Endocrinology Case 11

Expanded Case Evaluation
Expert's Answers

A. Expanded Database - Diagnostic Test Results

1 Test / Procedure: Abdominal Radiography
          Results:

Homogenous appearance to abdomen. Mild hepatomegaly, uterus not enlarged, stomach distended with gas but in normal position.

Review indications & protocol in notes.

What is your assessment?

Considerable intraabdominal fat. Hepatomegaly may be caused by hepatic lipidosis. Pyometra seems unlikely. Gas in stomach may be from aerophagia. No evidence of obstruction or intestinal ileus. Need ultrasonography to assess pancreas, liver and peritoneal space.

2 Test / Procedure: Abdominal Ultrasonography
          Results:

Liver: results suggest hepatic lipodosis. Pancreas appears normal. No evidence of peritoneal fluid. Uterus is slightly enlarged. Kidneys show changes in renal pelvis consistent with pyelonephritis.

Review indications & protocol in notes.

What is your assessment?

The inflammatory response in this dog is suggestive of pyelonephritis. Other sources of inflammation are ruled out. Liver changes are consistent with diabetic metabolism.

3 Test / Procedure: Serum Amylase and Lipase
          Results:

Amylase: 1200 U/L (388-1007) 

Lipase: 1800 (266-1769)

Review indications & protocol in notes.

What is your assessment?

Both enzymes are mildly elevated. While this might suggest pancreatitic inflammation, both enzymes are excreted in urine and elevations are known to occur in patients with pre-renal azotemia (decreased GFR).

4 Test / Procedure: Activated Clotting Time
          Results:

3.0 minutes (<2 minutes)

Review indications & protocol in notes.

What is your assessment?

The ACT is slightly prolonged. This can be associated with thrombocytopenia and/or decrease in clotting factors. Since this dog is predisposed to DIC (vasculitis, SIRS), clotting and platelet counts should be reassessed every 12-24 hours.

5 Test / Procedure: Urine Culture
          Results:

E. coli is isolated with >100,000 organisms per ml.

Review indications & protocol in notes.

What is your assessment

E. coli is a common pathogen in canine UTI. Based on results of all tests, it is reasonable to conclude the pyelonephritis is present and the infection may now be systemic. The cause of SIRS is identified and the dog should be managed for this infection and the consequences of diabetic ketoacidosis.

6 Test / Procedure: Thoracic Radiographs
          Results:

Normal

Review indications & protocol in notes.

What is your assessment?

No evidence of cardiopulmonary diseases. 

Heart murmur is may be incidential finding. 

Aspiration pneumonia is not present.

B. Final Diagnosis

Diabetic ketoacidosis with associated hepatic lipodosis.

Pyelonephritis with suspected bacteremia. 

SIRS with potential for DIC ( not currently present.)

C. Therapeutic Plan

1. Fluid and electrolyte Rx: Either lactated Ringers or normal saline supplemented with potassium. Anticipate hypophosphatemia and hypokalemia as patient responds to insulin. 

2. Continue parenteral regular insulin and glucose monitoring until dog is stable. 

3. Enrofloxicin was a good initial choice. Continue antibiotics and continue to monitor renal function, platelets and clotting. 

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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