Solutions to "What's Your Diagnosis?"

Problems:

  1. Seizures: R/O's: Toxicity vs. Infectious vs. Inflammatory vs. Idiopathic vs. Neoplastic
  2. Vomiting: R/O's: Toxicity vs. Inflammatory vs. Metabolic vs. Neoplastic
  3. Weakness
  4. FAD
  5. Bilateral Increased BVS: Aspiration pneumonia vs. other

Diagnostics:

  1. Recommend not waiting for recent blood work CBC and CHEM: Even though RDVM submitted blood work that same day, it seems that initial clinical signs are progressing rapidly.
  2. Blood gas: R/O acidosis
  3. Thoracic radiographs
  4. Call Poison Control for possible hypersensitivity to Front line and medicated shampoo.
  5. Abdominal Radiographs/ Abdominal ultrasound
  6. U/A

Results:

Chemistry Panel:
BUN: 107mg/dL (7-27)
CREA: 10.4 mg/dL (0.5-1.8)
PHOS:15.7 mg/dL (2.5-6.8)
ALP:232 U/L (23-212)
GLU 164mg/dL (74-143)
Cl 99 mmol/L (109-122)
Na 153 mmol/L (144-160)
K 3.8 mmol/L (3.5-5.8)
Otherwise normal

CBC
NEU 14.30 K/uL (2.00-12.0)
Otherwise normal

Blood gas (arterial):
pH 7.31 (7.36-7.44)
HCO3 13.7 mmol/L (24.0-26.0)
PCO2 29.0 mmHg (36.0-44.0)
tCO2 14.6 mmol/L (25-27)
PO2 192.0 mmHg (90.0-100.0)
tHb 11.3 g/dL (12.0-18.0)
So2 99.0%
Na 148.0 mmol/L (144-160)
K 4.0 mmol/L (3.5-5.8)
Cl 103.0 mmol/L (109-122)

U/A: Unable to obtain urine: pet has not urinated in a long time and still no urine?

Abdominal ultrasound:

Abdominal Ultrasound

Question #2.

This is the right kidney. Does it look normal?

No. Severely hyperechoic renal cortices.

Based on these results which are your R/O's:

Renal:

  1. Acute nephritis associated with Ethylene Glycol toxicity
  2. Acute tubular necrosis
  3. Nephrosis due to other toxic agents
  4. End stage renal disease
  5. Nephrocalcinosis

Question #3

What test would you perform?

Ethylene Glycol Test - Ethylene Glycol Test was positive!

Question #4

In this case describe treatment:

  1. Place Jug catheter to measure Central Venous Pressure
  2. IV fluids 2.5% Dextrose in 0.45% NaCl with KCl at 2-3 times maintenance
  3. 4-methylpryrazole (best). If unavailable use ethanol.
  4. Treat seizures with Valium or Phenobarbital
  5. Place urinary catheter to measure Ins/Outs
  6. If anuric AND PET IS HYDRATED
    a. Start with Furosamide 1mg/lb IV as a bolus. If no improvement repeat dosage
    b. If furosamide is not working - administer Mannitol 20% 0.25 gm/kg bolus IV over 10min. If no urine still or <0.5ml/lb/hr repeat Mannitol and repeat Furosamide as well.
    c. If urine production is still <0.5-1.0ml/lb/hr you can use glucose (20%) 10-20ml/lb IV as a bolus for 10-15min OR a Dopamine CRI.
  7. Last resort would be dialysis
  8. Monitor RR, HR, BP
  9. Repeat renal panel in 24 hrs.

In Cinnamon's case treatment consisted as of 1-6 and 8-9. Sadly, Cinnamon's recheck renal panel showed poor response to initial treatment. In light of no urine production aside from all our efforts for 24 hours, Owner decided to humanely euthanize Cinnamon.

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