Читать книгу Canine and Feline Epilepsy - Luisa De Risio - Страница 83

Emergency treatment of hypoglycaemia-induced seizures involves slow intravenous administration of 0.5–1 ml/kg of 50% dextrose, diluted 1:2 or 1:4 with sterile water, followed by an intravenous continuous rate infusion of 2.5–5% dextrose. Dextrose administration can be discontinued when clinical signs resolve.

Resolution of clinical signs may be difficult to achieve or to maintain in some dogs as the dextrose bolus may induce further insulin release from the tumour, leading to worsening of the hypoglycaemia. In such cases, repetitive dextrose boluses are not effective as a single strategy and either alternative or adjunctive therapies should be considered. These include: dexamethasone 0.1–0.5 mg/kg intravenously every 12 h, and glucagon at initial infusion rate of 5 ng/kg/min and subsequently adjusted based on blood glucose values up to 13 ng/kg/min. AEMs (see Chapters 12 and 24) may be necessary in severely affected cases. Frequent feeding of small meals should be initiated as soon as the animal can eat. Long-term treatment involves medical management (pre- and post-operatively or in dogs in which surgery cannot be performed) and surgical resection of the pancreatic mass and gross metastases. Whenever possible, surgical resection is considered the treatment of choice as despite being rarely curative, it offers the greatest chance of both durable control of clinical signs and prolonged survival time in dogs with insulinomas. However, outcome is affected by tumour staging. Some dogs can develop diabetes mellitus (transient or permanent) post-operatively. Medical management of insulinoma involves small frequent meals (every 4–6 h) of a diet rich in proteins, fat and complex carbohydrates, prednisolone 0.5 mg/kg/day orally (up to 4 mg/kg/day in refractory cases), and exercise restriction and avoidance of excitement. Additional medical therapy to relieve the hypoglycaemia may be required in some dogs and involves diazoxide 5 mg/kg every 12 h orally, which can be increased gradually without exceeding 60 mg/kg/day, or synthetic somatostatin such as octreotide (Goutal et al., 2012). Streptozotocin, a nitrosurea chemotherapeutic agent, can be used to selectively destroy beta cells in the pancreas or metastatic sites, but it can be nephrotoxic and emetogenic and its use in dogs warrants further investigations. At home immediate management of hypoglycaemic crisis involves oral administration of honey, corn syrup or maple syrup. Median survival time 12 to 14 months (range 0 days to 5 years) in dogs undergoing surgery in different studies. Whereas median survival ranges from 74 to 196 days in dogs undergoing medical treatment only. Combination of medical and surgical treatment resulted in a median survival time of 1316 days (44 months) in a recent study (Goutal et al., 2012).