Acute hemorrhagic diarrhea syndrome (AHDS) is a common emergency in veterinary practice which may present with varying severity from mild depression to severe life‐threatening illness. Individual patient management is highly based on clinician's discretion and experience which may lead to variation in decisions on hospitalization and treatment protocols.
The aim was to investigate disease severity, treatment, outcome and client satisfaction in dogs with AHDS treated as outpatients in a prospective, observational study. Data were collected from medical records (signalment, disease history and severity at presentation, treatment prescribed) and through client interviews at least seven days after initial presentation.

One‐hundred and fifty‐seven dogs presented with diarrhea. Of these, 141 were excluded due to either non‐hemorrhagic or only slightly blood‐admixed diarrhea (N=60), signs of gastrointestinal disease for ≥7 days (N=27), NSAID or corticosteroid use (N=5), other disease known to cause hemorrhagic diarrhea (N=28) or hospitalization in conjunction with initial presentation (N=21).

The final population consisted of sixteen dogs with a median AHDS index of 12 (IQR 10‐13), where 9/16 vomited >3x and 5/16 defecated >5x on the day of presentation. Five of the sixteen dogs were 5‐6% dehydrated and 5/16 had no appetite. Five dogs had tachycardia (IQR 128‐144 beats/minutes). None had hypo‐ or hyperthermia. All clients were instructed to contact the hospital in case of lack of improvement in the dog's condition. The option to hospitalize was discussed with all clients.

All dogs were prescribed a commercial gastrointestinal diet or home‐cooked boiled rice and chicken/white fish diet. A single subcutaneous injection with maropitant (1mg/kg) was administered to 13/16 dogs in conjunction with the consultation. Nine dogs received either pre‐ and probiotics (Canikur Pro® N=6) or probiotics (SivoMixx®, N=2; ZooLac Propaste® N=1). None of the 16 dogs received antimicrobials.

Clinical signs resolved in 15 of the 16 dogs without further veterinary consultations or additional medication. One dog was hospitalized the day after initial presentation due to increased defecation frequency (every half hour) and slightly decreased activity level. The dog was treated with maropitant and intravenous fluid therapy, and was discharged the following day, where the defecation frequency had reduced markedly. All clients expressed satisfaction with the prescribed treatment on follow‐up. The results of this study suggest that supportive nutritional and antiemetic treatment alone without antimicrobial therapy is sufficient in dogs with AHDS which can be managed as outpatients. Furthermore, high client satisfaction might be achievable despite refraining from antimicrobial prescription.