Page 343 - Cote clinical veterinary advisor dogs and cats 4th

144 Carpal Flexural Deformity of Puppies

• Electrocardiogram (ECG) (p. 1096) to ○ Activated charcoal (if asymptomatic): after care, serious intoxications may require several
days of in-hospital treatment.
identify cardiac arrhythmias emesis or if a few hours have elapsed after • Animals with only GI signs but no sub-
VetBooks.ir AV block with the possibility of exposure • Treat cardiac arrhythmias sequent cardiovascular signs have a good
exposure, 1-2 g/kg with a cathartic such
○ A combination of first- or second-degree
as 70% sorbitol 3 mL/kg PO
to an incriminating plant and compat-
prognosis.
ible clinical signs is highly suggestive of
patient: atropine 0.02-0.04 mg/kg IV,
containing plants.
the clinical diagnosis of glycoside plant ○ Bradyarrhythmias in a normotensive • Prognosis is generally good with grayanotoxin-
cardiotoxicosis. repeat as needed
○ Ventricular or atrial arrhythmias of virtu- ○ Ventricular arrhythmias (p. 1033) PEARLS & CONSIDERATIONS
ally any type are possible. ○ Digoxin immune Fab (Digibind) may
○ The most common ECG changes include be used for treating refractory cardiac Comments
first-, second-, or even third-degree AV arrhythmias or severe hyperkalemia in • Domesticated grayanotoxin plants, such as
block; ventricular arrhythmias; and ST- cardiac glycoside toxicosis. those sold in nurseries, appear to be less
segment changes. ○ Temporary cardiac pacing if profound toxic than their wild counterparts and mainly
• Blood pressure (p. 1065): hypotension bradycardia unresponsive to atropine cause GI signs.
possible • Supportive care • Cardiac glycosides are bitter tasting; however,
○ IV fluids as needed; avoid calcium- when leaves dry, sugar is released, and the
Advanced or Confirmatory Testing containing fluids (e.g., lactated Ringer’s leaves may be more attractive for ingestion.
• Serum digoxin levels (cardiac glycoside– solution) unless hypocalcemia • Cardiotoxicity of these plants is arrhythmo-
containing plants). Any detectable amount ○ Dextrose (bolus or CRI) as needed to genic; structural heart disease (e.g., valve
in a patient not receiving digoxin pharma- correct hypoglycemia (p. 552) disease) is not caused by these plants.
ceutically confirms the diagnosis. Test can ○ Correct acid-base status and electrolytes
be performed at a local human hospital or (notably hyperkalemia or hypokalemia Prevention
veterinary diagnostic laboratory. [pp. 495 and 516]) as needed. Advise clients to keep plants or flower bouquets
• Presence of oleandrin in GI contents and ○ Control seizures with a benzodiazepine if out of pet’s environment.
body fluids can confirm exposure to oleander needed (e.g., diazepam 0.5-1 mg/kg IV)
(available in some veterinary diagnostic (p. 903) Technician Tips
laboratories). ○ Control severe vomiting with metoclo- If unsure of type of plant/flower, consult with
pramide 0.1-0.4 mg/kg PO, SQ, or IM a plant nursery or floral shop.
TREATMENT q 6h or maropitant 1 mg/kg SQ q 24h or
2 mg/kg PO q 24h after GI obstruction Client Education
Treatment Overview is ruled out. Client should be made aware of toxic plants
Treatment is aimed at management of severe in the pet’s environment.
cardiac arrhythmias and systemic disturbances Possible Complications
(e.g., dehydration, hypoglycemia) and early Permanent cardiac damage SUGGESTED READING
decontamination of the patient (emesis induc- Page C, et al: Hypoglycemia associated with oleander
tion and administration of activated charcoal). Recommended Monitoring toxicity in a dog. J Med Toxicol 11:141-143, 2015.
An intravenous (IV) antidote (Digibind) ECG, electrolytes, blood pressure, heart rate,
exists for cardiac glycosides, but it is often pulse, ± glucose AUTHOR: Eric Dunayer, VMD, MS, DABT, DABVT
EDITOR: Tina Wismer, DVM, MS, DABVT, DABT
cost-prohibitive.
PROGNOSIS & OUTCOME
Acute General Treatment
• Decontamination of patient (p. 1087) • Cardiac glycosides: animals with moderate
○ Emesis induction if recent ingestion (p. to severe cardiovascular signs have a guarded
1188) and asymptomatic prognosis; even with intensive supportive

Carpal Flexural Deformity of Puppies Bonus Material Client Education
Sheet
Online

BASIC INFORMATION Epidemiology RISK FACTORS
Definition SPECIES, AGE, SEX Affected puppies come from breeds that typi-
Carpal flexural deformity (CFD) is an uncom- Generally affects medium-, large-, and giant- cally stand with fairly straight (almost 180°)
mon musculotendinous disorder producing breed puppies between 6 and 16 weeks of age. carpi.
transient flexion of the carpus and supination CFD has been described in a kitten. Clinical Presentation
of the manus in young animals.
GENETICS, BREED PREDISPOSITION HISTORY, CHIEF COMPLAINT
Synonyms Multiple affected littermates have been reported • Lameness and/or visible carpal deformity
Flexural deformity, contracture of the flexor for Doberman pinschers and shar-peis, suggest- • The onset is acute, with a possible sudden
tendon, flexion syndrome, carpal hyperflexion, ing familial predisposition. worsening after a few days.
carpal laxity syndrome, carpal hyperflexion • CFD is usually bilateral, although each
syndrome forelimb may be involved at a different time

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