ECC Newsletter June 2026

ECC articles from June 2026

Hi everybody,
As always, I hope you find the selection of articles below useful; who doesn’t like learning about pufferfish? If you’d like something to listen to as well, this month’s podcast is a discussion on CPR.
Best wishes,
Simon

Clinical features, diagnostic findings, and outcomes of emphysematous cholecystitis in 35 dogs: a retrospective case seriesJVIM. Open accesshttps://academic.oup.com/jvim/article/40/4/aalag113/8723855
Previously we have looked at gastrointestinal pneumatosis and there’ll be no surprise that this is another wonderful imaging finding for you! 35 cases of emphysematous cholecystitis. In addition to luminal gas, 10 also had emphysematous changes in the gall bladder wall, and 17 had gas in the hepatic parenchyma or extrahepatic bile ducts.
Clostridium spp and E. coli and were the most common isolates. Surgery was performed in 14/35 dogs, and medical management was pursued in 11/35 dogs (10 dogs were euthanased or lost to follow up).
These cases were identified by ultrasound predominantly. You might even be spotting and building a case for this on POCUS, or simply noting something you don’t recognise. That same gas interface can give you clues in animals with emphysematous cystitis too. Disclaimer – I don’t consider POCUS the place for diagnosing these, but I do consider it worthwhile improving our ability to interpret what we do see.

Pufferfish exposure and presumed tetrodotoxicosis in Australian dogs: 372 cases (2007–2018)Australian Vet Journal. Open access.https://onlinelibrary.wiley.com/doi/10.1111/avj.70102
I’ve never seen this, but the Australian intoxication literature never disappoints! Tetrodotoxin is the reason pufferfish preparation for human consumption is such a precise process with life threatening implications (it can readily cause paralysis and a hypoventilatory crisis after initial gastrointestinal signs, via sodium channel blockade).
This study retrospectively describes 372 dogs with exposure to, or clinical signs referable to, pufferfish ingestion. 155 dogs developed clinical signs. Usually these dogs had only eaten one pufferfish, and had found it on the beach.
Gastrointestinal signs included vomiting or regurgitation (often including a pufferfish). Neurological signs such as tremors, weakness and non-ambulatory tetraparesis occurred in approximately a quarter of the clinical cases. Non-ambulatory tetraparesis occurred in 13/155 clinical cases. We lose some acuity in the data beyond this point but hypoventilatory states were suspected, if not proven, amongst those with respiratory distress. When ventilated it was for a median of 10 hours, and all but 4/155 dogs survived.

Severity, etiology and outcomes of ionized hypocalcemia in azotemic cats and dogsFrontiers in Veterinary Science – Veterinary Emergency and Critical Care Medicine. Open access.https://www.frontiersin.org/journals/veterinary-science/articles/10.3389/fvets.2026.1847148/full
Ionised hypocalcaemia is common in azotaemic animals. This study retrospectively identified cats and dogs with (all-cause) azotaemia and ionised hypocalcaemia. 948 cases were included. Hypocalcaemia was deemed moderate (< 1mmol/L) in 12.8% of dogs and 22.8% of cats or severe (< 0.75mmol/L) in 1.9% of dogs and 1.3 % of cats. The rest were mild.
AKI was the cause of the azotaemia in 90/302 (30%) of cats and 383/646 (59%) of dogs. Post renal (ureteral and urethral obstructions) were the most common causes in cats, accounting for 126/302 cases.
If or when to correct ionised hypocalcaemia is a separate topic. Current IRIS guidelines suggest when low + clinical signs or when severely reduced, with the goal to stop clinical signs rather than normalising the calcium. You can learn plenty more about dyselectrolytaemias in AKI in that article.

Utility of Cytology of Spontaneously Expectorated Sputum Samples in the Diagnosis of Blastomycosis in DogsJVECChttps://onlinelibrary.wiley.com/doi/10.1111/vec.70125
I have definitely interpreted the sputum before in dogs with eosinophilic bronchopneumopathy, especially when finances were limiting. Nice to see the potential described in another condition. This group identified 16 cases in which cytology on expectorated sputum had been performed. Seven of those cases had blasto, and 6 of the sputum cytology analyses revealed blasto. This is not evaluating the ‘performance’ of the test but if you are in an endemic area I suspect you could imagine cases in which this could be useful.

Multi-Institutional, Retrospective Evaluation of Risk Factors Predicting Complications Associated With Perineal Urethrostomy in Cats With Urethral Obstruction (2009-2019): 140 Cases.JVECChttps://onlinelibrary.wiley.com/doi/10.1111/vec.70121
This study retrospectively evaluated 140 cats that underwent perineal urethrostomy after urethral obstruction. The most frequent post-operative complications were urinary tract infections (in 11/140 cats) strictures (in 5/140 cats) and surgical site infections (in 2/140 cats).

Measurement of abdominal fluid bilirubin concentration frequently fails to detect biliary tract rupture in dogs with gallbladder mucoceleJAVMA. Open access.https://avmajournals.avma.org/view/journals/javma/aop/javma.26.03.0228/javma.26.03.0228.xml
This group retrospectively identified dogs that had an abdominal fluid bilirubin concentration to serum bilirubin concentration ratio available, and that had had an exploratory laparotomy or post-mortem performed.
It reports 11 dogs with gall bladder mucocele and intra-operative or post-mortem confirmed biliary tract rupture. The often-proposed ratio of 2x (abdominal:serum) did not perform well in identifying the rupture in those dogs, with a median ratio of 0.7. Ratios seemed to perform better at determining rupture in dogs with non-GBM causes (e.g. leakage post sampling). Timings of the samples and cytological findings are also discussed.
Previous studies have documented cases in which this ratio fails to confirm biliary tract rupture, and a couple have also supported the use of bile acids rather than bilirubin. For me, recognising the limitations, the decisions to pursue surgery and the timing of that surgery could often be made irrespective of the biochemical analyses.

Here is a very interesting editorial from Critical Care Medicine, on a topic we also covered in the CPR podcast.
Slow Codes—It’s Time for an Honest Approachhttps://www.ovid.com/jnls/ccmjournal/abstract/10.1097/ccm.0000000000007252~slow-codesits-time-for-an-honest-approach
Linked to:Ethical Implications of the Slow Code: A Systematic Review of Ethics of Slow Codes in U.S. Hospitalshttps://journals.lww.com/ccmjournal/fulltext/10.1097/ccm.0000000000007233~ethical-implications-of-the-slow-code-a-systematic-review-of