 | 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. |
A. List the problems you have observed.
No.
Problem
1. PU/PD 2. EOSINOPHILIC GRANULOMA COMPLEX 3. HISTORY OF RECENT MEGESTEROL ACETATE THERAPY/REPOSITOL GLUCOCORTICOIDS. 4. OBESITY
B. Of the problems you have identified, which is (are) the most important to manage?
PU/PD
A. DX: List ruleouts for the problems you identified in Step 2
Problem
No.Ruleout(s)
1.
Diabetes mellitus, renal disease, hyperthyroidism 2.
Hypersensitivity disorders (atopy, food allergy, parasitic allergy) 3.
Insulin antagonism, adrenal cortical suppression 4.
Excessive caloric intake, decreased metabolic rate, genetic
B. List those diagnostic procedures that will be most cost-effective.
Problem
No.Diagnostic Procedure
1.
UA 2.
Biochemical profile 3.
Hemogram 4.
Total T4
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 | x 103 /mm3 | ||||
|
Differentials: |
Assessment: |
| Test | % | Absolute | Point your mouse here to view Hematology Norms |
Eosinophilia is present and is consistent with clinical findings of eosinophilic granuloma complex. Hemogram is not helpful in narrowing the list of rule outs for PU/PD, etc. |
| 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 Hematology 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 ? |
| Hyperglycemia is present. Cat may have diabetes mellitus (transient (drug induced), non-insulin dependent, insulin dependent) or the elevated glucose may be stress related (not if glucose is in the cats urine). The ALKP is increased. Bilirubin is 0 so this is not cholestasis. Megesterol acetate might be the explanaion. ALT is normal and we would expect it to increase with ALKP if hepatic lipidosis was present. |
| 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+ | |||
| Urobili | 2+ | Bilirubin | mg/dl | |||
| Amorph | moderate | mg/dl | ||||
| Casts | 0 |
| What is your assessment of the urinalysis data? |
| PU/PD is caused by glucosuria. Cat has diabetes mellitus but type can not be identified at this time. |
| Identify the major ruleout(s) supported by this data. |
| Feline diabetes mellitus |
Have you identified any new problems? |
NO | If so, what are they? |
| List the diagnostic tests or procedures that should be performed next. |
| TT4.B340 To assess duration of hyperglycemia, fructosamine assay (if available and affordable). |
RX:
| What immediate therapy would you prescribe for problems identified in Section 2? |
| 1. Diet: High fiber, high complex carbohydrate. Begin program of gradual weight reduction.
2. Stop megesterol acetate. 3. Assess cat weekly with FBG. 4. Have owner check urine glucose levels at home (special litter is available so owner can easily collect urine). 5. If hyperglycemia presists, glipizide or insulin therapy may be needed. |
| 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.
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