Signalment: 9 year, M/C, DSH. Weight 17 pounds
	History: Cat has a long history of eosinophilic granuloma complex and indolent ulcers. He is treated with methylprednislone acetate injections at 2.2 mg/kg every 6-8 weeks. Four weeks ago, he was started on megesterol acetate at 5 mg orally 3 times a week. During the past week, the owner has noticed a marked increase in appetite and thirst. The litter box seems very wet. There is no vomiting, diarrhea, coughing or sneezing. The cat is vaccinated every 2 years with polyvalent vaccine and every 3 years for rabies.
	Physical Examination: T. 102.4 F, HR 160, RR 30, MM pink, CRT <2.0 seconds. Lymph nodes are normal, oral cavity is normal, chest auscultation is negative, abdominal palpation is negative and there is no evidence of dehydration.
	Diagnostic Plan: Using the POVMR format, identify the problems and formulate a diagnostic plan for this case.

No.	Problem
1 .
2 .
3 .
4 .
5 .
6 .
7 .
8 .
9 .
10 .

B. Of the problems you have identified, which is (are) the most important to manage?

A. DX: List ruleouts for the problems you identified in Step 2.

Problem No.	Ruleout(s)
1 .
2 .
3 .
4 .
5 .
6 .
7 .
8 .
9 .
10 .

B. List those diagnostic procedures that will be most cost-effective.

1 .  2 . 

3 .  4 . 

5 .  6 . 

7 .  8 . 

9 .  10 . 

Analyze the initial database results.

Hematology:

RBC Morphology:

Test	Value	Unit	Point your mouse here to view Hematology Norms	Test	Value
WBC	8.5	x 103 /mm3		Normal
RBC	7.2	x 106 /mm3		Rouleaux	none
HGB	12	g/dl		Polychrome	none
PCV	40	%		Aniso	none
MCV	44	fl		Poik	none
MCV	16	pg		Crenation	none
MCHC	34	g/dl		Target	none
PLT	325	x 103 /mm3		Hypochrome	none
TP	7.6	g/dl		BasoStip	none
FIB		mg/dl		Sphero	none
Retic	0	%		NRBC/100 WBC	none
PUNT
AGGR
SED RATE		mm

Differentials:

Assessment: What is your assessment of the hematology data?

Test	%	Absolute	Point your mouse here to view Hematology Norms
SEG		4000
Band		200
Lymph		2300
Eosin		1500
Mono		500
Baso		0
Other
PLTest
Toxic change	none

Biochemical profile:

Test	Value	Unit	Point your mouse here to view Chemistry Norms	Test	Value	Unit
Sodium	150	m mol/L		T. Bili	0	mg/dl
Potassium	3.9	m mol/L		ALKP	150	u/l
Chloride	125	m mol/L		ALT	64	u/l
TCO2	17	m mol/L		AST		u/l
Urea	20	mg/dl		LDH		u/l
Creatinine	1.3	mg/dl		CK		u/l
Calcium	10.9	mg/dl		GGT		u/l
Phosphorus	3.8	mg/dl		Magnesium		mg/dl
Glucose	210	mg/dl		Osmolality		mosm/L
T. Protein	6.8	g/dl		Anion Gap		mosm/L
Albumin	3.6	g/dl
Globulin	3.2	g/dl
A/G ratio

What is your assessment of the biochemical profile?

Chemistry assessment

Urinalysis:

Microscopic Sediment Exam:

Test	Value	Unit		Test	Value	Unit
Volume	5	ml		WBC	0-2	ml
Color	Dark yellow			RBC	0-2
Transparency	Opague			Bacteria	0
Specific Gravity	1.041			Epitheliel	0-3
Phosphorus				Fat
Protein	0	mg/dl		Sperm
Ketones	0	mg/dl		CaOxalate
Bilirubin	0			CaCarbonate
Blood	0			TriplePhos	3+
Glucose	2+			Bilirubin		mg/dl
				Amorph	moderate	mg/dl
				Casts	0

What is your assessment of the urinalysis data?

Urinalysis assessment

Identify the major ruleout(s) supported by this data.

What does the data tell you?

Have you identified any new problems?	No Yes	If so, what are they?

List the diagnostic tests or procedures that should be performed next.

RX:

What immediate therapy would you prescribe for problems identified in Section 2?

Learning Issues:

	Compare the etiology and pancreatitic lesions found in diabetic dogs and cats.
	Describe the consequences of poorly controlled diabetes mellitus in dogs and cats.
	Describe the pathophysiology of IDDM, NIDDM and transient DM
	Compare the use of oral hypoglycemic agents in dogs and cats and describe their mechanisms of action.
	Review the types of insulin used in cats and ways to monitor glycemic control in this species.

3. Review Questions: Click here for the review questions.

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After class review, access will be provided to the Expert's Answers.

Problems? Content: Dr. Michael D. Lorenz; Web page operation: Betty Handlin
Copyright^© 1999 Oklahoma State University College of Veterinary Medicine
This page was last updated 10/19/07 09:51:09 AM