Updates in canine parvovirus

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At the Directions in Veterinary Medicine (DIVM), dvm360® symposium in Arlington-DC, held April 21 to 22, 2023, Kristin Zersen, DVM, DACVECC, presented on canine parvovirus (CPV) in puppies. She outlined symptoms, diagnostics, treatment, and outpatient protocol.

Understanding the threat of CPV

CPV is a viral infection that can cause hypovolemic shock, changes in mental state from underlying conditions, abdominal pain, weakness, and dehydration, mainly in puppies. If myocardial disease is reported with neonatal infections, there is a chance of peracute death. “The most frustrating thing is there is no specific treatment for parvoviral virus. The virus will run its course as we try to support our patients through that,” said Zersen. If it is suspected that a patient has CPV, a variety of tests—CBC, blood gas, lactate, fecal smear, and ultrasounds—will be conducted. These tests create a comprehensive picture of the patient and allow for a prioritized treatment plan for the most severe effects of this infection.¹

Treatment options for CPV

For the resuscitation of fluids, isotonic crystalloids, hydroxyethyl starch solutions (HES), hypertonic saline, and plasma can be used, Zersen said. HES requires less volume instruction, but veterinary literature is split about using HES for patients with acute kidney damage (AKI) or patients at risk for AKI. Zersen said plasma is another low-volume instruction as well as provides the patient with protein and coagulation factors. The downsides are cost, availability, and a risk of reactions due to plasma being a blood product. Hypertonic saline increases blood flow to the heart, contractility, and has immunomodulatory effects. Zersen recommended that should not be administered to dehydrated patients.¹

Isotonic crystalloids are part of fluid resuscitation. It is important to keep in mind the patient’s blood volume as that will determine what dosage should be administered. If signs of hypovolemic shock are still present, repeat the dosage. However, a lack of response means it is time to reassess this treatment option. “When my puppies require ongoing resuscitation, such significant losses that I’m having a hard time keeping up, this is a patient I’d consider plasma for,” instructed Zersen.¹

Outpatient protocol

Bringing a puppy home after stabilization requires around-the-clock care. They will have to be given subcutaneous fluids, usually every 6 hours for the first 24 hours, Zersen said. The patient may require a change in diet, too, as a nauseous puppy will likely not want to eat. Calorie dense foods are recommended. Dextrose, potassium, and pain meds act as a multimodal approach to nausea. For patients who are treated with plasma, oral recuperation fluids are a must, she added. Ultimately, puppies with CPV have a high survival rate. It is a matter of receiving appropriate medical care as soon as possible.¹

References

1. Zersen K. Treatment of canine parvovirus. Presented at: Directions in Veterinary Medicine, dvm360® Symposium; Arlington, Virginia. April 21-22, 2023.