dogs with hypophosphatemia was 10.7% (268/2,515). During the 11-year study period, 4,406 dogs with an infection were identified, of which 1,233 were diagnosed with presumptive sepsis and had a contemporaneous phosphate concentration. Hypophosphatemia was more prevalent in dogs with presumptive sepsis than in dogs without 21.7 vs. 10.2%; OR 2.44 [95% CI 2.12–2.81]; P < 0.0001. The mortality rate was greater in dogs with hypophosphatemia and presumptive sepsis than in dogs with hypophosphatemia without presumptive sepsis (15.3 vs. 3.1%; OR 5.70 [95% CI 3.76–8.52]; P < 0.0001), however hypophosphatemia was not associated with outcome in dogs with presumptive sepsis OR 0.87 [95% CI 0.60–1.26]; P = 0.518.Conclusions: In dogs with hypophosphatemia, a presumed diagnosis of sepsis was associated with increased mortality compared to other associated disease processes. In dogs with presumptive sepsis, hypophosphatemia was not associated with outcome.

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Section: Discussionsupporting

confidence: 64%

Hypophosphatemia in Dogs With Presumptive Sepsis: A Retrospective Study (2008–2018)

et al. 2021

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“…Hypomagnesemia is a variable finding in patients with refeeding syndrome. 3,14 In a previous study, low serum total magnesium was only detected in one of the cats reported with refeeding syndrome but was not measured in every case. 1,3,8,14 Hypomagnesemia developed on day 3 and improved to a low-normal value with supplementation.…”

Section: Dovepressmentioning

confidence: 93%

“…3,14 In a previous study, low serum total magnesium was only detected in one of the cats reported with refeeding syndrome but was not measured in every case. 1,3,8,14 Hypomagnesemia developed on day 3 and improved to a low-normal value with supplementation. The mechanism for hypomagnesemia in refeeding syndrome is not clear and is likely multifactorial, resulting from intracellular movement of magnesium ions into cells with carbohydrate feeding and poor dietary intake of magnesium.…”

Section: Dovepressmentioning

confidence: 93%

“…17 Hypophosphatemia is the primary electrolyte abnormality characteristic of refeeding syndrome. 4,14,16 Hypophosphatemia has been a prominent feature of refeeding syndrome in all previously reported feline cases and was often associated with hemolysis. 1,3,8,14 Our patient did not develop a hypophosphatemia on bloodwork throughout any of her evaluations, but her primary electrolyte abnormality was a total hypomagnesemia.…”

Section: Dovepressmentioning

confidence: 97%

“…4,14,16 Hypophosphatemia has been a prominent feature of refeeding syndrome in all previously reported feline cases and was often associated with hemolysis. 1,3,8,14 Our patient did not develop a hypophosphatemia on bloodwork throughout any of her evaluations, but her primary electrolyte abnormality was a total hypomagnesemia. Hypomagnesemia is a variable finding in patients with refeeding syndrome.…”

Section: Dovepressmentioning

confidence: 97%

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Management of Severe Hypomagnesemia as the Primary Electrolyte Abnormality with a Delayed Onset of Clinical Signs as a Result of Refeeding Syndrome in a Cat

Smith¹,

Hendricks²,

Centola³

2022

VMRR

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This case report describes severe hypomagnesemia in a cat attributed to refeeding syndrome with an onset of clinical signs from the magnesium deficiency apparent on the twelfth day following initiation of feeding. The patient initially presented in a state of cachexia from apparent malnutrition after missing from the owners care for five months. The patient was initially discharged five days after the initiation of feeding with only a mild hypokalemia apparent and requiring supplementation and returned for outpatient management. The patient presented through the emergency department on the twelfth day following the onset of feeding with the clinical signs of acute lethargy, vomiting, generalized tremors and a seizure episode and had a severe total hypomagnesemia on diagnostic bloodwork. The patient's clinical signs resolved following emergency treatment with parenteral magnesium sulfate as a continuous rate infusion and was later managed with oral magnesium hydroxide for a prolonged period of time. Electrolyte abnormalities and associated clinical signs typically occur between two and five days after initiation of feeding and up to ten days after starting food intake in humans with anorexia nervosa. This case report highlights that hypomagnesemia, while not the most common electrolyte disturbance to occur with refeeding syndrome, can occur without other significant electrolyte changes and can cause clinical signs greater than ten days following refeeding to a starving patient. This magnesium deficiency required prolonged treatment, but the patient made a complete recovery.

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Electrolyte Evaluation

Rahilly¹,

Vachon²

2023

Advanced Monitoring and Procedures for Small Animal Emergency and Critical Care

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Successful management and recovery following severe prolonged starvation in a dog

Cited by 12 publications

References 20 publications

Hypophosphatemia in Dogs With Presumptive Sepsis: A Retrospective Study (2008–2018)

Hypophosphatemia in Dogs With Presumptive Sepsis: A Retrospective Study (2008–2018)

Management of Severe Hypomagnesemia as the Primary Electrolyte Abnormality with a Delayed Onset of Clinical Signs as a Result of Refeeding Syndrome in a Cat

Electrolyte Evaluation

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