Same story, different endings: clinical course and outcomes of two dogs treated differently for delayed fulminant pulmonary haemorrhage 20 h after eastern brown snake (Pseudonaja textilis) envenomation

This report presents the clinical course and outcomes of two dogs that were treated differently upon recognition of respiratory distress due to delayed fulminant pulmonary haemorrhage (DFPH) 20 h after eastern brown snake envenomation. Two dogs from the same household were likely envenomated at the same time. Pulmonary haemorrhage was diagnosed based on pleural and lung ultrasound, decreasing packed cell volume and haemoptysis. Case 1 received a total of 7000 units of brown snake antivenom within the first 10 h after envenomation. The dog developed severe respiratory distress and anaemia approximately 20 h after envenomation. A decision to administer fresh whole blood was made, however, a marked deterioration in clinical signs occurred during the acquisition of blood. The dog was euthanased due to hypoxemic and hypercapnic respiratory failure. Case 2 received similar treatment to case 1 before DFPH. Case 2 developed moderate pleural effusion along with pulmonary haemorrhage after hospital admission. The dog was noticed to have respiratory distress approximately 1 h after case 1. Fresh frozen plasma was administered within 30 min, followed by packed red blood cells and autotransfusion, and the dog survived. These two cases are used as a foundation to discuss the pathophysiology of DFPH and its relation to the clinical signs. Furthermore, retrospective analysis of diagnostics and alternative approaches proposed, may assist clinicians in early recognition and optimal treatment of DFPH.