Page 734 - Small Animal Clinical Nutrition 5th Edition

Cardiovascular Disease 761

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Figures 1A (above) and 1B (right). Lateral and ventrodorsal radi-
ographs taken at the time of admission. Generalized cardiomegaly
and pulmonary edema consistent with CHF are present.

Therapy Including Feeding Plan
Therapy was initiated with furosemide (2 mg/kg body weight
subcutaneously, twice daily), enalapril (0.5 mg/kg body weight
per os, twice daily), digoxin (0.006 mg/kg body weight per os,
twice daily) and nitroglycerine (0.2 mg/hr transdermal patch,
applied for the initial 12 hours of hospitalization). After culture
of the surgical wound, a first-generation cephalosporin was given
orally. The dog was maintained in an oxygen-enriched environ-
ment (40% oxygen) and its respiratory rate was monitored
hourly.
A commercial veterinary therapeutic food designed for
patients with cardiovascular disease (Prescription Diet h/d
a
Canine ) was initially offered free choice, but was refused by the
dog. A different commercial veterinary therapeutic food
(Prescription Diet k/d Canine) was offered two days later when
the azotemia was beginning to resolve; this food was readily
accepted. This food avoids excess sodium, chloride, phosphorus,
potassium and protein found in regular commercial dog foods
(Table 36-5).

Progress Notes
The next day, the dog weighed 0.5 kg less, was afebrile, depressed
and refused food, but was breathing much easier. Oxygen supple-
mentation and nitroglycerine were discontinued. A serum bio-
chemistry profile revealed that the serum urea nitrogen and cre-
atinine concentrations had risen dramatically. An intravenous
catheter was placed and maintenance fluid therapy was initiated
with a relatively low-sodium physiologic electrolyte solution. Figure 2. M-mode echocardiography reveals a marked increase in
Digoxin was withheld for 24 hours, and furosemide and enalapril ventricular volume due to myocardial failure.
were discontinued for 12 hours. Dobutamine (2.5 µg/kg body
weight/min., increased to 5 µg/kg body weight/min. four hours later) was begun by continuous intravenous infusion to improve car-
diac and renal function. An electrocardiogram was monitored continuously during dobutamine therapy for ventricular ectopic activ-
ity or other tachyarrhythmias.
The patient was much brighter and more active the following day. The serum urea nitrogen and creatinine concentrations had
decreased. Fluid therapy and enalapril were continued, and the dobutamine drip was tapered over 12 hours. That evening,
furosemide and enalapril were administered.The serum urea nitrogen and creatinine concentrations were normal the next day.The