ECC Newsletter July 2026

Hi everybody,
This month – the sepsis and septic shock definitions, bicarbonate usage, thrombolysis in ATE cats, how to anaesthetise dogs with mitral valve disease and more! Plus, this month’s podcast is a discussion on adrenaline in anaphylaxis: https://podcasts.apple.com/gb/podcast/vet-lit-minis/id1788691126?i=1000778023024
As always, I hope you find the selection of articles useful.
Best wishes,
Simon

Sepsis in Dogs and Cats-Consensus Definition and Clinical Criteriahttps://onlinelibrary.wiley.com/doi/10.1111/vec.70129
Septic Shock and Prognosis in Dogs and Cats With Sepsis—Consensus Definition and Clinical Criteriahttps://onlinelibrary.wiley.com/doi/10.1111/vec.70130JVECC. Open access
These enable us to define patient populations and therefore make progress on everything from identification and management to prognostication and novel therapeutics.
The group created a consensus definition of sepsis as “the life-threatening syndrome associated with a dysregulated host response to infection, resulting in organ dysfunction” recommending that where infection is present, identification of organ dysfunction is required for the diagnosis of sepsis.
Septic shock was defined as “a subset of sepsis with increased mortality, associated with cardiovascular instability and metabolic abnormalities indicative of impaired tissue perfusion despite adequate fluid resuscitation.”
Recommendations are made on how to identify these states in clinical and research settings, with emphasis on predicting severity and prognosis in the second article. I can’t do these justice in any way but you will find the recommendation summaries in supporting file 10.

Clinical use of sodium bicarbonate in small animals: indications, electrolyte changes and survival outcome.JSAP. Open access.https://onlinelibrary.wiley.com/doi/10.1111/jsap.70174
This includes a nice summary in the introduction on the debate around bicarb use. (Unashamedly this is a great reason alone to read the literature – reading the introduction of a study for a recap!)
This group retrospectively described 25 dogs and 28 cats receiving bicarbonate at a university teaching hospital. Acidosis associated with kidney disease of some sort was the reported indication in most cases, followed by its usage during CPR as the second most frequent. The median dose administered was similar in cats and dogs (2.1mEq/kg in dogs (range 0.68-6.48) and 2.49 mEq/kg in cats (range 1-6.48)) and the original 8.4% solution was usually diluted 1:6 with sterile water.
Changes in animals with, for example, pre-existing hyperkalaemia or hypernatraemia are described within.
Only because I like maths and there’s a possibility some of you appreciate it too, I added a few revision calculations at the bottom of the email on the topic of 8.4% bicarb, dilutions, sodium concentrations etc…

Anaesthetic management of dogs with myxomatous mitral valve disease: results of a questionnaire survey of veterinary anaesthesiologists.JSAP.https://onlinelibrary.wiley.com/doi/10.1111/jsap.70180
This was a fun study – how would a selection of 21 anaesthesia specialists choose to anaesthetise dogs with varying degrees of mitral valve disease? Figure 1 does these results a lot of justice but the themes I can identify in sedation protocols would be these:
With worsening stage of mitral valve disease, there was: increasing agreement with opioid only protocols, less opposition to benzodiazepine incorporation, less (approaching zero) agreement with the use of alpha 2s (though these were sometimes considered in the early stages) and less agreement with acepromazine (often supported early on).
The ‘winner’ appeared to be opioid plus alfaxalone, being agreed with reasonably consistently through all stages.

Multicentre aortic thromboembolism thrombolysis evaluation in a retrospective study of 183 cats: the MATTERS studyFrontiers in Veterinary Science – Veterinary Emergency and Critical Care Medicine. Open access.https://www.frontiersin.org/journals/veterinary-science/articles/10.3389/fvets.2026.1845133/full
Cats with bilateral hindlimb thrombosis were retrospectively identified from two centres, and divided into those that had been treated with alteplase and those that had not. 115 cats were evaluated, 50 in the TPA group and 65 in the no-TPA group. TPA was administered a median of 4 hours after presentation. Evidence of reperfusion and mobility was more frequent in the TPA group, though the frequency of sudden death was higher and no difference in survival to discharge was documented between groups.

Characterization and outcomes of cats with cardiomyopathy undergoing subcutaneous ureteral bypass device placementJVIM. Open access.https://academic.oup.com/jvim/article/40/4/aalag127/8723123
This study documented that cardiomyopathy was identified in 40% of cats that had an echo, but it was the fluid overload data that I wanted to point out. Fluid overload was considered to have occured in 45% of the SUB cats identified. Admission creatinine was higher in those cases and median survival time was shorter. Far be it from me to infer any form of causality here but some more flags to revere the sick cat + overloaded state at least. This is a population in which, aside from this study, it seems easy to induce it in.

Retrospective evaluation of canine parvovirus monoclonal antibody supports faster clinical recovery in shelter dogs with naturally occurring canine parvovirusJAVMA. Open accesshttps://avmajournals.avma.org/view/journals/javma/aop/javma.26.04.0291/javma.26.04.0291.xml
Some promise here with shorter hospitalisation lengths but a reminder, as this group also alludes to, that the original data on this drug made a case for treatment in a shelter setting and that early/minimally clinical or preclinical cases could stand to benefit. It did not provide evidence that clinically affected dogs that were solidly into the throws of parvoviral enteritis would benefit. That evidence is yet to emerge but this contributes to it. If you are managing these cases days later then we should be cautious before extrapolating expectations to those populations.

Dogs and cats with acute-on-chronic kidney disease have worse outcomes than those with acute kidney injury following renal replacement therapyFrontiers in Veterinary Science – Veterinary Emergency and Critical Care Medicine. Open access.https://www.frontiersin.org/journals/veterinary-science/articles/10.3389/fvets.2026.1857111/full
I find this a useful readout to be conscious of if considering embarking on renal replacement therapy.

And a few case descriptions for your perusal:
Modified Manual Therapeutic Plasma Exchange Technique as a Successful Treatment for Postattenuation Neurological Signs (PANS) in a DogJVECC. Open access.https://onlinelibrary.wiley.com/doi/10.1111/vec.70144
Presumptive Acute Post-Hypoxic Myoclonus Following Return of Spontaneous Circulation in a Cat and a DogJVECC. Open access.https://onlinelibrary.wiley.com/doi/10.1111/vec.70140

As I mentioned…!
The original concentration of sodium bicarbonate was 8.4%Sodium bicarbonate = NaHCO₃Atomic masses: Na (23), H (1), C (12) and O (16) means a molecular mass of 84 Daltons.The mass of 1 mole of sodium bicarbonate (the molar mass) is therefore 84g.An 8.4% w/v solution says there is 8.4g in 100ml, so 84g in 1000ml i.e. 1mol/L or 1000mmol/LSodium bicarbonate dissociates into Na⁺ and HCO3^– in solution so there are 1000 mmol/L of both ions in this solution. Diluting 1:6 with water means one part sodium bicarb, and 6 parts water (7 total volumes). Whatever amount (in a given volume) or concentration (of a solution) can therefore be divided by 7 to get the concentration you’ve created. i.e. 1000mmol/L of sodium, divided by 7 gives 142.8 i.e. about 140 mmol/L of sodium in the end product.
Dilute away into a concentration that makes sense to you.