Page 252 - Cote clinical veterinary advisor dogs and cats 4th

Barbiturates Toxicosis 110.e3

Chronic Treatment from veterinarians of similar behavioral or ADDITIONAL SUGGESTED
If possible, directly address issues that predispose neurologic abnormalities in dogs with READINGS
VetBooks.ir Possible Complications • Bacterial cystitis may make regulation of Eggertsdóttir AV, et al: Occurrence of occult bacte- Diseases and Disorders
otherwise subclinical bacteriuria that resolved
to cystitis.
after antimicrobial therapy.
riuria in healthy cats. J Feline Med Surg 13:800-
803, 2011.
• Overt signs of cystitis
• Pyelonephritis diabetes mellitus more difficult; it is unclear McGhie JA, et al: Prevalence of bacteriuria in dogs
whether subclinical bacteria may have a
without clinical signs of urinary tract infection
• Urosepsis similar effect. presenting for elective surgical procedures. Aust
• Struvite urolithiasis • Exposure to antimicrobial drugs leads to Vet J 92:33-37, 2014.
expansion of antimicrobial-resistant microbes; Olby NJ, et al: Effect of cranberry extract on the
Recommended Monitoring unnecessary antimicrobial drug use can cause frequency of bacteriuria in dogs with acute thora-
Ask owner about urinary signs, and repeat more harm than good. columbar disk herniation: a randomized controlled
clinical trial. J Vet Intern Med 31:60-68, 2017.
urinalysis (by cystocentesis) 3 to 4 times per Puchot ML, et al: Subclinical bacteriuria in cats:
year. If overt cystitis is recognized, repeat urine Prevention prevalence, findings on contemporaneous urinalysis
culture and susceptibility before antimicrobial The role for cranberry extract in preventing and clinical risk factors. J Feline Med Surg 19:1238-
treatment. cystitis is largely unproven; other options that 1244, 2017.
may be safe but with unproven efficacy include Simpson AC, et al: The frequency of urinary tract
PROGNOSIS & OUTCOME probiotics (oral or vaginal), D-mannose, and infection and subclinical bacteriuria in dogs with
forskolin. allergic dermatitis treated with oclacitinib: a pro-
Risk of serious complications (e.g., pyelone- spective study. Vet Dermatol 28:485-e113, 2017.
phritis, urosepsis, urolithiasis) in pets with Technician Tips Weese JS, et al: Antimicrobial guidelines for the
treatment of urinary tract infections in dogs and
untreated subclinical bacteriuria remains • Never submit sample collected off the floor cats: Antimicrobial Guidelines Working Group of
unknown; these risks are minimal in humans. or off the table for microbial culture. the International Society for Companion Animal
• Cystocentesis is preferred for urine culture, Infectious Diseases Vet Med Int 2011. doi:10.4061/
PEARLS & CONSIDERATIONS unless there is a possibility of coagulopathy 2011/263768.
or bladder cancer. White JD, et al: Subclinical bacteriuria in older cats
Comments and its association with survival. J Vet Intern Med
• Animals cannot self-report important evi- Client Education 30:1824-1829, 2016.
dence of cystitis such as an uncomfortable Educate owners about clinical signs of cystitis, AUTHOR & EDITOR: Leah A. Cohn, DVM, PhD, DACVIM
sensation associated with voiding. Therefore, and request an immediate recheck if these signs
it is impossible to be certain that bacteriuria occur.
is truly asymptomatic in pets.
• In elderly humans, asymptomatic bacteriuria SUGGESTED READING
and cystitis have been associated with Wan SY, et al: Prevalence and clinical outcome of
delirium that resolves after antimicrobial subclinical bacteriuria in female dogs. J Am Vet
treatment. There have been anecdotal reports Med Assoc 245:106-112, 2014.

Barbiturates Toxicosis Client Education
Sheet

BASIC INFORMATION RISK FACTORS PHYSICAL EXAM FINDINGS
• Underlying liver disease will potentially • Decreased response to stimuli, obtunded
Definition decrease hepatic metabolism, resulting in mentation, or coma
Barbiturates are hypnotic, sedative, anticon- prolonged and more severe clinical signs. • Slow, shallow respirations
vulsant drugs derived from barbituric acid • Patients with kidney disease may accumulate • Hypotension: poor pulse quality, prolonged
(2,4,6-trioxohexahydropyrimidine). Barbiturate parent drug (may require dose adjustment) capillary refill time
toxicosis refers to the onset of clinical signs or decompensate with barbiturate-induced • Bradycardia
caused by an acute, excessive exposure to hypotension. • Mydriasis
barbiturates. • Patients with underlying cardiovascular (CV) • Ataxia
disease can be more sensitive to arrhythmo- • Hypothermia
genicity and potential hypoxemia.
Epidemiology • Puppies, kittens, and malnourished animals Etiology and Pathophysiology
SPECIES, AGE, SEX will potentially have decreased hepatic Source:
Both sexes and all breeds of dogs and cats metabolism, resulting in a longer duration • Based on their half-lives, barbiturates are
are susceptible; dogs are more likely to of more severe clinical signs. divided into ultrashort-acting, short-acting,
be involved due to indiscriminant eating Clinical Presentation and long-acting drugs:
habits. ○ Ultrashort-acting drugs: methohexital
HISTORY, CHIEF COMPLAINT (Brevital), thiamylal (Surital), thiopental
GENETICS, BREED PREDISPOSITION • History or evidence of exposure (Pentothal)
Greyhounds and other sighthounds have the • Rapid onset of central nervous system (CNS), ○ Short-acting drugs: amobarbital, butabar-
potential to show clinical signs for a prolonged respiratory, and CV depression, ataxia, bital (Buticaps, Butisol, Barbased, Butalan),
duration. hyporeflexia butalbital (marketed in combinations with

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