Alfredo PÃ © rez Rivero
Author of the book: Clinical hepatology and liver surgery in small and exotic animals. Edit Servetus 2012
Director of Taco Veterinary Hospital
Santa Cruz of Tenerife
Heat stroke is a frequent disorder in the practice of small animals, especially in warm and humid environments. Cats are relatively resistant to sunstroke.
Since the owner of the animal contacts the hospital, he should be instructed on the need to soak the dog with water at room temperature, and even warm, and put into operation the air conditioning of the vehicle during transport to the veterinary center. Once at the veterinary center, it is recommended to follow the following protocol.
- Administer IV fluids at room temperature.
- Wet the entire body, with a direct shower or by immersion in the bath (the best way to achieve immediate cooling).
- After wetting it, apply a fan.
- Give a skin massage because it increases peripheral circulation and increases heat loss.
- Discontinue cooling when body temperature reaches 39.5 ° C as hypothermia may occur. Patients suffering from hypothermia are more likely to die.
- After achieving the appropriate temperature, every 4 hours should be monitored for 12-24 hours, a hyperthermia after a normalization would indicate a possible infection, inflammation or inability to dissipate heat (as occurs in the obstruction of the upper airways) and should be investigated .
- Heating measures are frequently required, such as insulation with blankets, which can be hot water or forced air and use of oxygen cages with controlled temperature, in order to keep the patient in a normal temperature range, after treat initial hyperthermia [17,21].
It is not recommended:
- Immersed in cold ice water (contraindicated) as it causes peripheral vasoconstriction that inhibits heat loss by convection and radiation, producing also tremors that generate more heat.
- Although intraperitoneal washes with cold saline solution, sterile, gastric washes or enemas of fresh water can be effective, they consume labor and are not very practical, being able to interfere with monitoring and generate a rebound effect.
- Although ice packs in the groin, armpits and neck or head may be useful, some authors advise against it.
- Alcohol baths are not recommended, due to the risks of explosion and potential intoxication.
Reset the volemia
- It will start with isotonic solutions. The crystalloids are administered at the discretion of the veterinarian and must be adapted to the monitoring. An initial dose of crystalloids of 20-30 ml / kg, as a bolus, will be administered after which the heart rate, respiratory rate and blood pressure should be reevaluated and fluid doses adjusted. If there is significant abnormal hypotension or perfusion, colloids, such as hetastarch or 70 dextran, will be added in boluses of 5-10 ml / kg until the effect is achieved.
- In suspected cerebral edema, fluids should be administered with caution.
- To treat shock, fluid administration remains the mainstay of treatment.
- The administration of plasma and albumin products can be considered in life-threatening cases (8).
Physical and laboratory parameters related to perfusion and volume (for example, hematocrit and total solids, lactate, etc.) should be evaluated at the beginning and frequently, to monitor the progression and response to treatment. Nucleated erythrocytes, especially metarrubricites, are extremely common in heat stroke and decrease within 24-36 hours from hyperthermia. Its increase is associated with death and disseminated intravascular coagulopathy (CID), so it can be used for heat stroke prognostic purposes.
Treat the underlying causes
For example, dyspnea (obstruction of the upper respiratory tract), eclampsia, poisoning that causes tremors or seizure activity. In the obstruction of the upper respiratory tract and laryngeal edema it would be necessary to administer glucocorticoids, in addition to oxygen, but they would not be empirically indicated as they affect the kidneys and predispose to gastrointestinal ulcers, nor the antipyretic ones, such as flunixin meglum , carprofen, dipyrone or etodolac, then, in addition to being ineffective they can affect the kidneys and predispose to gastrointestinal ulcers.
A low or low platelet count and positive D-dimers support a CID. Before a coagulogram that suggests an impending CID, plasma will be transfused at 10 to 20 ml / kg / day. If there are no hemorrhages, heparin may be started at 75-100 IU / kg subcutaneously 3-4 times a day but if the number of platelets is less than 50,000 it would be contraindicated. Blood cell concentrates will be administered as many times as necessary to maintain a hematocrit greater than 20-25%.
In a state of hypercoagulability, difficult to demonstrate without a thromboelastography (TEG), heparinization would make sense but there are no clinical or consensus studies that support its use in CID. What is clearly justified is the use of fresh frozen plasma to improve coagulation times and stop clinical bleeding.
Petechiae, ecchymosis, bleeding from any orifice, platelet / smear count, prothrombin time, activated partial thromboplastin time, activated clotting time, TEG, fibrin degradation products and D-dimers should be monitored.
Nervous system problems
Neurological signs may occur due to hypoglycemia, increased intracranial pressure (ICP) or seizures. Seizures, cranial nerve deficiencies including pupillary response to light, difficulty walking, ataxia, hypoglycemia and sodium concentration must be monitored.
Hypoglycemia would be treated with a bolus of 0.5 / kg of 25% dextrose and blood glucose values would have to be monitored after bolus administration and every hour until three normal measurements were obtained, which could be extended 4-8 hours. If hypoglycemia occurs again, a bolus should be repeated and continued with a continuous infusion of 5% dextrose, as well as periodic glucose measurements and restore normoglycemia with a bolus 0.1 g / kg and maintain a infusion at speed constant from 2.5% dextrose in maintenance fluids, to achieve, without exceeding, normoglycemia.
If despite the normalization of blood glucose, neurological symptoms persist, a possible cerebral edema should be treated, with oxygen and mannitol at 0.5-1 g / kg IV in 15 minutes [9,19], but the vollemia must be stabilized before of the use of mannitol and avoid the suppression of liquids since hypovolemia will exacerbate the brain injury. In addition to mannitol, a hypertonic saline solution (3-5 ml / kg of 7% solution) can help attenuate cerebral edema.
Seizure activity contributes even more to the heat load and neuronal damage and is treated with diazepam in a bolus of 0.5 mg / kg IV.
The water balance is maintained by the correction of hypernatremia, slowly, with a water source or IV administration of 0.45% saline solution, maintenance fluids (for example, Norm M) or 5% dextrose solution ( D5W).
The parameters of the respiratory tract and circulatory system should be monitored to avoid hypoxemia, hypotension or hypercapnia.
Urinary tract problems
Electrolytes, bladder size, urine output and color, urinary density, test strip, urine sediment, creatine kinase (CK), blood urea nitrogen (BUN), creatinine, phosphorus and acid balance must be monitored. base, together with the parameters listed in the circulatory system.
A urinary catheter should be placed to control urinary output. If little urine is produced (less than 2 ml / kg / h), despite an average arterial pressure of 60 mmHg, an oligomeric or anuric renal failure would be considered.
If there is oliguria or anuria due to renal failure, it should be treated with appropriate fluids, followed by injections of furosemide at 2-4 mg / kg IV, 3-4 doses for 3-4 hours or continuous infusions at 0.5-1 mg / kg / hour Dopamine infusions at 2.5 g / kg / min can help increase urine production in dogs. In addition, acute renal failure would be treated with 0.5 g / kg IV mannitol boluses (up to three times) and the use of diltiazem has been recommended. A lack of response would justify the use of peritoneal dialysis or hemodialysis. Fluid overload should be avoided in oligarchic patients.
A hyperkalemia would be treated with sodium bicarbonate and / or dextrose and / or insulin.
Alkalization of urine at a pH of 8 can help prevent myoglobin precipitation in the kidney due to rhabdomyolysis.
Digestive system problems
Gastrointestinal and liver damage is treated with intravenous fluids, broad-spectrum antibiotics and gastric protectors.
Blood vomits and diarrhea should be monitored, especially pseudomembranous and liver enzymes and liver function (coagulation, glucose, bilirubin, ammonia, etc.). In the event of liver failure, liver antioxidants may be justified and probably do not harm.
Volumes of lost liquids will be administered, with synthetic crystalloids or colloids.
Due to the damage of the gastrointestinal tract, nutrition can be a challenge in these patients, protein levels drop rapidly and are difficult to fight, even after multiple plasma transfusions. The feeding should be started early (as soon as the vomiting in the patient ceases) through a nasosophageal or nasogostric tube. If the patient does not tolerate enteral nutrition, parenteral nutrition should be considered. Initially, microenteral nutrition will be provided through a nasosophageal or gastric tube and enteral nutrition or fluids will continue if hospitalization continues. A nasogastric tube can help keep the stomach depressed. The use of protectors such as famotidine (1-2 mg / kg q 12-24 hours IV) and sucralfate has been recommended.
In patients with hematochezia / hematemesis, broad-spectrum antibiotics should be administered, in addition to monitoring blood glucose and blood pressure. Antibiotics are not routinely sent, except for severe hypoperfusion combined with multiorganic failure or gastrointestinal compromise and should be recommended broad-spectrum. as cefoxitin (30 mg / kg IV every 6-8 hours) or ampicillin (22 mg / kg IV every 6-8 hours) combined with enrofloxacin (5 mg / kg IV every 12 hours). Aminoglycosides should be avoided, given the risk of potential kidney damage [17,19].
Respiratory system problems
Respiratory rate, effort, airway sounds, mucous membranes, auscultation, pulse oximetry, venous arterial / blood gases should be monitored and chest x-rays will be performed. Maintain the airway, as necessary, and avoid hypoxemia. It is crucial to have an adequate airway to minimize respiratory work and aid in heat dissipation through panting. The oxygen supplement may be useful for decreasing respiratory work and combating hypoxemia, but cages, masks and hoods can interfere with heat dissipation. A nasal cannula is a good option. In hypoxic patients who, despite the administration of oxygen, suffer hypoventilation or are at risk of failure of the respiratory muscles, a positive pressure would be indicated.
Circulatory system problems
Mental state, mucosal color, capillary refill time, heart rate, pulse quality, urine output, ECG, blood pressure, central venous pressure, pulmonary and arctic venous pressure, osmotic pressure, albumin and lactates should be monitored.
Bowls of crystalloids or synthetic colloids should be repeated until the vascular volume indicators are normalized, for example, PVC> 5-8 cm. Synthetic colloids can help maintain the effective circulating volume if the albumin or capillary cancer pressure is persistently below the reference range.
If after the normalization of the vascular volume the indicators of adequate cardiac output volume such as pulse, blood pressure, blood lactate are insufficient, a constant infusion (CRI) of a positive intropolar drug should be considered, for example , dobutamine or dopamine (5-10 ug / kg / min).
If afterwards, blood pressure and lactate have not normalized, vasopressors (dopamine 10-20 ug / kg / min, norepinephrine 0.2-2 ug / kg / min, or vasopressin 0.0001 up to 0.0004 units / kg / min).
Normalization of acidemia with NaHCO3 (1 mEq / kg or empirically based on the base deficit 0.3x Г— body weight in slow IV kg) maximizes the effects of adrenergic drugs.
Tachyarrhythmias should be treated with lidocaine boluses at 2 mg / kg IV followed by a CRI at 25-75 ug / kg / min.
Potassium should be normalized with potassium and / or magnesium supplements.
Urine production and possible arrhythmias (ECG) should be monitored.
Treatments such as lidocaine, procainamide, oxygen therapy, pain management (opioids) and electrolyte analysis should be considered as part of the treatment.
Current or potential secondary complications
Secondary complications include: hypoglycemia, coagulopathy, acute respiratory distress syndrome (ARDS) and renal failure.
The administration of glucose should be guided by the concentration of blood glucose.
In severe hypoalbuminemia, colloids can be used if a normovolemia with crystalloids has not been achieved.
Cardiac arrhythmias rarely need pharmacological treatment. Bolus lidocane or infusion is usually effective.
NSAIDs are not recommended since it is thought that hypothermia is not mediated by the hypothalamus.
Other recommended treatments
- A clinical benefit has been reported with parenteral administration of vitamin C, especially in critical care.
- Dexamethasone (DXM) is known as an immunosuppressive drug used to control inflammation. It may be an alternative therapy that can improve sunstroke victims by attenuating activated coagulation, systemic inflammation and ischemia during heat stroke.
- The use of eicosapentaenoic acid has been studied: it significantly increases the survival time after a heat stroke, decreases intestinal permeability and endotoxic plasma levels.
Even with the monitoring and treatment of multiple organs and systems affected by an integral heat stroke, the prognosis must be reserved. In general, retrospective studies of a heat stroke indicate that approximately one quarter to half of patients die. Arrhythmias, CID, renal failure, hypoglycemia, persistent hypotension, increased bilirubin, seizures and coma have been associated with an increase in mortality. Despite these complications, patients who survive the first 24 hours will often be discharged.
Brachycephalic breeds, dogs with laryngeal paralysis, obstruction of the upper respiratory tract or exercising in hot and humid weather are more susceptible to the development of a heat stroke, as well as dogs confined in non-ventilated areas, deprived of water or subjected Heat (hot dryers after the bath) are at risk of developing a heat stroke. The consequences are serious damage and multiorgan failure, such as liver and kidney failure, cerebral edema and coma, and CID.
The treatment is aimed at lowering the central body temperature first, increasing and maintaining the perfusion of vital organs and plasma transfusions indicated for the treatment of CID. Broad-spectrum antibiotics are indicated for the potential treatment of help in liver failure and septicemia due to intestinal bacterial translocation. Patients show no signs of organ failure until 2-3 days after the initial injury. The prognosis is reserved, especially if there is a multi-organ failure and a CID is developed. Patients can recover if intensive support treatment is started.
Symptoms of Heat Stroke in Dogs
- Body temperature higher than 42º C
- Excessive panting
- Sticky and discolored or too dark tongue
- Stupor and wobble, with possible loss of consciousness
- Diarrhea and vomiting
If you see that your pet suffers from any of these symptoms after exposure to heat or sun and its temperature is higher than 42º C, fill the bathtub with water (with not very cold water and no ice) and bathe it until it lowers temperature. Once the temperature has dropped, it is best to take it immediately to the veterinarian to rule out possible damage to internal organs.
Heat Stroke Treatment in Dogs
- Move the dog to a cool and shaded place and fan it. Put a wet cloth on his head.
- Bathe our pet with cool water (not very cold and without cubes).
- Take our dog to the vet urgently to rule out possible internal organ problems due to heat stroke.
If your dog has had the bad fortune of suffering a heat stroke, surely you do not want it to happen again. Here are some tips to avoid heat stroke in dogs:
How to avoid Heat Stroke:
- Do not take your dog for a walk in the central hours of the day on hot days. Better in the morning or with the fall of the sun.
- Make sure your dog always has cool water available. If you are outside, try to enable a shaded and cool area.
- If you go hiking with him and it is very hot, try to walk in the shade and offer him water often.
- Never leave your dog locked in the car in the supermarket parking lot when you go out to buy. Sometimes we entertain more of the account and forget>
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I left mine in a dog kindergarten, and when I went to pick it up, it made a very strange noise and it was hard to be apart. Dizzy, I told them from when I went to that and they told me that they had started doing it. When we arrived, we did not know that the dog did not take it directly to the vet and told us it was a blow. Warmth of having it in the sun, for a long time in an uncooled car and that it had been in the sun that I had picked it up at 7:00 am from the nursery. Never again. 4 o'clock in the morning was dead. I must report
His puppy of my daughter just died, a one-year-old Belgian shepherd, of age. I start to gasp a lot and drool. but as it was already at night we did not locate his veterinarian, and then another was called he was diagnosed with poisoning, and gave him almost a bottle of hydrogen peroxide
Supposedly to vomit. His tongue was on one side, he put a wide one so he could breathe, and took it to his clinic, the next day he said he was fine but was weak, and in the afternoon we went to seeing him I already delivered it dead ... I really do not believe that he died had expelled a few drops of blood. Rather, I think he drank a lot of hydrogen peroxide.
Be careful not to put in the hands of anyone who says is veterinarian to your puppy
My one-year-old Belgian pastor fallasio antier by heat stroke too late I realized what happened despite the treatment was very desperate, half a lot sad for k felt it was already his last days of life, he said goodbye to all places She turned, when we let her go, she was very afraid, of dying, when this was going to get very tense in her body. I struggle 3 times, I fight with each other, to keep up my luchona dog, but I fail at 4:35 pm. Amanesi doesn't hit the eye for a moment. I accompanied her, until her death.
My dog died) =
My dalmatian is 2 years 3 months 5 days ago eruptions erupted all over his back from his back to the height of his tail taken to the veterinarian and says that it may be allergic to any food that may have been given or even chicken he is getting corticosteroids better in the morning but the afternoon come back again may be this also heat stroke
AT THE SAME ONE I DIED, I DOGGED HER, WE LEFT HER CLOSED IN THE FOURTH, IT WENT CRAZY, RUNNING, CRYING, AND RUNNING IN TIME, WE DROPED IT, AND CAME OUT, RUNNING, AND DIDN'T RETURN TO THE HOUSE WHEN WE LOOKED FOR IT, WE FOUND A DEAD BUS.
My dog had a heat stroke, he reached 42 degrees, he was injected to lower the temperature, then it started to get worse and he was given atropine, he started to feel better
Then the veterinarian closed and handed it to my dog. 15 minutes later, she started to vomit now she is not wanting to sleep, not what else to do help me
A few days ago my puppy died, I guess it was a heat stroke. I tell them that I live in a house behind my mother's, I always put fresh water in my house. One day I went to my mother's house, the puppy was free because he liked it that way, since we adopted him as an adult and he never liked being locked up.
That day the puppy went to my mother's house and stayed there, there was no water within reach the weather was fatal, I trusted that in my house if I had water, that was at 5 in the afternoon, total that at 7 He returned to my house, the water was outside so I do not know if he would drink water.
The last time I saw him was at night at 1 in the morning.
I feel very sad for not having put another boat of water in my mother.
The puppy was panting and drooling, in my ignorance I didn't think I was having a heat stroke, I feel terrible because I know that I killed him with my ignorance and for not having put a boat with water. Help me.
Heatstroke? What is a heat stroke in dogs
(Photo via: mundoperros)
The first thing you should know is that your dog has a body temperature higher than yours, normally between 38-39 degrees Celsius (under normal conditions).
This has a great risk, and its temperature can rise rapidly.
If your dog is 40 degrees of temperature, or it is for fever, or is suffering a heatstroke.
Remember! Heat strokes in dogs, occur between 41-42 degrees. In addition, it can irreversibly affect your pet!
A sudden heat stroke can cause Death to your dog in 5-6 minutes!
Causes of heat stroke in dogs
(Photo via: pinterest)
Most of the time, when a dog suffers a heat stroke, it is usually due to carelessness of its owners! And we tend to think that our pet's body works like ours, and this is not the case!
The main causes of heat stroke in dogs are:
- Leave the dog inside the car in summer. This usually means sentencing him to death. And, even if you have left the air conditioning, your pet does not regulate its temperature as fast as you.
- Have your pet tied away from home in the sun. That is rather torture (if you see someone do it, remember, it is reportable!). Your pet would not only be at risk of heat stroke, but also of strangulation. And it is that when fleeing from the sun, he could drown! If you are thinking of having a dog to leave outside your home, DO NOT have a dog!
- Take walks with extreme temperatures. You can protect yourself from the sun with glasses, hat, etc., but ... and your dog? It's about using common sense.
- Leave your dog in the garden without shade. Your dog likes to lie in the sun, we know it! However, if you sleep, your body temperature may rise so high that you can't move! If it's extremely hot, try not to lie in the sun!
- Hot and humid weather. Deadly for your dog! And, if in addition to heat, there is humidity, your dog will have even more difficulty cooling and regulating its temperature!
Symptoms of heat stroke in dogs
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The symptoms of heat stroke in dogs are very evident. We tell you!
- Very agitated or nervous breathing
- Your dog loses strength or cannot move, is reluctant to get up
- Lack of balance
- Dark or bluish gums (caused by bad breath)
My dog is suffering a heat stroke, what can I do?
If you think your dog is suffering a heat stroke, There are several things you can do!
You have to take your dog to the vet, but in the meantime, you can apply these first aid.
- Put your pet in a cool, shady place.
- Give it fresh and clean water. EYE! Fresh, not cold.
- It prevents you from drinking too much and too fast, it could cause gastric torsion!
- If you don't want to drink, moisten your lips.
- Moisten your dog with fresh water, especially the neck and head areas *
*Eye! Don't cover your dog with wet towels or rags, you could cause the opposite effect. Simply wet it with your hand or with a damp cloth.
If the case is very extreme and if the vet recommended it (you can consult him by phone), bathe your pet with fresh water. Enter it slowly in the water and NEVER do it with ice water or putting ice cubes in the bathtub.
Have you managed to stabilize your dog? Don't forget to take you to the vet! He will assess whether he has suffered any internal damage.
What not to do
- Cover the animal with towels: although they are soaked in water, by covering it we make heat dissipation difficult.
- Use ice water: a drop in temperature too fast could harm you, a gradual decrease is better.
- Feed or drink even if you are aware: we will avoid a possible choking, since in these circumstances swallowing may be difficult.
- Force him to walk: The animal is usually weakened and forcing it to move can aggravate the clinical picture.
Veterinary treatment and care of the pet due to heat stroke
Is essential veterinary care even if the animal has improved, since the vital organs could be damaged. First, it will contribute oxygen Y intravenous fluid therapy to recover from dehydration and loss of energy and mineral salts. Meanwhile, it will measure your vital signs and add some additional medication treatment, depending on your symptomatology. It is necessary the hospitalization of the animal to observe its evolution since, once stabilized, your veterinarian must perform blood, urinary, and other complementary tests, to check the state of the vital organs. On some occasions there are significant damages, which end the life of your pet after a few hours after stabilization, hence the importance of rapid action and intensive surveillance.
Tips to prevent heat stroke in the pet
With the arrival of good weather it is convenient to follow a few simple tips daily to avoid exposing your pet to high temperatures and to prevent to suffer a heat stroke:
- Walk first and last hour of the day, avoid the central hours of the day to go for a walk, make the midday walks a little shorter, and choose the coolest and shaded areas you can.
- Prevent me from performingabrupt exercises, Especially if it's very hot.
- Offer him fresh water, keep your drinking fountain clean and change the water often. Leave more than one access point to fresh water and, if you go for a walk, bring a bottle or a folding bowl with you.
- Fraction the daily ration of food in several shots and leave the most for the coolest hours of the day.
- Never leave it indoors. like the car, for a very short time, since in less than 5 minutes it can become a real oven at more than 50 ºC. If there is no choice but to travel, bring enough fresh water, the air conditioner on, and pause occasionally to rest.