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injury that may be apparent based on history restore vascular-extravascular fluid balance as • Acute edema in a single limb may be due to
and exam. Persistent edema should be further needed. injury or envenomation; shaving sometimes
VetBooks.ir • Serum albumin should be assessed, and if Acute General Treatment • Dogs tend to suffer snake bites on the nose/ Diseases and Disorders
reveals a bite wound or injury not identified
investigated.
on exam of haired skin.
• Patients with severe decrease in oncotic
severe hypoalbuminemia is present, the cause
should be cause pursued (pp. 600 and 174).
especially if fluid therapy is necessary.
these bites cause local edema.
• Imaging studies are often warranted (espe- pressure may benefit from oncotic support, head, and cats suffer bites on a front limb;
cially if albumin is normal). ○ Synthetic colloids (hydroxyethyl starches, • Persistent edema in a single limb may be
dextrans): Hetastarch (6% hydroxyethyl related to neoplastic obstruction to venous
Differential Diagnosis starch 130/0.4 in 0.9% sodium chloride); or lymphatic return. For example, heman-
Myxedema (p. 503) may be confused with typical dose 1-2 mL/kg/h; adverse reac- giosarcoma in the musculature of the thigh
SQ edema. tions may include coagulopathy, volume in large breed dogs may cause edema in a
overload, kidney injury. single limb.
Initial Database ○ Human (HSA) or canine serum albumin • Myxedema due to hypothyroidism is nonpit-
• Complete blood count: depends on cause; (CSA): CSA is more expensive than HSA ting and often associated with hypothermia
low total solids with severe hypoalbuminemia but may be safer (HSA can cause life- and marked lethargy to stupor or coma.
• Serum biochemistry profile: evaluate for threatening immune-mediated reaction).
hypoalbuminemia Dose in grams = 10 × desired albumin Technician Tips
• Urinalysis: rule out pathologic proteinuria concentration (g/dL) − patient albumin Gentle physical manipulations (e.g., massage),
concentration (g/dL) × patient weight barring pain, skin fragility, or a fractious patient,
Advanced or Confirmatory Testing (kg) × 0.3 can be beneficial. Adequate movement (traction
Specific testing is guided by results of history, ○ Canine plasma transfusion: large volumes in cage flooring, walks outside for dogs) is also
exam, and screening tests: required to increase colloid oncotic pres- important for supporting normal lymphatic
• Thoracic radiographs often warranted sure; 45 mL/kg of plasma required to raise flow and reducing edema.
○ If right-sided CHF suspected from exam albumin 1 g/dL
(or echocardiography) SUGGESTED READING
○ Rule out cranial mediastinal mass as cause PROGNOSIS & OUTCOME Mathews KA: Monitoring fluid therapy and com-
of head/neck or forelimb edema. plications of fluid therapy. In DiBartola SP, editor:
○ Rule out metastatic neoplasia. Depends on cause. Lymphedema is usually Fluid, electrolyte, and acid-base disorders in small
• Abdominal imaging (radiographs, ultrasound) congenital or neoplastic in origin, can be very animal practice, ed 4, St. Louis, 2012, Saunders,
for hind limb edema challenging to manage long term, and is often pp 386-404.
• Special studies such as lymphangiogram, CT, incurable. AUTHOR: Mandi Kleman, DVM, DACVIM
MRI (p. 1132), or PET/CT may be useful. EDITOR: Leah A. Cohn, DVM, PhD, DACVIM
PEARLS & CONSIDERATIONS
TREATMENT
Comments
Treatment Overview • Pitting edema represents interstitial fluid
Management of SQ edema is typically non- accumulation, whereas nonpitting edema
emergent and is targeted toward treatment is formed by intracellular swelling (e.g.,
of the underlying condition, with therapy to wheal).

Ehrlichiosis, Monocytic Client Education
Sheet

BASIC INFORMATION GENETICS, BREED PREDISPOSITION • E. chaffeensis was originally recognized
German shepherd dogs are predisposed to severe as a human pathogen, but it can infect
Definition clinical disease; suspect deficient cell-mediated dogs.
Canine monocytic ehrlichiosis (CME) is a immunity.
common tick-borne disease caused by infec- GEOGRAPHY AND SEASONALITY
tion with Ehrlichia canis (dogs; rarely cats) or RISK FACTORS • E. canis: worldwide distribution, with
Ehrlichia chaffeensis (humans, dogs). Lack of adequate tick prevention and the risk highest prevalence in tropical climates (South
of tick exposure (e.g., geographic location, America, Caribbean) and subtropical climates
Synonyms outdoor activities) (southern United States)
Human monocytic ehrlichiosis (HME), canine ○ Acute infection: usually in warmer
and human monocytotropic ehrlichiosis, CONTAGION AND ZOONOSIS months, when brown dog tick activity is
tropical canine pancytopenia (old terminology), • Most infections occur by inoculation from a highest
ehrlichiosis tick bite; inadvertent inoculation with blood ○ Chronic form: occurs at any time of year
from an infected animal is less likely. Direct • E. chaffeensis: central, southeastern, and
Epidemiology transmission from dog to human has never eastern United States, from Florida to Maine
SPECIES, AGE, SEX been confirmed. ○ Most clinical cases occur from early
Dogs (common), cats (rare); no known age or • E. canis is a canine disease, but a human spring to mid-summer, when lone star
sex predisposition infection was documented in South America. tick activity is highest.

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