| مستخلص: |
Ibuprofen ingestion is known to cause significant toxicity in a wide range of species with reported clinical signs of gastrointestinal upset, abdominal pain, lethargy or depression, pale gums, collapse, and sudden death. A 6-month-old male neutered ferret presented on emergency for potential ibuprofen exposure. The exposure was suspected to have occurred 2 days prior to presentation. On examination, the patient was dehydrated, hypothermic, and painful on abdominal palpation. Bloodwork showed increased total solids and BUN, likely indicating dehydration, and an inverted Ca:P ratio. The patient was started on intravenous fluids, gastric protectants, antibiotics, and analgesics. After no clinical improvement in abdominal comfort, mentation, or hydration after 12 hours, radiographs were taken showing severe gastric distention with fluid and gas. Further discussion with the owner revealed a large part of the plastic bag holding ibuprofen was also missing, and concern was raised for potential foreign body obstructive process. After discussion of anesthetic risks and overall poor to grave prognosis, an exploratory gastrotomy was performed that revealed liquid contents with no obvious gastric outflow obstruction. Excellent intestinal peristalsis was observed intra-operatively; however, very few gastric contractions were observed. Repeated serum chemistry showed resolving BUN and TS with improvement in hydration status and correction of the Ca:P ratio. A culture of a peritoneal swab obtained during the first procedure showed Enterococcus and E. coli organisms susceptible to current antibiotics The patient was fed a mixture of barium and liquid diet postoperatively with subsequent radiographs showing no movement of barium past the stomach for more than 8 hours. Fluoroscopic studies were performed twice daily for the remainder of the 3 days in the hospital, which showed appropriate intestinal peristalsis but absent gastric contractions. An anesthetized attempt to pass an orogastric tube was unsuccessful, suspected due to significant lower esophageal sphincter tone. The patient's mentation and abdominal discomfort did not improve, scant melanotic stools were produced, and hematemesis occurred on examination during the third day. Due to concern for prolonged retention of gastric contents, and ulceration a gastrojejunostomy tube was surgically placed to allow for nutritional support via a CRI of liquid diet on the third day of hospitalization. Continued therapy with sucralfate, famotidine, omeprazole, cisapride, and alternating metoclopramide and lidocaine CRI's were administered through the fourth day. On the morning of the fifth day of hospitalization, the patient's PCV dropped to 13% and the stomach was markedly distended on imaging. Another attempt to pass an orogastric tube under anesthesia was again unsuccessful. Approximately 40 hours after the gastrojejunostomy tube was placed, the patient was found unresponsive and CPR was unsuccessful. A necropsy was performed, showing hemorrhagic liquid gastric contents. Histopathology showed ulcerative gastroenterocolitis, interstitial pneumonia, and splenic lymphoma. Trichrome stain indicated gastric fibrosis. Development of clinical signs consistent with NSAID toxicity was highly suggestive of ibuprofen toxicity; however, exposure was never definitively determined. A gastrojejunostomy tube was useful to provide nutritional support to a patient experiencing gastroparesis. The description of this surgical approach may be useful to provide support to similar critically ill pets. [ABSTRACT FROM AUTHOR] |
