Dysautonomia Case Dog Retriever - Disatonomía en Perros
Dysautonomia Case Dog Retriever - Disatonomía en Perros
Dysautonomia Case Dog Retriever - Disatonomía en Perros
CLINICAL PRESENTATION
On presentation, the dog appeared dull and
depressed, possibly due to general anaesthesia. Clear
fluid was vomited multiple times during the
consultation. Mucous membranes were tacky,
capillary refill time was approximately two seconds
and peripheral pulses were weak. Dehydration was
estimated at 7-8%. Heart rate was 120 beats per
minute with a matched pulse. Rectal temperature was
37°C. Abdominal palpation revealed only generalised Fig. 1: Lateral abdominal radiograph. Note the large amount of free abdominal
discomfort, thought to be due to the coeliotomy. gas and mineral opacities in small intestine and colon.
INITIAL TREATMENT
Initial management was directed at addressing
hypovolaemia and hypothermia.Warmed Hartmann’s
solution was administered intravenously at 60 ml/kg/hr
initially. A warm-air blanket was used to improve
body temperature.These measures (and likely further
time to recover from general anaesthesia) improved
the dog’s demeanour and cardiovascular status. Fig. 2: Ventrodorsal abdominal radiograph.
Heart rate had remained within the narrow range of Clinical sign Score Case score
80-100 beats per minute for much of the time. An
Bladder atony or dysuria 3 3
atropine response test abolishes parasympathetic
(vagal) control of heart rate. In most dogs this results Dilated pupils/reduced PLR 3 3
in an increase in heart rate due to sympathetic drive. Decreased tear production 3 3
In cases of dysautonomia, no significant change in Dry nasal mucus 3 3
rate would be expected as both sympathetic and Dilated, areflexic anal sphincter 3 3
parasympathetic control has been removed. Regurgitation/reduced oesophageal motility 3 0
Intravenous atropine at a dose of 0.02 mg/kg in this
Third eyelid prolapse 2 2
case failed to produce an increase in rate during the
60 minutes the rate was monitored, even when the Intestinal hypomotility 2 2
dog was exercised. Dysphagia 2 2
Syncope 2 0
It has been suggested that failure of sympathetic Vomiting 1 1
supply to intradermal blood vessels will prevent a Diarrhoea 1 1
normal reaction to intradermal injection with
Constipation/tenesmus 1 1
histamine. In this case, no weal or flare reaction
occurred (Fig. 8). Over the course of hospitalisation, Abdominal pain 1 0
the nasal mucosa became progressively more crusted Total 30 24
and dry (Fig. 9), suggesting a lack of secretion, Score: 0-10 - inconclusive (monitor and reassess); 11-20 - probable; 21-30 - positive
Gastrointestinal signs
remained elusive. Risk factors for dogs identified in
one retrospective study were living in a rural
environment, eating wildlife and spending >50% of If megaoesophagus or reduced oesophageal motility
their time outdoors. are present then feeding in a vertical position and
encouraging the animal to remain vertical for a time
In humans with the similar disease, subacute after feeding is useful.The type of diet (wet/dry) that
idiopathic autonomic neuropathy, antibodies against is best tolerated appears to depend on the individual.
ganglionic acetylcholine receptors have been Prokinetics to improve gastric and intestinal motility
identified, suggesting a possible immune-mediated may be used. Many of these drugs act on the myenteric
cause. These antibodies have been demonstrated in plexus, and, as a result, their efficacy may be poor. In
some canine cases of dysautonomia. Clostridium the cases reported, metoclopramide appears to have
botulinum types C/D, which produce neurotoxins, been used most commonly.This is a cholinomimetic,
have been identified as a potential cause in horses. acting on muscarinic receptors of smooth muscle. One
This toxin has been identified in seven out of eight potential problem is that lower oesophageal sphincter
cats affected in one outbreak and also in samples of tone may be increased with this drug, making
their dried food. At present, there are no reports of megaoesophagus management more difficult.
Failure of the parasympathetic system causes the Bethanechol chloride (Myotonine) is a muscarinic
most obvious clinical signs.The constellation of signs agonist. It increases detrusor muscle tone and may
includes: improve the animal’s ability to urinate. An
l weight loss improvement in ocular signs (lacrimation, pupillary
l vomiting response to light), salivation and appetite may be
l regurgitation seen. Pilocarpine drops may also be used to improve
l diarrhoea or constipation ocular signs; again this is a parasympathomimetic.
dysuria
PROGNOSIS
l