Wednesday, April 11, 2012

941. The 5-year-old Maltese "vomited" and collapsed at 10 pm - Standard Operating Procedure

"Why you did not give diazepam injection first and then take blood sample?" Dr Daniel asked me when we attended to this emergency. "Diazepam will not affect the blood test analysis."

The Maltese's neck extended skywards and he was recumbent. "His eyes are so staring and he has saliva coming out of his mouth," the mother said to me while the father and teenaged daughter were worried.

Naturally, the first thing to do is to give the diazepam to resolve the sky-looking head.

I don't know whether diazepam will affect the blood analysis but I prefer to do the basic. Take the blood before any drug is administered. That will be the basic of scientific research, in my opinion.

"We need to check for glucose level to see if there is hypoglycaemia," I said. "We can take some more blood after giving the IV drip." I had also included the glucose and multivitamin amounts to be added in the normal saline drip. The Hartmann's solution would be given soon.

"You can't take the blood to check for glucose level after administering glucose", Dr Daniel had pointed out.

After taking the blood, we gave glucose 50 ml IV, Normal saline and diazepam amongst others.

Within 1 minute, the dog's neck returned to normal position and was not rigid anymore. I asked the owners to come and see. The daughter's eyes were red.

"His eyes are closed and no more staring," the mum noted. Eyes are windows to the soul in this case. I mean, dilated pupils can indicate impending death from uncontrolled seizures and the mum must have meant "staring dilated pupils" as staring eyes.

"What's the cause of this seizure?," the mum asked me. She had consulted me earlier about this Maltese having ear infections 5 months ago but there is no more redness or ear itchiness now.

"It is hard to say. If it is sudden, it could be an injury to the brain. Is the Maltese a very active dog?" I asked.
"Yes, yes," the mum said. "He jumps up and down, to greet us, and he was doing it before dinner."

"The blood test will give us some answers," I said.
Dr Daniel said to me that the dog could be suffering from hypoglycaemia and went into fits as he was fed only once a day instead of twice a day. "Possible," I said. "Wait for the blood glucose result."

In conclusion, the standard operation procedure of taking the blood before treatment is still the best. Take blood before doing any treatment will NOT result in conflicting test results as, for example, after administering glucose and taking blood during emergency confusion will make the test for glucose invalid. There must always be a SOP in emergencies.

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