I have a 10-year-old German Shepherd with vomiting and di...

With a geriatric GSD of unknown history, my primary concern is ruling out immediate life-threats before we chase down the cause of the V/D. We have to assume the worst until proven otherwise. Let's start with triage and stabilization.

First, get a full set of vitals and assess perfusion. Heart rate, pulse quality, MM color, CRT, temperature, and a blood pressure reading are non-negotiable. Is this dog in shock? Geriatric patients have less reserve and can decompensate quickly.

Your immediate actions should be:

Place a large-bore IV catheter. Two if the patient looks compromised.

Run a point-of-care panel: PCV/TS, blood glucose, and lactate. This gives you a rapid snapshot of hydration, anemia, hypoglycemia, and perfusion.

Perform an AFAST scan. I'm looking for free fluid that would suggest a hemoabdomen from a ruptured splenic mass, or other intra-abdominal catastrophe.

If there are any signs of hypoperfusion (tachycardia, poor pulse quality, lactate >2.5 mmol/L), start fluid resuscitation immediately. Give a bolus of an isotonic crystalloid like LRS or Plasmalyte at 10-20 mL/kg and then reassess all perfusion parameters.

Once you have IV access and are addressing perfusion, get abdominal radiographs. A right lateral view is critical to rule out GDV, which must remain high on our list for this signalment.

For analgesia and nausea, I'd start with maropitant and an opioid. Methadone 0.2 mg/kg IV is an excellent choice for visceral pain.

This initial approach will stabilize the patient and rule out the most common surgical emergencies in this breed. Once we have this baseline data and the patient is more stable, we can proceed with a full chemistry, CBC, and further diagnostics with our Internal Medicine colleagues. Let me know what you find on your initial assessment.

Of course. This is a challenging presentation given the signalment and lack of history. While Marcus focuses on stabilization, my priority is to build a diagnostic framework to get to the "why."

My differential list is broad, but I'd prioritize it this way for a 10-year-old GSD:

Hypoadrenocorticism (Addison's Disease): This is a must-rule-out in any sick German Shepherd. The waxing/waning GI signs are classic.

Infectious Enteritis: Given the unknown history, hemorrhagic gastroenteritis (AHDS), clostridial overgrowth, and even parvovirus (despite the age) must be considered.

Gastrointestinal Disease: Foreign body/partial obstruction, dietary indiscretion, or an acute presentation of a chronic enteropathy or neoplasia (e.g., GI lymphoma).

Systemic Disease: Pancreatitis, acute kidney injury, or hepatobiliary disease presenting with GI signs.

Diagnostic Plan:
After initial stabilization, a minimum database is essential.
* Tier 1 (Essential): CBC, chemistry panel, and urinalysis. Pay close attention to the electrolytes, but remember the Na:K ratio can be normal in atypical Addison's. I strongly recommend a baseline cortisol. If it's >2 µg/dL, we can confidently rule out Addison's. Also, run a fecal float and a parvovirus SNAP test.
* Tier 2 (Imaging): Abdominal radiographs are crucial to assess for obstruction, foreign material, or evidence of ileus. An abdominal ultrasound would be my preferred next step to evaluate GI layering, pancreas, and adrenal gland size.

I would hold off on any corticosteroids until we have at least that baseline cortisol. Once we have the initial lab data, we can formulate a more targeted plan.

Confidence Level: Moderate — need more data.