Plus-Hex CLINICAL
Patient signalment
Species Breed Age Sex Weight
Presentation
Dog Weimaraner 6 months Male, entire 23.2 kg
This case study and nursing care analysis reviews the care given to a 6-month-old Weimaraner admitted to a veterinary hospital as an emergency. The patient presented with a 24-hour history of vomiting and eating lots of grass. He was inappetent, lethargic and had not been passing faeces. There was haematemesis on the morning of admission.
Assessment
When assessed on arrival, the patient was quiet and responsive, with a normal respiratory effort and good pulse quality. He was made comfortable on bedding before examination. The stethoscope was introduced to the patient to allow him to sniff it, to aid familiarisation, and his chest was gently stroked before auscultation was undertaken. All procedures were conducted in a calm manner to reduce patient stress and promote relaxation. At this stage, the patient was non-ambulatory; a colleague remained seated adjacent to him, prepared to provide restraint if required.
On auscultation of the patient ' s heart, it was apparent that he had a loud systolic murmur, which had not been previously noted by the referring veterinary practice. A heart murmur is produced by blood flow turbulence, and murmurs are more prolonged than normal heart sounds. They may be systolic( when the heart is emptying of blood), diastolic( when the heart is filling with blood) or continuous( occurring throughout the heartbeat). They are graded by their intensity and described by their location and when they occur in the cardiac cycle [ 1 ].
In this case, the murmur was thought to be a physiological‘ flow murmur’ due to the fact that the murmur was no longer detected following fluid therapy. A flow murmur can be common in young puppies and can also be caused by fluid loss due to vomiting causing a negative water balance. A decrease in the fluid content of the blood leads to a lower circulating blood volume and an increased blood concentration( haemoconcentration). As a result, the blood becomes more viscous, which can slow down or disrupt normal blood flow [ 2 ].
Heart rates in puppies may be 20 % faster than those of adult dogs, ranging between 70 and 180 beats per minute( bpm) [ 3 ]. The patient ' s heart rate on admission was 130 bpm, which was within the suggested range for puppies. Holden [ 4 ] suggests that capillary refill time( CRT) should be 1 – 1.5 seconds, whereas this patient ' s CRT was < 2 seconds. Holden [ 4 ] also indicates that values should return to normal limits within 1 hour of initiating fluid therapy. This is consistent with the second set of observations taken before anaesthetic induction, after more than 30 minutes of fluid therapy, when the heart rate had decreased to 100 bpm.
Doppler blood pressure measurements were taken, with systolic blood pressure results of 110, 140, 124, 120 and 114 mmHg. The average systolic blood pressure of 121.6 mmHg demonstrated no signs of hypotension. Full examination results are given in Table 1.
Table 1. Clinical assessment results.
Parameter Demeanour Temperature Heart rate Pulse quality Respiratory rate Respiratory effort Mucous membranes Capillary refill time ASA score
ASA, American Society of Anesthesiologists; QAR, quiet and responsive.
Results QAR 38.1 ° C 130 bpm Good 32 breaths / min Normal Pink, tacky < 2 seconds IIIE / IVE
Before taking a blood sample for analysis on an epoc blood analysis system( Siemens), cold spray was applied to the patient ' s neck to reduce any stress associated with the procedure. The results of blood analysis are presented in Table 2 [ 5 – 9 ]( page 36).
Intravenous fluid therapy( IVFT) was started immediately after the results of blood analysis were obtained. Hartmann ' s solution was prescribed. This is a crystalloid solution that contains sodium, potassium and chloride and is prescribed to replenish lost electrolytes [ 4 ]. Two 10 ml / kg fluid boluses were given to support the patient ' s hydration status.
The patient had tacky mucous membranes, suggesting that the degree of dehydration was 6 – 8 % [ 10 ]. Based on the University of Bristol ' s calculation for fluid deficit [ 11 ], this means that the volume of fluid lost could be between 1,392 and 1,856 ml( 23.2 kg × 0.06 = 1,393 ml; 23.2 kg × 0.08 = 1,856 ml).
Volume 40( 6) • December 2025
35