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260 Diarrhea, Antibiotic-Responsive/Small-Intestinal Dysbiosis

Nutrition/Diet Recommended Monitoring • Colloid support is often essential and should
not be overlooked.
• Withhold water until vomiting is adequately • Monitor vital parameters (temperature, heart • Exclude hypoadrenocorticism in high-risk
VetBooks.ir • Food should be offered as soon as vomiting blood pressure [p. 1065]) and ongoing fluid Technician Tips
rate, mucous membranes, CRT, pulse quality,
controlled, and then offer small amounts
breeds (pp. 512 and 1300).
every 1-2 hours.
losses every 2 hours.
is reduced. Easily digestible diets (e.g., boiled
white rice with cottage cheese, low-fat turkey • Initially, check hematocrit and total solids • Patient status can change quickly; careful
every 4-6 hours and glucose, BUN, and
breast) may be beneficial initially because electrolytes every 6-8 hours. attention to markers of perfusion (e.g., CRT,
gastric emptying times are shorter. • COP should be checked every 6-8 hours or pulse rate and quality, mental status, urine
as needed to guide decisions about colloid output) is essential.
Drug Interactions therapy. • Diarrhea can be profuse; wrapping the tail
• Maropitant is protein bound and may affect and shaving the hind end may improve
metabolism of other highly protein-bound PROGNOSIS & OUTCOME patient cleanliness and comfort.
drugs such as nonsteroidal antiinflammatories
and anticonvulsants. • Recovery is usually rapid and complete over Client Education
• Metoclopramide interacts with numerous 1-2 days; severely affected dogs may require Approximately 10%-15% of dogs will have
drugs; avoid concurrent use of sedatives, tran- supportive therapy for several days before repeated episodes of AHDS/HGE.
quilizers, and narcotics. It is also incompatible return of normal GI function.
with many antibiotics (including ampicillin), • Condition can progress quickly to multiple SUGGESTED READING
and infusion must be discontinued while organ dysfunction syndrome, DIC, and Mazzaferro E, et al: Fluid therapy for emergent small
other medications are administered. death. animal patients: crystalloids, colloids and albumin
• About 10% of affected dogs may die despite products. Vet Clin North Am Small Anim Pract
Possible Complications therapy. 43:721-734, 2013.
• Can progress to hypovolemic shock, DIC, AUTHOR: Audrey K. Cook, BVM&S, DACVIM,
and death if not treated appropriately PEARLS & CONSIDERATIONS DECVIM, DABVP
• Esophagitis may occur if vomiting is EDITOR: Rance K. Sellon, DVM, PhD, DACVIM
persistent. Comments
• Obtunded patients are vulnerable to aspira- • The diagnostic hallmark for AHDS/HGE is
tion pneumonia. a markedly elevated hematocrit with normal
• Translocation of bacteria across the compro- to slightly low total protein level.
mised intestinal mucosa may cause sepsis.

Diarrhea, Antibiotic-Responsive/Small-Intestinal Dysbiosis Client Education
Sheet

BASIC INFORMATION RISK FACTORS ○ A more general microbial overgrowth and/
Factors that allow dysregulation and/or over- or imbalance is associated with diarrhea,
Definition growth of small-intestinal bacteria include and antibiotic responsiveness is usually
Any diarrhea demonstrating responsiveness to underlying immunologic gastrointestinal (GI) favorable.
or resolution with antibiotic therapy. Antibiotic- disease, exocrine pancreatic insufficiency (EPI), • Secondary ARD occurs as a complication of
responsive diarrhea (ARD) and small-intestinal or other causes of maldigestion/malabsorption, other underlying primary GI disease, such as
bacterial overgrowth (SIBO), the previously used achlorhydria (primary or iatrogenic), intestinal ○ Chronic enteropathy, such as food-
term, are likely due to increased numbers and/or motility disorders (including those related to responsive diarrhea or idiopathic inflam-
changes in the composition of small-intestinal endocrinopathy), obstructive GI disease, and matory bowel disease (IBD)
bacteria, with associated clinical signs. ARD and the creation of blind intestinal loops after ○ EPI (common)
SIBO may be used interchangeably; however, GI surgery, all resulting in changes in the
because historically used cutoff values for small- microbiota. Antibiotic-induced dysbiosis has HISTORY, CHIEF COMPLAINT
intestinal bacterial counts are inadequate, the recently been recognized. In most animals, Small-bowel diarrhea, with variable severity
preferred terms are antibiotic-responsive diarrhea the microbiota recovers within a few weeks (p. 1215) and weight loss, poor body condition,
or small-intestinal dysbiosis (SID). after cessation of antibiotic administration, but borborygmus, flatulence, steatorrhea, vomiting
some animals may have prolonged dysbiosis, (due to underlying GI disease)
Synonyms potentially causing signs of intestinal disease.
Antibiotic-responsive enteropathy (ARE), PHYSICAL EXAM FINDINGS
tylosin-responsive diarrhea (TRD), small CONTAGION AND ZOONOSIS No physical examination findings are diagnostic
intestinal dysbiosis (SID) Possible if ARD is caused by infectious agents of ARD; nonspecific small-bowel diarrhea ±
with zoonotic potential (e.g., Salmonella spp, weight loss
Epidemiology Campylobacter spp)
SPECIES, AGE, SEX Etiology and Pathophysiology
Dogs and cats, either sex. Young animals Clinical Presentation • Bacterial counts in the small intestine can
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predominate, but all ages are represented. DISEASE FORMS/SUBTYPES reach > 10 colony-forming units (CFU)/
• Primary or idiopathic ARD, in which no mL for aerobic and anaerobic bacteria in
GENETICS, BREED PREDISPOSITION underlying functional abnormality or disease clinically healthy dogs. Normal dogs have
Beagles, German shepherds (immunoglobulin is identified (rare) a mix of aerobic and anaerobic bacteria (E.
A [IgA] dysregulation/deficiency suspected but ○ Likely encompasses several different coli, Streptococcus, Clostridium, Fusobacterium,
not confirmed) disorders Bacteroides).
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