Signalment: Feline domestic shorthair,10 years old, m/c
	History: One year ago cat developed miliary dermatitis and was treated with megesterol acetate at 5 mg orally twice a week for 6 months. Therapy was discontinued about 3 weeks ago. Three months ago cat began to lose weight. During the past 60 days cat has increased thirst and the litter box is wetter than normal. His appetite has increased and he passes large amounts of bulky feces. There is no vomiting, sneezing or coughing. Cat is vaccinated yearly for panleukopenia and upper respiratory viruses and every 3 years for rabies.
	Physical Examination: T. 103 F, HR 180-220, RR 50, and weight is 6 pounds. Cat is restless and uneasy. His coat is dull and ungroomed. Lymph nodes are normal. Thoracic auscultation reveals a definite gallop rhythm. Abdominal palpation reveals mild hepatomegaly and the mammary glands are enlarged and non-painful. Cervical palpation is negative.
	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	15500	x 103 /mm3		Normal	normal
RBC	5.8	x 106 /mm3		Rouleaux
HGB	12	gr/dl		Polychrome
PCV	36	%		Aniso
MCV	42	fl		Poik
MCV	15	pg		Crenation
MCHC	32	g/dl		Target
PLT	350000	x 103 /mm3		Hypochrome
TP	5.4	gr/dl		BasoStrip
FIB		mg/dl		Sphero
Retic	0.2	%		NRBC/199 WBC
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		11000
Band		200
Lymph		3300
Eosin		1000
Mono		0
Baso		0
Other		0
PLTest
Toxic change	0

Biochemical profile:

Test	Value	Unit	Point your mouse here to view Chemistry Norms	Test	Value	Unit
Sodium	148	m mol/L		T. Bili	0.2	mg/dl
Potassium	3.5	m mol/L		ALKP	150	u/l
Chloride	119	m mol/L		ALT	120	u/l
TCO2	16	m mol/L		AST		u/l
Urea	20	mg/dl		LDH		u/l
Creatinine	1.1	mg/dl		CK		u/l
Calcium	10.3	mg/dl		GGT	2	u/l
Phosphorus	3.5	mg/dl		Magnesium		mg/dl
Glucose	115	mg/dl		Osmolality		mosm/L
T. Protein	6.5	g/dl		Anion Gap		mosm/L
Albumin	3.1	g/dl
Globulin	3.4	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	yellow			RBC	36162
Transparency	clear			Bacteria	0
Specific Gravity	1.018			Epitheliel	0
Phosphorus				Fat	0
Protein	neg	mg/dl		Sperm	0
Ketones	neg	mg/dl		CaOxalate	0
Bilirubin	neg			CaCarbonate	0
Blood	neg			TriplePhos	2 plus
Urobili	neg			Bilirubin	0	mg/dl
				Amorph	0	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:

	Review the causes of PU/PD in cats and describe the mechanisms for hyperthyroidism
	Review the diagnostic procedures for confirming hyperthyroidism in cats
	Describe the sensitivity and specificity of diagnostic tests for feline dirofilariasis
	Review the ECG and radiographic findings of thyrotoxic cardiac disease
	Describe the pathophysiology of thyrotoxic cardiac diseases

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Copyright^© 1999 Oklahoma State University College of Veterinary Medicine
This page was last updated 10/19/07 09:51:09 AM