Presentation:

A 9 months old neuter male pothound dog that was brought to AcaseAweek Clinic for being lethargic, anorexic (not eating since 2 days), and vomiting. On the next day of hospitalization, the patient continued to be lethargic, anorexic, vomiting and became icteric. On detailed history the owner reported presence of rats around the patient’s environment.

Physical examination:

On the day of presentation:

• T: 102.1
• HR: 104
• RR: 40
• Tacky mucous membrane
• Fleas
• Vomiting

Next day:

• T: 101.0
• HR: 96
• RR: 30
• CRT: <2sec
• Icteric
• Lethargic
• Not eating

CBC:

• HCT: 32% (37.0-55.0)
• HGB: 11.5 g/dl (12-18)
• MCHC: 35.9 g/dl (30-36.9)
• WBC: 10.8 x10⁹/L (6.0-16.9)
• Granulocytes: 9.3 x10⁹/L (3.3-12.0)
• PLT: 37 x10⁹/L (175-500)

Biochemistry:

• ALB: 2.6 g/dl (2.3-4.0)
• ALKP: 879 U/L (23-212)
• ALT: 184 U/L (10-100)
• AMYL: 1260U/L (500-1500)
• CREA: 7.9 mg/dL (0.5-1.8)
• BUN: 130 mg/dL (7-27)
• GlOB: 5.6 g/dL (2.5-4.5)
• TP: 8.2 g/dL (5.2-8.2)
• TBIL: 9.5 mg/dL (0.0-0.9)

What is your tentative diagnosis?

What are your differentials?

What further tests you will do to confirm your diagnosis?

How will you treat and manage this case?

Solution to this case will be posted on 12/12/08