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tvpjournal.com | September/October 2015 | TOday'S VeTerinary PracTice canine PediaTricS: The VOmiTing PuPPy Peer reviewed 37 residual gastric volume. By day 4, JP was ingesting small amounts of meat-based baby food, and the nasogastric tube was removed. JP was dewormed with fenbendazole and discharged later that day. PROGNOSIS JP was discharged on day 4, and the owner was taught how to administer medications and encourage JP to eat. The primary care veterinarian performed a recheck examination 3 days later, and reported that JP was acting and eating normally at that time. The prognosis for canine parvovirus infection is fair to good. Perhaps surprisingly, severity of neutropenia is not a negative prognostic factor; rather, severity of dehydration and lymphopenia may be instead. 15 Recently, several studies have evaluated other measures that may affect prognosis. 16-18 A study from Colorado State University compared standard in-hospital treatment versus a modifed outpatient treatment (using volume resuscitation followed by SC fuid therapy and supportive care), with recent survival rates of 80% to 90% reported with treatment. 19 Both protocols can be successful, with a slightly lower survival rate in outpatients. 19 Hospitalization with intensive therapy was initially indicated for JP due to his severe hypoglycemia, dehydration, and shock, but a modifed outpatient protocol (SC fuids, antiemetics, antibiotics) may be a good alternative for less severely affected patients or clients with fnancial limitations. IN SUMMARY Although there are differences between young and adult animals, pediatric patients can still be treated aggressively and respond well to therapy. However, clinicians must be aware of their normal physiologic and hemodynamic measures. The small size of these patients should not limit our ability to appropriately treat them. BG = blood glucose; BUN = blood urea nitrogen; CBC = complete blood count; GI = gastrointestinal; PCV = packed cell volume; TS = total solids In critically ill neonate and pediatric patients, goals of treatment should be prioritized by the four H's: ` Hypovolemia/hydration ` Hypothermia ` Hypoglycemia ` Hypoxemia F LU iD ThERaPY ` Dehydration can rapidly progress to hypovolemia in neonates and pediatric patients; therefore, aggressive fluid therapy is warranted because these small patients can deteriorate quickly. ` Fluid requirements for neonates and pediatric patients are much higher than those for adults. ` In critically ill pediatric patients, fluid therapy for shock must initially be given by IV or intraosseous routes. 6,7 Intraperitoneal or SC routes are not adequate due to slower absorption and, ideally, should not be used in the critically ill, dehydrated, or hypovolemic patient. ` Colloids can be used in pediatric patients; however, keep in mind that puppies have a lower colloid osmotic pressure than adult dogs. 20 If necessary, a colloid (eg, hetastarch, 1 mL/kg/H; VetStarch, 2 mL/kg/H) can be used to keep colloid osmotic pressure above 15 mm Hg. No published data are available on colloid use in neonates. TEMPERaTURE ` Normal rectal temperature in neonates is 96°F ± 1.5°F (35.6°C ± 0.7°C) in the first week of life; then 98.6°F to 100°F (37°C to 38.2°C) in the second and third weeks of life. 21 ` Adult temperatures are reached by 7 weeks of age. 21 ` Careful warming should be initiated to prevent overheating. hYP o GLYCEMia ` Neonates and pediatric patients are prone to hypoglycemia due to decreased glycogen stores, inefficient hepatic gluconeogenesis, and an immature glucose feedback mechanism. ` Hypoglycemia is worsened by anorexia, ongoing losses (eg, vomiting, diarrhea), dehydration, and sepsis. ` Frequent BG monitoring is warranted in these patients; however, the minimum amount of blood should be drawn to prevent iatrogenic anemia. iMMUNE SYSTEM ` In neonate and pediatric patients, the immune system is not fully mature until 3 to 6 months. ` Poor husbandry (eg, lack of vaccination, lack of parasite prevention) often worsens clinical disease. Key Points: Treating the Pediatric Patient