Small Animal Emergency and Critical Care Medicine Q&A 22

An 11-month-old, male Doberman Pinscher is presented with a 3-day history of coughing. In the past few hours he has started to produce frank blood and blood clots when he coughs.

Question	Answer		Article
Based on the clinical presentation, what historical questions should be asked of the owner?	Possible exposure to rodenticides, previous bleeding episodes (e.g. following spaying or castration) which might indicate a coagulation factor deficiency, recent use of medications which could cause platelet function disorders, vitamin K malabsorption or immune-mediated thrombocytopenia.		[[|Link to Article]]
What diagnostic tests are indicated?	A coagulation profile is indicated, including a platelet count, PTT, OSPT and assays for fibrin degradation (or split) products and fibrinogen. An ACT and platelet estimate on a blood smear may help to indicate a coagulopathy. Thoracic radiographs are indicated to determine the source of the hemoptysis.		[[|Link to Article]]
Your initial diagnostic tests reveal an ACT of 3 minutes and a normal platelet estimate. What initial treatment would you implement?	Rodenticide toxicity is suspected. Treatment should consist of vitamin K1 therapy (loading dose of 5 mg/kg s/c then 2.5 mg/kg/day p/o), plus supportive care including oxygen supplementation if tachypneic or dyspneic, and whole blood or plasma replacement if indicated.		[[ |Link to Article]]