clin path presentation
TRANSCRIPT
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Next Appointment: Sylvester Stone (Feline,
M)“Vomiting”
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Vomiting
Foreign Body
Toxin/poison
Acute Renal Insult
Vomiting vs regurg?Vestibular
Otitis interna
Central
Gastrointestinal
stress
Abdominal
pancreatitis
dietary
Oesophagitis
gastritis
Dehydration Electrolytes imbalances metabolic alkalosis (non-ion gap)
Hepatic lipidosis
Gastric neoplasiahepatitis
Porto-systemic shunts
cholangiohepatitis
Central brain lesions
triaditisGall stones
intussusseption
pyelonephritishydronephrosis
Urolithiasis – renal vs blocked catperitonitis
endocrinopathiesDKA
hyperthyroid
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3 year old cat Acute lethargy Vomiting Anorexia
History
Physical Exam
• Obese• Comatose
Prognosis
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Haematology
Biochemistry
Bloods
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PCV (%) 50 24-45 NCC (x 109/L) 24 5.5-19.5 Segs (x 109/L) 23 2.5-12.5 Monos (x 109/L) 0.7 0-0.88
Lymphs (x 109/L) 0.3 1.5-7.0 Platelets Adequate
Haematology
Vomiting = Dehydration?
What else?
Stress Leukogram vs infection
ErythrocytosisAbsolute RelativePrimary DehydrationNeoplasia within bone marrow Splenic contractionSpleenLiverSecondaryHypoxiaCardiovascular diseaseAltitudeRenal neoplasia (EPO)
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Glucose 285 67-124 Stress? Urea 110 17-32 Creatinine 7.5 0.9-2.1 Calcium 6.5 8.5-11 Phosphorus 14 3.3-7.8 Total Protein 9.0 5.9-8.1 Dehydration? Albumin 4.9 2.3-3.9 Globulin 4.1 2.9-4.4 Total Bilirubin 0.3 0-0.3 ALT 35 30-100 ALP 45 11-210
Sodium 165 146-160 Potassium 6.8 3.7-5.4 Chlorine 107 112-129 TCO2 10 14-23 Anion gap 55 10-27 Calculated Osmolality 394 290-310 Measured Osmolality 440 290-310 Osmolality Gap 46 >10
Biochemistry
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Colour: yellow Transparency: cloudy USG 1.016 Protein + Gluc + Bilirubin – Blood + pH 5
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WBCs 2-3 RBCs 2-3 Epithelial cells 1-3 Casts 0 Bacteria 0 Crystals: Calcium oxalate monohydrate
Sediment
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TCO2 10 14-23
Anion gap 55 10-27 Calculated Osmolality 394 290-310 Measured Osmolality 440 290-310 Osmolality Gap 46 >10
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Kill or Cure?
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Serum Anion Gap: Its Uses and Limitations in Clinical Medicine (Jeffrey A, Kraut and Nicolaos E. Madias) http://cjasn.asnjournals.org/content/2/1/162.full
http://www.icatcare.org:8080/vets/practice-resources/ethylene-glycol-toxicity-cats
http://jaaha.org/doi/abs/10.5326/15473317-35-4-297?journalCode=aaha