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Disseminated Intravascular Coagulation 269

○ Alterations in neuronal excitability (e.g., • Tests of hearing: auditory stimulus, brainstem PEARLS & CONSIDERATIONS
electrolyte disturbances) damage (head • CT or MRI (p. 1132) of brain Comments
auditory evoked response testing.
VetBooks.ir • Animals can become disoriented despite • Cerebrospinal fluid (p. 1080) cytologic • Up to 75% of dogs 7 years or older will dem- Diseases and Disorders
mechanical
Direct
○
trauma)
onstrate at least one clinical sign consistent
analysis with biochemical ± serologic testing
with canine cognitive dysfunction syndrome.
normal cerebral function when they are
blind and/or deaf. as indicated by case findings • Approximately 25% of cats 11-14 years of
TREATMENT age and more than 50% of cats older than
DIAGNOSIS 15 years of age will demonstrate cognitive
Treatment Overview decline.
Diagnostic Overview Treat the underlying cause of disorientation • Animals with clinical signs of disorientation
The history and physical exam provide essential when possible. related to vision or hearing loss will com-
clues to investigate this nonspecific chief monly adapt to their surroundings and have
complaint. A neurologic exam is indicated Acute General Treatment a good quality of life, provided they are not
in all cases, as are routine laboratory tests to Acute treatment varies according to the cause. used for tasks requiring these senses and if
investigate metabolic causes. their home environment does not change
Chronic Treatment drastically (e.g., moving furniture frequently).
Differential Diagnosis Animals with incurable disorientation (e.g., • Selegiline may be associated with adverse
• Differential diagnosis for disorientation age-related cognitive dysfunction) may need effects and drug interactions.
○ Psychological (e.g., stereotypies) special care:
○ Vision impairment • Confine within a yard or home to prevent Technician Tips
○ Hearing impairment wandering away • For any patient with disorientation/confusion
○ Primary (e.g., head trauma) or secondary • Take animal outside to urinate/defecate more always be cognizant of potential infectious
(e.g., hepatic encephalopathy) disease frequently if dog is inappropriately urinating/ zoonotic disease (e.g., rabies) and handle
affecting the brain defecating in the house accordingly.
• Selegiline hydrochloride 0.5-1 mg/kg PO q • Exercise caution as disorientated/confused
Initial Database 24h is FDA approved for canine cognitive animals may become aggressive.
• Age of onset dysfunction but benefit may be minor.
○ NOTE: diagnosis of age-related cognitive Client Education
dysfunction is one of exclusion in elderly Nutrition/Diet When applicable, provide client with client
patients; therefore, first consider other • Several diets have been formulated for dogs education sheets: “How to Change the Envi-
diseases resulting in disorientation. with cognitive dysfunction (e.g., Hill’s ronment for a Pet That Is Blind” and “How
• Complete neurologic exam (p. 1136) Prescription Diet b/d, Purina Bright Mind). to Change the Environment for a Pet That
• Complete ophthalmic exam (p. 1137) • Several nutraceutical supplements are mar- Is Deaf.”
• CBC, serum biochemistry, urinalysis: rec- keted for the same condition (e.g., Senilife,
ognize underlying systemic condition and Ceva Animal Health; ProNeurozone, Animal SUGGESTED READING
preanesthetic evaluation (if needed) Health Options; Neutricks, Novifit [SAMe], ASPCA Poison Control Center: Information and
Virbac) or for reducing neurodegeneration links pertaining to toxicologic information on
Advanced or Confirmatory Testing (e.g., NeuroConnex, Animal Necessity). various plants and drugs (websites). www.aspca.
• Clinical laboratory diagnostic tests for • Further study of the efficacy of these therapies org/pet-care/animal-poison-control/.
endocrinopathies, liver function tests, is warranted. AUTHOR: Aubrey A. Webb, DVM, PhD
toxicology screen, as suggested by clinical EDITOR: Leah A. Cohn, DVM, PhD, DACVIM
information PROGNOSIS & OUTCOME
• Tests of vision: scotopic and photopic maze
testing/obstacle course, electroretinogram Prognosis depends on the cause.

Disseminated Intravascular Coagulation

BASIC INFORMATION RISK FACTORS • Chronic DIC: secondary to solid tumors
Primary disorders that may lead to disseminated and hematopoietic neoplasia; common in
Definition intravascular coagulation (DIC) are infectious, dogs with hemangiosarcoma
An acquired syndrome in which coagulation inflammatory, neoplastic, or traumatic.
is abnormally and inappropriately activated, HISTORY, CHIEF COMPLAINT
with widespread fibrin deposition in the ASSOCIATED DISORDERS Typically reflect the primary disease (see above);
microvasculature. Depletion of platelets and DIC is a secondary condition developing from signs of DIC are nonspecific and may be
coagulation factors can result in overt an underlying primary disease (see Risk Factors indistinguishable from signs of the underlying
hemorrhage. above and Disease Forms below). disorder.
Epidemiology Clinical Presentation PHYSICAL EXAM FINDINGS
SPECIES, AGE, SEX DISEASE FORMS/SUBTYPES • Varies and depends on primary disease and
• Dogs of any age, breed, or sex • Acute DIC: associated with fulminant extent of thrombosis or factor depletion and
• Infrequently identified in cats diseases (e.g., sepsis, anaphylaxis, heatstroke, spontaneous/exaggerated hemorrhage.
pancreatitis, envenomation)

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