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Our baby princess yorkie (4 lbs) started on Wednesday night…

Our baby princess yorkie...

Our baby princess yorkie (4 lbs) started on Wednesday night with diarrhea, by Thursday morning she had diarrhea with blood, so we decided to take it to the Dr. They identified illness-vomiting/diarrhea/GI. They run all the tests on her, and results were negative even fecal for bacterias, pancreatitis, Giardia...everything negative but she still continued with bloody diarrhea. Amylase 357; Bun 32; Eosinophil 0,6%; RBC 9.550; hemoglobin 22; hematocrit 67.210%; MPV 13.3 FL. No evidence of intestinal obstruction. They gave her Cerenia (injectable) 10 mg/ml - 0.03 mL IV; Famotidine (injectable)10 mg/ml - 0.17 mL IV; pyrantel pamoate 50 mg/ml 0.5 mL; IV fluid therapy 16 mL/hr LRS IV; metronidazole (injectable) 5 mg/ml - 1.3 mL IV @ 2 pm and 6 pm. At 7 pm we picked her up, but she was still very week and bloody diarrhea persisted, so they suggested to take her to ER for overnight fluids and care. Upon intake she had at 9:15 pm BG 22 and they gave her 7 ml of 50% dextrose and 7 ml salon admin IV. By 10 Pm her BG was 99, they gave her metronidazole (5 mg/ml) 4.5 ml IV BID; Barium 7 ml per rectum, ondansetron (2 mg/ml) 0.18 ml IV BID, hetastarch 2 ml IV q2 hrs. By 11 pm her BG went down to 29 and they gave her 5 ml of 50% dextrose and 5 ml salon admin IV; bag spiked to10% dextrose, line flushed. By 1 am her BG went up to 89, temp 100.6. By 2 am her BG went down to 49 and they gave her 6 ml of 50% dextrose and 6 ml saline IV. At 3 am more profuse bloody diarrhea came from her rectum, she stopped breathing, they intubated her, did CPR but she didn’t respond and passed away. We want to know for peace of mind what went wrong? For us it seems that medication given at the 1st place was not enough to attack the bacteria on time and let it reproduce the entire day, so when we took her to ER was probably too late. She was the light of our lives, please let us know what do you think happened and if we could have done something better?

Veterinarian's Assistant: I'll do all I can to help. Hopefully it didn't make a mess. Did the Yorkie eat anything unusual?

No that we know, we went for Xmas to Pennsylvania and she might have had chicken that she stole from another dog food bowl.

Veterinarian's Assistant: What is the Yorkie's name?

Bella

Veterinarian's Assistant: Is there anything else important you think the Veterinarian should know about Bella?

She had pancreatitis in the past about 1 year and a half ago, 8 years old, 4 lbs weight

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Answered in 17 minutes by:
1/7/2018
Dr. Schmidt
Dr. Schmidt, Veterinarian
Category: Veterinary
Satisfied Customers: 1,029
Experience: Associate Veterinarian
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Hello, this is Dr. Schmidt. Thank you for using JustAnswer. I am so sorry to hear about your devastating loss. The most striking part of that story is the fact that she did not respond to the IV dextrose. Usually in this type of a scenario, you are looking at a massive infection somewhere, in her case I worry the most about her GI tract, specifically devitalized bowel or a GI perforation or something along those lines. A devitalized bowel or a GI perforation would cause a massive infection in the body and the excess bacteria would eat up the glucose at a fast rate that wouldn't respond to regular treatment. This doesn't always show up on initial bloodwork and xrays. That is the first thing that comes to mind in a dog that went from happy/healthy to what you were describing. It would also explain the vomiting and diarrhea she had leading up to this. The other possibility would be a liver condition that is common in Yorkies called Microvascular dysplasia. It is a liver condition that can cause liver failure. They don't always have elevated liver enzymes with this, but they will often have a hard time controlling their blood sugar and it can spiral out of control quickly sometimes. The other thing I think of with what you're describing would be a tumor in the pancreas called an insulinoma. This is a very tiny tumor that cannot be detected on xray and rarely detected on ultrasound, but it can cause severe drops in blood sugar that are unresponsive to supplementation. I think the most likely thing would be sepsis, likely from the GI tract. I worry about some devitalized bowel being a likely cause, but an autopsy would be the only way to know for sure.

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Customer reply replied 3 months ago
Thank you Dr Schmidt. Do you think that the dose of antibiotic given to her within the day was very low considering she wasn’t responding to the treatment? What is the dose of metronidazole that’s usually given in emergency cases?

It is lower than the dose that I usually use in a case like this personally. I also usually add in at least one other antibiotic to give a little better coverage there. They might not have been as worried about an infection in her case because her white blood cell count started off normal, but I have seen these cases start off with normal white blood cell counts and then get a lot worse from there.

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Customer reply replied 3 months ago
for all I have been reading that dose seems very low to attack a bacteria. Do you think that the process at the ER with the dextrose and the amounts was the appropriate? By seeing the pattern her glucose took we think that the increase of dextrose given at 2 am shocked her and that’s why she collapsed. What do you think about that part of the process?

The only part of that that was a little strange was the fact that they started her on a 10% dextrose drip, which is a lot higher than usual, but the rest of the protocol is pretty standard to be honest with you.

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Customer reply replied 3 months ago
When they run the BG on ER the first time when we arrived it was 22 and they said it was very low and she could have seizures, so they had to increase her levels of sugar and keep her hydrated. For BG at that level what would have you done? Or what would have been the right path to keep her stable?

I would have kept her on a 5% dextrose drip and monitored her blood glucoses every hours and given her a 50% dextrose bolus as needed if her blood glucose got below 60.

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But to be honest with you, once they are at that stage, it can be pretty difficult to keep them stable no matter what you do.

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It sounds like she was pretty unstable by the time she got to the ER unfortunately.

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Customer reply replied 3 months ago
Sorry Dr for so many questions, our heads are just not in the right place right now and we’re trying to understand what really happened. If we’d have taken our baby to you with those symptoms: vomit, bloody diarrhea; what would have you done from A to Z?

I probably would have repeated bloodwork, xrays, and done an ultrasound to try to find out the underlying cause so I could taylor my treatment plan to that. And as far the what specific treatments, it would all depend on what I found on my diagnostics.

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Customer reply replied 3 months ago
Understand. In this emergency cases what’s the usual dose of antibiotic (metronidazole) that’s given and what other antibiotic could have been used to reinforce the treatment?
I personally use metronidazole at a 15 mg/kg dose every 12 hours and unasyn at a 30 mg/kg dose every 8 hours and most of the time I will add in Baytril at a 5 mg/kg dose once a day.
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Customer reply replied 3 months ago
with these medicines and doses, diarrhea would have stopped and she could have hold her glucose right? Together with the IV fluids.?
It depends on the underlying cause. If she was already septic from devitalized bowel or a GI perforation, by the time she got to the ER, she wouldn't have had a very good chance no matter what antibiotics she was on I'm sorry to say.
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Customer reply replied 3 months ago
from everything we’ve discussed, it’s safe to assume my baby would not have been in that condition had she be given the antibiotics you outlined in the doses you described two responses ago. This is so hard

Yes, it definitely is. I understand where you're coming from. It is so awful to lose a pet under any circumstances, much less so unexpectedly.

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Customer reply replied 3 months ago
she had an ultrasound two months prior so the tumor isn’t likely. The rest seems right. But you think, in your best opinion that my baby would y have been in that severe condition upon arrival at the 24 hour clinic had she had the antibiotics described above in those doses?
Customer reply replied 3 months ago
Would not have been

Actually, dogs age a lot quicker than we do, so I wouldn't count that out at this point at all. Two months is almost a year to them. Especially an insulinoma which is a very small tumor in the first place. And I really can't say for 100% certain. It might not have made a difference depending on what was the underlying cause. Have you thought about requesting an autopsy to know for sure what happened?

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Customer reply replied 3 months ago
I had to go there on Friday to see her. They brought her to me with a towel. I didn’t have the courage at first to lift it, so I started rubbing her legs. Then I lifted the rest. I held her for three hours to warm her. Then I cleaned her face and butt. I gave her a bow, put a warm jacket in her and put her on a bed in her favorite seated position with her head up. I gave her her bone and one of her giraffe toys. She looks beautiful. They put her back in the freezer. I was thinking to dry freeze and preserve her because the hardest thing is taking away the touch of her paws and rubbing her coat. So I guess my question is whether I can do the autopsy and still preserve her. What do you think

I think that if you really want to know what happened to her, an autopsy is the only way to get answers. It might give you some peace of mind to know why this happened. I really can only provide educated guesses unfortunately, but an autopsy would let you know for sure. They can still get some good information even though she has been frozen. I know it won't change anything. Ultimately, it's up to you, but I think it might at least give you some peace of mind. I respect your decision either way, I know how hard it must be for you to be struggling with this.

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Customer reply replied 3 months ago
It can I do the autopsy and still preserve her via freeze drying.

I'm not sure about that to be perfectly honest with you. If you ask the ER clinic about that, they can ask whatever pathologist they typically recommend for their autopsies.

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Customer reply replied 3 months ago
If this was GI tract infection with devitalized bowel or a GI perforation, and she had received 5% dextrose drip with monitored blood glucoses every hour with 50% dextrose bolus as needed if her blood glucose got below 60, in conjunction with metronidazole at a 15 mg/kg dose every 12 hours and unasyn at a 30 mg/kg dose every 8 hours and Baytril at a 5 mg/kg dose once a day, would she have been critical upon arrival at the ER or would she have been stable and able to receive IV fluid?

She was receiving IV fluids, but the fluid just had dextrose in it. And if she had devitalized bowel or a perforation, she probably would have been critical regardless. I don't think it was anything that the ER or your regular vet did wrong, I think this was just a very serious issue in a very small dog that was too much for her little body to handle.

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But again, if you really want answers, get an autopsy done. That is really the only way to know for sure.

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I hope that makes sense. I don't think any more speculation is useful or even helpful anymore. It is going to drive you crazy the more you go around and around with this. I would recommend doing the autopsy. Otherwise, it is only speculation. Let me know if you have any more questions, but again, I don't know if I will be able to give you anything definitive in this case. I can only give you my opinion, which isn't by any means fact and won't take the place of autopsy results.

If you have a moment to fill out a positive review (by clicking on the **stars** at the top of the page) for me I would greatly appreciate it. This is the only way the website can credit me for my time. Thank you so much and good luck!

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Customer reply replied 3 months ago
What I’m asking is a specific question. If it was the GI tract infection, wouldn’t the more agressive antibiotics have staved off the infection for the fluids to take.

If that was all that was going on, then yes definitely.

Dr. Schmidt
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Satisfied Customers: 1,029
Experience: Associate Veterinarian
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