Pulsus alternans in a critically ill dog hospitalized for xylitol toxicity

A 2-year-old spayed female Great Pyrenees cross dog was presented following the consumption of pure xylitol sweetener. Blood tests revealed hepatocellular leakage and cholestasis, hyperlactatemia, thrombocytopenia, and prolonged prothrombin and activated partial thromboplastin times. Thoracic radiographs on day 2 of hospitalization were consistent with pulmonary hemorrhage. Prior to death, the dog developed pulsus alternans suggestive of myocardial dysfunction secondary to severe systemic inflammation. This is the first report of pulsus alternans in a critically ill dog prior to clinical deterioration and death. This is also the first documentation of pulsus alternans with a high-definition oscillometric device. Key clinical message: Increased recognition of pulsus alternans and its potential implications in veterinary medicine may contribute to the identification of cardiovascular complications associated with systemic disease.