Bruno
Monday, August 3, 2026 at 11:18 PM
Subjective
Chief Complaint
Bruno, a 7-year-old neutered male Great Dane, presented as an emergency for repeated unproductive retching, a rapidly distending abdomen and restlessness that started about two hours before arrival.
History
- Ate his full evening meal (about 4 cups of dry kibble) at 8:30 PM, drank a large amount of water and played in the yard afterwards.
- Unproductive retching every few minutes since about 9:00 PM; drooling heavily; unable to settle or lie down.
- Owner noticed his belly "swelling up" over the past hour.
- No known access to toxins, bones or foreign objects.
- No current medications. Vaccinations up to date. No previous gastropexy.
Additional History
- Fed once daily from a raised bowl.
- A littermate died of "bloat" at 5 years of age.
- No previous episodes of vomiting, diarrhea or abdominal pain.
Objective
Vital Signs
- Triage: Immediate (red) — taken straight to the treatment area on arrival
- Temperature: 101.9°F (38.8°C)
- Weight: 62 kg
- Heart Rate: 168 bpm, weak femoral pulses with intermittent pulse deficits
- Respiratory Rate: 52 breaths/min, shallow
- Mucous Membranes / Capillary Refill Time: Pale pink and tacky; CRT 2.5 seconds
- Blood Pressure: 84 mmHg systolic (Doppler)
- Body Condition Score: BCS 5/9
Physical Exam
- Mentation: Quiet, anxious but responsive; standing with a hunched posture.
- Abdominal: Marked cranial abdominal distension, tympanic ("ping") on percussion; painful on palpation.
- Cardiovascular: Tachycardia with an irregular rhythm; no murmur.
- Respiratory: Rapid, shallow breathing; lung sounds clear bilaterally.
- Oral: Hypersalivation; mucous membranes pale and tacky.
- Hydration: Estimated 6–7% dehydrated.
- Neurological: Ambulatory; no deficits apart from dull mentation.
- Coat and Skin: No wounds or other abnormalities.
Diagnostics
- Right lateral abdominal radiograph: Severely gas-distended, compartmentalized stomach with the pylorus displaced craniodorsally ("double bubble" sign), consistent with gastric dilatation-volvulus.
- Lactate: 4.8 mmol/L on admission; 2.6 mmol/L after initial fluid resuscitation.
- PCV/TS: 54% / 7.0 g/dL.
- Blood glucose: 128 mg/dL. Potassium: 3.4 mmol/L.
- ECG: Sinus tachycardia with intermittent single ventricular premature complexes (VPCs).
Assessment
- Gastric dilatation-volvulus (GDV) with hypovolemic and obstructive shock — surgical emergency.
- Lactate falling after resuscitation (4.8 → 2.6 mmol/L), a favourable prognostic sign.
- Ventricular premature complexes, most likely secondary to poor perfusion and myocardial ischemia; risk of progression to ventricular tachycardia during and after surgery.
- Mild hypokalemia.
- Prognosis fair to good with prompt surgery; guarded if gastric necrosis is found and partial gastrectomy or splenectomy is required.
Plan
- Two 18 G cephalic IV catheters placed; balanced isotonic crystalloid bolus of 20 mL/kg (1,240 mL) over 15 minutes, repeated once after reassessment of heart rate, pulse quality and blood pressure.
- Flow-by oxygen during stabilization.
- Analgesia: methadone 0.2 mg/kg IV.
- Gastric decompression: percutaneous trocarization with a 14 G catheter on the right flank, releasing a large volume of gas; abdominal distension and respiratory effort improved.
- Potassium chloride added to fluids at 20 mEq/L; recheck electrolytes post-operatively.
- Continuous ECG monitoring; lidocaine 2 mg/kg IV bolus followed by a CRI at 50 µg/kg/min if VPCs become sustained, multiform or faster than 160 bpm.
- Pre-operative CBC, chemistry and coagulation panel (PT/aPTT) submitted.
- Emergency exploratory laparotomy tonight: gastric derotation, assessment of gastric wall and splenic viability, right-sided incisional gastropexy; partial gastrectomy and/or splenectomy if needed.
- Post-operative ICU hospitalization for an estimated 48–72 hours: IV fluids, methadone analgesia, maropitant 1 mg/kg IV q24h, continuous ECG, lactate and PCV/TS q6–8h, small amounts of water from 12 hours and small, frequent meals from 24 hours after surgery if not vomiting.
- Client communication: Owners informed that GDV is fatal without surgery and that delay increases the risk of stomach wall necrosis. Itemized estimate (low and high range) for stabilization, surgery and 2–3 days of hospitalization reviewed and signed; deposit taken. Owners consented to surgery and elected full CPR. Owners to be called after surgery and again in the morning.
Client Discharge Note
Thank you for getting Bruno to us so quickly tonight. Acting fast makes a real difference with this condition.
Summary
Bruno has a condition called gastric dilatation-volvulus (GDV, or "bloat"), in which the stomach fills with gas and twists on itself. This cuts off its blood supply and puts pressure on the large blood vessels, which is why he was in shock when he arrived. We gave him intravenous fluids, pain relief and oxygen, and released gas from his stomach with a needle to relieve the pressure. His circulation and lactate level improved with this treatment. He also has some irregular heartbeats, which are common with GDV and which we are monitoring closely. Bruno is going to surgery tonight to untwist his stomach, check that the stomach and spleen are healthy, and tack the stomach to the body wall (gastropexy) so it cannot twist again.
Key Topics We Discussed
Surgery:
- Surgery is the only treatment for GDV. During the operation we will check the stomach wall and spleen; if any part has been damaged by the loss of blood supply, it may need to be removed.
- We will call you as soon as Bruno is out of surgery.
Hospitalization:
- Bruno will stay in our intensive care unit for about 2–3 days for fluids, pain relief and continuous heart monitoring.
- The first 48 hours after surgery carry the highest risk of complications, especially irregular heart rhythms. We will update you every morning and evening, and immediately if anything changes.
Estimate and Consent:
- We reviewed the estimate for stabilization, surgery and hospitalization, and you signed the consent form and chose full resuscitation if needed. We will contact you before the costs exceed the high end of the estimate.
When Bruno Goes Home:
- Expect strict rest with short leash walks only for 2 weeks while the incision heals; skin sutures or staples are removed in 10–14 days.
- Feed 3–4 small meals a day instead of one large meal, from a bowl on the floor, and avoid vigorous exercise for an hour before and two hours after meals.
- The gastropexy prevents the stomach from twisting again, but the stomach can still fill with gas. If you see retching without producing anything, a swollen belly or restlessness again, call us or come in straight away.
Family History:
- Because his littermate also had GDV, other related dogs may be at higher risk. A preventive gastropexy (often done at the time of spay or neuter) is worth discussing with their veterinarians.
Thank you for entrusting us with Bruno's care. Please call us at any time tonight if you have questions.