Betsy, a 5-year-old spayed boxer, was presented for a 2-day history of vomiting, anorexia, and azotemia.
History and Examination
Betsy appeared dull and depressed but responsive. Mucous membranes were hyperemic, and capillary refill time was <1 second. Clinical dehydration was not detected. BCS was 5/9 with mild abdominal distension. Mild hypothermia (98.6F [37C]) was present, but heart and respiratory rates were normal. Severe generalized abdominal pain and ptyalism were noted.
Betsy was up-to-date on core vaccinations. More than a year before presentation, leptospirosis vaccination with serovars Canicola, Icterohaemorrhagiae, Pomona, and Grippotyphosa had been administered. Betsy received monthly heartworm and topical flea preventives but no other medications. She had access to several acres of wooded property and had suffered superficial skin wounds from a raccoon a week before presentation. Although a rabies booster was indicated, it was not administered. Betsy was hospitalized and treated with IV fluids and maropitant (1 mg/kg SC once a day), as well as enrofloxacin (5 mg/kg IV once a day) and ampicillin (20 mg/kg IM 3 times a day) for presumptive infection, but no improvement was seen. Abdominal distention developed, and Betsy was referred for specialty care. The referring veterinarian observed that Betsy did not urinate overnight despite receiving fluid therapy.
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