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Today's VeTerinary PracTice | september/october 2015 | tvpjournal.com canine PediaTrics: The VomiTing PuPPy Peer reviewed 32 JP, a 6-week-old, 3.5-kg intact male pit bull mix, presented for anorexia, vomiting, and bloody diarrhea. He had been acquired from a fea market and seemed healthy but thin. HISTORY The day after the owners acquired JP, the puppy began vomiting and, the following day, he had diarrhea. On day 4, JP was presented to the primary care veterinarian, who evaluated him for progressive listlessness, anorexia, continued vomiting, and bloody diarrhea. The owners stated that JP had 2 littermates at the flea market that were not as playful as JP. They also confirmed the puppies had not received any vaccinations. SNAP Parvo Test (idexx.com) results were positive, and JP was referred to another facility that had an isolation unit and provided 24-hour care. PHYSICAL EXAMINATION The physical examination fndings of JP upon presentation to the referral facility are listed in Table 1. JP also had bloody diarrhea staining his ventral abdomen and hindlimbs. He vomited just after palpation. While JP was able to stand with support, he was extremely weak. DIAGNOSTIC APPROACH Peripheral IV access was attempted but, due to JP's volume-depleted state, multiple attempts at cephalic catheterization failed. An 18-gauge, 6-cm catheter was placed into the left jugular vein, allowing a minimal volume of blood to be obtained for analysis of packed cell volume (PCV), total solids (TS), blood urea nitrogen (BUN) (Azostix, usa.healthcare. siemens.com), blood glucose (BG), and blood smear. Fecal fotation was performed on voided stool. Depending on available resources and the fnancial limitations of the owners, diagnostics can follow 3 tiers of diagnostic evaluation (see Levels of Diagnostic Evaluation). Initial Analysis • Initial laboratory tests revealed: » BG concentration of 36 mg/dL (pediatric [6- to 8-weeks old] reference interval, 134–272 mg/dL) » PCV of 40% (pediatric [6- to 8-weeks old] reference interval, 27%–36%) » TS of 4.8 g/dL (pediatric [6- to 8-weeks old] reference interval, 3.9–4.2 g/dL) » BUN level of 30 to 40 mg/dL (pediatric [6- to 8-weeks old] reference interval, 14–15.5 mg/dL). • Blood smear revealed fewer neutrophils than expected, with mild toxic change; this was grossly estimated to be a white blood cell count of 2000 to 3000 (cells/mcL) on 100× Canine PediatriCs: The Vomiting Puppy Justine A. Lee, DVM, Diplomate ACVECC & ABT VETgirl (vetgirlontherun.com) Leah A. Cohn, DVM, PhD, Diplomate ACVIM (Small Animal Internal Medicine) University of Missouri Table 1. Physical Examination Findings at Referral Facility BEhavioR Listlessness C a RD ia C/RESP i RaT o RY Tachycardia (heart rate, 180 beats/min) Tachypnea (respiratory rate, 40 breaths/min), but not dyspneic Poor pulse quality Pale pink mucous membranes B oDY CoNDiTioN Hypothermia (96°F [35.6°C]) 12% dehydration (marked skin tenting and sunken eyes) Cachexia, with a 3/9 body condition score PaLPaTioN Painful abdominal palpation Fluid-flled intestinal loops