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5-Fluorouracil Toxicosis
BASIC INFORMATION 
DEFINITION
Adverse effects caused by exposure to 5-fluorouracil (5-FU), a pyrimidine analog-type antineoplastic antimetabolite drug used for palliative management of certain carcinomas in humans and occasionally in dogs.
SYNONYMS
Common brand names: Efudex, Fluoroplex, and Carac. Generic: 2,4-dioxo-5-fluoropyrimidine; 5-fluoro-2,4(1H,3H); pyrimidinedione; 5-FU; NSC 19893; Ro2-9757; CAS 51-21-8.
EPIDEMIOLOGY
SPECIES, AGE, SEX
Dogs and cats of any age, breed, and either sex. Dog cases are more common. Dogs are more likely to develop neurologic effects (seizures) compared to humans. Cats are more sensitive to toxic effects of 5-FU than dogs.
ETIOLOGY AND PATHOPHYSIOLOGY
5-FU or similar agents are available for use as injection, topical creams (0.5%-5%) or lotions (1%-5%), and capecitabine (prodrug of fluorouracil) as tablets. Flucytosine is an antifungal agent that must be converted to 5-FU.
Toxicosis occurs after ingestion of products containing 5-FU and occasionally secondary to repeated use in dogs or cats.
5-FU inhibits RNA processing and function and DNA synthesis and repair, inhibiting cell division. Actively dividing cell lines (bone marrow stem cells, intestinal crypt cells) are most affected.
The mechanism of neurotoxicity may be production of fluorocitrate, which limits cellular energy production by interfering with the Krebs cycle.
DIAGNOSIS 
DIAGNOSTIC OVERVIEW
History of exposure and presence of clinical signs consistent with exposure to 5-FU within 30 minutes to 5 hours after exposure
DIFFERENTIAL DIAGNOSIS
Diseases or intoxications that could cause vomiting (see p. 1173) and/or seizures (see pp. 1009 and 1425)
INITIAL DATABASE
TREATMENT 
TREATMENT OVERVIEW
Stabilize the patient first; control vomiting and seizures. Provide supportive care once the animal has been stabilized.
ACUTE GENERAL TREATMENT
CHRONIC TREATMENT
Intensive supportive care may be needed for days/weeks, especially if myelosuppression occurs.
PROGNOSIS AND OUTCOME 
Guarded to poor, once signs occur. Out of 72 cases of 5-FU toxicosis, 35 dogs died and 11 were euthanized.
PEARLS & CONSIDERATIONS 
COMMENTS
TECHNICIAN TIPS
Estimating the ingested amount by obtaining a good history of exposure may predict the prognosis early on.
Abdominal Compartment Syndrome
BASIC INFORMATION 
DEFINITION
Impaired organ function resulting from increased intraabdominal pressure (IAP >20 mm Hg). This syndrome is likely underrecognized in veterinary medicine and has a high prevalence in human ICU patients.
EPIDEMIOLOGY
RISK FACTORS
CLINICAL PRESENTATION
DISEASE FORMS/SUBTYPES
ETIOLOGY AND PATHOPHYSIOLOGY
DIAGNOSIS 
DIAGNOSTIC OVERVIEW
IAP must be measured to confirm the diagnosis of abdominal compartment syndrome.
INITIAL DATABASE
Most common method of measuring IAP is the intravesicular or “bladder” technique, which is an indirect measurement.
ADVANCED OR CONFIRMATORY TESTING
TREATMENT 
TREATMENT OVERVIEW
Medical management is crucial to prevention and treatment of IAH. Surgical decompression is the definitive treatment if medical management fails to prevent further increases in IAP and organ dysfunction and failure.
ACUTE, GENERAL TREATMENT
DRUG INTERACTIONS
Hepatic and renal elimination of drugs may be altered by ACS, requiring dosage adjustment or alternative drug choices.
PROGNOSIS AND OUTCOME 
Prognosis depends on underlying cause and associated abnormalities, organ dysfunction, and disease. In human medicine, ACS is a significant cause of morbidity and mortality (approaching 70%). Disregard for elevated IAP and delay of surgery are associated with further increases in patient mortality.
PEARLS & CONSIDERATIONS 
COMMENTS
TECHNICIAN TIP
IAP is most easily measured in recumbent patients. If the patient is conscious and mobile, care must be taken to prevent the patient from chewing the catheter and retaining the proximal portion in the abdomen or bladder (Elizabethan collar essential).
Abdominal Distention
BASIC INFORMATION
CLINICAL PRESENTATION
HISTORY, CHIEF COMPLAINT
ETIOLOGY AND PATHOPHYSIOLOGY

DIAGNOSIS
DIAGNOSTIC OVERVIEW
Apparent on physical examination alone. Careful abdominal palpation and diagnostic imaging help to elucidate the cause.
INITIAL DATABASE
ADVANCED OR CONFIRMATORY TESTING
TREATMENT
TREATMENT OVERVIEW
Treatment of underlying disease and therapeutic abdominal drainage if large-volume ascites is causing the abdominal compartment syndrome (see p. 4)
PEARLS & CONSIDERATIONS
Aberrant Adrenocortical Disease (Increased Adrenal Sex Hormone Production)
BASIC INFORMATION 
DEFINITION
Clinical signs of hyperadrenocorticism are present, but cortisol test results are normal, and one or more of the adrenal sex hormones is/are increased.
DIAGNOSIS 
DIAGNOSTIC OVERVIEW
The disorder is suspected when typical signs of hyperadrenocorticism are identified, but specific diagnostic tests (e.g., ACTH stimulation) are inconsistent with hyperadrenocorticism. Confirmation is obtained with identification of elevated serum levels of adrenal sex hormones.
ADVANCED OR CONFIRMATORY TESTING
TREATMENT 
TREATMENT OVERVIEW
Resolution of clinical signs is the goal of treatment; medications are typically used for controlling pituitary-based disease, and surgical excision is the treatment of choice for primary adrenal tumors.
CHRONIC TREATMENT
POSSIBLE COMPLICATIONS
See Hyperadrenocorticism, p. 548; Adrenal Neoplasia (Adenoma/Carcinoma), p. 43

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