Anaphylactic Shock (Apollo's Story)

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Filed Under: Emergency / Critical Care


Apollo is an approximately 2 year old pit bull who was adopted about 2 months ago by a family that found him wandering the woods behind their home.  They brought him to the Allen shelter to see if anyone would claim him, and after 5 days, he was released to their care and Apollo went to his new amazing home. 

On March 20th, Apollo suddenly vomited and collapsed outside.  He was brought to his Primary Care Veterinarian, McKinney Animal Hospital (Dr. Ewa Cissik).  Blood work showed that Apollo could not clot his blood, and one of his liver values was high, suggesting anaphylaxis.  They placed an IV catheter and gave him an injection of epinephrine, and referred him to CVSEC. 

On presentation to CVSEC, Apollo was in shock- he was weak, with a high heart rate and thread pulses, all classic signs of shock.  We started him on IV fluids to treat shock, and started to thaw frozen plasma to replenish clotting proteins.  We also ran some diagnostics, and one of the key diagnostics was an AFAST. 

AFAST stands for "abdominal focused assessment for trauma and shock.  It is a type of ultrasound, or sonogram, which is performed within 2 minutes.  It's not a comprehensive, organ-by-organ test; rather, it looks at a few key areas of the abdomen to allow for rapid assessment and treatment. The striking findings for Apollo were that he had a small amount of fluid collected in his belly, and his gall bladder bore what is called a "halo sign".  The halo sign is a bright ring of fluid, and can serve as a marker of anaphylactic shock. 

Anaphylactic shock is seen with some frequency in our ER, about 1 case every week or two, and is more common in dogs than in cats.  The causes of anaphylaxis can vary from a bee sting to a plant to a drug, but in most cases, the trigger is never identified.  Anaphylaxis differs from a typical allergic reaction in a few ways.  First, in anaphylaxis, shock and collapse are hallmarks, and vomiting or diarrhea is very common.  In an allergic reaction, usually facial swelling or hives are seen on a dog that is still wagging its tail and acting very normal.  Second, the way anaphylaxis is generated in the body is different at the cellular level than an allergic reaction as well, which may explain the difference in the way the two processes appear.  And third, the treatment is vastly different.  Dogs with allergic reactions are usually treated with an antihistamine and maybe a steroid and discharged within an hour or two (the exception to this is if hives develop in the throat, constricting the airway- that is an emergency!).  Patients with anaphylaxis are usually hospitalized for days; require intensive care and monitoring, IV fluids, transfusions, and IV drips of epinephrine (adrenaline) to keep them alive.  Anaphylaxis is survivable, but the best outcomes result from prompt Veterinary attention.  Fortunately for Apollo, he collapsed right in front of his family, so they were able to respond quickly and appropriately. 

Apollo spent 3 days in the Hospital, received three transfusions of plasma, and a lot of medications.  After about 12 hours of treatment, he started to eat and drink.  On his last day of hospitalization, he was off all IV medications, and went home to his family that evening. 

Apollo's story is a success for three reasons:

1. His Family had an appropriate and rapid response to his development of shock.

2. His Primary Care Vet, Dr. Cissik, treated him appropriately prior to referral.

3. The CVSEC Team is very familiar with the treatment of anaphylaxis and we know that in order to get Patients through, we   have to act aggressively. 

By:  Dr. Jennifer Mahon