Introduction
Fusili is a one year, female ferret who presented to the University of Florida Emergency and Critical Care department for acute lethargy, trembling, and stiffness.
Synopsis
On initial examination, she had an obtunded mentation and was ataxic when attempting to walk. She was hypothermic at 94.2°F (34.5°C) and had a sinus arrhythmia (HR 80–220 bpm). A blood glucose was 69 mg/dL, PCV/TS was 52%/9.0 g/dL and a venous blood gas showed a respiratory acidosis with metabolic compensation (pH 7.266, pCO2 69.5, HCO3 31.9). After speaking with the owners further, it was discovered that they have medical grade marijuana containing THC and the stoppers to the bottles frequently go missing because she likes to chew on them. A urine 5 panel drug screen was positive for THC (remainder was negative). Fusili received 0.25 ml/kg 50% dextrose diluted 1:1 IV slow, lactated Ringer’s at 45 ml/kg/day, intralipid emulsion (ILE) (1.5 ml/kg bolus then 0.25 ml/kg/min over 60 minutes), and active warming. Throughout the night, there was no improvement in mentation and a recheck venous blood gas showed a worsening respiratory acidosis with metabolic compensation (pH 7.21, pCO2 94.4, HCO3 31.9). Fusili was given propofol to effect, intubated with an uncuffed endotracheal tube, and placed on the mechanical ventilator. She continued to be hypercapneic (pCO2 96.3) while on the ventilator, so the tidal volume and frequency was increased, and an inspiratory pause was added. After 8 hours on the ventilator, Fusili woke up from sedation and chewed the endotracheal tube. At that point, we disconnected her from the mechanical ventilator and she was spontaneously breathing. A recheck venous pCO2 was 45.2 and she was given another dose of ILE. Her pCO2 remained 45.2 four hours after being weaned off the ventilator.
Conclusion
In total, Fusili received 3 doses of ILE during her stay and was discharged 12 hours after coming off the ventilator with instructions to monitor respiratory rate and effort. For future cases, use of a larger endotracheal tube with an increased tidal volume is recommended, along with assist control and time as a trigger, as SIMV with Vsens may not have been sensitive enough to detect the breaths.
E-mail: lucy.sumners@ufl.edu