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Syncope 953

Chronic Treatment • Oral amino acid supplementation: Promod and periodic IV amino acid infusions. In
1 scoop/10 kg PO q 24h
• Amino acid infusions: 25 mL/kg slow IV over • Oral vitamin E supplementation: one study of affected dogs with a history
VetBooks.ir tions are available with varying compositions; • Oral essential fatty acids were often euthanized within 12 weeks of Diseases and Disorders
of phenobarbital administration, patients
6-8 hours. Several crystalline amino acid solu-
400 IU/DOG PO q 12h
no data suggest that one product is more
diagnosis despite drug discontinuation.
efficacious than another. Solutions without
additional electrolytes are preferred. • Oral zinc methionine supplementation: • Surgical excision of pancreatic tumor may
result in remission.
Zinpro 1.5 mg/kg PO q 24h
○ 10% crystalline amino acid solution • Oral S-adenosylmethionine may attenuate • Superficial necrolytic dermatitis in cats: poor
(Aminosyn); high-osmolality solution and liver damage.
a jugular venous catheter is recommended • Consultation with a veterinary nutritionist PEARLS & CONSIDERATIONS
to avoid thrombophlebitis (p. 1123) may be helpful.
○ 3% amino acid and electrolyte solution Comments
(Procalamine, B. Braun) is an alternative Drug Interactions • The visually distinctive skin lesions of super-
product. Lower cost; less hypertonicity (can Using antiinflammatory doses of oral gluco- ficial necrolytic dermatitis are recognizable
therefore be injected in peripheral veins). corticosteroids is controversial. It may give markers of an underlying systemic disease.
○ No defined protocols for frequency of temporary relief, but diabetes and deterioration • Dermatologic signs often precede onset of
administration (i.e., may be performed of the liver are possible complications. clinical signs of internal disease.
bimonthly, monthly, or when clinical signs • Hyperkeratotic, fissured footpads in an
return) Possible Complications older dog are highly suggestive of superficial
○ Most patients demonstrate clinical • Discomfort while walking may become necrolytic dermatitis.
improvement in 5-10 days. Some dogs sufficiently severe to constitute a reason for
show dramatic improvement in demeanor euthanasia. Technician Tips
with resolution of skin lesions after receiv- • Monitor for signs of encephalopathy (slow Pododermatitis may be extremely painful. Use
ing infusion. down infusion rate if indicated) when using care and a gentle approach when walking dogs
• Insulin therapy if indicated (p. 251) IV amino acid infusions. suspected or confirmed of having SND (may be
• Octreotide (somatostatin analog inhibits • Postsurgical pancreatitis and biliary obstruc- reluctant to walk due to intense footpad pain).
glucagon release) 2-3 mcg/kg SQ q 12h in tion may occur.
nonresectable or recurrent glucagonoma- SUGGESTED READING
associated disease: can improve skin lesions PROGNOSIS & OUTCOME Hall-Fonte DL, et al: Hepatocutaneous syndrome
and systemic clinical signs. Anorexia is likely in shih tzus: 31 cases (1996-2014). J Am Vet Med
side effect. • Prognosis is generally poor: most dogs die or Assoc 248(7):802, 2016.
are euthanized within 5 months of develop-
Nutrition/Diet ing skin lesions. However, 20% of dogs in AUTHOR: Vincent E. Defalque, DVM, DACVD
• High-quality protein diet. Adding 3-6 entire one study were maintained for 12 months EDITOR: Manon Paradis, DMV, MVSc, DACVD
hard-boiled eggs per day may be beneficial. or more with oral protein hyperalimentation

Syncope Client Education
Sheet

BASIC INFORMATION • Neurocardiogenic syncope: boxer, golden • No postictal phase (i.e., mentation normal
retrievers, brachycephalic breeds after event)
Definition • According to underlying heart disease: many • Duration: seconds (and virtually always
A sudden, temporary loss of consciousness breed predispositions < 1 minute; otherwise, likely to be fatal)
resulting in collapse, followed by spontaneous • Recovery: complete and rapid
recovery and caused by a transient cerebral RISK FACTORS
deficiency of oxygen. • Cardiac disease/arrhythmia PHYSICAL EXAM FINDINGS
• Pulmonary hypertension Depends on underlying disorder(s):
Synonyms • Autonomic dysfunction (neurocardiogenic • Cardiac: murmur, arrhythmia, altered arterial
• Faint, collapse syncope) pulse quality, pulse deficits, cyanotic mucous
• Neurocardiogenic syncope: vasovagal • Drugs: beta-blockers, diuretics, vasodilators membranes, and pulmonary rales or crackles
syncope (hypotensive syncope) are possible.
• Tussive syncope: cough-drop phenomenon • Anemia, hypoglycemia • Neurologic exam (p. 1136): cranial nerve
abnormalities, altered reflexes, proprioceptive
Epidemiology Clinical Presentation deficits, and altered mentation are possible.
SPECIES, AGE, SEX HISTORY, CHIEF COMPLAINT • Upper airway exam: stenotic nares, hypo-
• Depends on underlying cause: cardiac versus • Acute collapse, with altered or loss of plastic trachea, everted laryngeal saccules,
noncardiac causes consciousness elongated soft palate (i.e., brachiocephalic
• Acquired heart disease: middle-aged to older • No clinical signs or brief staggering or ataxia airway syndrome)
animals before the event
• Congenital heart disease: young animals • Exercise, excitement, or coughing may Etiology and Pathophysiology
precipitate the event. A detailed list of causes are provided on p. 1284.
GENETICS, BREED PREDISPOSITION • ± Clonic movements (usually absent) Cardiac:
• Tussive syncope: older, small-breed dogs with • ± Involuntary urination or defecation (usually • Bradyarrhythmias: syncope can result when
pulmonary or airway disease absent) there is a 6-8 second pause in electrical

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