Case 19

A 4.5 year old neutered male large breed mix canine was presented to AcaseAweek Clinic with sudden onset of acute hind limbs weakness for 2 days. The patient is both indoor and outdoor and is current on all the vaccinations, deworming and heart worm prevention.



Physical Exam:

T= 101.9 oF
HR/PR=114
R=panting
Weight= 37.8kg
MM=moist and pink
CRT=<2 sec



Neurological: Mild pain on palpation of spine in thoraco-lumber area.

No other abnormalities noted at this time on P/E.



CBC and Biochemistry: All values within normal limits.



4Dx snap test: Negative.



Radiographs: Pelvic radiograph on this patient was normal. Lateral and VD view of thoraco-lumber area were taken and are as shown below (Click on the images to enlarge):

What are your radiographic findings?
What is your tentative and differential diagnosis?
What further diagnostic tests you will perform?
What will be your treatment plan?




Solution to this case

Solution for Case 18

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Based on clinical assessment the problem list is as follows:

• Lethargy
• Dehydration
• Putrid smell from oral cavity
• Underweight
• Mildly elevated platelets
• Elevated BUN/CREA
• Mildly elevated ALT
• Severely elevated GLUCOSE in blood
• Glucosuria
• Proteinuria
• Hematouria
• Elevated leukocytes in urine

Tentative diagnosis: Diabetes mellitus.

DDx: Renal glucosuria, stress induced hyperglucemia, acromegaly, hyperthyriodism.

Further Diagnostic tests: Urine culture and sensitivity test for UTI, T4 test.

From history, PE and lab results the confirmatory diagnosis is Diabetes mellitus. The patient’s primary problems are related to his diabetes which accounts for his lethargy, dehydration, and body condition.

The elevated BUN/CREA and total protein are due to dehydration. The hyperglycemia and glucosuria are confimatory findings for the diabetes mellitus. The presence of blood and leukocytes in the urine are likely due to a UTI, urine culture and sensitivity are required.

In stress induced hyperglycemia does not lead to glucosuria. In renal glucosuria or Fanconi syndrome there is not hyperglycemia.

Acromegaly should be suspected in difficult cases of diabetes mellitus. Here acromegaly  was ruled out by PE findings. Physical appearnace duing PE and growth hormone assay can confirm acromegaly.

Some of these symptoms (weight loss, PU/PD, vomiting, and weakness etc.) could also be due to hyperthyroidism. But T4 levels were normal in this cat.

The cause of the malodorous oral cavity could be related to diabetes or renal disease or other causes include abscesses, periodontal disease, and pneumonia.

Vomition may be due to hyperglycemia or elevated BUN/CREA.

Treatment Plan:

1. IV fluids (without glucose or dextrose)
2. Insulin
3. Monitor blood glucose levels

The best insulin for cats is ultralente, which is a long acting insulin. The owner is to monitor blood glucose levels at home and regular insulin (fast acting but short duration) is on hand for emergencies.

Dose of insulin is 0.5U/kg Q12h since his BG is > 360 mg/dL, and recheck BG curve weekly for first month. Once BG is <250 mg/dl, insulin can be adjusted to keep BG less than 250mg/dl.

Antibiotics for UTI based on culture and sensitivity should be administered.

The cat should be put on high fiber diet and semi-moist food should be avoided. Some cats can be maintained on oral hypoglycemic agents such as glipizide.

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