Heat Stroke
Rufus, a 5 year old, neutered male Shar-Pei/Pug mix, was presented on referral to Vescone for treatment for heat stroke. He was out for a walk on a warm, humid summer afternoon when he collapsed on the side walk. His walker was unable to pick him up, and approximately 30 minutes elapsed between when he collapsed and when the local animal control officer was able to bring him to his local veterinary hospital. After he arrived there, his body temperature exceeded 111F. He was bathed in cool water and given cool water enemas to decrease his body temperature. He had difficulty breathing (from upper airway swelling), therefore was sedated and in order to have a tube placed in his trachea for airway support. He was also given steroids to treat his upper airway swelling. He was kept on supplemental oxygen and was given a bolus of intravenous fluids during the 1.5 hours prior to referral to VESCONE. He was also given other medications to protect him from bacterial movement into his bloodstream from damage to his GI tract secondary to his high body temperature. He began vomiting and having diarrhea when he was moved (turned). He was transferred to Vescone with his endotracheal tube in place and on IV fluids (a technician from his veterinary hospital accompanied the owners).
On presentation to VESCONE, he was poorly responsive, had evidence of microscopic bleeding on his mucus membranes and ventral abdomen, and was in shock. He was continued on supplemental oxygen via his endotracheal tube, given more intravenous fluids, and was given other medication to address possible brain swelling. He was continued on antibiotics as well (prophylactic to address the potential for GI bacterial translocation and sepsis).
Lab testing showed evidence of kidney damage, consumption of his clotting factors, severely decreased platelet count (which was the likely cause of the microscopic bleeding) and evidence of poor perfusion. He was given plasma transfusions to replace his clotting factors and was continued on intravenous fluids, antibiotics and gastric protectants.
Through the first day of hospitalization, Rufus’s clinical condition improved significantly. He was able to get up on his own, was breathing comfortably enough to be taken off supplemental oxygen, was oriented to his surroundings, and was even wagging his tail at the doctors and nurses who were caring for him. His follow-up diagnostics performed the second day showed that in addition to kidney, gastrointestinal and hematologic damage, he had also sustained damage to his liver and heart from the extreme elevation in his body temperature. He was started on additional medications to address these issues as well. He refused to eat, despite the dramatic improvements he made throughout his hospital stay, therefore he was started on tube feeding to give him the energy his body needed to heal.
He remained hospitalized for a total of four and a half days, making incremental improvements daily. Everyone in his family and at Vescone were elated when Rufus started eating on his own on the afternoon of his fifth day in the hospital, because that meant he was able to go home. By this time, his kidney and liver damage seemed to be resolving, his platelets were increasing, he had no evidence of ongoing bleeding, and the injury to his heart seemed to be healing as well.
Rufus was at higher risk for heat stroke because of his facial conformation. Dogs with shortened faces such as Pugs, Bull dogs and Boston terriers have more difficulty keeping themselves cool because their nostrils are smaller than other breeds of similar size, their soft palates tend to be elongated, and sometimes their tracheas can be narrowed in diameter. Other risk factors for heat stroke include environmental factors including high humidity and high temperature as well as individual risk factors including obesity and other diseases (laryngeal paralysis and some systemic diseases). During hot days (or even warm days during the spring, before dogs have had a chance to acclimate to the weather changes), dogs should be kept in (or always have access to) cool, well ventilated, shaded areas with plenty of fresh water to drink. If your pet ever appears unwilling or unable to finish a walk, their gums appear pale or brick red, they have a high heart rate (greater than 130 beats per minute), or if they have ever been stuck in a hot car or other enclosed space, they should be cooled down (a cool water bath from the hose is fine) and should be evaluated by a veterinarian right away. Studies have shown that good first aid (the cool water bath) before transport can have a dramatic effect on survival and clinical outcome.
Rufus was at higher risk for heat stroke because of his facial conformation. Dogs with shortened faces such as Pugs, Bull dogs and Boston terriers have more difficulty keeping themselves cool because their nostrils are smaller than other breeds of similar size, their soft palates tend to be elongated, and sometimes their tracheas can be narrowed in diameter. Other risk factors for heat stroke include environmental factors including high humidity and high temperature as well as individual risk factors including obesity and other diseases (laryngeal paralysis and some systemic diseases). During hot days (or even warm days during the spring, before dogs have had a chance to acclimate to the weather changes), dogs should be kept in (or always have access to) cool, well ventilated, shaded areas with plenty of fresh water to drink. If your pet ever appears unwilling or unable to finish a walk, their gums appear pale or brick red, they have a high heart rate (greater than 130 beats per minute), or if they have ever been stuck in a hot car or other enclosed space, they should be cooled down (a cool water bath from the hose is fine) and should be evaluated by a veterinarian right away. Studies have shown that good first aid (the cool water bath) before transport can have a dramatic effect on survival and clinical outcome.
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