It's early on a Saturday morning, and your first call has come in. A 5-year-old Standard Poodle with vomiting and diarrhoea is on its way, collapsed.
Think you can solve the case? Grab a pen and paper, set a timer (to record your CPD!) and settle down...
A 5-year-old neutered male Standard Poodle is presented as an emergency appointment by the owner of a local boarding kennels. He has been boarding there for the last four days while his owners are away.
The kennel owner reports that the dog was quiet yesterday evening and refused his dinner. Overnight, he passed several episodes of diarrhoea, which became haemorrhagic by the morning. He has vomited twice since breakfast and is now weak, dull and reluctant to stand.
The kennel owner is concerned about “something infectious”. There are other dogs on site, and although no other dogs are currently unwell there was one with mild diarrhoea last week. The patient is reported to be fully vaccinated according to the kennels’ admission record, but the kennel owner does not have access to his full medical history.
On arrival, the dog is quiet, weak and ambulatory only with support. He is taken straight through for triage while you contact the owner.
Explaining to the owner that from triage the dog does in fact need to see a vet this morning, you continue your examination.
On initial examination, the dog is dull and weak but responsive. He is able to lift his head and interact briefly, but quickly becomes recumbent again.
His mucous membranes are bright red and tacky, with a capillary refill time of approximately 2.5 seconds. Peripheral pulses are weak and slightly thready. His extremities feel cool.
Heart rate is 92 beats per minute with a regular rhythm. No murmur is detected.
Respiratory rate is 28 breaths per minute, with no obvious increased respiratory effort. Lung sounds are unremarkable.
Rectal temperature is 37.7°C.
Abdominal palpation reveals mild, diffuse discomfort but no obvious focal pain, mass effect or abdominal distension. The bladder cannot be felt. There is faecal staining around the perineum, consistent with the reported haemorrhagic diarrhoea.
A skin tent is present
Body condition score is 4/9 and weight is 28.4kg.
Following two fluid boluses of 350ml, the dog is brighter. He can now maintain sternal recumbency without support and briefly wags his tail when handled. His mucous membranes are pinker and less tacky, with a CRT of 2s and his peripheral pulse quality has improved.
During this period, he passes another small volume of watery haemorrhagic diarrhoea. No urine has yet been obtained.
The response to fluids is encouraging, but incomplete. His lactate has improved but remains increased, his blood pressure remains marginal, and his heart rate remains inappropriately normal for a dog that is still not fully perfused.
Adjust your differential list if needed, then move on to further testing...
With those further tests in mind, your differential diagnosis list should be shorter.
You may have a diagnosis, but the dog isn't out of the woods yet!
The owner is on the phone demanding an update...
Great news - your patient is far better and ready for discharge. You handed to the day team on Monday morning, and they have made an ongoing plan for treatment and discharge.
Well done, you’ve worked through one Addisonian crisis, but this case also used skills from several emergency domains: shock, ECG interpretation, electrolytes, POCUS, endocrine emergencies and GI emergencies. If you found yourself hesitating at any point, that is exactly what structured emergency medicine CPD is designed to fix.
Now, don't forget to log your CPD and reflect on what you learned today! If this case showed holes in your knowledge, make a plan to fix them.