Mystery Diagnosis – By Dr. Carrie Davis
A dog presented to the ER after the owner returned home from work to find her abnormal. She was indoor and the only animal in the house. She seemed normal that morning before the owner left for work. Now, she smelled like alcohol (booze), was stumbling, falling over, acting drunk, was burping and had flatulence. The owner does not know what she could have gotten in to.
a-Drunk (alcohol ingestion)
c-Bread dough ingestion
Upon questioning the owner, there was no alcohol available. There were no illegal drugs in the house and no medications she had exposure to. She only goes out in a fenced yard when the owners are home. The owner reported that her husband had made bread the night before, but she had no idea how the dog could have been exposed to the dough, or when.
On physical exam, I found a gooey white substance on the rectal exam.
Answer: C, Bread dough ingestion
Explanation: Bread dough ingestion can cause ethanol toxicosis (alcohol toxicity). During the process of rising, yeast produces ethanol. Internal body temperature (while in the stomach and small intestines) causes the dough to rise rapidly, producing more and more ethanol. This ethanol is rapidly absorbed from the gastrointestinal tract, making the dog “drunk”. Alcohol is metabolized in the liver by an enzyme. This enzyme limits the breakdown of alcohol, so the duration of symptoms will vary.
Ingesting bread dough is an emergency which should be evaluated by your veterinarian. In addition to the “drunk” behavior, other severe complications are possible. Because dough expands, enlarges and produces gas, severe complications are possible such as obstruction, GDV (bloat and twist of the stomach), and even rupture of the stomach. Severe mental depression can occur such that the dog is unable to protect their airway and aspirate any vomit they may produce. Further, they can literally have severe sedation and difficulty breathing. Low body temperatures, low blood sugar and muscle tremors are possible complications. There are metabolic toxins produced with the breakdown of alcohol, as well.
Depending on the timing of ingestion, your vet may decontaminate (vomiting or stomach pump), administer charcoal (if safe, they must be alert enough to not aspirate!), perform blood work, hospitalize on IV fluids and supportive care. We monitor the blood sugar, metabolic stability, body temperature, ECG, electrolytes and breathing/awareness. We may try to increase the metabolism of the alcohol with IV dextrose (sugar), warming the body and liver support medication.
Do NOT induce vomiting at home. Your dog should first be evaluated for safety of the airway/alertness and ability to vomit safely. Also, timing of ingestion (if it is not in the stomach, vomiting will not help). Any history of vomiting or retching will also direct our treatment plan. If your dog is retching with no production of vomit, then it is not safe to induce vomiting. We may advise radiographs prior to any further treatment and then to decontaminate with a stomach pump.
Outcome: This dog did great. She was fully recovered in about 15-18 hours of supportive care. She had blood work, radiographs, charcoal administered and was supported with heat to maintain a normal body temperature and IVF with dextrose. Her ingestion was chronic and the dough was not in the stomach any longer. So, vomiting or decontamination was not needed. However, she still required supportive care.
The prognosis for ingestion of bread dough is excellent if treated promptly.
Parvo is a term most dog owners are familiar with from their annual veterinary vaccination visits. And most people are lucky enough to never know parvo more intimately. Others aren’t. Parvo, a viral disease that most commonly affects puppies under a year of age, causes extremely dramatic symptoms. Severe lethargy is usually the first obvious sign, quickly followed by frequent and violent vomiting and then repeated episodes of bloody diarrhea. Other symptoms can include dehydration, abdominal cramping, malnutrition, clotting disorders, serious protein loss and secondary bacterial infections. Parvo attacks the cells lining the intestines, making it impossible for the body to absorb any nutrients or medications that are given orally. Parvo and its complications are usually fatal if left untreated. Aggressive and expensive treatment can pull many affected puppies through, but prevention is the most effective method of saving lives. $100 worth of vaccinations can prevent on average $3,500 of treatment. Our puppies need to play, snuggle and have fun, not lie miserable, hospitalized in an intensive care unit.
Most people know that puppies require a series of vaccinations between the ages of eight and sixteen weeks because their veterinarian tells them it is important. But you may be left wondering whether all these vaccinations are absolutely necessary. The answer is a resounding yes! Puppies, similar to human infants, obtain antibodies to many diseases by nursing from their mothers. If a female dog has been well-vaccinated against parvo, she will pass these antibodies to her puppies, giving them immunity to the disease during the first weeks of their lives. Mom’s antibodies, however, are short-lived and are eventually eliminated from the body. The goal of vaccination is for a puppy to develop its own antibodies against parvo before his/her mom’s antibodies have disappeared. It would be convenient if we could know exactly when these maternal antibodies disappear but we only know that it is usually somewhere between eight and sixteen weeks of age. If we vaccinate while mom’s antibodies are still present, they prevent a puppy from forming his/her own antibodies. If we vaccinate after mom’s antibodies disappear, we’ve left the puppy unprotected. Our goal is to begin vaccination at eight weeks and repeat the vaccination every three weeks until a puppy reaches at least sixteen weeks of age.
Vaccination is the best defense we have against parvo, but not the only one. Many people enjoy taking their puppy to dog parks, play dates, the beach, training classes and pet stores, not realizing that these are the most common locations for transmission of parvo. The disease is transmitted from one dog to another via the fecal-oral route and viral particles can remain active in the soil for up to a year in our southern climate. A puppy that walks on ground contaminated by parvo can later lick his/her feet, thereby contracting the disease. It is always safest if puppies are kept in their own house and yard until they are over sixteen weeks old and have received their entire series of vaccinations. It is after this time that they can be introduced to the rest of the world’s adventures.
If a puppy develops lethargy, vomiting or diarrhea, bring him/her to a veterinarian immediately for a parvo test, as well as further diagnostics to rule out other diseases with similar symptoms. Parvo is very quickly and easily diagnosed by a test that is performed via a rectal swab. Your vet will also run initial blood work which will help determine the most appropriate treatment plan. Parvo treatment almost always requires hospitalization, unless it is a very mild case. Hospital stays last, on average, three to five days with some puppies requiring up to ten days of hospitalization, which can become very involved as well as expensive. It is very important for owners of parvo puppies to be aware of the big medical, emotional and financial commitments required for the intensive care of their puppy. While in the hospital, parvo puppies require intravenous fluids, electrolytes, sugars, vitamins, antibiotics, numerous types of anti-nausea medications, stomach-protectants and pain medications. Puppies often need to be fed liquid diets into a tube that is passed from their nose to their stomach. It is also not uncommon for parvo puppies to require plasma and blood transfusions if they have extreme protein or blood loss through their GI tracts.
Although a few puppies won’t survive, most puppies that are treated aggressively early on in the disease process do pull through successfully, though their daily improvements and set-backs can provide for a real roller-coaster ride. After a parvo puppy has recovered from the acute phase of the disease, he/she will continue to be weak for a while and will still be shedding the virus for up to three weeks, easily infecting other puppies. However, once a parvo puppy is again well-nourished and strong, he/she should have no lasting signs that the disease ever occurred.
Parvo is a terrible virus, as anyone with an affected puppy will tell you, but prevention is simple. Always vaccinate your puppies thoroughly as directed by your veterinarian and make sure to keep puppies protected and away from all public areas until they are completely vaccinated. Follow these simple guidelines and your puppy will be well on the road to a happy and healthy life.