symptomatic management of primary acute gastroenteritis€¦ · causes of acute gastrointestinal...

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Table 1. Selected Causes of Secondary Acute GastroenteritisAlgal • Prototheca species

Bacterial •Campylobacter species •Clostridia species•Escherichia coli •Neorickettsia helminthoeca • Salmonella species

Drugs •Antibiotics•Cyclosporine •Glucocorticoids•Mycophenolate •Nonsteroidal anti-inflammatory drugs

Parasitic •Ancylostoma caninum •Ollulanus tricuspis• Physaloptera species• Strongyloides species• Toxoascaris leonina• Toxocara canis

Protozoal •Cryptosporidium parvum •Giardia species• Isospora canis

Systemic disease

•Bacterial cholecystitis •Gallbladder mucocele •Gastric dilatation and volvulus •Hepatic disease •Hypoadrenocorticism • Pancreatitis • Pyometra •Renal disease• Sepsis • Septic peritonitis• Splenic torsion

Toxins •Chocolate• Lead•Mushrooms•Organophosphates•Xylitol• Zinc

Viral •Canine coronavirus •Canine parvovirus• Feline immunodeficiency virus• Feline leukemia virus• Feline parvovirus (panleucopenia virus)

Acutegastroenteritisisatermusedtodescribeasyndromecharacterizedbythesuddenonsetofvomitingand/ordiarrheacausedbygastrointestinalmucosalinflammation.Thisdiagnosisisseldomconfirmedby

histopathologicevaluation;instead,itisbasedonaconsistentclinicalpresentationandexclusionofotherpotentialcausesforthepatient’sclinicalsigns.Mucosalinflammationisassumed,butnotproventobepresent.Therefore,acute gastroenteropathyisperhapsamoreappropriatename.

DIAGNOSTIC EVALUATIONAcutegastroenteritisisamongmanypotentialcausesofacutevomitinganddiarrhea(Table 1).However,inmanycases,thecauseofprimaryacutegastroenteritisisnotdetermined.Rapidresolutionofclinicalsignsoftenmeansthatextensivediagnosticevaluationisunnecessary.Physical ExaminationNospecificphysicalexaminationfindingsarepathognomonicforacutegastroenteritis,andsomedogsdonothaveanysignificantabnormalities.Findingsconsistentwithacutegastroenteritisincludelethargy,pytalism,andabdominaldiscomfort.Itisparticularlyimportanttoassessthepatient’s

hydrationstatusandpalpatetheabdomencarefully,checkingforphysicalexaminationfindingsthatwouldwarrantfurtherdiagnosticevaluation(ie,abnormalitiesthatsuggesttheproblemismoresignificantthanstraightforwardacutegastroenteritis)(Table 2).Findingsthatindicatedehydrationincludedryoralmucousmembranes,prolongedcapillaryrefilltime,andprolongedskintent.Tachycardia,weakpulses,andcoolextremitiesareconsistentwithhypovolemia.

Laboratory AnalysisPatientswithanormalphysicalexaminationand

Symptomatic Management of Primary Acute GastroenteritisYuri Lawrence, DVM, MA, MS, Diplomate ACVIM (Small Animal Internal Medicine), and Jonathan Lidbury, BVMS, MRCVS, Diplomate ACVIM (Small Animal Internal Medicine) & ECVIM (Companion Animal) Texas A&M University

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mildclinicalsignsmaynotrequirelaboratorytestingoninitialpresentation.However,laboratorytestingmaybeindicatedtoruleoutextra-gastrointestinalcausesofacutegastrointestinalsigns,suchasacutekidneyinjury,acutehepatitis,andpancreatitis,andmetaboliccomplicationsofacutegastroenteritis,suchaselectrolyteandacidbaseabnormalities.Whenperformed,laboratorytestingshould

includeacompletebloodcount,serumbiochemicalprofile,andurinalysis.Measurementofserumcaninepancreas-specificlipaseconcentrationmayalsobeindicatedtodiagnosepancreatitis,andbaselineserumcortisolconcentrationmaybemeasuredinordertoexcludehypoadrenocorticism.Additionallaboratorytestingforinfectiousdisease

shouldbeconsideredbasedongeographiclocationandsignalment.Forexample,serologyassistsindiagnosisofSalmonpoisoningdiseaseinthePacificNorthwest.Indogswithdiarrhea,fecalflotationanddirectsmearexaminationshouldbeperformedtoscreenforprimaryorconcurrentparasitism(Figure 1).Inpatientswithclinicalfindings(Table 2)or

laboratoryresultsthatsuggestaseriousunderlyingcause,orthosethatdonotrespondtotherapy,furtherdiagnosticevaluationisindicated.Earlyidentificationisespeciallyimportantinpatientsrequiringsurgicalintervention,suchasthosewithanobstructiveintestinalforeignbody(Figure 2).

ImagingAbdominalultrasonographyand/orabdominalradiographyarestronglyadvisedinpatientspresentingwithabdominalpaintoscreenfordiseasesrequiringsurgicalintervention.Itisimportantto

rememberthatpancreas-specificlipaseconcentrationscanbeincreasedindogsandcatswithgastrointestinalforeignbodies.Therefore,itisessentialtoruleoutgastrointestinalforeignbodieswithabdominalradiographsand,possibly,abdominalultrasoundbeforepancreatitisisdiagnosed.Ifthereishighsuspicionforagastrointestinalforeignbodythatmayhavebeenobscuredbyfluidorgas,diagnosticimagingshouldberepeated.

THERAPEUTIC APPROACHWhenacutegastroenteritisistheprimarycauseofvomitingand/ordiarrhea,thesymptomatictreatmentsdiscussedinthisarticleareappropriatefortherapy.However,ifgastroenteritisoccurs

FIGURE 1. Gastric nematode presumed to be Physaloptera rara visualized during gastroscopy. The hemorrhage observed is associated with gastric biopsy.

Table 2. Selected Clinical Findings That Indicate Further Diagnostic Evaluation in Dogs & Cats with Acute Vomiting and/or Diarrhea •Abdominal pain•Anorexia•Bradycardia•Chronic vomiting or diarrhea•Hematemesis•Hyperthermia or fever• Jaundice• Lack of current vaccinations• Lymphadenopathy•Masses or organomegaly on abdominal palpation•Melena • Polyuria/polydipsia• Tachycardia• Tachypnea, cough, or abnormal lung sounds•Weak pulses•Weakness•Weight loss

learn MoreTurn to page 77 to read the article,Endoscopic Foreign Body Retrieval.

FIGURE 2. Fabric gastric foreign body visualized during gastroscopy.



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secondarytoanunderlyingdisease,suchashypoadrenocorticism,itisessentialtotreattheprimaryconditioninadditiontoprovidingsymptomaticandsupportivetherapy.Thisarticleemphasizessymptomatictreatmentof

primaryacutegastroenteritisratherthandetailingspecifictreatmentofseriousunderlyingdiseasesthatmaycausesimilarclinicalsigns.

ANTIEMETIC DRUGSForacutegastroenteritis,antiemetictherapyisoftenusedfortheinitial24to48hourswhenvomitingisaprominentclinicalsign(Table 3).Benefitsinclude:• Improvedpatientcomfort•Decreasedongoingfluidandelectrolytelosses• Earlierreintroductionofenteralnutrition•Reducedriskofesophagitisandesophagealstrictureformation.Takecarenottomaskongoingdiseasewith

prolonged(ie,greaterthan3days)antiemetictherapy.Inaddition,toreducetheriskofgastrointestinalperforationandavoiddelayofsurgicalinterventionbymaskingclinicalsignsofintestinalobstruction,donotadministerantiemeticorprokineticdrugtherapywhenaforeignbodyissuspectedorconfirmed.Severalclassesofantiemeticdrugsareusedinsmall

animalmedicine.Occasionally,refractorycasesrequiretheuseofmorethanoneofthesedrugsatthesametime.

Ondansetron & DolasetronOndansetronanddolasetronareserotonin(5-HT3)antagonistswithpotentantiemeticactivitythatarecommonlyusedoff-labeltocontrolnauseaindogsandcats.Thisclassofdrugblocksthechemoreceptortriggerzoneandvagalafferentpathwaysinvolvedinemesis.Inourexperience,thesedrugsareveryeffectiveforcontrolofvomitingindogsandcats.

MaropitantSubstancePisaneurotransmitterthatbindstoneurokinin-1(NK-1)receptorsandcanresultinvomiting.Therefore,NK-1receptorantagonistsarepowerfulantiemeticseffectiveattreatingbothperipheralandcentralcausesofvomiting.Maropitant,aNK-1receptorantagonist,is

currentlytheonlylicensedantiemeticforuseindogsandcatsand,inouropinion,isveryeffective.Thisdrugmayalsohaveananalgesiceffectand,thus,iswidelyusedinpatientswithvomitingandabdominalpain,suchasthosewithpancreatitis.1Theefficacyofmaropitantforthecontrolofpresumednauseaiscontroversialassomestudieshaveshownabenefitwhileothershavenotdocumentedabenefit.2-6

WhilemaropitantisnotlicensedforIVuse,weandotherclinicianshaveadministereditbythisroute—atadoseof1mg/kgQ24H—withoutapparentadverseeffects.Themanufacturerrecommendsthatafter5daysofcontinuous

Table 3. Medical Therapy for Vomiting Due to Acute GastroenteritisDRUG DOGS CATS

AntiemeticsOndansetron 0.1–1 mg/kg PO Q 12–24 H 0.1–1 mg/kg PO or IV Q 12–24 H

Dolasetron 0.5–1 mg/kg IV Q 12 H 0.6 mg/kg IV Q 12 H

Maropitant 1 mg/kg SC Q 24 H2 mg/kg PO Q 24 H1 mg/kg IV Q 24 Ha

1 mg/kg SC Q 24 H2 mg/kg PO Q 24 H1 mg/kg IV Q 24 Ha

Metoclopramide 0.2 mg/kg SC or PO Q 8 H1–2 mg/kg/H IV CRI

0.2–0.4 mg/kg PO or SC Q 6–8 H1–2 mg/kg/H IV CRI

GastroprotectantsSucralfate 0.5–1 g PO Q 8–12 H (tablet or slurry)b 0.5 g PO Q 8–12 H (tablet or slurry)b

Famotidine 1 mg/kg PO or IV Q 12 H 1 mg/kg PO or IV Q 12 H

Omeprazole 1 mg/kg PO Q 12 H 1 mg/kg PO Q 12 H

Pantoprazole 1 mg/kg IV Q 24 H 1 mg/kg IV Q 24 H

Misoprostol 2–5 mcg/kg PO Q 8–12 H Not applicable

a. Not a manufacturer recommended route of administrationb. Potential reduced risk of emesis if administered as a slurry

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administrationthedrugshouldbediscontinuedfor24hourstoavoiddrugaccumulation;thentreatmentcanberestarted,ifnecessary.

MetoclopramideAntidopaminergicagents,suchasmetoclopramide,havebothcentralandperipheralantiemeticeffectsandareusedoff-labelindogsandcats.Metoclopramidealsostimulatesthereleaseofacetylcholinefrompostganglionicnervesintheperipheralnervoussystem,whichleadstoincreasedgastriccontractionsandincreasedgastroesophagealsphinctertone.Thispromotilityeffectmayalsocontributetoitsantiemeticproperties.Metoclopramidecancauseneurologicsideeffects,

includingexcitementandrestlessness.Theshorthalf-lifeofthisdrugnecessitatesfrequentdosing.Inourexperience,itismosteffectivewhendeliveredviaanIVconstantrateinfusionbutisnotaseffectiveasmaropitant,ondansetron,ordolasetron.Metoclopramidemaynothaveadirectcentralantiemeticeffectandisalesseffectiveantiemeticagentincatsthanindogs.7Forthisreason,weseldomuseitforthispurposeintheformerunlessaprokineticagentisalsoindicated.

PhenothiazinesPhenothiazines,suchaschlorpromazineandprochlorperazine,arepotentcentrallyactingantidopaminergicsthatinhibitthevomitingcenterandchemoreceptortriggerzone.Thisclassofdrugalsohasantihistaminergicandanticholinergicproperties.8Theyarenotrecommendedinhypovolemic

patientsduetopotentialforhypotension,andthesedrugsarenotlicensedforuseindogsandcats.Phenothiazinescancausemildsedationandarenolongercommonlyusedduetotheavailabilityofothereffectiveantiemeticdrugs.

GASTROPROTECTANTSSucralfateSucralfateisasulfateddisaccharidethatbindstotheacidicmoietiesofexposedcollagenindamagedmucosa,creatingaprotectivebarrieragainstfurtheraciddamage.Italsostimulatesprostaglandinreleaseandcellularproliferationatsitesofulcerationandincreasesmucusproductionandbicarbonatesecretion.Sucralfateisrecommendedonlyincasesofsuspected

gastrointestinalerosionorulceration,suchasthosethatpresentwithhematemesisormelena.Itcaninterferewithabsorptionofotherdrugs,andistypicallygivenatleast2hoursbeforeorafterothermedications.

Famotidine & RanitidineFamotidineandranitidinearehistamine-2(H2)-receptorantagoniststhatcompetitivelyinhibithistamine-inducedacidsecretionbythegastricparietalcells.Famotidineismoreeffectiveatincreasing

caninegastricpHcomparedwithranitidine,butranitidinealsohasanticholinesteraseactivity.ThisactivitymayresultinsomeprokineticactionbutinstudieswasonlyaseffectiveasasalineplaceboatincreasinggastricpHindogsandcats;thus,itisnotrecommendedforitsacid-suppressingeffects.9,10

H2-receptorantagonistsarelessefficaciousthanprotonpumpinhibitors(PPIs)in vivo,butthedegreeofgastricacidinhibitionnecessaryfortherapeuticeffectisunknown.H2-receptorantagonistsmayalsohavecytoprotectiveproperties.11,12

Omeprazole & PantoprazoleOmeprazoleandpantoprazolearePPIsthatirreversiblyinhibitacidproductionbygastricparietalcells.ThisclassofdrugismoreefficaciousandhasalongerdurationofactivitythanH2-receptorantagonists;itmayalsoexertacytoprotectiveeffectbyenhancingprostaglandinsynthesis.9-11,13

Indogsandcats,twice-dailydosingofomeprazoleismoreeffectiveatreducinggastricacidsecretionthanonce-dailyadministration.9,10Coadministrationoffamotidineandpantoprazoledoesnotseemtobeanymoreeffectivethantherapywithpantoprazolealoneand,thus,thereisnobenefitinusingaH2-receptorantagonistforthefirst24hoursoftherapy.14

Becauseofthis,PPIsarethepreferredtreatmentfordogsandcatsknownorsuspectedtohaveesophagealorgastroduodenalulceration.11,14Anecdotally,somedogsandcatswithacute

gastroenteritis,butnootherfindingsthatindicategastroduodenalulceration,suchashematemesisormelena,appeartorespondfavorablytoacid-suppressingdrugs.However,useofthesedrugshasnotprovenbeneficialinanystudiesindogsandcatswithuncomplicatedgastroenteritis;thus,theyarenotroutinelyrecommendedforbriefepisodes.Inhumans,long-termuseofPPIshasbeen

associatedwithsuchsideeffectsascobalamindeficiency,irondeficiency,hypomagnesemia,increasedsusceptibilitytopneumonia,entericinfections,fractures,hypergastrinemia,andcancer.15Toourknowledge,otherthanhypergastrinemia,thesideeffectsdescribedabovehavenotbeenreportedindogsandcatsreceivinglong-termtreatmentwithPPIs.



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MisoprostolMisoprostolisasyntheticprostaglandinE1thatactsonparietalcellstoinhibitsecretionofgastricacid.Additionally,ithasacytoprotectiveeffectbyincreasingsecretionofmucusbygastricgobletcells,increasinggastricmucosalbloodflowandincreasingturnoverofgastricmucosalcells.PPIsandH2-receptorantagonistsarethoughtto

bemoreeffectivefortreatmentofgastrointestinalulcers,andmisoprostolmaycausevomiting,diarrhea,andabdominalpain.Useofmisoprostolis,therefore,notadvisedindogswithacutegastroenteritisunlessgastroduodenalulcerationassociatedwithnonsteroidalanti-inflammatorydrug(NSAID)useisthoughttobethecause.

ANTIDIARRHEAL THERAPYMostcasesofuncomplicatedacutegastroenteritisthatpresentwitheithersmallorlargeboweldiarrhearesolvewithouttherapeuticintervention.Casesthatpresentwithdiarrheashouldhaveafecalexaminationandconsiderempiricaldewormingwithabroadspectrumanthelminthic.However,thereareafewoptionsforsymptomatictreatmentofdiarrhea.

LoperamideLoperamide,anopioidantimotilitydrug,hasbeenusedoff-labelindogswithdiarrhea.Itdecreasesintestinalmotilityandreducesmucosalsecretions.DosesusedtotreatdiarrheacancauseneurologictoxicityindogswiththeABCB1(formerlyMDR1)mutation;therefore,avoidthisdruginalldogscarryingthisalleleandat-riskdogbreeds(ie,Australianshepherd,Shetlandsheepdog,long-hairedwhippet,collie,Englishshepherd,Germanshepherd)thathaveanunknownstatus.Wedonotrecommenduseofthisdrugfortreatingdogsorcatswithacutegastroenteritisduetothispotentialtoxicityandbecausethediarrheaassociatedwithgastroenteritisisusuallyself-limiting.

ProbioticsProbioticsarelivemicroorganismsthatconferahealthbenefitonthehost.16Thesehealtheffectsareexertedbydirectinhibitionofcolonizationbypathogenicmicroorganisms,orbyimmune-enhancingeffectsongut-associatedlymphoidtissue.17-19Probiotics(Table 4)aresometimesusedtotreat

dogsandcatswithacutediarrhea.Eachprobiotichasadifferentformulationofbacteria,anditisunknownwhich,ifany,aremostusefulfortreatmentofacutegastroenteritiswithresultantdiarrhea.Therefore,

furtherstudyoftheseproductsisneededbeforedefinitiverecommendationscanbemade.Theefficacyofsomeprobioticsfortreatmentof

chronicdiarrheaindogsandcatshasbeenevaluatedbut,toourknowledge,therehaveonlybeen2studiesevaluatingtheefficacyofprobioticsindogswithacutediarrhea;bothfoundthatprobioticsdecreasedthedurationofdiarrheaindogswithacuteidiopathicdiarrhea.20-23

Whenselectingaprobiotic,itisimportanttochooseaproductthathasbeensubjectedtoadequatequalitycontrolduringthemanufacturingprocess,suchastheoneslistedinTable 4.

Antimicrobial TherapyAntimicrobialtherapywithmetronidazoleortylosinissometimesusedempiricallyindogsandcatswithidiopathicacutegastroenteritisthatpresentwitheithersmallorlargeboweldiarrhea.Bothantibioticsareusedtopotentiallytreatspecificbacteriathatmaycauseacutegastroenteritis(eg,Clostridium perfringens).However,astudyevaluatingtheefficacyof

amoxicillin/clavulanicacidindogswithacutehemorrhagicdiarrheasyndrome(formerlycalledhemorrhagicgastroenteritis)demonstratednobenefitintreateddogsversuscontroldogs.24Therefore,routineantibiotictherapy(includingtheuseofmetronidazole)isnotrecommendedindogsorcatswithacutegastroenteritis.Antibiotictherapymayhavearoleindogsandcats

suspectedtohavebacterialtranslocationthroughadamagedgastrointestinalmucosalbarrier,andthisispotentiallymorelikelyincasesofgastrointestinalbleeding.However,wereserveantimicrobialtherapyforpatientswith:•Moredefinitiveevidenceoftranslocation,suchasleukocytosis,elevatedimmaturewhitebloodcellcount,andpyrexia

• Leukopeniaorthosethatareimmunosuppressed•Aspecificbacterialenteropathogen(eg,campylobacteriosis)

•Chronicdiarrhea(asatherapeutictrialtoruleoutdysbiosis).

Table 4. Examples of Commercial Probiotics for Dogs & Cats • FortiFlora (purina.com)• Prostora (iams.com)• Proviable (nutramaxlabs.com)• Sivoy (sivoy.net)

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NUTRITIONAL MANAGEMENT FastingTheconceptofcompletefastinghasbeenquestionedinrecentyearsfordogswithacutegastroenteritis.Completerestrictionoffoodmaybereasonableforashortperiod,butanearlyreturntoappropriateoralintakeisadvisedunlesscontraindicated,suchasincasessuspectedtohaveforeignbodies.

Diet ConsiderationsAwidevarietyofcommerciallyavailabledietsismarketedfordogsandcatswithgastroenteritis.Eachisformulatedwithslightlydifferentproteinandcarbohydratesourcesandfatcontent;somecontainotherpotentiallybeneficialconstituents,suchasfructooligosaccharidesoromega-3fattyacids.Catsshouldreceiveenteralnutritionassoonas

possibletoavoidproteincaloriemalnutrition,whichcanleadtofelinehepaticlipidosis.Acommerciallyavailable,highlydigestibledietisrecommended.Thegoaloffeedingahighlydigestibledietistoreducetheriskformalabsorption.

Dietary FiberForpatientswithlargeboweldiarrhea,dietaryfiberisanimportantcomponentofdietarymanagement.Whiletheoptimalamountandtypeofdietaryfiberfortreatmentofdogsandcatswithacutegastroenteritisarenotknown,thereisgeneralagreementthat,indogsandcats:•Dietaryfermentable fiberenhancesnormalcolonicfunctionbyprovidingafuelsourceforcolonocytes

•Dietarynonfermentable fiberincreasesfecalbulk,whichpromotesnormalizedcolonicmotorfunctionanddefecation.Potentialsourcesincludecannedpumpkin,brown

rice,peas,andcarrots.Therearenoestablishedguidelinesforfibersupplementationincasesofsmallboweldiarrhea.Inonestudy,dogswithcolitisthatreceived

addeddietaryfiberexperiencedsignificantclinicalimprovementcomparedwithdogsfeddietswithoutaddedfiber.25

FLUID THERAPYAcutegastroenteritiscanleadtofluidlossesandelectrolyteimbalancesthatnecessitatefluidtherapy.

Subcutaneous TherapySCfluidtherapymaybeappropriateformilddehydrationorwhenoutpatienttherapyiselectedduetofinancialconcerns;however,itwouldbeconsideredinappropriateforsignificantdehydrationorhypovolemia.SCfluidsshouldnotbesupplementedwithdextrosebecausebacterialcontaminationandcellulitiscandevelop.WheresupplementationwithdextroseisneededIVadministrationispreferable.

Oral TherapyOralelectrolytesolutionscanbeusedincasesofmilddehydration.Inarecentstudy,thisrouteofadministrationwassafeandeffectiveindogswithhemorrhagicdiarrhea.26

Intravenous TherapyGoal-directed,targetedIVfluidtherapytocorrectanestimatedpercentdehydrationoveraspecifictimeframeandtoachievenormovolemiaisrecommendedformoderatetoseveredehydrationorhypovolemia.Balancedreplacementcrystalloidsolutions,suchaslactatedRinger’ssolution,areanappropriatechoiceinmostpatients.Ongoingmonitoringofserumelectrolyteconcentrationsisrecommendedbecausesupplementationissometimesrequired.

H2=histamine-2;NK-1=neurokinin-1;NSAID=nonsteroidalanti-inflammatorydrug;PPI=protonpumpinhibitor

YURI LAWRENCEYuri Lawrence, DVM, MA, MS, Diplomate ACVIM (Small Animal Internal Medicine), is enrolled in the Texas A&M University Gastrointestinal PhD program and also serves as a senior clinician at the institution’s small animal hospital. Dr. Lawrence received his DVM from Tufts University; then completed an MA in anatomy and neurobiology at Boston University, internship in small animal medicine and surgery at North Carolina State University, and residency in small animal internal medicine and MS in veterinary science at Oregon State University.

JONATHAN LIDBURY Jonathan Lidbury, BVMS, MRCVS, Diplomate ACVIM (Small Animal Inter-nal Medicine) & ECVIM (Companion Animal), is an assistant professor of vet-erinary small animal internal medicine at Texas A&M University. Dr. Lidbury received his BVMS from University of Glasgow in Scotland and completed his small animal internal medicine res-idency at Texas A&M University. His clinical and research interests include small animal hepatology and gastro-enterology.

Inonestudy,dogswithcolitisthatreceived

Yuri Lawrence, DVM, MA, MS, Diplomate

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References1. BoscanP,MonnetE,MamaK,etal.Effectofmaropitant,aneurokinin1receptorantagonist,onanestheticrequirementsduringnoxiousvisceralstimulationoftheovaryindogs.Am J Vet Res2011;72(12):1576-1579.

2. delaPuente-RedondoVA,TiltN,RowanTG,ClemenceRG.Efficacyofmaropitantfortreatmentandpreventionofemesiscausedbyintravenousinfusionofcisplatinindogs.Am J Vet Res2007;68(1):48-56.

3. RauSE,BarberLG,BurgessKE.Efficacyofmaropitantinthepreventionofdelayedvomitingassociatedwithadministrationofdoxorubicintodogs. J Vet Intern Med2010;24(6):1452-1457.

4. LorenzuttiAM,Martin-FloresM,LitterioNJ,etal.Evaluationoftheantiemeticefficacyofmaropitantindogsmedicatedwithmorphineandacepromazine.Vet Anaesth AnalgJune2015[epubaheadofprint].

5. MasonSL,GrantIA,ElliottJ,etal.Gastrointestinaltoxicityaftervincristineorcyclophosphamideadministeredwithorwithoutmaropitantindogs:Aprospectiverandomisedcontrolledstudy.J Small Anim Pract2014;55(8):391-398.

6. HayKrausBL.Efficacyofmaropitantinpreventingvomitingindogspremedicatedwithhydromorphone.Vet Anaesth Analg2013;40(1):28-34.

7. TrepanierL.Acutevomitingincats:Rationaltreatmentselection. J Feline Med Surg2010;12(3):225-230.

8. PeroutkaSJ,SynderSH.Relationshipofneurolepticdrugeffectsatbraindopamine,serotonin,alpha-adrenergic,andhistaminereceptorstoclinicalpotency.Am J Psychiatry1980;137(12):1518-1522.

9. BersenasAM,MathewsKA,AllenDG,ConlonPD.Effectsofranitidine,famotidine,pantoprazole,andomeprazoleonintragastricpHindogs.Am J Vet Res2005;66(3):425-431.

10.SutaloS,RuettenM,HartnackS,etal.Theeffectoforallyadministeredranitidineandonce-dailyortwice-dailyorallyadministeredomeprazoleonintragastricpHincats. J Vet Intern Med2015;29(3):840-846.

11.TolbertK,BissettS,KingA,etal.Efficacyoforalfamotidineand2omeprazoleformulationsforthecontrolofintragastricpHindogs. J Vet Intern Med2011;25(1):47-54.

12.WilliamsonKK,WillardMD,PaytonME,DavisMS.Efficacyofomeprazoleversushigh-dosefamotidineforpreventionofexercise-inducedgastritisinracingAlaskansleddogs.J Vet Intern Med2010;24(2):285-288.

13.ChandranathSI,BastakiSM,SinghJ.Acomparativestudyontheactivityoflansoprazole,omeprazoleandPD-136450onacidifiedethanol-andindomethacin-inducedgastriclesionsintherat.Clin Exp Pharmacol Physiol2002;29(3):173-180.

14.TolbertMK,OdunayoA,HowellRS,etal.Efficacyofintravenousadministrationofcombinedacidsuppressantsinhealthydogs. J Vet Intern Med2015;29(2):556-560.

15.SheenE,TriadafilopoulosG.Adverseeffectsoflong-termprotonpumpinhibitortherapy.Dig Dis Sci2011;56(4):931-950.

16.SchrezenmeirJ,deVreseM.Probiotics,prebiotics,andsynbiotics--approachingadefinition.Am J Clin Nutr2001;73:361S-364S.

17.SandersME.Probiotics:Considerationsforhumanhealth.Nutr Rev2003;61(3):91-99.

18.MacphersonAJ,UhrT.InductionofprotectiveIgAbyintestinaldendriticcellscarryingcommensalbacteria.Science2004;303:1662-1665.

19.IsolauriE,Sütasy,KankaanpääP,etal.Probiotics:Effectsonimmunity.Am J Clin Nutr2001;73(2):444S-450S.

20.KelleyRL,MinikhiemD,KielyB,etal.Clinicalbenefitsofprobioticcanine-derivedBifidobacterium animalisstrainAHC7indogswithacuteidiopathicdiarrhea.Vet Therap2009;10(3)121-130.

21.BybeeSN,ScorzaAV,LappinMR.EffectoftheprobioticEnterococcusfaeciumSF68onpresenceofdiarrheaincatsanddogshousedinananimalshelter.J Vet Intern Med2011;25(4):856-860.

22.HerstadHK,NesheimBB,L’Abée-LundT,etal.Effectsofaprobioticinterventioninacutecaninegastroenteritis—acontrolledclinicaltrial. J Small Anim Pract2010;51:34-38.

23.HartML,SuchodolskiJS,SteinerJM,etal.Open-labeltrialofamulti-strainsynbioticincatswithchronicdiarrhea. J Feline Med Surg2012;14:240-245.

24.UntererS,StrohmeyerK,KruseBD,etal.Treatmentofasepticdogswithhemorrhagicgastroenteritiswithamoxicillin/clavulanicacid:Aprospectiveblindedstudy.J Vet Intern Med2011;25(5):973-979.

25.LeibMS.Treatmentofchronicidiopathiclarge-boweldiarrheaindogswithahighlydigestibledietandsolublefiber:Aretrospectivereviewof37cases. J Vet Intern Med2000;14(1):27-32.

26.ReinekeEL,WaltonK,OttoCM.Evaluationofanoralelectrolytesolutionfortreatmentofmildtomoderatedehydrationindogswithhemorrhagicdiarrhea.JAVMA2013;243(6):851-857.

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