Abstract

An adult female bottlenose dolphin (Tursiops truncatus) presented with acute inappetance at the end of the day, finishing only 6 lbs down from normal food base. Persistent anorexia and lethargy the following morning prompted the acquisition of a voluntary blood sample that demonstrated a leukocytosis (WBC 11,300) and markedly abnormal serum chemistry changes; azotemia (BUN=150, Cr =5.6), hyperkalemia (K=6.7), and hyperphosphatemia (Phos=8.1). Initial treatment consisted of injectable antibiotics (Ceftazidime 20 mg/kg), oral fluids (water), and anti-inflammatory (Dexamethasone 0.2 mg/kg). Recheck blood analysis showed worsening azotemia (BUN = 258, Cr = 12.1), hyperkalemia (9.1) and hyperphosphatemia (15.0) with EKG changes (tented T waves, wide QRS, and flat P waves) on telemetry. Ultrasound examination revealed ascites, pleural effusion, and bilateral renal calculi with hydronephrosis and hydroureter consistent with post-renal obstruction. Medical treatment for hyperkalemia consisted of intravenous boluses of 10% calcium gluconate (10 mL), sodium bicarbonate (1mEq/kg), and 25% dextrose solution (50 mL) with subcutaneous Regular insulin (1 unit/kg). Peritoneal dialysis was successfully performed by placing a 28 cm human peritoneal dialysis catheter (Quinton®, Kendall, Tyco healthcare) into the peritoneal space via the right flank using a local anesthetic block (Lidocaine 2%) and infusing 4-5 L of dialysis fluid (1.5% Dextrose) into the abdominal cavity. In 36 hrs, two exchanges of dialysate fluid resulted in the following: BUN (204), Cr (8.5) and K (6.9). Optimally, 4-5 fluid exchanges per day are desirable in humans; however logistically 1-2 exchanges were performed per day over 5 days.

Acknowledgements

The authors would like to thank the SWC Animal Training and Animal Care staff members, along with Allete Odon (peritoneal dialysis nurse) and Drs. Jason Davis and Samir Nangia from UCSD Division of Nephrology for additional consultation on this case.