Signalment: German shepherd, male, 10 years old
	History: Long history of pelvic limb lameness since 2-3 years of age. During last month, pelvic limb weakness has gotten severe. Treated aggressively with NSAIDS and nutraceuticals with no improvement. Dog's weakness improves with rest. PU/PD has been present for at least 3 months. Vaccinations are current. Dog is inside and outside in fenced yard. Appetite is usually good. No vomiting or diarrhea are reported. Dog does not cough.
	Physical Examination: T. 100.5; P. 85; RR: panting; Wt. 93 pounds; MM pink; CRT <3.0 seconds. Fleas are numerous. The gait is stiff and dog gets up very slowly. Moderate pain and crepitus in both coxofemoral joints. Neurological examination is normal except dog seems to tire with mild exercise. Obvious muscle tremors present after exercise. No other abnormalities found.
	Diagnostic Plan: Using the POVMR format, identify the problems and formulate a diagnostic plan for this case.

No.	Problem
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8 .
9 .
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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	16300	x 103 /mm3		Normal
RBC	7	x 106 /mm3		Rouleaux	none
HGB	18	gr/dl		Polychrome	none
PCV	45	%		Aniso	none
MCV	65	fl		Poik	none
MCV	22	pg		Crenation	none
MCHC	33	g/dl		Target	none
PLT	265000	x 103 /mm3		Hypochrome	none
TP	6.5	gr/dl		BasoStrip	none
FIB		mg/dl		Sphero	none
Retic	0	%		NRBC/199 WBC	none
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		9210
Band		82
Lymph		3178
Eosin		1874
Mono		1956
Baso		0
Other		0
PLTest
Toxic change

Biochemical profile:

Test	Value	Unit	Point your mouse here to view Chemistry Norms	Test	Value	Unit
Sodium	150	m mol/L		T. Bili	0.2	mg/dl
Potassium	4.5	m mol/L		ALKP	45	u/l
Chloride	115	m mol/L		ALT	22	u/l
TCO2	17	m mol/L		AST		u/l
Urea	45	mg/dl		LDH		u/l
Creatinine	1.2	mg/dl		CK		u/l
Calcium	17.6	mg/dl		GGT		u/l
Phosphorus	3.5	mg/dl		Magnesium		mg/dl
Glucose	111	mg/dl		Osmolality		mosm/L
T. Protein	6.2	g/dl		Anion Gap		mosm/L
Albumin	3.1	g/dl
Globulin	2.9	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	neg	ml
Color	pale yellow			RBC	neg
Transparency	clear			Bacteria	neg
Specific Gravity	1.014			Epitheliel	neg
Phosphorus				Fat	neg
Protein	neg	mg/dl		Sperm	neg
Ketones	neg	mg/dl		CaOxalate	neg
Bilirubin	neg			CaCarbonate	neg
Blood	neg			TriplePhos	neg
Urobili	neg			Bilirubin	neg	mg/dl
Glucose	0			Amorph	neg	mg/dl
				Casts	neg

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/describe the causes of hypercalcemia in dogs and cats.
	Describe the consequences of hypercalcemia on renal function in dogs and cats.
	Describe the drugs/agents that decrease serum calcium levels in dogs and cats.
	Describe the pathophysiology of the hypercalcemia of malignancy.
	Describe the treatment/management of canine heartworm disease.

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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