NorthStar VETS Cool Case Casey

The team at NorthStar VETS is doing innovative and amazing things every day as they work to advance the level of care available to your pet. This series of posts highlights cool cases at NorthStar VETS and the types of things done to save pets and improve their quality of life. These are cases using innovative and cutting-edge medical techniques, and/or stories of pets beating the odds. Read the story below and watch the doctor tell you the story in their own words via the video at the end. This is the story of Casey, a patient of Dr. Steven Berkowitz of our Emergency and Critical Care team, and how a relatively new technique helped save this dog’s life in an innovative way.

About Casey
Casey was an 8-year-old Labrador Retriever that presented to NorthStar VETS late one morning after her owner found her laying on her side and minimally responsive. After a little investigation, they realized that she had eaten an entire bottle of her phenobarbital that she was on for seizures secondary to a brain tumor. Unfortunately, she had ingested just under 100mg/kg of body weight (her actual dose was 2mg/kg)!

About Phenobarbital
According to multiple sources, the elimination half-life of phenobarbital in dogs is anywhere from 12 hours to 2 days. In other words, it could remain active in her body for up to 5 times the half-life, or up to 10 days in her system, and thus have harmful effects.

For years, the treatments for phenobarbital and other barbiturate intoxications was to merely treat the symptoms with supportive care and IV fluids, and there was some literature that recommended using activated charcoal to speed the gastrointestinal clearance of the medications, with limited success.

How things went for Casey
On presentation, Casey was found to be minimally responsive, had a heart rate of 60 beats per minute with poor pulses, and a respiratory rate of 20, and had lost her gag and swallowing reflex. At the dose of phenobarbital she got into, she was at risk of severe central nervous system (CNS) depression, including cessation of breathing and heart contractions secondary to medullary depression.

About the new procedure
Due to recent studies and case reports, Dr. Berkowitz of the Emergency and Critical Care team opted to try a novel therapy of giving her intravenous lipid emulsion. This is a product made of 100% soybean oil that has been purified and approved for parenteral nutrition and some intoxications. The exact mechanism of action of this therapy is not well established, but in cases of highly lipophilic (fat soluble) medications, it has been surmised that there is a “lipid sink” effect as well as an “extended lipid phase.” In these two theories, we suspect that by giving a substance with a high fat content, that we prevent the toxins from leaving the vasculature, and therefore preventing it from reaching the neurological tissue, thus preventing the effects of the drug. The extended phase theory also intimates that it can actually cause the bound medication/toxin from the tissue, and back into the highly lipid filled vasculature, thus removing the toxin from the affected tissues.

Within 1 hour of initiating the intravenous lipid emulsion, Casey was not only more alert, but she was wagging her tail and trying to stand up and walk to the nursing staff. Now that she was able to swallow, she was then also given an oral dose of activated charcoal. Approximately 4 hours later, she started to become very dull again. She was given a second round of intravenous lipid emulsion, and within hours, she was walking around, barking at other dogs and eating well. By the next morning, which was less than 18 hours after presentation, Casey was doing so well that she was discharged and walked herself out of the front door! Beyond the obvious success, what is so wonderful with this result is that in cases where lipid therapy was not given, many of these dogs passed away as a result of intoxication and the inability, even with CPR, to maintain a respiratory drive. In addition, those patients that did make it, often needed to be hospitalized for several days and Casey left in less than 1!

NorthStar VETS had recent success with the lipid emulsion technique when a dog got into insecticide.

Be prepared for pet emergencies at home. Download your free copy of the NorthStar VETS Pet Emergency Care Handbook.

Learn more about the Emergency and Critical Care service at NorthStar VETS

Steven Berkowitz, DVMSteven Berkowitz, DVM
Dr. Steven Berkowitz attended St. Georges University and did his clinical year at the University of Illinois. Berkowitz joined NorthStar VETS after serving as the Chief of Emergency and Critical Care at another specialty hospital. Prior to that, he completed a three-year residency in Emergency and Critical Care medicine at the Oradell Animal Hospital in Paramus, NJ. His residency was completed at one of only a few recognized veterinary trauma centers in the United States. Prior to his residency, he was a staff Emergency Veterinarian at Animal Specialty Center in Yonkers, NY as well as serving as an emergency doctor at Animal Emergency and Referral Associates in Fairfield, NJ for 3 years. Dr. Berkowitz can be seen on seasons 5 and 6 of “Animal Precinct” on Animal Planet, which was filmed during his internship at The Bergh Memorial Animal Hospital of the ASPCA in New York City.

Dr. Berkowitz has special interest in the management of metabolic and endocrine derangements, trauma, as well as management of the septic patient.

The information presented on this web site is not intended to take the place of your family veterinarian’s advice and is not intended to diagnose, treat, cure or prevent any disease. Discuss this information with your own veterinarian to determine what is right for your pet. All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. We can not and do not give you medical advice via this blog. The information contained in this online site and emails is presented in summary form only and intended to provide broad understanding and knowledge. The information should not be considered complete and should not be used in place of a visit, call, consultation or advice of your veterinarian. We do not recommend the self-management of your pet’s health problems.

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