Signalment: Canine, miniature poodle, F/S, 5 years old, 15 lb..
	History: Two week duration of lethargy, depression, anorexia, and sporadic vomiting. One week ago dog developed muscle fasiculations and has had 2 tetanic seizures. Dog urinated and defecated during seizures. There have been no other major illnesses and vaccinations and heartworm preventative have been given on a regular basis. Owner is unaware of any exposure to toxins. Dog is housed indoors and in a fenced in yard.
	Physical Examination:T: 102.5 F; RR 40; HR 90; MM pink; CRT <2.0 seconds. Multiple tongue lacerations, excessive dental calculi, muscle fasiculations and twitching are noted. Dog seems stiff when walking. Neurological examination is normal except for stiffness of muscles and mild depression. Rest of P.E. is negative.
	Diagnostic Plan:Using the POVMR format, identify the problems and formulate a diagnostic plan for this case.

No.	Problem
1.	Vomiting with anorexia and depression
2.	Seizures, muscle stiffness, and tetany
3.	Tongue lacerations
4.	Periodontal disease
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.	Life threatening metabolic diseases: renal failure; adrenal insufficiency, liver failure; pancreatitis. Primary GI diseases: partial obstruction, inflammatory bowel disease, neoplasia. Primary CNS disease (see problem #2); Toxicity (see problem #2)
2.	Toxicity: (organophosphates, chlorinated hydrocarbons, lead); Tetanus; Hypocalcemia; Hypoglycemia; Hepatic encephalopathy; Meningoencephalitis (viral, bacterial, fungal)
3.	Trauma (during seizures)
4.	Periodontal disease (inactivate until dog is stable)
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	16200	x 103 /mm3		Normal
RBC	6.5	x 106 /mm3		Rouleaux	none
HGB	17	gr/dl		Polychrome	none
PCV	42	%		Aniso	none
MCV	65	fl		Poik	none
MCV	24	pg		Crenation	none
MCHC	33	g/dL		Target	none
PLT	280000	x 103 /mm3		Hypochrome	none
TP	6.9	g/dL		BasoStrip	none
FIB		mg/dL		Sphero	none
Retic	0	%		NRBC/100 WBC	none
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 hemogram is essentially normal. The absence of basophilic stippling and nucleated red blood cells does not eliminate chronic lead poisoning.
SEG		10000
Band		200
Lymph		4000
Eosin		500
Mono		1500
Baso		0
Other		0
PLTest
Toxic change

Biochemical profile:

Test	Value	Unit	Point your mouse here to view Chemistry Norms	Test	Value	Unit
Sodium	148	m mol/L		T. Bili	0.01	mg/dl
Potassium	4.1	m mol/L		ALKP	121	u/l
Chloride	112	m mol/L		ALT	31	u/l
TCO2	22	m mol/L		AST		u/l
Urea	16	mg/dl		LDH		u/l
Creatinine	1	mg/dl		CK		u/l
Calcium	6.5	mg/dl		GGT		u/l
Phosphorus	8.3	mg/dl		Magnesium		mg/dl
Glucose	135	mg/dl		Osmolality		mosm/L
T. Protein	6.4	g/dl		Anion Gap		mosm/L
Albumin	3.5	g/dl
Globulin	2.9	g/dl
A/G ratio

What is your assessment of the biochemical profile ?

The dog is severely hypocalcemic and moderately hyperphosphatemic. This suggests a deficiency of PTH or failure of kidney conversion of Vitamin D to 1,25-Vitamin D3. Dog does not have renal failure, hypoglycemia, or Addison's disease. Tetanus is ruled out.

Urinalysis:

Microscopic Sediment Exam:

Test	Value	Unit		Test	Value	Unit
Volume	5	ml		WBC	1 to 2	ml
Color	yellow			RBC	2 to 3
Transparency	clear			Bacteria	0
Specific Gravity	1.017			Epitheliel	0
Phosphorus				Fat	0
Protein	0	mg/dl		Sperm	0
Ketones	0	mg/dl		CaOxalate	0
Bilirubin	0			CaCarbonate	0
Blood	0			TriplePhos	0
Urobili	0			Bilirubin	0	mg/dl
				Amorph	0	mg/dl
				Casts	0

What is your assessment of the urinalysis data?

The urinalysis is essential normal.

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

Hypocalcemia (hypoparathyroidism)

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

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

Parathromone assay

RX:

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

Careful administration of calcium gluconate. Give calcium orally and consider vitamin D therapy.

Learning Issues:

	Review/describe the causes of hypocalcemia in dogs.
	Describe the clinical signs of eclampsia in dogs.
	Describe the causes of tetany in dogs.
	Review the indications for PTH assay in dogs.

Continue with Expanded Case Evaluation

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