A Case A Week for Veterinarians
Providing veterinarians a challenging case for brain storming every week ... A Case A Week a website for Vets prepared by Dr Mofya Saul and Dr Rajesh Banga.
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Monday, November 24, 2008
Case 4
Presentation:
A 12 year old spayed female Labrador was presented to AcaseAweek Clinic with one week history of vomiting, decreased appetite and lethargy. Bad breath of the pet was also a complaint. The patient was brought to clinic 4 month back for ehrlichia and mild azotemia. She is currently on Hill’s k/d diet.
Physical exam:
  • Weight: 34.8 kg
  • Temperature: 100.7
  • Pulse: 136
  • Respiration rate: 28
  • Mucus membranes: pale
  • Capillary refill time: > 2 seconds.
  • Dehydration: ~5%
  • Abdomen was tender upon palpation.
Lab tests: (Reference Values)
  • BUN: 112 mg/dl
  • Creatinine: >13.6 mg/dl
  • Phosphorous: 16.1
  • PCV: 25%
  • USG: 1.011
  • TP: 6.4 mg/dl
  • Albumin: 2.7 mg/dl
  • Non-regenerative anemia was also noted.



What is your tentative diagnosis?
Give differentials for your diagnosis.
What further diagnostic test(s) will be performed to confirm the tentative diagnosis?
How will you treat and manage this case?

posted by Dr Banga's Websites @ 12:00 AM  
1 Comments:
  • At November 25, 2008 at 9:16 AM, Blogger Irene Arboleda said…

    Tentative Diagnosis:

    Chronic Renal failure (CRF)

    Differentials Diagnosis:

    Hypoadrenocorticism
    Hypothyroidism
    Renal Secondary Hyperparathyroidism
    Inflammatory Bowel Disease

    Further Diagnostic Tests:

    (1) Abdominal Ultrasound to detect changes in kidney size and presence of renal neoplasia
    (2) Blood Pressure Measurement using Doppler techniques
    (3) Echocardiogram to evaluate hypertensive heart disease as a sequela to renal failure
    (4) TSH Stimulation Test

    Treatment and Management:

    (1)Fluid therapy to address dehydration
    (2) Sodium, protein and phosphorus restricted diet and free access to fresh water at all times
    (3) For Hypertension, calcium channel blocker Amlodipine and ACE inhibitors Enalapril
    (4)Cimetidine at 10mg/kg initial dose followed by 5 mg/kg q 8-12 h to minimize vomitting
    (5) Eryhtropoietin Replacement such as r-HuEPO (Epogen and Procrit, give ferrous sulfate before and simultaneously

     
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