Background

Anticoagulants poisoning is very common in dogs. Clinical signs are caused by the coagulopathy. We describe a case of oliguric AKI caused by the development of a bilateral sub-obstructive ureteral and intraparietal bladder hematoma in a dog poisoned by anticoagulant rodenticide.

Case Presentation

A four-year-old, female, entire Epagneul Breton came to the hospital after anticoagulant ingestion. Time of ingestion was unknown. The dog presented with obtundation, pale mucous membranes, weak pulses, heart rate of 180 bpm, paradoxical breathing, rectal temperature of 38°C, MAP of 60 mm Hg. FAST revealed free fluid in pleural, pericardial and peritoneal cavities. Blood works showed moderate anemia (RBC 3.43 M/µL [5.65–8.87 M/µL]; HCT 22% [37–55%]; Hgb 9 g/dl [2–18 g/dl]), prolonged coagulation times (APTT 327 sec [94–123 sec]; PT 27 sec [14–20 sec]), total protein 4.7 g/dl [5.2–8.2 g/dl], BUN 36 mg/dl [5–24 mg/dl], creatinine 0.9 mg/dl [0.4–1.3 mg/dl]. Oxygen, 5 mg/kg IV of vitamin K1 and infusion of 10 ml/kg of fresh frozen plasma were started as initial therapies. Ringer lactate (4 ml/kg/h IV), amoxicillin-clavulanic acid (25 mg/kg IV) and N-acetylcysteine (50 mg/kg IV) were also started and continued in intensive care. During the first 24 hours, clinical conditions and cavity effusions improved. After 48 hours the dog appeared lethargic, anorexic, with abdominal pain and no urination had been noticed for 12 hours; worsening of renal function parameters (BUN 90 mg/dl; creatinine 5.3 mg/dl) and anemia (RBC 2.34 M/µL, HCT 14.3%, HGB 5.9 g/dl) were detected. An abdominal ultrasound showed the presence of non-lithiasic echogenic material in the distal third portion of both ureters as a presumptive sub-obstructive intraluminal hematoma. The presence of thickenings, negative for color doppler, was also found on examination of the bladder wall (hematomas and clots). Dog was catheterized and urinary output monitored.

Analgesic and fluidic plans were revised.

After 72 hours clinical and renal parameters improved (creatinine 1.8 mg/dl) and the dog was successfully discharged.

New/Unique Information

To the author’s knowledge, this is the first case report of an anticoagulants-related AKI and intraluminal bilateral ureteral and bladder parietal hematoma in a rodenticide intoxicated dog.

E-mail: gianilaceccherini@virgilio.it