Case 1 Endocrinology Answers

Endocrinology Case 1

Expert's Answers

1. Data Base Collection

	Signalment: Cockapoo, 1.5 years, male, 12 pounds
	History: Severe polydipsia and polyuria of 6 months duration. Dog drinks at least 3 quarts of water each day and usually more. Urinates a large volume every 2-3 hours. Appetite is very good and dog seems to feel good as long as he has free access to water. On monthly heartworm preventative and receives yearly vaccinations. There are no other clinical signs reported by the owner.
	Physical Examination: T. 102.5 F, RR 30, HR 130. Dog is 3-5% dehydrated. There are no other abnormalities found on physical examination.
	Diagnostic Plan:Using the POVMR format, identify the problems and formulate a diagnostic plan for this case.

2. Problem Identification

A. List the problems you have observed.

No.

Problem

1.

PU/PD with dehydration

2.

3.

4.

5.

6.

7.

8.

9.

10.

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

3. Plan Formulation

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

Problem
No.

Ruleout(s)

1.

Renal Disease (congenital or acquired), Diabetes mellitus, Central diabetes insipidus, Nephrogenic diabetes insipidus, Psychogenic polydipsia, Hypercalcemia, Hyperadrenocorticism

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.

4. Assessment & Follow-up

Analyze the initial database results.

Hematology: RBC Morphology:

Test Value Unit
Point your
mouse here
to view Hematology Norms Test Value

WBC 8500 x 10³ /mm³ ^Normal

RBC x 10⁶ /mm³ ^Rouleaux

HGB gr/dl ^Polychrome

PCV 64 % ^Aniso

MCV fl ^Poik

MCV pg ^Crenation

MCHC g/dL ^Target

PLT x 10³ /mm³ ^Hypochrome

TP 8.5 g/dL ^BasoStrip

FIB mg/dL ^Sphero

Retic % ^{NRBC/100
WBC}

PUNT

AGGR

SED RATE x 10³ /mm³

Differentials:
Assessment:
What is your assessment of the hematology data?

Test % Absolute
Point your
mouse here
to view Hematology Norms The animal is hemoconcentrated confirming the clinical findings of dehydration. There is no evidence of inflammatory disease. The results do not aid in narrowing the list of ruleouts.

SEG

Band

Lymph

Eosin

Mono

Baso

Other

PLTest

Toxic
change

Biochemical profile:

Test Value Unit Point your
mouse here
to view Chemistry Norms Test Value Unit

Sodium 160 m mol/L T. Bili 0.2 mg/dl

Potassium 4.6 m mol/L ALKP 110 u/l

Chloride 130 m mol/L ALT 20 u/l

TCO2 16 m mol/L AST u/l

Urea 40 mg/dl LDH u/l

Creatinine 1.1 mg/dl CK u/l

Calcium 10.5 mg/dl GGT u/l

Phosphorus 3.3 mg/dl Magnesium mg/dl

Glucose 110 mg/dl Osmolality mosm/L

T. Protein 8 g/dl Anion Gap mosm/L

Albumin 6 g/dl

Globulin 2 g/dl

A/G ratio

What is your assessment of the biochemical profile ?

The dog is hemoconcentrated which explains the increased sodium, chloride, and albumin. Azotemia is present. This is most likely pre-renal since the urine specific gravity is less than 1.008. The mild increase in ALKP is mostly likely due to the dogs age. There is no evidence of cholestatsis but corticosteroid induction can not be eliminated at this time. Diabetes mellitus and hypercalcemia are ruled out.

Urinalysis: Microscopic Sediment Exam:

Test Value Unit Test Value Unit

Volume 10 ml WBC 0-1 ml

Color pale yellow RBC 0

Transparency clear Bacteria 0

Specific Gravity 1.002 Epitheliel 0

Phosphorus Fat 0

Protein neg. mg/dl Sperm 0

Ketones neg. mg/dl CaOxalate 0

Bilirubin neg. CaCarbonate 0

Blood neg. TriplePhos 0

Urobili neg. Bilirubin 0 mg/dl

Amorph 0 mg/dl

Casts 0

What is your assessment of the urinalysis data?

The urine specific gravity is very low (<1.008). This suggests that the dog can dilute glomerular filtrate in loop of Henle but can not conserve water from collecting ducts. Diabetes mellitus is ruled out.

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

Diabetes insipidus, psychogenic polydipsia, hyperadrenocorticism

Have you identified any new problems?
If so, what are they?

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

ADH response test, Cortisol screening test (LDDST or ACTH stimulation test)

RX:

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

The dog should be observed very carefully since it is in a state of precarious water balance. It should not be deprived of water.

Learning Issues:

	Review the physiologic events that occur in each component of the nephron.
	Describe the indications and contraindications for the modified water deprivation test.
	Describe the indications and procedure for ADH response test.

No.	Problem
1.	PU/PD with dehydration
2.
3.
4.
5.
6.
7.
8.
9.
10.

Problem No.	Ruleout(s)
1.	Renal Disease (congenital or acquired), Diabetes mellitus, Central diabetes insipidus, Nephrogenic diabetes insipidus, Psychogenic polydipsia, Hypercalcemia, Hyperadrenocorticism
2.
3.
4.
5.
6.
7.
8.
9.
10.

Test	Value	Unit	Point your mouse here to view Hematology Norms	Test	Value
WBC	8500	x 10³ /mm³		^Normal
RBC		x 10⁶ /mm³		^Rouleaux
HGB		gr/dl		^Polychrome
PCV	64	%		^Aniso
MCV		fl		^Poik
MCV		pg		^Crenation
MCHC		g/dL		^Target
PLT		x 10³ /mm³		^Hypochrome
TP	8.5	g/dL		^BasoStrip
FIB		mg/dL		^Sphero
Retic		%		^{NRBC/100 WBC}
PUNT
AGGR
SED RATE		x 10³ /mm³

Test	%	Absolute	Point your mouse here to view Hematology Norms	The animal is hemoconcentrated confirming the clinical findings of dehydration. There is no evidence of inflammatory disease. The results do not aid in narrowing the list of ruleouts.
SEG
Band
Lymph
Eosin
Mono
Baso
Other
PLTest
Toxic change

Endocrinology Case 1

Expert's Answers

1. Data Base Collection

2. Problem Identification

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

3. Plan Formulation

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

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

4. Assessment & Follow-up

Analyze the initial database results.

RX:

Learning Issues:

Continue with Expanded Case Evaluation