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| GI InTerVenTIon: PaTIenT wITh acuTe DIarrhea Probiotic Studies in Companion Animals Dogs with Acute Diarrhea Kelley, et al. In one study, 31 young adult dogs with acute, uncomplicated, nonspecific diarrhea were enrolled in an unblinded, randomized prospective study, receiving either Bifidobacterium animalis strain ahc7 (Prostora, iams.com) or placebo for 2 weeks.17 Mean time to diarrhea resolution was significantly less for the probiotic group (3.9 ± 2.3 vs 6.6 ± 2.7 days). Hersted, et al. In a double-blinded, placebocontrolled study, 36 dogs with acute diarrhea or acute gastroenteritis were randomized to receive a probiotic cocktail (2 Lactobacilli species and 2 Bacillus species) or placebo.18 Duration of abnormal stools was shorter for dogs receiving probiotics (1.3 vs 2.2 days). There was no difference in duration of vomiting between groups. These study results suggest that probiotic therapy is a rational approach for shortening the duration of diarrhea, improving patient comfort in dogs assessed to have acute, self-limiting diarrhea. Similar studies in cats have yet to be published. Prevention of Diarrhea Probiotics likely have a role in diarrhea prevention, such as for pets in stressful conditions. cats and dogs housed in an animal shelter were studied to determine whether feeding Enterococcus faecium SF-68 (FortiFlora, nestlepurina.com) would decrease episodes of diarrhea and improve fecal scores.19 animals in one room were supplemented daily with FortiFlora while controls received a placebo. The percentage of cats with diarrhea ≥ 2 days was significantly lower in the probiotic group (7.7% vs 20.7%), suggesting that probiotics may lessen how long cats have diarrhea. Diarrhea prevalence rates were low for all dogs so statistical differences were not detected. cation (eg, disruption of intestinal epithelial barrier) • Increased risk for sepsis (eg, immunosuppression, portosystemic shunting). Pets with acute bloody diarrhea of unknown cause are usually treated with an antibiotic, such as amoxicillin/clavulanic acid, or monitored very closely because: • Ruling out enteric bacterial infection is challenging • Bacterial translocation is a potentially life-threatening complication. Markedly hemorrhagic diarrhea is often interpreted as evidence of a breach of intestinal integrity, justifying use of antimicrobials, although no studies document an increased risk for bacterial translocation or sepsis in these patients. Fluid Therapy Administration. An animal's deficit due to dehydration can be calculated by multiplying the percent of estimated dehydration (from physical examination) times body weight (kg). Maintenance fluids (44–66 mL/kg/day) should be added to this deficit. Continued losses from diarrhea should 56 Today's Veterinary Practice May/June 2013 be estimated and added to the fluid volume administered. If mild dehydration is present, a balanced isotonic polyionic fluid (lactated Ringer's) can be administered subcutaneously, but animals with severe dehydration caused by life-threatening acute diarrhea require intravenous fluid therapy.20 Further Diagnostics. If diarrhea worsens or other clinical signs develop, the animal should be re-evaluated and further diagnostics considered. Any underlying conditions should be specifically treated. If further diagnostic testing is needed, fluid therapy consisting of crystalloids and possible addition of colloids should be instituted prior to obtaining a definitive diagnosis. Feeding. Food should be withheld for no more than 12 hours and an antiemetic administered if vomiting occurs to allow feeding as soon as possible. Puppies with parvoviral diarrhea treated by early enteral feeding showed more rapid clinical improvement than puppies held off food.21 Monitoring. Careful monitoring is required during fluid therapy. • Physical examination findings that indicated dehydration should gradually improve as the patient is rehydrated during the first 24 hours of therapy. • Hematocrit and total protein should decrease. • Body weight should be measured frequently, as changes accurately reflect hydration. » After hydration has been reestablished, body weight should remain relatively stable throughout the treatment. » Falling weight suggests dehydration while increasing weight supports overhydration. • Serum electrolytes should be monitored daily for several days in animals with profuse diarrhea or severe electrolyte abnormalities. SUMMARY • Dogs and cats frequently develop diarrhea that starts abruptly and lasts for less than 7 days. • Most cases are mild and self-limiting, and likely associated with changes to the intestinal microbiota. • In mild cases, in which there is no indication for antimicrobial therapy, nutritional management, therapeutic deworming, and probiotic therapy, sometimes in conjunction with an antidiarrheal agent, should be considered. • In cases with more severe, sometimes life-threatening, signs, a thorough and logical diagnostic plan must be followed to obtain an accurate diagnosis and guide appropriate therapy. n cPe = Clostridium perfringens enterotoxin; eLISa = enzyme-linked immunosorbent assay; GI = gastrointestinal; hGe = hemorrhagic gastroenteritis; IBD = inflammatory bowel disease; Pcr = polymerase chain reaction For Dr. armstrong's biography and article references, go to todaysveterinarypractice.com.