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Hypothermia 523

DIAGNOSIS TREATMENT Recommended Monitoring
• Recheck daily to weekly initially until
VetBooks.ir The diagnosis is based on classic appearance Treatment goal is to control the inciting cause if Slowly wean down/off oral and then topical Diseases and Disorders
Treatment Overview
Diagnostic Overview
hypopyon and aqueous flare begin to resolve.
identified and treat underlying anterior uveitis.
with associated aqueous flare. Hypopyon can be
antiinflammatory medications over weeks to
difficult to appreciate if mild and hidden by an
resolved.
elevated nictitating membrane. Tilting the nose Acute General Treatment months after aqueous flare/hypopyon have
ventrally (causing the globe to rotate dorsally) Topical antiinflammatory therapy: • Other monitoring is dictated by the underly-
can allow visualization of mild hypopyon. • Corticosteroid (prednisolone or dexametha- ing cause of the anterior uveitis/hypopyon.
sone) q 6h initially. Do not use if corneal
Differential Diagnosis ulceration is present. PROGNOSIS & OUTCOME
• Lipid-laden aqueous humor: complete • Nonsteroidal antiinflammatory medications
cloudiness of the anterior chamber with (e.g., diclofenac, ketorolac) q 6h initially; Guarded, depending an inciting cause, degree of
variably opaque, whitish aqueous humor with can be used in conjunction with topical aqueous flare, degree of hypopyon, and presence
minimal hyperemia and blepharospasm. It is steroids of any secondary complications
most commonly seen in dogs with diabetes Oral antiinflammatory therapy
mellitus or hyperlipidemia but also seen in • Corticosteroid (prednisone): do not use until PEARLS & CONSIDERATIONS
dogs that eat a large amount of fat. systemic infectious disease has been ruled out
• Fibrin in the anterior chamber can occur with and best to avoid with corneal ulceration. Comments
anterior uveitis. Fibrin is usually in strands • Nonsteroidal antiinflammatory medications Differentiating lipid-laden aqueous humor from
and can be throughout anterior chamber. (e.g., meloxicam, deracoxib) cannot be used hypopyon is important. Lipid-laden aqueous
Conglomerations of fibrin may be noted in conjunction with oral steroids but can humor is rarely painful and almost always fills
but are less dense than hypopyon and more be used with either or both types of topical the entire anterior chamber.
amorphous. antiinflammatory drugs.
Cycloplegic: Technician Tips
Initial Database • Atropine q 6-24h is used to stabilize the Motion and shaking the head can rapidly
• Complete physical exam blood-aqueous barrier to lessen leukocyte change the appearance of the hypopyon.
• Complete ophthalmic exam (p. 1137) influx into the anterior chamber. It minimizes
• If no ocular cause (corneal ulceration, posterior synechiae by causing mydriasis. Client Education
trauma) is found, advanced testing should • Do not use if IOP are high-normal or Trying to identify the underlying cause is
be done. elevated because atropine may increase risk important because it can dictate the prognosis.
of glaucoma.
Advanced or Confirmatory Testing SUGGESTED READING
• CBC, serum biochemistries, urinalysis Chronic Treatment Bergstrom BE, et al: Canine panuveitis: a retrospective
• Thoracic radiographs Treat underlying cause if present. The hypopyon evaluation of 55 cases (2000-2015). Vet Ophthal-
• Infectious disease diagnostics, depending on usually resolves within several days of appropri- mol 20:390-397, 2017.
location or travel history ate therapy.
• Ocular ultrasound if posterior segment is not AUTHOR: Brian Skorobohach, DVM, DACVO
EDITOR: Diane V. H. Hendrix, DVM, DACVO
visible (to determine if a retinal detachment Possible Complications
is present) Ocular complications may include glaucoma,
• Aqueocentesis for cytology and culture in cataract, posterior synechiae, and endothelial
selected cases (e.g., lymphoma suspects) cell degeneration (persistent corneal edema).

Hypothermia

BASIC INFORMATION • Hypothyroidism (dogs) PHYSICAL EXAM FINDINGS
• Renal disease (generally mild hypothermia) • Shivering
Definition • Head trauma • Weakness, ataxia
Core body temperature < 99.5°F (37.5°C) in Clinical Presentation • Cardiac arrhythmia (generally bradyar-
dogs, < 100°F (37.8°C) in cats rhythmia)
DISEASE FORMS/SUBTYPES • Hypotension
Epidemiology • Mild hypothermia: 90°F-99.5°F (32.2°C- • Coma
SPECIES, AGE, SEX 37.5°C) • Other abnormalities may be related to
Any dog or cat • Moderate hypothermia: 82°F-90°F (27.8°C- underlying disease (e.g., dermatologic change
32.2°C) related to hypothyroidism, heart murmur
RISK FACTORS • Severe hypothermia: <82°F (27.8°C) related to cardiac disease).
• Neonates and geriatric patients
• General anesthesia HISTORY, CHIEF COMPLAINT Etiology and Pathophysiology
• Cold environment • Weak/collapsed patient • Initial compensation: peripheral vasoconstric-
• Cardiac disease (low rectal temperature, core • Exposure to cold environmental temperatures tion, shivering (not if patient anesthetized),
temperature usually normal) • Recovering from or undergoing general piloerection
• Systemic inflammatory response/sepsis (cats) anesthesia • Respiratory rate/effort

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