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Presented for 1st time with 9 yr old MN 10# westie from westie rescue group. On drive up here from Smithtown, Long Island? dog went into resp distress and was rushed to animal hospital down in westmoreland, ny? Stayed there for a few days. guess at the time dog was rescued from shelter down there dog had been bathed in peroxide and chlorohexidine?The vet at that time noted severe dental dz, 1/6 lf SHM and abdomen felt bloated, facial alopecia and pruritis. Bdwk was run then cbc/chem/t4 AND 4dx HWT.
I don't have the specifics all the faxed medical report says is elevated bun, trig's, neuts, wbcs and slightly low pcv. T4? HWT was neg. Dog was placed on baytril for a week 22mg sid. skin scrape was + for Sarcoptic mange and dog was given 1% ivermec injection. At hosp dog had diarrhea. dog given ace for excessive barking and anxiety. T=99.1 HR=120 RR=40.
1 wk later dog was given another dose of ivermec injection and was neg for sarcoptic but + for demodex. dog was sent home with goodwinol ointment and lyme sulfur dip.
Dog came in today to recheck skin for mites as many other dogs at foster home and because dog seemed weak couldn't walk. Although was walking around ok in exam room. On PE today here by me:
dog was barking and happy......but emaciated/cachexic with BCS=1-2/9!!!!!
normal temp=100.4, mm=pk/mm=2 sec/good femoral pulses
didn't seem ataxic , although hind legs seemed to high hitch? flip forward a little? CP intact all 4 feet. good anal tone. no head tilt etc. could right itself if crossed hind legs.
all foot pads and accessory carpal pads ulcerated
diffuse alopecia, esp around nose/face/feet
severe dental dz
panting, SHM 2-3/6 heard more on rt side to me, lungs sounded a little wheezy? no nasal discharge seen.
repeated skin scrape =neg from tail, feet, nose, top of head
disc w/O continuing tx for at least next 2-4 wk with oral ivomec and take off goodwinol and lyme sulfur dip. (Nervous though a little with this due to recent resp distress syndrome in past?but I thought Ivomec doses in oral syrup so little:1% ivomec into 108ml cherry syrup-day 1 50ug/kg
day 2-3 100ug
day 4-6 150 ug
day 7-9 200ug
day 10-16 300ug
day 17-45 400ug)
also continued dog on oral baytril 22mg sid x next 3 wk
upon PE dog seemed to have abdominal pain in cranial abdomen but couldn't really palpate anything specific. just felt bloated. dog looks like a goat! disc w/O I was more worried about something going on internally than just skin problem. O okayed repeated bdwk and x-rays.
bdwk:hct 30.5% (NL=37%)
WBC normal at 12.68
plt 1121(NH=500)
chem:Bun 31 (NH=27)
Cr wnl at 0.7
GGT=8(NH=7) and ALKP 657 (NH=212)--no one knows if he is PU/PD/PP?-cushings? emaciation/malnourished? bone?
On rectal exam dog does have a little soft stool with some blood tinge | Ascites? | Can the client learn to check bg's at home? |
I have a client with a 9 and 1/2 year old F/S Bull terrierx that has been significantly PU/PD since early Jan. We started work up with an annual health screen. CBC and T4 were WIN. Chem profile showed elevated ALKP and Chol. UA showed SG of 1.004.With 12 hour water deprivation concentrated to 1.011. 4DX tests were neg. Urine culture was neg. Abdominal ultrasound was normal. Lepto titers are neg. Low dose dex test was normal. What are my other options for testing and treating this dog? Owner is getting frustrated with PU/PD and running out of money for further testing. Wondering about atypical Cushings disease or diabetes insipidus as other possible diagnoses. | Does dog look cushingoid at all? | Can you provide a bit more information, especially labwork that might have been run concurrent with these episodes, the presence of gi signs, how high the fevers are and whether they are responsive to any antibiotic? |
I have a client with a 9 and 1/2 year old F/S Bull terrierx that has been significantly PU/PD since early Jan. We started work up with an annual health screen. CBC and T4 were WIN. Chem profile showed elevated ALKP and Chol. UA showed SG of 1.004.With 12 hour water deprivation concentrated to 1.011. 4DX tests were neg. Urine culture was neg. Abdominal ultrasound was normal. Lepto titers are neg. Low dose dex test was normal. What are my other options for testing and treating this dog? Owner is getting frustrated with PU/PD and running out of money for further testing. Wondering about atypical Cushings disease or diabetes insipidus as other possible diagnoses. | Liver completely normal on ultrasound? | Any chance the blood sat around unspun before sending out the lab? |
I have a client with a 9 and 1/2 year old F/S Bull terrierx that has been significantly PU/PD since early Jan. We started work up with an annual health screen. CBC and T4 were WIN. Chem profile showed elevated ALKP and Chol. UA showed SG of 1.004.With 12 hour water deprivation concentrated to 1.011. 4DX tests were neg. Urine culture was neg. Abdominal ultrasound was normal. Lepto titers are neg. Low dose dex test was normal. What are my other options for testing and treating this dog? Owner is getting frustrated with PU/PD and running out of money for further testing. Wondering about atypical Cushings disease or diabetes insipidus as other possible diagnoses. | Adrenal size equal and within normal range? | Is he normotensive without urinary tract infection? |
I have a client with a 9 and 1/2 year old F/S Bull terrierx that has been significantly PU/PD since early Jan. We started work up with an annual health screen. CBC and T4 were WIN. Chem profile showed elevated ALKP and Chol. UA showed SG of 1.004.With 12 hour water deprivation concentrated to 1.011. 4DX tests were neg. Urine culture was neg. Abdominal ultrasound was normal. Lepto titers are neg. Low dose dex test was normal. What are my other options for testing and treating this dog? Owner is getting frustrated with PU/PD and running out of money for further testing. Wondering about atypical Cushings disease or diabetes insipidus as other possible diagnoses. | Proteinuria? | Don't you just love people? |
I have a client with a 9 and 1/2 year old F/S Bull terrierx that has been significantly PU/PD since early Jan. We started work up with an annual health screen. CBC and T4 were WIN. Chem profile showed elevated ALKP and Chol. UA showed SG of 1.004.With 12 hour water deprivation concentrated to 1.011. 4DX tests were neg. Urine culture was neg. Abdominal ultrasound was normal. Lepto titers are neg. Low dose dex test was normal. What are my other options for testing and treating this dog? Owner is getting frustrated with PU/PD and running out of money for further testing. Wondering about atypical Cushings disease or diabetes insipidus as other possible diagnoses. | Hypertension? | Do you run controls? |
I have a client with a 9 and 1/2 year old F/S Bull terrierx that has been significantly PU/PD since early Jan. We started work up with an annual health screen. CBC and T4 were WIN. Chem profile showed elevated ALKP and Chol. UA showed SG of 1.004.With 12 hour water deprivation concentrated to 1.011. 4DX tests were neg. Urine culture was neg. Abdominal ultrasound was normal. Lepto titers are neg. Low dose dex test was normal. What are my other options for testing and treating this dog? Owner is getting frustrated with PU/PD and running out of money for further testing. Wondering about atypical Cushings disease or diabetes insipidus as other possible diagnoses. | How high was alkp and cholesterol? | Why do you think this dog has myoglobinuria? |
I have a client with a 9 and 1/2 year old F/S Bull terrierx that has been significantly PU/PD since early Jan. We started work up with an annual health screen. CBC and T4 were WIN. Chem profile showed elevated ALKP and Chol. UA showed SG of 1.004.With 12 hour water deprivation concentrated to 1.011. 4DX tests were neg. Urine culture was neg. Abdominal ultrasound was normal. Lepto titers are neg. Low dose dex test was normal. What are my other options for testing and treating this dog? Owner is getting frustrated with PU/PD and running out of money for further testing. Wondering about atypical Cushings disease or diabetes insipidus as other possible diagnoses. | Have you measured uccrs or done a routine acth stim test? | Are the clients doing the curves at home? |
Hi-
I saw a 2 yr. old male cat last week Wednesday with anterior uveitis ( precipitates seen in the anterior chamber in line with the pupil, increased vascularity of the iris, mild corneal edema) There was no topical corneal damage or history of truama. The cat was from a farm environment prior to being adopted and now lives indoors with the owners other cat. The cat has been tested for Feleuk, FIV and was negative for both viruses. A chem panel was perfromed, and that was normal. No other serology was performed for any other organisms yet.
The cat was started on 1% Pred. Acetate to the left eye q' 6 hours and home on 6mg Onsior PO SID for 3 days. Owner to recheck the eye yesterday ( 5 days of therapy). The eye was much improved and the corneal was clear, the iris looked quiet and the fundic exam was normal. There was a small pinkish/white "blob" of material floating in the anterior chanber and would settle ahainst the ventral drainage angle when upright.
My question is, how long do these last? Are they permanent and do I have to worry about them adhering to and blocking a section of the drainage angle.? I plan on seeing this cat on a regular basis to monitor. IS there anything I should be doing now to maximize the outcome?
Thanks-
☼ | Questioning about other physical changes such as weight loss, anorexia, vomiting, diarrhea and the animal’s environment (does this animal have exposure to other animals, to mycotic organisms etc., exposure to endemic areas? | (not just by looking at internal quality control but do you compare how it reads to your in-house chem analyzer sometimes? |
14 yr DMH MN sudden onset very weak in rear. Owner called because she thought he had a saddle thrombus per her internet search. PE: Cat somewhat subdued; knuckling on L front and somewhat weak in rear. Blood work CBC, Chem, T4 all normal except cholesterol of 263. In the home with the cat relaxed (purring even) the Doppler BP reading on the L rear leg was well over 300. The instrument only reads to 300, but I was clearly hearing the pulse waves past that mark. I repeated the test and made sure nothing was kinked, etc. Don't ask about the retina, as I am horrible at funduscopic exams. The cat appears visual (can dart past me down a hall without hitting me or anything else). The heart sounds completely normal with a rate of 160.
I put the cat on 1.25mg Amlodipine SID. He weighs 11#, but I wanted to treat this somewhat aggressively. The owner says 2 days later that he is doing better with getting around, feels good, and is eating well. We plan to recheck the BP in one week. I recommended a cardiac ultrasound to check for HCM, but the owner probably does not want to pur this.
My question: should I put this cat on plavix as a precaution for the potential that all this may be caused by clots floating around from HCM?
Thanks,
☼ | Was the potassium normal (above 4.0)? | What exactly does the complete neuro exam look like? |
14 yr DMH MN sudden onset very weak in rear. Owner called because she thought he had a saddle thrombus per her internet search. PE: Cat somewhat subdued; knuckling on L front and somewhat weak in rear. Blood work CBC, Chem, T4 all normal except cholesterol of 263. In the home with the cat relaxed (purring even) the Doppler BP reading on the L rear leg was well over 300. The instrument only reads to 300, but I was clearly hearing the pulse waves past that mark. I repeated the test and made sure nothing was kinked, etc. Don't ask about the retina, as I am horrible at funduscopic exams. The cat appears visual (can dart past me down a hall without hitting me or anything else). The heart sounds completely normal with a rate of 160.
I put the cat on 1.25mg Amlodipine SID. He weighs 11#, but I wanted to treat this somewhat aggressively. The owner says 2 days later that he is doing better with getting around, feels good, and is eating well. We plan to recheck the BP in one week. I recommended a cardiac ultrasound to check for HCM, but the owner probably does not want to pur this.
My question: should I put this cat on plavix as a precaution for the potential that all this may be caused by clots floating around from HCM?
Thanks,
☼ | Do you have a urinalysis? | R/o dermatophytosis? |
Hi: I am the overnight doc and just inherited this case- my first horrible DKA.
P is a 7yo FS Chi that was dx'd DM over a year ago. O stopped giving insulin 3 weeks ago. P arrived to our clinic last night in DKA.
On presentation, records indicate P was dehydrated, dull mentation. P has hx of heart murmur (4/6 L apical systolic) and severe dental disease. P also has bilateral cataracts. BCS 3/9 with generalized atrophy.
P's bloodwork last night 3/2/13 @ 6:30pm:
CBC- HCT 33.7% (N/N/N), WBC 30.28 (neutrophilia 23.62, monocytosis 5.85, basophilia 0.17, low end of normal lymphocytes 0.51), Plt 358,000
CHEM- Glu >686, BUN 103, Cr 1.1, P 8.3, Ca 4.9, TP 5.7, Alb 3.4, Glob 2.3, ALT 151, ALP 1021, GGT 29, Tbil 0.6, Chol 289, Na 114, K 4.0, Cl 86
P started on 2.2u/kg HumulinR added to 250 0.9% NaCl bag @ 16mL/hr, 1mg/kg cerenia SQ SID, 1mg/kg famotidine IV SID, BG q4hr
Overnight P continued to have dull mentation. P then broke with diarrhea.
Today, P broke with hematochezia, almost constantly leaking out of anus. Other DVM added ampicillin 22mg/kg IV TID
BGs since yesterday:
3/1--- 6:30pm - >686 ; 8pm- HI;
3/2--- 12am- HI; 4:30am- 774; 8am- 737; 10am- 721 (then doc gave 1u HumulinR IM); 1pm- HI (doc gave another 1u HumulinR IM); 3pm- 668; 7:30pm, 625 (all of these by glucometer)
I inherited case and to me P appears obtunded, pale pink mm, warm core temp (101 rectal) but cold distal extremities with HR 160. I bolused 4mL/kg hetastarch IV and HR dec to 135-ish. SpO2 88% with accurate coinciding HR. Small BP cuff has leak, so unable to get a BP.
I rechecked bloodwork with the following:
BG (glucometer) 625
CHEM- Glu 460, Bun >130, Cr 1.4, P 2.9, Ca 4.2, TP (didn't read), ALB 1.7, ALT 97, ALP 786, GGT 15, Tbili 0.7, Chol 213, Na 152, K 3.7, Cl 118
PCV 29%, TS 5.6
Ketones in serum
P started having twitches in pelvic limbs, so gave 0.5mL/kg of 10% Ca Gluconate in case due to low iCa. (We can't measure iCa here and I was taught not to trust iCa calculation).
P continues to be obtunded. P is still pale pink and CRT ~3s. HR was ~128-132 but in the last hour has slowly back increased to ~145. P has RR of ~24 with abdominal effort. Heart murmur sounds static with no crackles/wheezes but harsh lung sounds in four quadrants. I don't have a way to measure blood pH/bicarb. P is still on HumulinR CRI @ 16mL/hr, which is 0.1u/kg/hr. Every time I take off the O2, her SpO2 drops to ~90%.
I'm going to add in baytril for the horrible hematochezia. (It smells like parvo-gut!!)
Here is my question: What else can I do?
1. DKA- I know not to rapidly decrease blood glucose. So far electrolytes are ok. Was it a mistake to give CaGlu? Just continue the CRI and recheck Na/K/P to ensure nothing changing in a "bad" direction?
2. Diarrhea- ampi/baytril seems right to me. I like the famotidine (is 1mg/kg SID the same as 0.5mg/kg BID?) but not sure the P needs cerenia. But then again, cerenia is a cure-all these days, right? (hehe) I am going to make a (risky?) assumption that the increase in BUN is due to the intestinal bleeding.
3. Dehydration vs Heart murmur- I'm afraid to give too many crystalloids bc of fluid overload. I've done only 4mL/kg HES. Should I just continue a 15mL/kg/day CRI in addition to the 0.9% NaCL/HumulinR CRI? Continue slow boluses? I'm not sure why, but I'm afraid to do all the HES. We don't have a syringe pump here, so I think doing short boluses will be easier for P.
4. Tachycardia- Is this pain from the horrible hematochezia? Is this hypovolemic shock? (P still has mildly cold extremities).
5. Low SpO2/ inc RR- Due to acidemia? Due to hypovolemia?
Any suggestions? Anything I've missed due to being slightly overwhelmed?
Thanks | Did she get regular fluids to try to rehydrate her before starting the insulin cri? | What diet he's on? |
Hi: I am the overnight doc and just inherited this case- my first horrible DKA.
P is a 7yo FS Chi that was dx'd DM over a year ago. O stopped giving insulin 3 weeks ago. P arrived to our clinic last night in DKA.
On presentation, records indicate P was dehydrated, dull mentation. P has hx of heart murmur (4/6 L apical systolic) and severe dental disease. P also has bilateral cataracts. BCS 3/9 with generalized atrophy.
P's bloodwork last night 3/2/13 @ 6:30pm:
CBC- HCT 33.7% (N/N/N), WBC 30.28 (neutrophilia 23.62, monocytosis 5.85, basophilia 0.17, low end of normal lymphocytes 0.51), Plt 358,000
CHEM- Glu >686, BUN 103, Cr 1.1, P 8.3, Ca 4.9, TP 5.7, Alb 3.4, Glob 2.3, ALT 151, ALP 1021, GGT 29, Tbil 0.6, Chol 289, Na 114, K 4.0, Cl 86
P started on 2.2u/kg HumulinR added to 250 0.9% NaCl bag @ 16mL/hr, 1mg/kg cerenia SQ SID, 1mg/kg famotidine IV SID, BG q4hr
Overnight P continued to have dull mentation. P then broke with diarrhea.
Today, P broke with hematochezia, almost constantly leaking out of anus. Other DVM added ampicillin 22mg/kg IV TID
BGs since yesterday:
3/1--- 6:30pm - >686 ; 8pm- HI;
3/2--- 12am- HI; 4:30am- 774; 8am- 737; 10am- 721 (then doc gave 1u HumulinR IM); 1pm- HI (doc gave another 1u HumulinR IM); 3pm- 668; 7:30pm, 625 (all of these by glucometer)
I inherited case and to me P appears obtunded, pale pink mm, warm core temp (101 rectal) but cold distal extremities with HR 160. I bolused 4mL/kg hetastarch IV and HR dec to 135-ish. SpO2 88% with accurate coinciding HR. Small BP cuff has leak, so unable to get a BP.
I rechecked bloodwork with the following:
BG (glucometer) 625
CHEM- Glu 460, Bun >130, Cr 1.4, P 2.9, Ca 4.2, TP (didn't read), ALB 1.7, ALT 97, ALP 786, GGT 15, Tbili 0.7, Chol 213, Na 152, K 3.7, Cl 118
PCV 29%, TS 5.6
Ketones in serum
P started having twitches in pelvic limbs, so gave 0.5mL/kg of 10% Ca Gluconate in case due to low iCa. (We can't measure iCa here and I was taught not to trust iCa calculation).
P continues to be obtunded. P is still pale pink and CRT ~3s. HR was ~128-132 but in the last hour has slowly back increased to ~145. P has RR of ~24 with abdominal effort. Heart murmur sounds static with no crackles/wheezes but harsh lung sounds in four quadrants. I don't have a way to measure blood pH/bicarb. P is still on HumulinR CRI @ 16mL/hr, which is 0.1u/kg/hr. Every time I take off the O2, her SpO2 drops to ~90%.
I'm going to add in baytril for the horrible hematochezia. (It smells like parvo-gut!!)
Here is my question: What else can I do?
1. DKA- I know not to rapidly decrease blood glucose. So far electrolytes are ok. Was it a mistake to give CaGlu? Just continue the CRI and recheck Na/K/P to ensure nothing changing in a "bad" direction?
2. Diarrhea- ampi/baytril seems right to me. I like the famotidine (is 1mg/kg SID the same as 0.5mg/kg BID?) but not sure the P needs cerenia. But then again, cerenia is a cure-all these days, right? (hehe) I am going to make a (risky?) assumption that the increase in BUN is due to the intestinal bleeding.
3. Dehydration vs Heart murmur- I'm afraid to give too many crystalloids bc of fluid overload. I've done only 4mL/kg HES. Should I just continue a 15mL/kg/day CRI in addition to the 0.9% NaCL/HumulinR CRI? Continue slow boluses? I'm not sure why, but I'm afraid to do all the HES. We don't have a syringe pump here, so I think doing short boluses will be easier for P.
4. Tachycardia- Is this pain from the horrible hematochezia? Is this hypovolemic shock? (P still has mildly cold extremities).
5. Low SpO2/ inc RR- Due to acidemia? Due to hypovolemia?
Any suggestions? Anything I've missed due to being slightly overwhelmed?
Thanks | Does the patient seem dehydrated? | Can i see some of the owner's curves? |
Hi: I am the overnight doc and just inherited this case- my first horrible DKA.
P is a 7yo FS Chi that was dx'd DM over a year ago. O stopped giving insulin 3 weeks ago. P arrived to our clinic last night in DKA.
On presentation, records indicate P was dehydrated, dull mentation. P has hx of heart murmur (4/6 L apical systolic) and severe dental disease. P also has bilateral cataracts. BCS 3/9 with generalized atrophy.
P's bloodwork last night 3/2/13 @ 6:30pm:
CBC- HCT 33.7% (N/N/N), WBC 30.28 (neutrophilia 23.62, monocytosis 5.85, basophilia 0.17, low end of normal lymphocytes 0.51), Plt 358,000
CHEM- Glu >686, BUN 103, Cr 1.1, P 8.3, Ca 4.9, TP 5.7, Alb 3.4, Glob 2.3, ALT 151, ALP 1021, GGT 29, Tbil 0.6, Chol 289, Na 114, K 4.0, Cl 86
P started on 2.2u/kg HumulinR added to 250 0.9% NaCl bag @ 16mL/hr, 1mg/kg cerenia SQ SID, 1mg/kg famotidine IV SID, BG q4hr
Overnight P continued to have dull mentation. P then broke with diarrhea.
Today, P broke with hematochezia, almost constantly leaking out of anus. Other DVM added ampicillin 22mg/kg IV TID
BGs since yesterday:
3/1--- 6:30pm - >686 ; 8pm- HI;
3/2--- 12am- HI; 4:30am- 774; 8am- 737; 10am- 721 (then doc gave 1u HumulinR IM); 1pm- HI (doc gave another 1u HumulinR IM); 3pm- 668; 7:30pm, 625 (all of these by glucometer)
I inherited case and to me P appears obtunded, pale pink mm, warm core temp (101 rectal) but cold distal extremities with HR 160. I bolused 4mL/kg hetastarch IV and HR dec to 135-ish. SpO2 88% with accurate coinciding HR. Small BP cuff has leak, so unable to get a BP.
I rechecked bloodwork with the following:
BG (glucometer) 625
CHEM- Glu 460, Bun >130, Cr 1.4, P 2.9, Ca 4.2, TP (didn't read), ALB 1.7, ALT 97, ALP 786, GGT 15, Tbili 0.7, Chol 213, Na 152, K 3.7, Cl 118
PCV 29%, TS 5.6
Ketones in serum
P started having twitches in pelvic limbs, so gave 0.5mL/kg of 10% Ca Gluconate in case due to low iCa. (We can't measure iCa here and I was taught not to trust iCa calculation).
P continues to be obtunded. P is still pale pink and CRT ~3s. HR was ~128-132 but in the last hour has slowly back increased to ~145. P has RR of ~24 with abdominal effort. Heart murmur sounds static with no crackles/wheezes but harsh lung sounds in four quadrants. I don't have a way to measure blood pH/bicarb. P is still on HumulinR CRI @ 16mL/hr, which is 0.1u/kg/hr. Every time I take off the O2, her SpO2 drops to ~90%.
I'm going to add in baytril for the horrible hematochezia. (It smells like parvo-gut!!)
Here is my question: What else can I do?
1. DKA- I know not to rapidly decrease blood glucose. So far electrolytes are ok. Was it a mistake to give CaGlu? Just continue the CRI and recheck Na/K/P to ensure nothing changing in a "bad" direction?
2. Diarrhea- ampi/baytril seems right to me. I like the famotidine (is 1mg/kg SID the same as 0.5mg/kg BID?) but not sure the P needs cerenia. But then again, cerenia is a cure-all these days, right? (hehe) I am going to make a (risky?) assumption that the increase in BUN is due to the intestinal bleeding.
3. Dehydration vs Heart murmur- I'm afraid to give too many crystalloids bc of fluid overload. I've done only 4mL/kg HES. Should I just continue a 15mL/kg/day CRI in addition to the 0.9% NaCL/HumulinR CRI? Continue slow boluses? I'm not sure why, but I'm afraid to do all the HES. We don't have a syringe pump here, so I think doing short boluses will be easier for P.
4. Tachycardia- Is this pain from the horrible hematochezia? Is this hypovolemic shock? (P still has mildly cold extremities).
5. Low SpO2/ inc RR- Due to acidemia? Due to hypovolemia?
Any suggestions? Anything I've missed due to being slightly overwhelmed?
Thanks | Has she gained weight? | Why feed the dry at night? |
Hi: I am the overnight doc and just inherited this case- my first horrible DKA.
P is a 7yo FS Chi that was dx'd DM over a year ago. O stopped giving insulin 3 weeks ago. P arrived to our clinic last night in DKA.
On presentation, records indicate P was dehydrated, dull mentation. P has hx of heart murmur (4/6 L apical systolic) and severe dental disease. P also has bilateral cataracts. BCS 3/9 with generalized atrophy.
P's bloodwork last night 3/2/13 @ 6:30pm:
CBC- HCT 33.7% (N/N/N), WBC 30.28 (neutrophilia 23.62, monocytosis 5.85, basophilia 0.17, low end of normal lymphocytes 0.51), Plt 358,000
CHEM- Glu >686, BUN 103, Cr 1.1, P 8.3, Ca 4.9, TP 5.7, Alb 3.4, Glob 2.3, ALT 151, ALP 1021, GGT 29, Tbil 0.6, Chol 289, Na 114, K 4.0, Cl 86
P started on 2.2u/kg HumulinR added to 250 0.9% NaCl bag @ 16mL/hr, 1mg/kg cerenia SQ SID, 1mg/kg famotidine IV SID, BG q4hr
Overnight P continued to have dull mentation. P then broke with diarrhea.
Today, P broke with hematochezia, almost constantly leaking out of anus. Other DVM added ampicillin 22mg/kg IV TID
BGs since yesterday:
3/1--- 6:30pm - >686 ; 8pm- HI;
3/2--- 12am- HI; 4:30am- 774; 8am- 737; 10am- 721 (then doc gave 1u HumulinR IM); 1pm- HI (doc gave another 1u HumulinR IM); 3pm- 668; 7:30pm, 625 (all of these by glucometer)
I inherited case and to me P appears obtunded, pale pink mm, warm core temp (101 rectal) but cold distal extremities with HR 160. I bolused 4mL/kg hetastarch IV and HR dec to 135-ish. SpO2 88% with accurate coinciding HR. Small BP cuff has leak, so unable to get a BP.
I rechecked bloodwork with the following:
BG (glucometer) 625
CHEM- Glu 460, Bun >130, Cr 1.4, P 2.9, Ca 4.2, TP (didn't read), ALB 1.7, ALT 97, ALP 786, GGT 15, Tbili 0.7, Chol 213, Na 152, K 3.7, Cl 118
PCV 29%, TS 5.6
Ketones in serum
P started having twitches in pelvic limbs, so gave 0.5mL/kg of 10% Ca Gluconate in case due to low iCa. (We can't measure iCa here and I was taught not to trust iCa calculation).
P continues to be obtunded. P is still pale pink and CRT ~3s. HR was ~128-132 but in the last hour has slowly back increased to ~145. P has RR of ~24 with abdominal effort. Heart murmur sounds static with no crackles/wheezes but harsh lung sounds in four quadrants. I don't have a way to measure blood pH/bicarb. P is still on HumulinR CRI @ 16mL/hr, which is 0.1u/kg/hr. Every time I take off the O2, her SpO2 drops to ~90%.
I'm going to add in baytril for the horrible hematochezia. (It smells like parvo-gut!!)
Here is my question: What else can I do?
1. DKA- I know not to rapidly decrease blood glucose. So far electrolytes are ok. Was it a mistake to give CaGlu? Just continue the CRI and recheck Na/K/P to ensure nothing changing in a "bad" direction?
2. Diarrhea- ampi/baytril seems right to me. I like the famotidine (is 1mg/kg SID the same as 0.5mg/kg BID?) but not sure the P needs cerenia. But then again, cerenia is a cure-all these days, right? (hehe) I am going to make a (risky?) assumption that the increase in BUN is due to the intestinal bleeding.
3. Dehydration vs Heart murmur- I'm afraid to give too many crystalloids bc of fluid overload. I've done only 4mL/kg HES. Should I just continue a 15mL/kg/day CRI in addition to the 0.9% NaCL/HumulinR CRI? Continue slow boluses? I'm not sure why, but I'm afraid to do all the HES. We don't have a syringe pump here, so I think doing short boluses will be easier for P.
4. Tachycardia- Is this pain from the horrible hematochezia? Is this hypovolemic shock? (P still has mildly cold extremities).
5. Low SpO2/ inc RR- Due to acidemia? Due to hypovolemia?
Any suggestions? Anything I've missed due to being slightly overwhelmed?
Thanks | How has her urine output been? | What's his weight/ bcs? |
Hi: I am the overnight doc and just inherited this case- my first horrible DKA.
P is a 7yo FS Chi that was dx'd DM over a year ago. O stopped giving insulin 3 weeks ago. P arrived to our clinic last night in DKA.
On presentation, records indicate P was dehydrated, dull mentation. P has hx of heart murmur (4/6 L apical systolic) and severe dental disease. P also has bilateral cataracts. BCS 3/9 with generalized atrophy.
P's bloodwork last night 3/2/13 @ 6:30pm:
CBC- HCT 33.7% (N/N/N), WBC 30.28 (neutrophilia 23.62, monocytosis 5.85, basophilia 0.17, low end of normal lymphocytes 0.51), Plt 358,000
CHEM- Glu >686, BUN 103, Cr 1.1, P 8.3, Ca 4.9, TP 5.7, Alb 3.4, Glob 2.3, ALT 151, ALP 1021, GGT 29, Tbil 0.6, Chol 289, Na 114, K 4.0, Cl 86
P started on 2.2u/kg HumulinR added to 250 0.9% NaCl bag @ 16mL/hr, 1mg/kg cerenia SQ SID, 1mg/kg famotidine IV SID, BG q4hr
Overnight P continued to have dull mentation. P then broke with diarrhea.
Today, P broke with hematochezia, almost constantly leaking out of anus. Other DVM added ampicillin 22mg/kg IV TID
BGs since yesterday:
3/1--- 6:30pm - >686 ; 8pm- HI;
3/2--- 12am- HI; 4:30am- 774; 8am- 737; 10am- 721 (then doc gave 1u HumulinR IM); 1pm- HI (doc gave another 1u HumulinR IM); 3pm- 668; 7:30pm, 625 (all of these by glucometer)
I inherited case and to me P appears obtunded, pale pink mm, warm core temp (101 rectal) but cold distal extremities with HR 160. I bolused 4mL/kg hetastarch IV and HR dec to 135-ish. SpO2 88% with accurate coinciding HR. Small BP cuff has leak, so unable to get a BP.
I rechecked bloodwork with the following:
BG (glucometer) 625
CHEM- Glu 460, Bun >130, Cr 1.4, P 2.9, Ca 4.2, TP (didn't read), ALB 1.7, ALT 97, ALP 786, GGT 15, Tbili 0.7, Chol 213, Na 152, K 3.7, Cl 118
PCV 29%, TS 5.6
Ketones in serum
P started having twitches in pelvic limbs, so gave 0.5mL/kg of 10% Ca Gluconate in case due to low iCa. (We can't measure iCa here and I was taught not to trust iCa calculation).
P continues to be obtunded. P is still pale pink and CRT ~3s. HR was ~128-132 but in the last hour has slowly back increased to ~145. P has RR of ~24 with abdominal effort. Heart murmur sounds static with no crackles/wheezes but harsh lung sounds in four quadrants. I don't have a way to measure blood pH/bicarb. P is still on HumulinR CRI @ 16mL/hr, which is 0.1u/kg/hr. Every time I take off the O2, her SpO2 drops to ~90%.
I'm going to add in baytril for the horrible hematochezia. (It smells like parvo-gut!!)
Here is my question: What else can I do?
1. DKA- I know not to rapidly decrease blood glucose. So far electrolytes are ok. Was it a mistake to give CaGlu? Just continue the CRI and recheck Na/K/P to ensure nothing changing in a "bad" direction?
2. Diarrhea- ampi/baytril seems right to me. I like the famotidine (is 1mg/kg SID the same as 0.5mg/kg BID?) but not sure the P needs cerenia. But then again, cerenia is a cure-all these days, right? (hehe) I am going to make a (risky?) assumption that the increase in BUN is due to the intestinal bleeding.
3. Dehydration vs Heart murmur- I'm afraid to give too many crystalloids bc of fluid overload. I've done only 4mL/kg HES. Should I just continue a 15mL/kg/day CRI in addition to the 0.9% NaCL/HumulinR CRI? Continue slow boluses? I'm not sure why, but I'm afraid to do all the HES. We don't have a syringe pump here, so I think doing short boluses will be easier for P.
4. Tachycardia- Is this pain from the horrible hematochezia? Is this hypovolemic shock? (P still has mildly cold extremities).
5. Low SpO2/ inc RR- Due to acidemia? Due to hypovolemia?
Any suggestions? Anything I've missed due to being slightly overwhelmed?
Thanks | Is there any chance of getting an echo? | How much should he weigh? |
Hi: I am the overnight doc and just inherited this case- my first horrible DKA.
P is a 7yo FS Chi that was dx'd DM over a year ago. O stopped giving insulin 3 weeks ago. P arrived to our clinic last night in DKA.
On presentation, records indicate P was dehydrated, dull mentation. P has hx of heart murmur (4/6 L apical systolic) and severe dental disease. P also has bilateral cataracts. BCS 3/9 with generalized atrophy.
P's bloodwork last night 3/2/13 @ 6:30pm:
CBC- HCT 33.7% (N/N/N), WBC 30.28 (neutrophilia 23.62, monocytosis 5.85, basophilia 0.17, low end of normal lymphocytes 0.51), Plt 358,000
CHEM- Glu >686, BUN 103, Cr 1.1, P 8.3, Ca 4.9, TP 5.7, Alb 3.4, Glob 2.3, ALT 151, ALP 1021, GGT 29, Tbil 0.6, Chol 289, Na 114, K 4.0, Cl 86
P started on 2.2u/kg HumulinR added to 250 0.9% NaCl bag @ 16mL/hr, 1mg/kg cerenia SQ SID, 1mg/kg famotidine IV SID, BG q4hr
Overnight P continued to have dull mentation. P then broke with diarrhea.
Today, P broke with hematochezia, almost constantly leaking out of anus. Other DVM added ampicillin 22mg/kg IV TID
BGs since yesterday:
3/1--- 6:30pm - >686 ; 8pm- HI;
3/2--- 12am- HI; 4:30am- 774; 8am- 737; 10am- 721 (then doc gave 1u HumulinR IM); 1pm- HI (doc gave another 1u HumulinR IM); 3pm- 668; 7:30pm, 625 (all of these by glucometer)
I inherited case and to me P appears obtunded, pale pink mm, warm core temp (101 rectal) but cold distal extremities with HR 160. I bolused 4mL/kg hetastarch IV and HR dec to 135-ish. SpO2 88% with accurate coinciding HR. Small BP cuff has leak, so unable to get a BP.
I rechecked bloodwork with the following:
BG (glucometer) 625
CHEM- Glu 460, Bun >130, Cr 1.4, P 2.9, Ca 4.2, TP (didn't read), ALB 1.7, ALT 97, ALP 786, GGT 15, Tbili 0.7, Chol 213, Na 152, K 3.7, Cl 118
PCV 29%, TS 5.6
Ketones in serum
P started having twitches in pelvic limbs, so gave 0.5mL/kg of 10% Ca Gluconate in case due to low iCa. (We can't measure iCa here and I was taught not to trust iCa calculation).
P continues to be obtunded. P is still pale pink and CRT ~3s. HR was ~128-132 but in the last hour has slowly back increased to ~145. P has RR of ~24 with abdominal effort. Heart murmur sounds static with no crackles/wheezes but harsh lung sounds in four quadrants. I don't have a way to measure blood pH/bicarb. P is still on HumulinR CRI @ 16mL/hr, which is 0.1u/kg/hr. Every time I take off the O2, her SpO2 drops to ~90%.
I'm going to add in baytril for the horrible hematochezia. (It smells like parvo-gut!!)
Here is my question: What else can I do?
1. DKA- I know not to rapidly decrease blood glucose. So far electrolytes are ok. Was it a mistake to give CaGlu? Just continue the CRI and recheck Na/K/P to ensure nothing changing in a "bad" direction?
2. Diarrhea- ampi/baytril seems right to me. I like the famotidine (is 1mg/kg SID the same as 0.5mg/kg BID?) but not sure the P needs cerenia. But then again, cerenia is a cure-all these days, right? (hehe) I am going to make a (risky?) assumption that the increase in BUN is due to the intestinal bleeding.
3. Dehydration vs Heart murmur- I'm afraid to give too many crystalloids bc of fluid overload. I've done only 4mL/kg HES. Should I just continue a 15mL/kg/day CRI in addition to the 0.9% NaCL/HumulinR CRI? Continue slow boluses? I'm not sure why, but I'm afraid to do all the HES. We don't have a syringe pump here, so I think doing short boluses will be easier for P.
4. Tachycardia- Is this pain from the horrible hematochezia? Is this hypovolemic shock? (P still has mildly cold extremities).
5. Low SpO2/ inc RR- Due to acidemia? Due to hypovolemia?
Any suggestions? Anything I've missed due to being slightly overwhelmed?
Thanks | Have you considered a recheck platelet count and clotting times? | For a little dog this size, i'd expect that you're giving in the range of 1.25 mg/day of prednisone, right? |
Hi: I am the overnight doc and just inherited this case- my first horrible DKA.
P is a 7yo FS Chi that was dx'd DM over a year ago. O stopped giving insulin 3 weeks ago. P arrived to our clinic last night in DKA.
On presentation, records indicate P was dehydrated, dull mentation. P has hx of heart murmur (4/6 L apical systolic) and severe dental disease. P also has bilateral cataracts. BCS 3/9 with generalized atrophy.
P's bloodwork last night 3/2/13 @ 6:30pm:
CBC- HCT 33.7% (N/N/N), WBC 30.28 (neutrophilia 23.62, monocytosis 5.85, basophilia 0.17, low end of normal lymphocytes 0.51), Plt 358,000
CHEM- Glu >686, BUN 103, Cr 1.1, P 8.3, Ca 4.9, TP 5.7, Alb 3.4, Glob 2.3, ALT 151, ALP 1021, GGT 29, Tbil 0.6, Chol 289, Na 114, K 4.0, Cl 86
P started on 2.2u/kg HumulinR added to 250 0.9% NaCl bag @ 16mL/hr, 1mg/kg cerenia SQ SID, 1mg/kg famotidine IV SID, BG q4hr
Overnight P continued to have dull mentation. P then broke with diarrhea.
Today, P broke with hematochezia, almost constantly leaking out of anus. Other DVM added ampicillin 22mg/kg IV TID
BGs since yesterday:
3/1--- 6:30pm - >686 ; 8pm- HI;
3/2--- 12am- HI; 4:30am- 774; 8am- 737; 10am- 721 (then doc gave 1u HumulinR IM); 1pm- HI (doc gave another 1u HumulinR IM); 3pm- 668; 7:30pm, 625 (all of these by glucometer)
I inherited case and to me P appears obtunded, pale pink mm, warm core temp (101 rectal) but cold distal extremities with HR 160. I bolused 4mL/kg hetastarch IV and HR dec to 135-ish. SpO2 88% with accurate coinciding HR. Small BP cuff has leak, so unable to get a BP.
I rechecked bloodwork with the following:
BG (glucometer) 625
CHEM- Glu 460, Bun >130, Cr 1.4, P 2.9, Ca 4.2, TP (didn't read), ALB 1.7, ALT 97, ALP 786, GGT 15, Tbili 0.7, Chol 213, Na 152, K 3.7, Cl 118
PCV 29%, TS 5.6
Ketones in serum
P started having twitches in pelvic limbs, so gave 0.5mL/kg of 10% Ca Gluconate in case due to low iCa. (We can't measure iCa here and I was taught not to trust iCa calculation).
P continues to be obtunded. P is still pale pink and CRT ~3s. HR was ~128-132 but in the last hour has slowly back increased to ~145. P has RR of ~24 with abdominal effort. Heart murmur sounds static with no crackles/wheezes but harsh lung sounds in four quadrants. I don't have a way to measure blood pH/bicarb. P is still on HumulinR CRI @ 16mL/hr, which is 0.1u/kg/hr. Every time I take off the O2, her SpO2 drops to ~90%.
I'm going to add in baytril for the horrible hematochezia. (It smells like parvo-gut!!)
Here is my question: What else can I do?
1. DKA- I know not to rapidly decrease blood glucose. So far electrolytes are ok. Was it a mistake to give CaGlu? Just continue the CRI and recheck Na/K/P to ensure nothing changing in a "bad" direction?
2. Diarrhea- ampi/baytril seems right to me. I like the famotidine (is 1mg/kg SID the same as 0.5mg/kg BID?) but not sure the P needs cerenia. But then again, cerenia is a cure-all these days, right? (hehe) I am going to make a (risky?) assumption that the increase in BUN is due to the intestinal bleeding.
3. Dehydration vs Heart murmur- I'm afraid to give too many crystalloids bc of fluid overload. I've done only 4mL/kg HES. Should I just continue a 15mL/kg/day CRI in addition to the 0.9% NaCL/HumulinR CRI? Continue slow boluses? I'm not sure why, but I'm afraid to do all the HES. We don't have a syringe pump here, so I think doing short boluses will be easier for P.
4. Tachycardia- Is this pain from the horrible hematochezia? Is this hypovolemic shock? (P still has mildly cold extremities).
5. Low SpO2/ inc RR- Due to acidemia? Due to hypovolemia?
Any suggestions? Anything I've missed due to being slightly overwhelmed?
Thanks | Is the patient painful on abdominal palpation? | Did we do any discriminating tests to figure out if the dog has pdh or an adrenal tumor? |
Our lovely 19 yo F/S DSH clinic cat has been having recurrent UTI's over the last few years. The frequency of recurrence has worsened over last several months. We have presumptively diagnosed her with chronic pancreatitis/IBD based on many U/S, labwork and response to treatment. She has been on prednisolone since April 2011, her current dose is 5 mg SID.
We have cultured several urinary organisms over time--Enterococcus faecalis, alpha hemolytic Strep, E. coli three times. And have demonstrated clearance of the infection based on cultures on samples taken via cysto always 5 to 7 days after finishing antibiotics.
However, as of the last 3 or 4 months, we have been treating her repeatedly with convenia, knowing that it was a big no-no--no excuse, other than stupidity, to be frank--we were aware of the risks but did it anyway.
C&S on December 8, 2012 was was E. coli with the following sensitivity profile:
Amikacin - S
Amoxicillin - R
Clavamox - R
Cefalexin - R
Cefovecin - R
Ceftiofur - R
Chloramphenicol - I
Cipro - S
Doxycycline - R
Enrofloxacin - I
Gentamycin - S
Imipenim - S
Marbofloxacin - S
Nitrofurantoin - S
Tetracycline - R
Tobramycin - S
TMS - S
We started her on Zeniquin for an 8 week course.
A month later (Jan 10th), she had an abdominal U/S. She had bilateral pylectasia, both kidneys had mildly decreased corticomedullary detail.
Pelvis Kidney length
L kidney 0.18cm 3.5cm
R kidney 0.12cm 3.64cm
Also, re the L kidney -- a shadowing structure in the L renal pelvis possibly resembling a forming renolith (0.21cm--how can this
be when the whole pelvis measures 0.18cm?)
And, re the R kidney --- an anechoic thin walled cyst like structure 0.19cm x 0.15cm.
Her bladder was WNL, apical wall 2mm, bladder was very empty at time of U/S.
We kept her on the Zeniquin and recultured February 21st. We now have Methicillin Resistant Staphylococcus epidermis with the following profile:
Amikacin - S
Amoxicillin - R
Clavamox - R
Cefalexin - R
Cefovecin - R
Chloramphenicol - S
Cipro - R
Clindamycin - R
Doxycycline - S
Enrofloxacin - I
Gentamycin - S
Imipenim - R
Marbofloxacin - R
Mupirocin - S
Nitrofurantoin - S
Oxacillin - R
Penicilllin - R
Rifampin - I
Tetracycline - S
TMS - S
Her bloods have been good, with frequent mild increases in BUN. USG has between 1.022 and 1.032-- usually 1.026 to 1.028.
She has been free from LUT signs which would recur like clockwork 2 weeks post Convenia. I think we used it 4 times in a row :(. She has also been free of LUT signs since starting on the Zeniquin.
After reading a few posts, it seems that I should be starting her on Clavamox? Should I continue the Zeniquin as well--she has been on the Zeniquin since January 10th, so 7 weeks. As I type this, the thought is lurking in my brain that having her on Zeniquin for this long is not a good idea, aside from our blatant overuse of Convenia.
Also, as of February 21, she is now diabetic as well. She is on Glargine 1 unit BID and doing well--1st curve due right away here.
Looking back at her entire history today, I'm realizing that we should be doing more for her IBD. We have not checked her B12 or folate for 2 years. Is it still recommended to test folate as well, and, if low, supplement?
She is on Metronidazole chronically to control diarrhea, as well as gabapentin 20 mg BID for arthritis. She has bilateral elbow arthritis, quite severe on one side. We had started her on buprenorphine when we started the gabapentin but that has gone by the wayside. I have been reading about Convenia for pain, especially bladder pain, what do you think of doing a 5 days on, 2 days off protocol? Just a thought as could avoid any sedation from buprenorphine. Any other ideas for pain--she is easy to pill so could start amantadine, etc. We have used Cartrophen or Adequen, but not for some time, so time to do another round.
She currently eats Purina Maintenance, as she tolerates the best in terms of vomiting and diarrhea.
Thank you in advance for your comments and suggestions. | As for "her bloods have been good" - how good? | Still significantly pu/pd? |
Our lovely 19 yo F/S DSH clinic cat has been having recurrent UTI's over the last few years. The frequency of recurrence has worsened over last several months. We have presumptively diagnosed her with chronic pancreatitis/IBD based on many U/S, labwork and response to treatment. She has been on prednisolone since April 2011, her current dose is 5 mg SID.
We have cultured several urinary organisms over time--Enterococcus faecalis, alpha hemolytic Strep, E. coli three times. And have demonstrated clearance of the infection based on cultures on samples taken via cysto always 5 to 7 days after finishing antibiotics.
However, as of the last 3 or 4 months, we have been treating her repeatedly with convenia, knowing that it was a big no-no--no excuse, other than stupidity, to be frank--we were aware of the risks but did it anyway.
C&S on December 8, 2012 was was E. coli with the following sensitivity profile:
Amikacin - S
Amoxicillin - R
Clavamox - R
Cefalexin - R
Cefovecin - R
Ceftiofur - R
Chloramphenicol - I
Cipro - S
Doxycycline - R
Enrofloxacin - I
Gentamycin - S
Imipenim - S
Marbofloxacin - S
Nitrofurantoin - S
Tetracycline - R
Tobramycin - S
TMS - S
We started her on Zeniquin for an 8 week course.
A month later (Jan 10th), she had an abdominal U/S. She had bilateral pylectasia, both kidneys had mildly decreased corticomedullary detail.
Pelvis Kidney length
L kidney 0.18cm 3.5cm
R kidney 0.12cm 3.64cm
Also, re the L kidney -- a shadowing structure in the L renal pelvis possibly resembling a forming renolith (0.21cm--how can this
be when the whole pelvis measures 0.18cm?)
And, re the R kidney --- an anechoic thin walled cyst like structure 0.19cm x 0.15cm.
Her bladder was WNL, apical wall 2mm, bladder was very empty at time of U/S.
We kept her on the Zeniquin and recultured February 21st. We now have Methicillin Resistant Staphylococcus epidermis with the following profile:
Amikacin - S
Amoxicillin - R
Clavamox - R
Cefalexin - R
Cefovecin - R
Chloramphenicol - S
Cipro - R
Clindamycin - R
Doxycycline - S
Enrofloxacin - I
Gentamycin - S
Imipenim - R
Marbofloxacin - R
Mupirocin - S
Nitrofurantoin - S
Oxacillin - R
Penicilllin - R
Rifampin - I
Tetracycline - S
TMS - S
Her bloods have been good, with frequent mild increases in BUN. USG has between 1.022 and 1.032-- usually 1.026 to 1.028.
She has been free from LUT signs which would recur like clockwork 2 weeks post Convenia. I think we used it 4 times in a row :(. She has also been free of LUT signs since starting on the Zeniquin.
After reading a few posts, it seems that I should be starting her on Clavamox? Should I continue the Zeniquin as well--she has been on the Zeniquin since January 10th, so 7 weeks. As I type this, the thought is lurking in my brain that having her on Zeniquin for this long is not a good idea, aside from our blatant overuse of Convenia.
Also, as of February 21, she is now diabetic as well. She is on Glargine 1 unit BID and doing well--1st curve due right away here.
Looking back at her entire history today, I'm realizing that we should be doing more for her IBD. We have not checked her B12 or folate for 2 years. Is it still recommended to test folate as well, and, if low, supplement?
She is on Metronidazole chronically to control diarrhea, as well as gabapentin 20 mg BID for arthritis. She has bilateral elbow arthritis, quite severe on one side. We had started her on buprenorphine when we started the gabapentin but that has gone by the wayside. I have been reading about Convenia for pain, especially bladder pain, what do you think of doing a 5 days on, 2 days off protocol? Just a thought as could avoid any sedation from buprenorphine. Any other ideas for pain--she is easy to pill so could start amantadine, etc. We have used Cartrophen or Adequen, but not for some time, so time to do another round.
She currently eats Purina Maintenance, as she tolerates the best in terms of vomiting and diarrhea.
Thank you in advance for your comments and suggestions. | Is there hematuria? | Would get a fasted glu .....maybe he is on board line for becoming diabetic? |
Our lovely 19 yo F/S DSH clinic cat has been having recurrent UTI's over the last few years. The frequency of recurrence has worsened over last several months. We have presumptively diagnosed her with chronic pancreatitis/IBD based on many U/S, labwork and response to treatment. She has been on prednisolone since April 2011, her current dose is 5 mg SID.
We have cultured several urinary organisms over time--Enterococcus faecalis, alpha hemolytic Strep, E. coli three times. And have demonstrated clearance of the infection based on cultures on samples taken via cysto always 5 to 7 days after finishing antibiotics.
However, as of the last 3 or 4 months, we have been treating her repeatedly with convenia, knowing that it was a big no-no--no excuse, other than stupidity, to be frank--we were aware of the risks but did it anyway.
C&S on December 8, 2012 was was E. coli with the following sensitivity profile:
Amikacin - S
Amoxicillin - R
Clavamox - R
Cefalexin - R
Cefovecin - R
Ceftiofur - R
Chloramphenicol - I
Cipro - S
Doxycycline - R
Enrofloxacin - I
Gentamycin - S
Imipenim - S
Marbofloxacin - S
Nitrofurantoin - S
Tetracycline - R
Tobramycin - S
TMS - S
We started her on Zeniquin for an 8 week course.
A month later (Jan 10th), she had an abdominal U/S. She had bilateral pylectasia, both kidneys had mildly decreased corticomedullary detail.
Pelvis Kidney length
L kidney 0.18cm 3.5cm
R kidney 0.12cm 3.64cm
Also, re the L kidney -- a shadowing structure in the L renal pelvis possibly resembling a forming renolith (0.21cm--how can this
be when the whole pelvis measures 0.18cm?)
And, re the R kidney --- an anechoic thin walled cyst like structure 0.19cm x 0.15cm.
Her bladder was WNL, apical wall 2mm, bladder was very empty at time of U/S.
We kept her on the Zeniquin and recultured February 21st. We now have Methicillin Resistant Staphylococcus epidermis with the following profile:
Amikacin - S
Amoxicillin - R
Clavamox - R
Cefalexin - R
Cefovecin - R
Chloramphenicol - S
Cipro - R
Clindamycin - R
Doxycycline - S
Enrofloxacin - I
Gentamycin - S
Imipenim - R
Marbofloxacin - R
Mupirocin - S
Nitrofurantoin - S
Oxacillin - R
Penicilllin - R
Rifampin - I
Tetracycline - S
TMS - S
Her bloods have been good, with frequent mild increases in BUN. USG has between 1.022 and 1.032-- usually 1.026 to 1.028.
She has been free from LUT signs which would recur like clockwork 2 weeks post Convenia. I think we used it 4 times in a row :(. She has also been free of LUT signs since starting on the Zeniquin.
After reading a few posts, it seems that I should be starting her on Clavamox? Should I continue the Zeniquin as well--she has been on the Zeniquin since January 10th, so 7 weeks. As I type this, the thought is lurking in my brain that having her on Zeniquin for this long is not a good idea, aside from our blatant overuse of Convenia.
Also, as of February 21, she is now diabetic as well. She is on Glargine 1 unit BID and doing well--1st curve due right away here.
Looking back at her entire history today, I'm realizing that we should be doing more for her IBD. We have not checked her B12 or folate for 2 years. Is it still recommended to test folate as well, and, if low, supplement?
She is on Metronidazole chronically to control diarrhea, as well as gabapentin 20 mg BID for arthritis. She has bilateral elbow arthritis, quite severe on one side. We had started her on buprenorphine when we started the gabapentin but that has gone by the wayside. I have been reading about Convenia for pain, especially bladder pain, what do you think of doing a 5 days on, 2 days off protocol? Just a thought as could avoid any sedation from buprenorphine. Any other ideas for pain--she is easy to pill so could start amantadine, etc. We have used Cartrophen or Adequen, but not for some time, so time to do another round.
She currently eats Purina Maintenance, as she tolerates the best in terms of vomiting and diarrhea.
Thank you in advance for your comments and suggestions. | Pyuria? | Is there any evidence of other sease in this patient, inclung pancreatitis and obesity? |
Our lovely 19 yo F/S DSH clinic cat has been having recurrent UTI's over the last few years. The frequency of recurrence has worsened over last several months. We have presumptively diagnosed her with chronic pancreatitis/IBD based on many U/S, labwork and response to treatment. She has been on prednisolone since April 2011, her current dose is 5 mg SID.
We have cultured several urinary organisms over time--Enterococcus faecalis, alpha hemolytic Strep, E. coli three times. And have demonstrated clearance of the infection based on cultures on samples taken via cysto always 5 to 7 days after finishing antibiotics.
However, as of the last 3 or 4 months, we have been treating her repeatedly with convenia, knowing that it was a big no-no--no excuse, other than stupidity, to be frank--we were aware of the risks but did it anyway.
C&S on December 8, 2012 was was E. coli with the following sensitivity profile:
Amikacin - S
Amoxicillin - R
Clavamox - R
Cefalexin - R
Cefovecin - R
Ceftiofur - R
Chloramphenicol - I
Cipro - S
Doxycycline - R
Enrofloxacin - I
Gentamycin - S
Imipenim - S
Marbofloxacin - S
Nitrofurantoin - S
Tetracycline - R
Tobramycin - S
TMS - S
We started her on Zeniquin for an 8 week course.
A month later (Jan 10th), she had an abdominal U/S. She had bilateral pylectasia, both kidneys had mildly decreased corticomedullary detail.
Pelvis Kidney length
L kidney 0.18cm 3.5cm
R kidney 0.12cm 3.64cm
Also, re the L kidney -- a shadowing structure in the L renal pelvis possibly resembling a forming renolith (0.21cm--how can this
be when the whole pelvis measures 0.18cm?)
And, re the R kidney --- an anechoic thin walled cyst like structure 0.19cm x 0.15cm.
Her bladder was WNL, apical wall 2mm, bladder was very empty at time of U/S.
We kept her on the Zeniquin and recultured February 21st. We now have Methicillin Resistant Staphylococcus epidermis with the following profile:
Amikacin - S
Amoxicillin - R
Clavamox - R
Cefalexin - R
Cefovecin - R
Chloramphenicol - S
Cipro - R
Clindamycin - R
Doxycycline - S
Enrofloxacin - I
Gentamycin - S
Imipenim - R
Marbofloxacin - R
Mupirocin - S
Nitrofurantoin - S
Oxacillin - R
Penicilllin - R
Rifampin - I
Tetracycline - S
TMS - S
Her bloods have been good, with frequent mild increases in BUN. USG has between 1.022 and 1.032-- usually 1.026 to 1.028.
She has been free from LUT signs which would recur like clockwork 2 weeks post Convenia. I think we used it 4 times in a row :(. She has also been free of LUT signs since starting on the Zeniquin.
After reading a few posts, it seems that I should be starting her on Clavamox? Should I continue the Zeniquin as well--she has been on the Zeniquin since January 10th, so 7 weeks. As I type this, the thought is lurking in my brain that having her on Zeniquin for this long is not a good idea, aside from our blatant overuse of Convenia.
Also, as of February 21, she is now diabetic as well. She is on Glargine 1 unit BID and doing well--1st curve due right away here.
Looking back at her entire history today, I'm realizing that we should be doing more for her IBD. We have not checked her B12 or folate for 2 years. Is it still recommended to test folate as well, and, if low, supplement?
She is on Metronidazole chronically to control diarrhea, as well as gabapentin 20 mg BID for arthritis. She has bilateral elbow arthritis, quite severe on one side. We had started her on buprenorphine when we started the gabapentin but that has gone by the wayside. I have been reading about Convenia for pain, especially bladder pain, what do you think of doing a 5 days on, 2 days off protocol? Just a thought as could avoid any sedation from buprenorphine. Any other ideas for pain--she is easy to pill so could start amantadine, etc. We have used Cartrophen or Adequen, but not for some time, so time to do another round.
She currently eats Purina Maintenance, as she tolerates the best in terms of vomiting and diarrhea.
Thank you in advance for your comments and suggestions. | Clinical signs? | Amazing isn't it? |
Hello
Riley is a 13 yr old M(N) DSH. Oct 3/12 he was diagnosed with diabetes. The rest of his blood work was good. These are very good owners and they do their own BG curves. Riley was started on caninsulin , 1 unit bid. The owners measured his water intake, increased to 2 units bid. We saw some improvement in energy and decrease in water consumption. he eventually was on 31/2 units bid. STill pu/pd but not as severe. In January of this year he was not doing as well. His energy was down, he was mildly dehyrated. I did a C&S on his urine. No growth. His curves were down to 8 mmol/L but only staying down for a couple of hours. He would be over 20 by the time the next injection was given. We decided to change the insulin to glargine. He started to show improvement. When he was up to 41/2 units bid his curves looked good. He was going down to 5 and 6 and staying under 18. The owners have done multiple curves throughout Feb and they generally look good. Riley does not.
He has developed a neuropathy and his energy is down. He is also pu/pd
I have run complete blood and urine on him including fructosamine, fpl and cobalamin
Hi thyroid is normal range, his glucose is 17.4 (this was later in the day) 8-9 hours post injection. His fructosamin was 526 (should be under 349). His fpl is 5.6 (0-3.5 ug/L). I do not have the cobalamin results back as yet. When the owner had checked his BG the day before he had gone down to 4 and stayed under 17. Everything was normal
Any suggestions would be helpful
Thank you
☼ | The day before what? | What's the globulin level? |
Hello
Riley is a 13 yr old M(N) DSH. Oct 3/12 he was diagnosed with diabetes. The rest of his blood work was good. These are very good owners and they do their own BG curves. Riley was started on caninsulin , 1 unit bid. The owners measured his water intake, increased to 2 units bid. We saw some improvement in energy and decrease in water consumption. he eventually was on 31/2 units bid. STill pu/pd but not as severe. In January of this year he was not doing as well. His energy was down, he was mildly dehyrated. I did a C&S on his urine. No growth. His curves were down to 8 mmol/L but only staying down for a couple of hours. He would be over 20 by the time the next injection was given. We decided to change the insulin to glargine. He started to show improvement. When he was up to 41/2 units bid his curves looked good. He was going down to 5 and 6 and staying under 18. The owners have done multiple curves throughout Feb and they generally look good. Riley does not.
He has developed a neuropathy and his energy is down. He is also pu/pd
I have run complete blood and urine on him including fructosamine, fpl and cobalamin
Hi thyroid is normal range, his glucose is 17.4 (this was later in the day) 8-9 hours post injection. His fructosamin was 526 (should be under 349). His fpl is 5.6 (0-3.5 ug/L). I do not have the cobalamin results back as yet. When the owner had checked his BG the day before he had gone down to 4 and stayed under 17. Everything was normal
Any suggestions would be helpful
Thank you
☼ | Can you post the last curve you had and maybe a couple before that? | Was the stim in september started 3-5 hours after the am trilostane was given with food? |
Hello
Riley is a 13 yr old M(N) DSH. Oct 3/12 he was diagnosed with diabetes. The rest of his blood work was good. These are very good owners and they do their own BG curves. Riley was started on caninsulin , 1 unit bid. The owners measured his water intake, increased to 2 units bid. We saw some improvement in energy and decrease in water consumption. he eventually was on 31/2 units bid. STill pu/pd but not as severe. In January of this year he was not doing as well. His energy was down, he was mildly dehyrated. I did a C&S on his urine. No growth. His curves were down to 8 mmol/L but only staying down for a couple of hours. He would be over 20 by the time the next injection was given. We decided to change the insulin to glargine. He started to show improvement. When he was up to 41/2 units bid his curves looked good. He was going down to 5 and 6 and staying under 18. The owners have done multiple curves throughout Feb and they generally look good. Riley does not.
He has developed a neuropathy and his energy is down. He is also pu/pd
I have run complete blood and urine on him including fructosamine, fpl and cobalamin
Hi thyroid is normal range, his glucose is 17.4 (this was later in the day) 8-9 hours post injection. His fructosamin was 526 (should be under 349). His fpl is 5.6 (0-3.5 ug/L). I do not have the cobalamin results back as yet. When the owner had checked his BG the day before he had gone down to 4 and stayed under 17. Everything was normal
Any suggestions would be helpful
Thank you
☼ | How are his clinical signs of diabetes? | Is it the same number of calories each time? |
Hello
Riley is a 13 yr old M(N) DSH. Oct 3/12 he was diagnosed with diabetes. The rest of his blood work was good. These are very good owners and they do their own BG curves. Riley was started on caninsulin , 1 unit bid. The owners measured his water intake, increased to 2 units bid. We saw some improvement in energy and decrease in water consumption. he eventually was on 31/2 units bid. STill pu/pd but not as severe. In January of this year he was not doing as well. His energy was down, he was mildly dehyrated. I did a C&S on his urine. No growth. His curves were down to 8 mmol/L but only staying down for a couple of hours. He would be over 20 by the time the next injection was given. We decided to change the insulin to glargine. He started to show improvement. When he was up to 41/2 units bid his curves looked good. He was going down to 5 and 6 and staying under 18. The owners have done multiple curves throughout Feb and they generally look good. Riley does not.
He has developed a neuropathy and his energy is down. He is also pu/pd
I have run complete blood and urine on him including fructosamine, fpl and cobalamin
Hi thyroid is normal range, his glucose is 17.4 (this was later in the day) 8-9 hours post injection. His fructosamin was 526 (should be under 349). His fpl is 5.6 (0-3.5 ug/L). I do not have the cobalamin results back as yet. When the owner had checked his BG the day before he had gone down to 4 and stayed under 17. Everything was normal
Any suggestions would be helpful
Thank you
☼ | He is eating o.k.? | How many kcals is this kitty eating daily (evo dry has 626 kcal/cup)? |
Hello
Riley is a 13 yr old M(N) DSH. Oct 3/12 he was diagnosed with diabetes. The rest of his blood work was good. These are very good owners and they do their own BG curves. Riley was started on caninsulin , 1 unit bid. The owners measured his water intake, increased to 2 units bid. We saw some improvement in energy and decrease in water consumption. he eventually was on 31/2 units bid. STill pu/pd but not as severe. In January of this year he was not doing as well. His energy was down, he was mildly dehyrated. I did a C&S on his urine. No growth. His curves were down to 8 mmol/L but only staying down for a couple of hours. He would be over 20 by the time the next injection was given. We decided to change the insulin to glargine. He started to show improvement. When he was up to 41/2 units bid his curves looked good. He was going down to 5 and 6 and staying under 18. The owners have done multiple curves throughout Feb and they generally look good. Riley does not.
He has developed a neuropathy and his energy is down. He is also pu/pd
I have run complete blood and urine on him including fructosamine, fpl and cobalamin
Hi thyroid is normal range, his glucose is 17.4 (this was later in the day) 8-9 hours post injection. His fructosamin was 526 (should be under 349). His fpl is 5.6 (0-3.5 ug/L). I do not have the cobalamin results back as yet. When the owner had checked his BG the day before he had gone down to 4 and stayed under 17. Everything was normal
Any suggestions would be helpful
Thank you
☼ | Is he meal fed or free choice? | What does this ecg show you? |
A 7 yo lab presented to me for Achilles tendon rupture 6 months ago on a left side.
Surgery went well, recovery also.
Became lame on the right side 2 months ago,
Rads showed mild patellar tendinitis (same as you sometimes see at the 6 week TPLO recheck) but also confirmed stifle effusion and mild DJD which was consistent with my suspicion of a partial CCL tear.
in surgery: partial tear and nothing abnormal with the patellar tendon,
4 weeks post-op, the patellar tendon is 5 times normal size. It is obviously enlarged clinically.
Ultrasound did not show much, nor rads (I will post them tomorrow).
Have you guys seen severe patellar tendinitis like this?
☼ | What surgery did you do? | How long has the dog been diabetic? |
A 7 yo lab presented to me for Achilles tendon rupture 6 months ago on a left side.
Surgery went well, recovery also.
Became lame on the right side 2 months ago,
Rads showed mild patellar tendinitis (same as you sometimes see at the 6 week TPLO recheck) but also confirmed stifle effusion and mild DJD which was consistent with my suspicion of a partial CCL tear.
in surgery: partial tear and nothing abnormal with the patellar tendon,
4 weeks post-op, the patellar tendon is 5 times normal size. It is obviously enlarged clinically.
Ultrasound did not show much, nor rads (I will post them tomorrow).
Have you guys seen severe patellar tendinitis like this?
☼ | Could you have caused some iatrogenic trauma with a saw blade if it was not protected adequately for a tplo/ tta cut? | Hard to say for sure, but with the results you report, i'm leaning toward primary renal insufficiency in this dog...possibly congenital? |
Signalment: 10 yr old SF Bobtail feline 19.2lbs The cat is overwt. 4.5/5
H/O chronic (years years years) of episodic looser stool to diarrhea and periodic vomiting.
Ran a cobalamine/ folate test- Cobalamine high 1583 (276-1425) Folate normal 12.1 (8.9-19.9) waiting for a TLI- but TLI done last year was normal.
This cat is also being worked up for a heart murmur that was recently ausculted. When radiographing the thorax, I noticed gas in the small intestine at the edge of the rads. Ultrasound of the abdomen has been done twice and no gross abnorms found. The ultrasound was performed by general practitioner but they have experience.
These are owners that keep a running record of what each cat in the house does. They have binders upon binders for years back. That has it's pro's and con's. When the cat has a looser/ mucoid or otherwise abnormal stool- they give amforal for 1 or 2 days and then dont have a problem for a month or two.
They feed taste of the wild dry food and solid gold tuna. I have tried to get a diet switch, but there is a But to everything I say.
Thanks
☼ | Were bowel loops measured? | Is the patient drinking? |
Hello!
I am hoping to get some advice on one of my diabetic feline patients. Nicky is a 10 year old, MN, DLH cat that was diagnosed with diabetes mellitus ~9 months ago. He is 5.83 kg and has maintained this weight since his diagnosis. He was started on 1 u of glargine insulin BID and at his 1 week blood glucose curve his blood glucose was staying in the 500s. I kept increasing his glargine by 1 unit every 2 weeks based on blood glucose curves that remained in the mid to high 400s - low 500s. I checked fructosamine levels to try to rule out a stress induced hyperglycemia and his fructosamine levels remained consistently high also. Owners report that he remains persistently PU/PD at home even after adjusting his insulin level. He is currently receiving 9 units of glargine BID. Nicky presented last month with diabetic ketoacidosis. Even with a CRI of regular insulin at 0.10 U/kg/hr (which is the double the dose I usually use to treat cats with DKA) I could only drop his blood glucose to the mid 300s. An abdominal ultrasound was performed and there was no evidence of pancreatitis and the adrenal glands appeared normal (the ultrasound was performed by a general practioner and not a radiologist however). Urine cultures were negative. Except for the diabetes, ketoacidosis, and a stress leukogram the rest of the bloodwork was unremarkable.
Even though Nicky does not show classic clinical signs of acromegaly, I found it interesting that he was maintaining his body weight with persistent blood glucose in the 400 - 500 range. I ran some tests to rule out insulin resistance and now I'm more confused than ever!
Insulin-like Growth Factor = 140 (normal 12 - 92)
Insulin autoantibodies = 80 (normal less than 20)
Low dose dexamethasone supression test - Pre = 7.4, 4 hr = 1.0, 8 hr = 1.64
Is it possible that Nicky has both acromegaly and hyperadrenocorticism? I've been trying to refer Nicky to an internist, but his owners have been reluctant. I recommended an ultrasound with a radiologist and possible MRI or CT scan, but again they are reluctant to pursue a trip to a specialty clinic. Do I just keep increasing his glargine dose until I can get his blood glucose in the mid 200s or do I try a different type of insulin.
Any advice would be greatly appreciated!! | What does of dexamethasone did you use? | Could you screen with saliva-swab felv tests and do blood test only on those that are questionable or come up positive? |
6 year old, M/N, Chihuahua mix, 14.19#.
Owners are an elderly couple that can’t see well. They can’t do spot BG at home and have a hard time getting dose of insulin correct when drawing up themselves. We currently draw up insulin doses a few days to a week in advance for them to give.
Hx: 3/23/12 presented with pancreatitis & DKA (weight was 25.6# on 11/8/11 & 19# on 3/27/12 on presentation)
-hospitalized and recovered well after 8 days in hospital
-sent home with Royal Canin LF dry & canned BID and 5 units NPH BID
-We couldn’t seem to get him regulated so we then Dx: Cushing’s on 7/1/12 and Trilostane BID was started. 15.75#
-Long story short, after several incidents of DKA, and fluctuations with food (dog wouldn’t eat well when DKA), we decided to change to levemir insulin 0.5 units BID on 8/18/12. 12.6#. He always had “flat curves”
-After spot checks and such insulin dose was gradually increased to 1.5units BID over time and on 8/29/12 saw bruising on dog and Dx, IMT, likely due to new insulin. 13.25#
-Tx: Pred and Imuran PO. Dog is still recovering well with medical management. Currently on tapered dose Imuran EOD, totally off pred since 12/8/12.
-9/18/12 “flat curve” but much better, nadir seems to be 6-7hrs post inj, 140.
-Owners are an elderly couple that can’t see well. They can’t do spot BG at home and have a hard time getting dose of insulin correct when drawing up themselves. We currently draw up insulin doses a few days to a week in advance for them to give.
-By 11/23/12, dog was up to 3 units levemir BID and didn’t seem regulated still.
-12/29/12, owner became ill and a technician took dog home with her for ~2 weeks. Tech was able to do spot checks prior to feeding and giving insulin and based on old curves, nadir spot checks too. Based on those numbers and clinical signs, it appears Somogyi effect was occurring. Tech was able to get dog down to ½ unit levemir BID with much better numbers. 6-7hrs post inj. nadir was 85-236with that dose and dog was eating consistently (OTC dry BID). 15.19# (goal weight 14-15 #)
-1/19/13 returned dog to owner. Dose ½ unit BID levemir
-2/20/13 dog’s 6-7hrs post inj. nadir spot checks consistently high (485-256) and PU/PD. Suspect owner isn’t actually injecting the insulin every time. Owner has a hard time seeing.
2/25/13: Tech took dog home again to try and regulate. Didn't want dog to go DKA again. 14.19# dog BCS: 3/5.
Here are the numbers so far: eating well BID prior to BG and Injection. No signs of hypoglycemia. No PU/PD. Most injections drawn up previously to mimic what owners do at home.
2/25/12: 7pm, BG 637 (last dose ½ unit 7am by owner), gave 1 unit levemir
2/26/13: 7am, BG 98, gave ½ unit levemir; 7pm, BG 446, gave ½ unit levemir
2/27/13: 7am, BG 132, gave ½ unit levemir; 7pm, BG 248, gave ½ unit levemir
2/28/13: 7am, BG 213, gave ½ unit levemir; 2pm BG 99, 7pm, BG 238, gave ½ unit levemir
3/1/13: 7am, BG 270, gave ½ unit levemir; 2pm BG 69, 7pm, BG 505, gave ½ unit levemir
3/2/13: 7am, BG 73, gave 1/4 unit levemir; 2pm BG 170, 7pm, BG 491, gave ½ unit levemir
3/3/13: 7am, BG 80, gave ½ unit levemir; 2pm BG 52, 7pm, BG 359, gave ½ unit levemir
3/4/13: 7am, BG 464, gave ½ unit levemir; 2pm BG 123.
Two thoughts here: Cushing’s is making this impossible to regulate and/or the levemir is lasting longer than 12 hours and messing up numbers. Our next plan is to do a 18hr +/- curve on 3/7/13.
Any other thoughts/advice? Dog looks great and is acting great. Best he has ever been! | How was the cushing's diagnosed? | Is the patient eating better than she was? |
6 year old, M/N, Chihuahua mix, 14.19#.
Owners are an elderly couple that can’t see well. They can’t do spot BG at home and have a hard time getting dose of insulin correct when drawing up themselves. We currently draw up insulin doses a few days to a week in advance for them to give.
Hx: 3/23/12 presented with pancreatitis & DKA (weight was 25.6# on 11/8/11 & 19# on 3/27/12 on presentation)
-hospitalized and recovered well after 8 days in hospital
-sent home with Royal Canin LF dry & canned BID and 5 units NPH BID
-We couldn’t seem to get him regulated so we then Dx: Cushing’s on 7/1/12 and Trilostane BID was started. 15.75#
-Long story short, after several incidents of DKA, and fluctuations with food (dog wouldn’t eat well when DKA), we decided to change to levemir insulin 0.5 units BID on 8/18/12. 12.6#. He always had “flat curves”
-After spot checks and such insulin dose was gradually increased to 1.5units BID over time and on 8/29/12 saw bruising on dog and Dx, IMT, likely due to new insulin. 13.25#
-Tx: Pred and Imuran PO. Dog is still recovering well with medical management. Currently on tapered dose Imuran EOD, totally off pred since 12/8/12.
-9/18/12 “flat curve” but much better, nadir seems to be 6-7hrs post inj, 140.
-Owners are an elderly couple that can’t see well. They can’t do spot BG at home and have a hard time getting dose of insulin correct when drawing up themselves. We currently draw up insulin doses a few days to a week in advance for them to give.
-By 11/23/12, dog was up to 3 units levemir BID and didn’t seem regulated still.
-12/29/12, owner became ill and a technician took dog home with her for ~2 weeks. Tech was able to do spot checks prior to feeding and giving insulin and based on old curves, nadir spot checks too. Based on those numbers and clinical signs, it appears Somogyi effect was occurring. Tech was able to get dog down to ½ unit levemir BID with much better numbers. 6-7hrs post inj. nadir was 85-236with that dose and dog was eating consistently (OTC dry BID). 15.19# (goal weight 14-15 #)
-1/19/13 returned dog to owner. Dose ½ unit BID levemir
-2/20/13 dog’s 6-7hrs post inj. nadir spot checks consistently high (485-256) and PU/PD. Suspect owner isn’t actually injecting the insulin every time. Owner has a hard time seeing.
2/25/13: Tech took dog home again to try and regulate. Didn't want dog to go DKA again. 14.19# dog BCS: 3/5.
Here are the numbers so far: eating well BID prior to BG and Injection. No signs of hypoglycemia. No PU/PD. Most injections drawn up previously to mimic what owners do at home.
2/25/12: 7pm, BG 637 (last dose ½ unit 7am by owner), gave 1 unit levemir
2/26/13: 7am, BG 98, gave ½ unit levemir; 7pm, BG 446, gave ½ unit levemir
2/27/13: 7am, BG 132, gave ½ unit levemir; 7pm, BG 248, gave ½ unit levemir
2/28/13: 7am, BG 213, gave ½ unit levemir; 2pm BG 99, 7pm, BG 238, gave ½ unit levemir
3/1/13: 7am, BG 270, gave ½ unit levemir; 2pm BG 69, 7pm, BG 505, gave ½ unit levemir
3/2/13: 7am, BG 73, gave 1/4 unit levemir; 2pm BG 170, 7pm, BG 491, gave ½ unit levemir
3/3/13: 7am, BG 80, gave ½ unit levemir; 2pm BG 52, 7pm, BG 359, gave ½ unit levemir
3/4/13: 7am, BG 464, gave ½ unit levemir; 2pm BG 123.
Two thoughts here: Cushing’s is making this impossible to regulate and/or the levemir is lasting longer than 12 hours and messing up numbers. Our next plan is to do a 18hr +/- curve on 3/7/13.
Any other thoughts/advice? Dog looks great and is acting great. Best he has ever been! | If it was diagnosed by acth stim, what were the numbers? | Her dm management? |
6 year old, M/N, Chihuahua mix, 14.19#.
Owners are an elderly couple that can’t see well. They can’t do spot BG at home and have a hard time getting dose of insulin correct when drawing up themselves. We currently draw up insulin doses a few days to a week in advance for them to give.
Hx: 3/23/12 presented with pancreatitis & DKA (weight was 25.6# on 11/8/11 & 19# on 3/27/12 on presentation)
-hospitalized and recovered well after 8 days in hospital
-sent home with Royal Canin LF dry & canned BID and 5 units NPH BID
-We couldn’t seem to get him regulated so we then Dx: Cushing’s on 7/1/12 and Trilostane BID was started. 15.75#
-Long story short, after several incidents of DKA, and fluctuations with food (dog wouldn’t eat well when DKA), we decided to change to levemir insulin 0.5 units BID on 8/18/12. 12.6#. He always had “flat curves”
-After spot checks and such insulin dose was gradually increased to 1.5units BID over time and on 8/29/12 saw bruising on dog and Dx, IMT, likely due to new insulin. 13.25#
-Tx: Pred and Imuran PO. Dog is still recovering well with medical management. Currently on tapered dose Imuran EOD, totally off pred since 12/8/12.
-9/18/12 “flat curve” but much better, nadir seems to be 6-7hrs post inj, 140.
-Owners are an elderly couple that can’t see well. They can’t do spot BG at home and have a hard time getting dose of insulin correct when drawing up themselves. We currently draw up insulin doses a few days to a week in advance for them to give.
-By 11/23/12, dog was up to 3 units levemir BID and didn’t seem regulated still.
-12/29/12, owner became ill and a technician took dog home with her for ~2 weeks. Tech was able to do spot checks prior to feeding and giving insulin and based on old curves, nadir spot checks too. Based on those numbers and clinical signs, it appears Somogyi effect was occurring. Tech was able to get dog down to ½ unit levemir BID with much better numbers. 6-7hrs post inj. nadir was 85-236with that dose and dog was eating consistently (OTC dry BID). 15.19# (goal weight 14-15 #)
-1/19/13 returned dog to owner. Dose ½ unit BID levemir
-2/20/13 dog’s 6-7hrs post inj. nadir spot checks consistently high (485-256) and PU/PD. Suspect owner isn’t actually injecting the insulin every time. Owner has a hard time seeing.
2/25/13: Tech took dog home again to try and regulate. Didn't want dog to go DKA again. 14.19# dog BCS: 3/5.
Here are the numbers so far: eating well BID prior to BG and Injection. No signs of hypoglycemia. No PU/PD. Most injections drawn up previously to mimic what owners do at home.
2/25/12: 7pm, BG 637 (last dose ½ unit 7am by owner), gave 1 unit levemir
2/26/13: 7am, BG 98, gave ½ unit levemir; 7pm, BG 446, gave ½ unit levemir
2/27/13: 7am, BG 132, gave ½ unit levemir; 7pm, BG 248, gave ½ unit levemir
2/28/13: 7am, BG 213, gave ½ unit levemir; 2pm BG 99, 7pm, BG 238, gave ½ unit levemir
3/1/13: 7am, BG 270, gave ½ unit levemir; 2pm BG 69, 7pm, BG 505, gave ½ unit levemir
3/2/13: 7am, BG 73, gave 1/4 unit levemir; 2pm BG 170, 7pm, BG 491, gave ½ unit levemir
3/3/13: 7am, BG 80, gave ½ unit levemir; 2pm BG 52, 7pm, BG 359, gave ½ unit levemir
3/4/13: 7am, BG 464, gave ½ unit levemir; 2pm BG 123.
Two thoughts here: Cushing’s is making this impossible to regulate and/or the levemir is lasting longer than 12 hours and messing up numbers. Our next plan is to do a 18hr +/- curve on 3/7/13.
Any other thoughts/advice? Dog looks great and is acting great. Best he has ever been! | Cortrosyn used? | What is her diet? |
Good morning. I have an approximately 7 year old, male, neutered diabetic cat who recently suffered from episodes of hypoglycemia and we suspect may have had seizures while boarding. He was receiving 5 units Glargine insulin twice daily. On Sunday morning before receiving insulin and food he had a hypoglycemic episode - very wobbly, drooling, vocalizing, standing still looking disorientated and urinated. His blood glucose level was 1.7 mmol/L. After the episode, he was fine and ate readily. Throughout the day, he was fed small frequent meals, his blood glucose hovering around 3.6 mmol/L. He went home Sunday night (owner is a vet tech who checks his glucose at home). Overnight Sunday night/Monday morning, "Gary" had three more episodes of vocalizing, drooling and once urinated. Each episode lasted less than 45 seconds, however when the owner checked Gary's glucose, it was 16 mmol/L. He came back to the clinic Monday morning, his glucose level was 18.8mmol/L. We gave him 2 units Glargine and he ate well. Later in the afternoon, he had another drooling, vocalizing and urination episode that lasted 30 seconds. His glucose at that time was 21 mmol/L, which was coincidently checked just 15 minutes before the event. Apparently while boarding the previous week there were two mornings (Wed and Fri) where his kennel was a mess - litter everywhere, urine and water everywhere. I suspect Gary may have had seizures those nights.
Given that Gary seems to be having seizures now that his blood glucose is normal, could hypoglycemic derived seizures have created an epileptic focus in his brain and I should now start him on Phenobarbital if he keeps having these episodes? Is the damage permanent, requiring anti-epileptic medications for life?
Thank you for your thoughts and advice,
☼ | Was the owner checking curves prior to boarding? | Recently started (just diagnosed)? |
Good morning. I have an approximately 7 year old, male, neutered diabetic cat who recently suffered from episodes of hypoglycemia and we suspect may have had seizures while boarding. He was receiving 5 units Glargine insulin twice daily. On Sunday morning before receiving insulin and food he had a hypoglycemic episode - very wobbly, drooling, vocalizing, standing still looking disorientated and urinated. His blood glucose level was 1.7 mmol/L. After the episode, he was fine and ate readily. Throughout the day, he was fed small frequent meals, his blood glucose hovering around 3.6 mmol/L. He went home Sunday night (owner is a vet tech who checks his glucose at home). Overnight Sunday night/Monday morning, "Gary" had three more episodes of vocalizing, drooling and once urinated. Each episode lasted less than 45 seconds, however when the owner checked Gary's glucose, it was 16 mmol/L. He came back to the clinic Monday morning, his glucose level was 18.8mmol/L. We gave him 2 units Glargine and he ate well. Later in the afternoon, he had another drooling, vocalizing and urination episode that lasted 30 seconds. His glucose at that time was 21 mmol/L, which was coincidently checked just 15 minutes before the event. Apparently while boarding the previous week there were two mornings (Wed and Fri) where his kennel was a mess - litter everywhere, urine and water everywhere. I suspect Gary may have had seizures those nights.
Given that Gary seems to be having seizures now that his blood glucose is normal, could hypoglycemic derived seizures have created an epileptic focus in his brain and I should now start him on Phenobarbital if he keeps having these episodes? Is the damage permanent, requiring anti-epileptic medications for life?
Thank you for your thoughts and advice,
☼ | Does he usually eat well while he is there? | Have you ruled out food and flea allergies? |
Good morning. I have an approximately 7 year old, male, neutered diabetic cat who recently suffered from episodes of hypoglycemia and we suspect may have had seizures while boarding. He was receiving 5 units Glargine insulin twice daily. On Sunday morning before receiving insulin and food he had a hypoglycemic episode - very wobbly, drooling, vocalizing, standing still looking disorientated and urinated. His blood glucose level was 1.7 mmol/L. After the episode, he was fine and ate readily. Throughout the day, he was fed small frequent meals, his blood glucose hovering around 3.6 mmol/L. He went home Sunday night (owner is a vet tech who checks his glucose at home). Overnight Sunday night/Monday morning, "Gary" had three more episodes of vocalizing, drooling and once urinated. Each episode lasted less than 45 seconds, however when the owner checked Gary's glucose, it was 16 mmol/L. He came back to the clinic Monday morning, his glucose level was 18.8mmol/L. We gave him 2 units Glargine and he ate well. Later in the afternoon, he had another drooling, vocalizing and urination episode that lasted 30 seconds. His glucose at that time was 21 mmol/L, which was coincidently checked just 15 minutes before the event. Apparently while boarding the previous week there were two mornings (Wed and Fri) where his kennel was a mess - litter everywhere, urine and water everywhere. I suspect Gary may have had seizures those nights.
Given that Gary seems to be having seizures now that his blood glucose is normal, could hypoglycemic derived seizures have created an epileptic focus in his brain and I should now start him on Phenobarbital if he keeps having these episodes? Is the damage permanent, requiring anti-epileptic medications for life?
Thank you for your thoughts and advice,
☼ | Was the bg measured before or after the episode started? | Do the owners "reward" the spinning, even accidentally? |
Good morning. I have an approximately 7 year old, male, neutered diabetic cat who recently suffered from episodes of hypoglycemia and we suspect may have had seizures while boarding. He was receiving 5 units Glargine insulin twice daily. On Sunday morning before receiving insulin and food he had a hypoglycemic episode - very wobbly, drooling, vocalizing, standing still looking disorientated and urinated. His blood glucose level was 1.7 mmol/L. After the episode, he was fine and ate readily. Throughout the day, he was fed small frequent meals, his blood glucose hovering around 3.6 mmol/L. He went home Sunday night (owner is a vet tech who checks his glucose at home). Overnight Sunday night/Monday morning, "Gary" had three more episodes of vocalizing, drooling and once urinated. Each episode lasted less than 45 seconds, however when the owner checked Gary's glucose, it was 16 mmol/L. He came back to the clinic Monday morning, his glucose level was 18.8mmol/L. We gave him 2 units Glargine and he ate well. Later in the afternoon, he had another drooling, vocalizing and urination episode that lasted 30 seconds. His glucose at that time was 21 mmol/L, which was coincidently checked just 15 minutes before the event. Apparently while boarding the previous week there were two mornings (Wed and Fri) where his kennel was a mess - litter everywhere, urine and water everywhere. I suspect Gary may have had seizures those nights.
Given that Gary seems to be having seizures now that his blood glucose is normal, could hypoglycemic derived seizures have created an epileptic focus in his brain and I should now start him on Phenobarbital if he keeps having these episodes? Is the damage permanent, requiring anti-epileptic medications for life?
Thank you for your thoughts and advice,
☼ | Did we do a complete biochemical profile too? | Is it the same each time? |
I have a patient who is a 14 yr old M/N DSH that is diabetic. He has been a bear to regulate and would love to get some additional input from other eyes.
He was receiving 2 units of insulin twice daily and not being monitored at home. He crashed and went to EC and now it has been difficult to get him back in shape. His owner is now monitoring his glucose levels at home and these are some of my recent results. I did get her to do a 12 hour curve included below.
His insulin is Lantus insulin.
2/18/13 10:45a 674 1.5 10:45a
2/18/13 10:45p 403 1.5 10:45p
2/19/13 10:20a 388 1.5 10:20a
2/19/13 10:45p 236 1.5 10:45p
2/20/13 11:20a 514 1.5 11:20a
2/20/13 11:20p 198 1.5 11:20p
2/21/13 10:00a 417 1.5 10:00a
2/21/13 12:00p 367 - -
2/21/13 2:00p 144 - -
2/21/13 4:00p 48 - -
2/21/13 6:00p 122 - -
2/21/13 8:00p 251 - -
2/21/13 10:00p 350 1.5 10:00p
2/22/13 10:00a 732 1.5 10:00a
Thanks to those results, I suspected Somogyi and decreased his dose to just 1 unit BID. The new results are as follows:
Date Time Blood Glucose Units of Insulin Time of Injection
2/25/13 10:10a 532 1 10:10a
2/25/13 10:50p 410 1 10:50p
2/26/13 10:15a 531 1 10:15a
2/26/13 10:10p 169 1 10:10p
2/27/13 10:20a 489 1 10:20a
2/27/13 10:10p 265 1 10:10p
2/28/13 11:10a 524 1 11:10a
2/28/13 10:20p 259 1 10:20p
3/1/13 11:10a 580 1 11:10a
3/1/13 11:20p 443 1 11:20p
3/2/13 11:45a 523 1 11:45a
3/2/13 10:40p 280 1 10:40p
3/3/13 11:40a 562 1 11:40a
3/3/13 11:40p 180 1 11:40p
I am about to have her do another 12 hr curve since he is due for that but wanted to know if there is any additional advice based on this. Owner is financially limited so while I have suggested ultrasound and urine culture, o is not willing to pursue that at this time. Thanks for your help.
Sincerely,
☼ | Was the cat just diagnosed with diabetes? | Will he eat canned diets eagerly? |
I have a patient who is a 14 yr old M/N DSH that is diabetic. He has been a bear to regulate and would love to get some additional input from other eyes.
He was receiving 2 units of insulin twice daily and not being monitored at home. He crashed and went to EC and now it has been difficult to get him back in shape. His owner is now monitoring his glucose levels at home and these are some of my recent results. I did get her to do a 12 hour curve included below.
His insulin is Lantus insulin.
2/18/13 10:45a 674 1.5 10:45a
2/18/13 10:45p 403 1.5 10:45p
2/19/13 10:20a 388 1.5 10:20a
2/19/13 10:45p 236 1.5 10:45p
2/20/13 11:20a 514 1.5 11:20a
2/20/13 11:20p 198 1.5 11:20p
2/21/13 10:00a 417 1.5 10:00a
2/21/13 12:00p 367 - -
2/21/13 2:00p 144 - -
2/21/13 4:00p 48 - -
2/21/13 6:00p 122 - -
2/21/13 8:00p 251 - -
2/21/13 10:00p 350 1.5 10:00p
2/22/13 10:00a 732 1.5 10:00a
Thanks to those results, I suspected Somogyi and decreased his dose to just 1 unit BID. The new results are as follows:
Date Time Blood Glucose Units of Insulin Time of Injection
2/25/13 10:10a 532 1 10:10a
2/25/13 10:50p 410 1 10:50p
2/26/13 10:15a 531 1 10:15a
2/26/13 10:10p 169 1 10:10p
2/27/13 10:20a 489 1 10:20a
2/27/13 10:10p 265 1 10:10p
2/28/13 11:10a 524 1 11:10a
2/28/13 10:20p 259 1 10:20p
3/1/13 11:10a 580 1 11:10a
3/1/13 11:20p 443 1 11:20p
3/2/13 11:45a 523 1 11:45a
3/2/13 10:40p 280 1 10:40p
3/3/13 11:40a 562 1 11:40a
3/3/13 11:40p 180 1 11:40p
I am about to have her do another 12 hr curve since he is due for that but wanted to know if there is any additional advice based on this. Owner is financially limited so while I have suggested ultrasound and urine culture, o is not willing to pursue that at this time. Thanks for your help.
Sincerely,
☼ | What is she feeding the cat? | What is the cat's current diet? |
I have a patient who is a 14 yr old M/N DSH that is diabetic. He has been a bear to regulate and would love to get some additional input from other eyes.
He was receiving 2 units of insulin twice daily and not being monitored at home. He crashed and went to EC and now it has been difficult to get him back in shape. His owner is now monitoring his glucose levels at home and these are some of my recent results. I did get her to do a 12 hour curve included below.
His insulin is Lantus insulin.
2/18/13 10:45a 674 1.5 10:45a
2/18/13 10:45p 403 1.5 10:45p
2/19/13 10:20a 388 1.5 10:20a
2/19/13 10:45p 236 1.5 10:45p
2/20/13 11:20a 514 1.5 11:20a
2/20/13 11:20p 198 1.5 11:20p
2/21/13 10:00a 417 1.5 10:00a
2/21/13 12:00p 367 - -
2/21/13 2:00p 144 - -
2/21/13 4:00p 48 - -
2/21/13 6:00p 122 - -
2/21/13 8:00p 251 - -
2/21/13 10:00p 350 1.5 10:00p
2/22/13 10:00a 732 1.5 10:00a
Thanks to those results, I suspected Somogyi and decreased his dose to just 1 unit BID. The new results are as follows:
Date Time Blood Glucose Units of Insulin Time of Injection
2/25/13 10:10a 532 1 10:10a
2/25/13 10:50p 410 1 10:50p
2/26/13 10:15a 531 1 10:15a
2/26/13 10:10p 169 1 10:10p
2/27/13 10:20a 489 1 10:20a
2/27/13 10:10p 265 1 10:10p
2/28/13 11:10a 524 1 11:10a
2/28/13 10:20p 259 1 10:20p
3/1/13 11:10a 580 1 11:10a
3/1/13 11:20p 443 1 11:20p
3/2/13 11:45a 523 1 11:45a
3/2/13 10:40p 280 1 10:40p
3/3/13 11:40a 562 1 11:40a
3/3/13 11:40p 180 1 11:40p
I am about to have her do another 12 hr curve since he is due for that but wanted to know if there is any additional advice based on this. Owner is financially limited so while I have suggested ultrasound and urine culture, o is not willing to pursue that at this time. Thanks for your help.
Sincerely,
☼ | Does the cat get fed before or after insulin administration? | Was the hypertension based on 3-4 visits where all we did was blood pressures or was it based on a single visit where there may have been white coat hypertension? |
I'm treating an 8 year old intact female schnauzer diagnosed with diabetes nearly 1 month ago. I'm not at the office right now so I don't have actual weight and lab work. Weight at start was approximately 13.5 pounds. Urine culture was negative. Ketones were in the urine; bloodwork had glucose of around 300 to 400.
Ultrasound of abdomen: abnormal uterus - possibly cystic; mild inflammatory changes around the pancreas (from memory).
The pharmacy did not have Humulin N and I was not familiar with Novalin at the time so I started treatment with Glargine at 2 units bid, placed pet on the Royal Canin diabetic food, and sq fluids for 3 days. Pet came in for a recheck with another doctor and they ran a glucose which was at 98. Insulin was decreased to 1 unit bid.
Came in for glucose curve 1 week later. Pet had lost 0.5 pounds. Glucose did not register on the glucometer until around 1500 and then it was 459. Changes: increase insulin to 1.5 units bid and increase to 3/4 cup of dry bid and 2/3 can bid. Dog was otherwise bar and PU/PD.
1 week later: I was not present. Dog came in for glucose curve. Readings were too high to read except for the second reading which was 451. Patient had lost a little more weight - approximately 12.8 pounds now. No exam done. I've increased the insulin back to 2 units bid and insured the owner was feeding the correct amount of food. We have observed the owner giving the insulin and she is doing it correctly.
My questions: Do I need to change insulin? How stable with diabetes does this dog need to be to have the OHE? Do I need to discontinue the diabetic diet and return to regular food? What else should be done? Any help is appreciated.
Thanks - ☼ | This is really a good time to teach the owner how to generate curves at home---any chance of that? | Is there weight loss? |
I'm treating an 8 year old intact female schnauzer diagnosed with diabetes nearly 1 month ago. I'm not at the office right now so I don't have actual weight and lab work. Weight at start was approximately 13.5 pounds. Urine culture was negative. Ketones were in the urine; bloodwork had glucose of around 300 to 400.
Ultrasound of abdomen: abnormal uterus - possibly cystic; mild inflammatory changes around the pancreas (from memory).
The pharmacy did not have Humulin N and I was not familiar with Novalin at the time so I started treatment with Glargine at 2 units bid, placed pet on the Royal Canin diabetic food, and sq fluids for 3 days. Pet came in for a recheck with another doctor and they ran a glucose which was at 98. Insulin was decreased to 1 unit bid.
Came in for glucose curve 1 week later. Pet had lost 0.5 pounds. Glucose did not register on the glucometer until around 1500 and then it was 459. Changes: increase insulin to 1.5 units bid and increase to 3/4 cup of dry bid and 2/3 can bid. Dog was otherwise bar and PU/PD.
1 week later: I was not present. Dog came in for glucose curve. Readings were too high to read except for the second reading which was 451. Patient had lost a little more weight - approximately 12.8 pounds now. No exam done. I've increased the insulin back to 2 units bid and insured the owner was feeding the correct amount of food. We have observed the owner giving the insulin and she is doing it correctly.
My questions: Do I need to change insulin? How stable with diabetes does this dog need to be to have the OHE? Do I need to discontinue the diabetic diet and return to regular food? What else should be done? Any help is appreciated.
Thanks - ☼ | How much does she weigh and how many calories are in a can of this diet? | Any stranguria/hematuria/pollakiuria or just the excessive volume? |
Hello, I have been treating an 11 year old male/castrated miniature schnauzer for a couple of years now. I first met him in July 2012. He presented for urinary issues, had bladder stones which were surgically removed, and a cystotomy was performed. A urine culture did show a Staphylococcus pseudintermedius and he was treated with appropriate antibiotics based on the sensitivity. On his presurgical bloodwork his alkne phosphatase was elevated at 400.
One month later his alkne phosphatase was 854 and his ALT was 152. He was doing very well in terms of his urination. He was put on UD food as soon as the stone analysis came back (calcium oxalate). We discussed different reasons for the AlkPhos being elevated.
One month later he had some diarrhea issues. Fecal sent to reference laboratory including Giardia testing negative. A GI panel was normal. This owner is very thorough and wanted us to explore every option for GI distress. We did find that the stool seemed to have some sandy material in it and deduced that the dog must have been ingesting material from where construction was being done around the house.
We ended up doing an ACTH stimulation test b/c of the elevated AlkPhos and the owner reported voracious appetite, PU/PD. The pre-sample was 7.2 and the post 25.4. Given the clinical signs and these numbers the owner decided to do a trial of trilostane. We started at a dose of 10 mg once daily. The owner gave 2 doses and called and said that Pepper had developed diarrhea and wasn't eating well. I told him that I wasn't sure if this was another bout of GI distress vs reaction to the trilostane. He stopped the trilostane and the problem got better.
We started Pepper back on trilostane at every other day and he seemed to do better. When we started back at once daily, on the second dose the diarrhea returned. I had the owner bring the dog in that very day for another ACTH stimulation test to make sure that the cortisol wasn't getting too low. The pre-sample was 5.9 and the post was 11.4. Another fecal test including Giardia is negative.
Have you had any cases like this previously? When I did the ACTH stimulation test it was day 2 of getting trilostane once daily. The ACTH stim test was done this time yesterday. The owner just stopped by and said that the diarrhea has continued. I have started metronidazole. I appreciate any input you may have. ☼ | Are you sure that each dose is being given with food? | Was the dog a good eater before the diabetes? |
Hello, I have been treating an 11 year old male/castrated miniature schnauzer for a couple of years now. I first met him in July 2012. He presented for urinary issues, had bladder stones which were surgically removed, and a cystotomy was performed. A urine culture did show a Staphylococcus pseudintermedius and he was treated with appropriate antibiotics based on the sensitivity. On his presurgical bloodwork his alkne phosphatase was elevated at 400.
One month later his alkne phosphatase was 854 and his ALT was 152. He was doing very well in terms of his urination. He was put on UD food as soon as the stone analysis came back (calcium oxalate). We discussed different reasons for the AlkPhos being elevated.
One month later he had some diarrhea issues. Fecal sent to reference laboratory including Giardia testing negative. A GI panel was normal. This owner is very thorough and wanted us to explore every option for GI distress. We did find that the stool seemed to have some sandy material in it and deduced that the dog must have been ingesting material from where construction was being done around the house.
We ended up doing an ACTH stimulation test b/c of the elevated AlkPhos and the owner reported voracious appetite, PU/PD. The pre-sample was 7.2 and the post 25.4. Given the clinical signs and these numbers the owner decided to do a trial of trilostane. We started at a dose of 10 mg once daily. The owner gave 2 doses and called and said that Pepper had developed diarrhea and wasn't eating well. I told him that I wasn't sure if this was another bout of GI distress vs reaction to the trilostane. He stopped the trilostane and the problem got better.
We started Pepper back on trilostane at every other day and he seemed to do better. When we started back at once daily, on the second dose the diarrhea returned. I had the owner bring the dog in that very day for another ACTH stimulation test to make sure that the cortisol wasn't getting too low. The pre-sample was 5.9 and the post was 11.4. Another fecal test including Giardia is negative.
Have you had any cases like this previously? When I did the ACTH stimulation test it was day 2 of getting trilostane once daily. The ACTH stim test was done this time yesterday. The owner just stopped by and said that the diarrhea has continued. I have started metronidazole. I appreciate any input you may have. ☼ | Is this small or large-bowel diarrhea? | We're sure the owner is complying with the diet? |
Hello, I have been treating an 11 year old male/castrated miniature schnauzer for a couple of years now. I first met him in July 2012. He presented for urinary issues, had bladder stones which were surgically removed, and a cystotomy was performed. A urine culture did show a Staphylococcus pseudintermedius and he was treated with appropriate antibiotics based on the sensitivity. On his presurgical bloodwork his alkne phosphatase was elevated at 400.
One month later his alkne phosphatase was 854 and his ALT was 152. He was doing very well in terms of his urination. He was put on UD food as soon as the stone analysis came back (calcium oxalate). We discussed different reasons for the AlkPhos being elevated.
One month later he had some diarrhea issues. Fecal sent to reference laboratory including Giardia testing negative. A GI panel was normal. This owner is very thorough and wanted us to explore every option for GI distress. We did find that the stool seemed to have some sandy material in it and deduced that the dog must have been ingesting material from where construction was being done around the house.
We ended up doing an ACTH stimulation test b/c of the elevated AlkPhos and the owner reported voracious appetite, PU/PD. The pre-sample was 7.2 and the post 25.4. Given the clinical signs and these numbers the owner decided to do a trial of trilostane. We started at a dose of 10 mg once daily. The owner gave 2 doses and called and said that Pepper had developed diarrhea and wasn't eating well. I told him that I wasn't sure if this was another bout of GI distress vs reaction to the trilostane. He stopped the trilostane and the problem got better.
We started Pepper back on trilostane at every other day and he seemed to do better. When we started back at once daily, on the second dose the diarrhea returned. I had the owner bring the dog in that very day for another ACTH stimulation test to make sure that the cortisol wasn't getting too low. The pre-sample was 5.9 and the post was 11.4. Another fecal test including Giardia is negative.
Have you had any cases like this previously? When I did the ACTH stimulation test it was day 2 of getting trilostane once daily. The ACTH stim test was done this time yesterday. The owner just stopped by and said that the diarrhea has continued. I have started metronidazole. I appreciate any input you may have. ☼ | Did he have any testing before the trilostane to see if this was pdh vs at? | I wonder if the dog ate well in the hospital? |
Hello, I have been treating an 11 year old male/castrated miniature schnauzer for a couple of years now. I first met him in July 2012. He presented for urinary issues, had bladder stones which were surgically removed, and a cystotomy was performed. A urine culture did show a Staphylococcus pseudintermedius and he was treated with appropriate antibiotics based on the sensitivity. On his presurgical bloodwork his alkne phosphatase was elevated at 400.
One month later his alkne phosphatase was 854 and his ALT was 152. He was doing very well in terms of his urination. He was put on UD food as soon as the stone analysis came back (calcium oxalate). We discussed different reasons for the AlkPhos being elevated.
One month later he had some diarrhea issues. Fecal sent to reference laboratory including Giardia testing negative. A GI panel was normal. This owner is very thorough and wanted us to explore every option for GI distress. We did find that the stool seemed to have some sandy material in it and deduced that the dog must have been ingesting material from where construction was being done around the house.
We ended up doing an ACTH stimulation test b/c of the elevated AlkPhos and the owner reported voracious appetite, PU/PD. The pre-sample was 7.2 and the post 25.4. Given the clinical signs and these numbers the owner decided to do a trial of trilostane. We started at a dose of 10 mg once daily. The owner gave 2 doses and called and said that Pepper had developed diarrhea and wasn't eating well. I told him that I wasn't sure if this was another bout of GI distress vs reaction to the trilostane. He stopped the trilostane and the problem got better.
We started Pepper back on trilostane at every other day and he seemed to do better. When we started back at once daily, on the second dose the diarrhea returned. I had the owner bring the dog in that very day for another ACTH stimulation test to make sure that the cortisol wasn't getting too low. The pre-sample was 5.9 and the post was 11.4. Another fecal test including Giardia is negative.
Have you had any cases like this previously? When I did the ACTH stimulation test it was day 2 of getting trilostane once daily. The ACTH stim test was done this time yesterday. The owner just stopped by and said that the diarrhea has continued. I have started metronidazole. I appreciate any input you may have. ☼ | (e.g. was there an ultrasound? | Do you know what made them want to look for cushings in the first place? |
I am starting my cat on the Royal Canin Fiber response diet for constipation, this is a dry kibble. What are good choices for canned food to give also? Should I go higher fiber like w/d, or high protein/low carb? She is not overweight and has no other illnesses.
Thank you | What was the previous diet, and how often is the constipation occurring? | Is it grossly suggestive of steroid hepatopathy? |
I am starting my cat on the Royal Canin Fiber response diet for constipation, this is a dry kibble. What are good choices for canned food to give also? Should I go higher fiber like w/d, or high protein/low carb? She is not overweight and has no other illnesses.
Thank you | Is the cat on any medications (for constipation or otherwise)? | The cortisol samples were submitted to a commercial lab? |
Probably a long shot, but wanted to see if anyone is awake and on here. If not, maybe I can learn something!
Pepe is a 13 yo mn poodle who presented to the EC for vomiting throughout the day. Unremarkable physical exam. He has been a well-managed diabetic dog for 2 years. A week ago started amoxicillin at daytime vet for suspected UTI. 3/5: not acting right, daytime vet found heart murmur and started enalapril and lasix. 3/6: didn't eat breakfast so owner didn't give insulin. Later in the day, dog started vomiting and continued throughout the day. In the evening, a seizure came after a round of vomiting.
Presented to EC 3/7 12:30a. Blood Glucose on AlphaTrak2 HI (>500). Plan was to give Cerenia and go to daytime vet first thing in the morning. Pain from shot set off another seizure, approx. 30 sec. Patient stopped breathing, heart stopped. Placed IVC and gave 0.5ml Adrenalin IV, began breathing for patient. Heartbeat came back, strong pulses. Then breathing came back. Patient regained consciousness 15 minutes later and seemed quite stable. About an hour after event, patient very disoriented and thrashing in cage, gave 0.6ml diazepam.
CBC abnormalities: hi neutrophils (24.9), hi monocytes (2.0), lo lymphocytes (0.3)
SMA abnormalities: hi ALP (206), hi ALT (207), hi BUN (176), hi CRE (7.6), hi PHOS (18.7), hi K+ (6.3), lo Na+ (126).
A few questions:
1. Should I give insulin since BG is sooo high? Or wait until patient is more stable?
2. High or low rate of fluids? I am not sure if daytime vet was concerned about pulmonary edema, but right now the kidneys seem like a bigger issue.
3. Is the hyperkalemia & hyperphosphatemia most likely due to the kidneys? Diabetes? Seizure? At what point would you try to reduce it?
Even if I don't get a reply this morning, I am sure I can learn from this case, so I would appreciate some feedback! Thanks! | Did you get any urine for ketones or a usg (pre fluids)? | What does he weigh? |
Probably a long shot, but wanted to see if anyone is awake and on here. If not, maybe I can learn something!
Pepe is a 13 yo mn poodle who presented to the EC for vomiting throughout the day. Unremarkable physical exam. He has been a well-managed diabetic dog for 2 years. A week ago started amoxicillin at daytime vet for suspected UTI. 3/5: not acting right, daytime vet found heart murmur and started enalapril and lasix. 3/6: didn't eat breakfast so owner didn't give insulin. Later in the day, dog started vomiting and continued throughout the day. In the evening, a seizure came after a round of vomiting.
Presented to EC 3/7 12:30a. Blood Glucose on AlphaTrak2 HI (>500). Plan was to give Cerenia and go to daytime vet first thing in the morning. Pain from shot set off another seizure, approx. 30 sec. Patient stopped breathing, heart stopped. Placed IVC and gave 0.5ml Adrenalin IV, began breathing for patient. Heartbeat came back, strong pulses. Then breathing came back. Patient regained consciousness 15 minutes later and seemed quite stable. About an hour after event, patient very disoriented and thrashing in cage, gave 0.6ml diazepam.
CBC abnormalities: hi neutrophils (24.9), hi monocytes (2.0), lo lymphocytes (0.3)
SMA abnormalities: hi ALP (206), hi ALT (207), hi BUN (176), hi CRE (7.6), hi PHOS (18.7), hi K+ (6.3), lo Na+ (126).
A few questions:
1. Should I give insulin since BG is sooo high? Or wait until patient is more stable?
2. High or low rate of fluids? I am not sure if daytime vet was concerned about pulmonary edema, but right now the kidneys seem like a bigger issue.
3. Is the hyperkalemia & hyperphosphatemia most likely due to the kidneys? Diabetes? Seizure? At what point would you try to reduce it?
Even if I don't get a reply this morning, I am sure I can learn from this case, so I would appreciate some feedback! Thanks! | Has the patient urinated in the last 24 hours? | It is probably unlikely but if the dog has only had one seizure, do you think there is a possibility that it could have had access to a toxin? |
Probably a long shot, but wanted to see if anyone is awake and on here. If not, maybe I can learn something!
Pepe is a 13 yo mn poodle who presented to the EC for vomiting throughout the day. Unremarkable physical exam. He has been a well-managed diabetic dog for 2 years. A week ago started amoxicillin at daytime vet for suspected UTI. 3/5: not acting right, daytime vet found heart murmur and started enalapril and lasix. 3/6: didn't eat breakfast so owner didn't give insulin. Later in the day, dog started vomiting and continued throughout the day. In the evening, a seizure came after a round of vomiting.
Presented to EC 3/7 12:30a. Blood Glucose on AlphaTrak2 HI (>500). Plan was to give Cerenia and go to daytime vet first thing in the morning. Pain from shot set off another seizure, approx. 30 sec. Patient stopped breathing, heart stopped. Placed IVC and gave 0.5ml Adrenalin IV, began breathing for patient. Heartbeat came back, strong pulses. Then breathing came back. Patient regained consciousness 15 minutes later and seemed quite stable. About an hour after event, patient very disoriented and thrashing in cage, gave 0.6ml diazepam.
CBC abnormalities: hi neutrophils (24.9), hi monocytes (2.0), lo lymphocytes (0.3)
SMA abnormalities: hi ALP (206), hi ALT (207), hi BUN (176), hi CRE (7.6), hi PHOS (18.7), hi K+ (6.3), lo Na+ (126).
A few questions:
1. Should I give insulin since BG is sooo high? Or wait until patient is more stable?
2. High or low rate of fluids? I am not sure if daytime vet was concerned about pulmonary edema, but right now the kidneys seem like a bigger issue.
3. Is the hyperkalemia & hyperphosphatemia most likely due to the kidneys? Diabetes? Seizure? At what point would you try to reduce it?
Even if I don't get a reply this morning, I am sure I can learn from this case, so I would appreciate some feedback! Thanks! | Did you repeat the k+ to make sure it's not spurious? | Can you check the urine for glucose? |
Hi there. I've got a client with a 9 yr old SF pug recently diagnosed with diabetes. The pug's past medical includes "skin sensitivity/allergies" year round--which the owner has "treated very successfully with a boutique brand of food named "FROM"?
(prior to the diabetes dx). Yesterday, pet was seen for a hypoglycemic crisis and insulin adjustment. O mentioned she was thinking of trying a raw diet.
Can you suggest a few foods that might be an empirically good choice for this diabetic and "sensitive skin" pug. I am trying to provide some sound sound scientific bases for steering her away from the misleading nutrition information she's receiving from pet store employees--but, this client has been very strongly brainwashed with the success of the "FROM" diet--which I'm not certain is going to help regulate her pug's diabetes.
Thank you! | What is the bcs? | Usg? |
Hi, I've been managing a cat with diabetes for quite some time now.. in December 2011 he had episodes of vomiting, and was found to be diabetic. He's had all the right treatment, urine cultures, a very conscientious owner. He is fed low carb canned and dry (using 'Binky's list' of foods).
The cat is 8 yrs old, and weighs 19lbs (8.7kg) he's a big cat, not what I'd call obese. He gets 8 Units Lantus BID. (was on 10U until 4 months ago)
Lately his owner said he's had periods during the day where he seems quiet, and 2 days ago he vomited once. He came yesterday for a curve:
Got 8U at 8am
10am 4.1 mmol/L
12 6.2
2pm 7.5
4pm 5.5
6pm 6.6
7pm 5.7
he ate canned food throughout the day and seemed quite happy to me.
Is this good regulation? Or time to try to decrease the insulin? In the past four years I've had four cats stop insulin altogether about 1-2 years after starting..
☼ | Are the curves being done in the home or at your clinic? | Did you know? |
Hi, I've been managing a cat with diabetes for quite some time now.. in December 2011 he had episodes of vomiting, and was found to be diabetic. He's had all the right treatment, urine cultures, a very conscientious owner. He is fed low carb canned and dry (using 'Binky's list' of foods).
The cat is 8 yrs old, and weighs 19lbs (8.7kg) he's a big cat, not what I'd call obese. He gets 8 Units Lantus BID. (was on 10U until 4 months ago)
Lately his owner said he's had periods during the day where he seems quiet, and 2 days ago he vomited once. He came yesterday for a curve:
Got 8U at 8am
10am 4.1 mmol/L
12 6.2
2pm 7.5
4pm 5.5
6pm 6.6
7pm 5.7
he ate canned food throughout the day and seemed quite happy to me.
Is this good regulation? Or time to try to decrease the insulin? In the past four years I've had four cats stop insulin altogether about 1-2 years after starting..
☼ | How much is the client feeding (kcals/day)? | Do you know how to cross post to other folders? |
Hello all,
I have a friend with a diabetic cat. She is on DM, eats it well, and is currently controlled on 1u lantus SQ bid. The owner works odd days/hours and is having a hard time getting people to volunteer to give the cat its insulin. Most of the time, she can give it bid at 7a/7p, but once to maybe twice a week (and not every week), she works an odd shift and can't give the pm dose. I work ER and don't have a lot of experience with stable diabetics or long term management and have a few questions.
1) I know some cats can be controlled on sid dosing. So far, the cat has been pretty easy to control, and the diabetes was diagnosed before DKA developed. Is she a good candidate to try on sid dosing? What should the starting insulin dose be?
2) If sid dosing doesn't work, would it be better to completely skip the pm dose and resume with a normal dose in the am, or give a partial dose in between the usual dose times? I had considered recommending to give a partial dose in those cases, check a BG the next am, and give no insulin if 100 or so, a half dose if between 100-200ish, and a full dose if > 200 or so. I can't decide which way to go and which is more prone to complications.
Any other thoughts or recommendations?
Thanks,
☼ | I assume canned dm? | Has he had abdominal us? |
9yo, 11.5lb NM Pomeranian was diagnosed as diabetic in November 2011. Was treated with Humulin-N at 4U twice daily. Glucose curves showed good control for 4 months, but then another curve showed hypoglycemia. Insulin was lowered to 2U twice daily and the dog has done well. Soon after a curve that showed good control, the dog presented for PU/PD in July 2012. Pulled blood and it had a high ALKP. Ran ACTH stim test and it came back high, so we started treatment with Vetoryl 30mg PO SID per directions on label. All went well for quite a while. The owner bumped the insulin back up to 3U when she noted that the dog was PU/PD more than normal. Two s ago the dog was presented for a curve, and the numbers never went down. 3U humulin -N were given at 7:30. BG q2h was 103, 133, 262, 358, 464. My options that I see are: 1) recheck ACTH stim test to make sure that the Vetoryl dose is correct; 2) change vetoryl dose to divided twice daily it trilostaine really doesn't give adequate coverage for 24 hours; 3) change type of insulin. The dog has to eat Royal Canin SO food for bladder stones.
I really don't know what to tell the owner. | What exactly did the stim look like? | Results? |
9yo, 11.5lb NM Pomeranian was diagnosed as diabetic in November 2011. Was treated with Humulin-N at 4U twice daily. Glucose curves showed good control for 4 months, but then another curve showed hypoglycemia. Insulin was lowered to 2U twice daily and the dog has done well. Soon after a curve that showed good control, the dog presented for PU/PD in July 2012. Pulled blood and it had a high ALKP. Ran ACTH stim test and it came back high, so we started treatment with Vetoryl 30mg PO SID per directions on label. All went well for quite a while. The owner bumped the insulin back up to 3U when she noted that the dog was PU/PD more than normal. Two s ago the dog was presented for a curve, and the numbers never went down. 3U humulin -N were given at 7:30. BG q2h was 103, 133, 262, 358, 464. My options that I see are: 1) recheck ACTH stim test to make sure that the Vetoryl dose is correct; 2) change vetoryl dose to divided twice daily it trilostaine really doesn't give adequate coverage for 24 hours; 3) change type of insulin. The dog has to eat Royal Canin SO food for bladder stones.
I really don't know what to tell the owner. | What have the acth stims looked like since the vetoryl was started? | Did you find it useful? |
9yo, 11.5lb NM Pomeranian was diagnosed as diabetic in November 2011. Was treated with Humulin-N at 4U twice daily. Glucose curves showed good control for 4 months, but then another curve showed hypoglycemia. Insulin was lowered to 2U twice daily and the dog has done well. Soon after a curve that showed good control, the dog presented for PU/PD in July 2012. Pulled blood and it had a high ALKP. Ran ACTH stim test and it came back high, so we started treatment with Vetoryl 30mg PO SID per directions on label. All went well for quite a while. The owner bumped the insulin back up to 3U when she noted that the dog was PU/PD more than normal. Two s ago the dog was presented for a curve, and the numbers never went down. 3U humulin -N were given at 7:30. BG q2h was 103, 133, 262, 358, 464. My options that I see are: 1) recheck ACTH stim test to make sure that the Vetoryl dose is correct; 2) change vetoryl dose to divided twice daily it trilostaine really doesn't give adequate coverage for 24 hours; 3) change type of insulin. The dog has to eat Royal Canin SO food for bladder stones.
I really don't know what to tell the owner. | Are you starting the stims 3-5 hours after the am trilostane is given with food? | What were you looking to treat by combining the 2? |
9yo, 11.5lb NM Pomeranian was diagnosed as diabetic in November 2011. Was treated with Humulin-N at 4U twice daily. Glucose curves showed good control for 4 months, but then another curve showed hypoglycemia. Insulin was lowered to 2U twice daily and the dog has done well. Soon after a curve that showed good control, the dog presented for PU/PD in July 2012. Pulled blood and it had a high ALKP. Ran ACTH stim test and it came back high, so we started treatment with Vetoryl 30mg PO SID per directions on label. All went well for quite a while. The owner bumped the insulin back up to 3U when she noted that the dog was PU/PD more than normal. Two s ago the dog was presented for a curve, and the numbers never went down. 3U humulin -N were given at 7:30. BG q2h was 103, 133, 262, 358, 464. My options that I see are: 1) recheck ACTH stim test to make sure that the Vetoryl dose is correct; 2) change vetoryl dose to divided twice daily it trilostaine really doesn't give adequate coverage for 24 hours; 3) change type of insulin. The dog has to eat Royal Canin SO food for bladder stones.
I really don't know what to tell the owner. | Are you using cortrosyn? | Can you get them on board for monitoring and treatment? |
9yo, 11.5lb NM Pomeranian was diagnosed as diabetic in November 2011. Was treated with Humulin-N at 4U twice daily. Glucose curves showed good control for 4 months, but then another curve showed hypoglycemia. Insulin was lowered to 2U twice daily and the dog has done well. Soon after a curve that showed good control, the dog presented for PU/PD in July 2012. Pulled blood and it had a high ALKP. Ran ACTH stim test and it came back high, so we started treatment with Vetoryl 30mg PO SID per directions on label. All went well for quite a while. The owner bumped the insulin back up to 3U when she noted that the dog was PU/PD more than normal. Two s ago the dog was presented for a curve, and the numbers never went down. 3U humulin -N were given at 7:30. BG q2h was 103, 133, 262, 358, 464. My options that I see are: 1) recheck ACTH stim test to make sure that the Vetoryl dose is correct; 2) change vetoryl dose to divided twice daily it trilostaine really doesn't give adequate coverage for 24 hours; 3) change type of insulin. The dog has to eat Royal Canin SO food for bladder stones.
I really don't know what to tell the owner. | On the current bg curve....was the insulin/food given at the hospital at the normal time or at home at the normal time? | Does he have to get up at night to prevent the dog from urinating in the house? |
9yo, 11.5lb NM Pomeranian was diagnosed as diabetic in November 2011. Was treated with Humulin-N at 4U twice daily. Glucose curves showed good control for 4 months, but then another curve showed hypoglycemia. Insulin was lowered to 2U twice daily and the dog has done well. Soon after a curve that showed good control, the dog presented for PU/PD in July 2012. Pulled blood and it had a high ALKP. Ran ACTH stim test and it came back high, so we started treatment with Vetoryl 30mg PO SID per directions on label. All went well for quite a while. The owner bumped the insulin back up to 3U when she noted that the dog was PU/PD more than normal. Two s ago the dog was presented for a curve, and the numbers never went down. 3U humulin -N were given at 7:30. BG q2h was 103, 133, 262, 358, 464. My options that I see are: 1) recheck ACTH stim test to make sure that the Vetoryl dose is correct; 2) change vetoryl dose to divided twice daily it trilostaine really doesn't give adequate coverage for 24 hours; 3) change type of insulin. The dog has to eat Royal Canin SO food for bladder stones.
I really don't know what to tell the owner. | Was the first bg of 103 mg/dl collected at 9:30 am? | Is it really incontinence or could it be pollakiuria? |
Hi, I have a shelter cat approximately 8 years old, spayed female, 11 1/2 pounds. She drinks a lot of water and fills her litter box, she does this at night, during the day she does not drink much. Blood work, only thing out of line is the amylase at 2896 IU/L(normal 100-1200). Sodium is 157 (normal 145-158 mEq/L). Her UA is normal except SG is 1.009. I was going to do a water deprivation test but her urine is 1.015 SG this morning so Diabetes Insipitus in lower on my list of differentials. Is it possible for bored cats to drink a lot of water? She is in a small cage with not much to do. Does Pancreatitis cause PU/PD in cats? She has a normal PE and acts normal, as much as we can tell. Any other tests I can run? | What diet is this kitty eating? | How many calories/day does he get? |
Bailey is a 14 yo m/n dog with a history of doxycycline responsive PU/PD. He presented in September with a recent onset of urinating large volumes of urine in the house. CBC and Chemistry values were all WNL. Abdominal radiograph was normal. A UA and culture were sent off to Antech. Culture results showed a methicillin resistant coagulase negative Staph spp. approx 100,000 colonies. UA - SG 1.008, PH 8, Blood 2+, RBC 4-10. He was started on doxycycline for three weeks and his symptoms improved.
In January he presented for the same thing. Basic bloodwork was WNL. Owners requested a Cushing's disease test. We ran an LDDS which came back normal at 0.7 8 hours post. Owners declined a repeat urine culture. We ran a 4 week course of doxycycline during which time Bailey's PU cleared up.
Four days after stopping the doxycycline his symptoms returned.
Could this be doxycycline responsive leptospirosis?
Would you recommend further testing at this point? Treatment options? The owners are aggravated that he is urinating in the house again.
Sincerely,
☼ | The culture was on a cysto sample? | Good for you for running the acth stim now! was there no pred for at least 12 hours before the test was run? |
Hello,
I am treating a 12yo fs rottie who has had a long coat her whole life (genetic variation?). Mom has shaved her down every year and last year the coat did the funky spotty growth with areas of long hair and areas of no growth.
At that time she felt great did geriatric blood and thyroid MSU all wnl.
Last month she came in and coat still the same mom says now she seems more lethargic, tried nsaids to see if pain and no change. No pu/pd or pp just not right. Repeated geriatric 1/18 which has t4 and tsh all normal except mild increase in alt 185
urine sp. gr 1.046 no glucose
2/21 alt now 244 and more lethargic
abdominal us normal except slightly plump rt adrenal
scheduled LDDS and 2 days later she became pu/pd
now urine glucoes 5+ and bl glucose 521
started nph insulin and scheduled ACTH stim
results pre 1.4 (1-5) post 9 (8-17)
so i would say thid dog has endocrine disease dt coat and now DM showing up but I am stuck.
Am i missing something here dont really think the coat is due to the DM coming on for a year then popping up overnight?
thank you for any help, ☼ | I'm not overly worried that she has cushing's....the urine concentration was good in february and it's the alt that's elevated, not the sap? | How often are these episodes occurring? |
Hello,
I am treating a 12yo fs rottie who has had a long coat her whole life (genetic variation?). Mom has shaved her down every year and last year the coat did the funky spotty growth with areas of long hair and areas of no growth.
At that time she felt great did geriatric blood and thyroid MSU all wnl.
Last month she came in and coat still the same mom says now she seems more lethargic, tried nsaids to see if pain and no change. No pu/pd or pp just not right. Repeated geriatric 1/18 which has t4 and tsh all normal except mild increase in alt 185
urine sp. gr 1.046 no glucose
2/21 alt now 244 and more lethargic
abdominal us normal except slightly plump rt adrenal
scheduled LDDS and 2 days later she became pu/pd
now urine glucoes 5+ and bl glucose 521
started nph insulin and scheduled ACTH stim
results pre 1.4 (1-5) post 9 (8-17)
so i would say thid dog has endocrine disease dt coat and now DM showing up but I am stuck.
Am i missing something here dont really think the coat is due to the DM coming on for a year then popping up overnight?
thank you for any help, ☼ | Did the acth stim get run using cortrosyn? | You mention a number of medications; have you tried any behavioral modification techniques? |
Hello,
I am treating a 12yo fs rottie who has had a long coat her whole life (genetic variation?). Mom has shaved her down every year and last year the coat did the funky spotty growth with areas of long hair and areas of no growth.
At that time she felt great did geriatric blood and thyroid MSU all wnl.
Last month she came in and coat still the same mom says now she seems more lethargic, tried nsaids to see if pain and no change. No pu/pd or pp just not right. Repeated geriatric 1/18 which has t4 and tsh all normal except mild increase in alt 185
urine sp. gr 1.046 no glucose
2/21 alt now 244 and more lethargic
abdominal us normal except slightly plump rt adrenal
scheduled LDDS and 2 days later she became pu/pd
now urine glucoes 5+ and bl glucose 521
started nph insulin and scheduled ACTH stim
results pre 1.4 (1-5) post 9 (8-17)
so i would say thid dog has endocrine disease dt coat and now DM showing up but I am stuck.
Am i missing something here dont really think the coat is due to the DM coming on for a year then popping up overnight?
thank you for any help, ☼ | Absolutely sure that there's no exposure to exogenous steroids, including topicals on eyes, ears or skin? | Type of diarrhea? |
Hello,
I am treating a 12yo fs rottie who has had a long coat her whole life (genetic variation?). Mom has shaved her down every year and last year the coat did the funky spotty growth with areas of long hair and areas of no growth.
At that time she felt great did geriatric blood and thyroid MSU all wnl.
Last month she came in and coat still the same mom says now she seems more lethargic, tried nsaids to see if pain and no change. No pu/pd or pp just not right. Repeated geriatric 1/18 which has t4 and tsh all normal except mild increase in alt 185
urine sp. gr 1.046 no glucose
2/21 alt now 244 and more lethargic
abdominal us normal except slightly plump rt adrenal
scheduled LDDS and 2 days later she became pu/pd
now urine glucoes 5+ and bl glucose 521
started nph insulin and scheduled ACTH stim
results pre 1.4 (1-5) post 9 (8-17)
so i would say thid dog has endocrine disease dt coat and now DM showing up but I am stuck.
Am i missing something here dont really think the coat is due to the DM coming on for a year then popping up overnight?
thank you for any help, ☼ | Can you post pictures? | Quantity? |
Hello,
I would appreciate any input I can get...I am a bit confused.
Penny is a 12.5 year old spayed female DSH. Penny initally was presented in April 2012 for signs consistant with a UTI. I diagnosed Diabetes as well as a UTI. She was (and is) obese, with no other complaints. The owner had a hard time being convinced that her cat had diabetes so initially delayed treatment while she monitored urine glucose strips. During this time...only a week or two...she started describing an increase in thirst. She finally agreed to treatment, but was only able/willing to treat once a day. We put her on m/d diet and glargine SID. Initially, she was a bit difficult to regulate, but we were able to get her regulated and she acutally went into remission. We slowly decreased the insulin and kept monitoring fructosamine levels. She has been off insulin since 9/6/12. Fructosamine 9/28/12 was 239. The owner has been monitoring urine strips off and on since then.
At the beginning of January, the owner called with a report that Penny was voracious and kept begging and crying for food. She noted that the urine strips were changiing color again. A urinalysis was negative for glucose, but had a small amount of RBC's and occassional WBC's (cysto sample) Sp. Grav 1.25. BG done in house was 133 and 124 (we are in the process of comparing glucometers--Alpha trak 2 and One Touch, respectively). CBC/Chem results follow: (sent to Idexx)
Alk Phos 23
ALT 426
AST 120
CK 620
GGT 2
Amylase 1554
Lipase 264
Albumin 4.0
T.Prot 7.9
Glob 3.9
T bili 0.1
Dir bili 0.0
BUN 33
Creat 1.4
Chol 260
Calc 10.0
Phos 4.3
TCO2 22
Potass 3.6
sodiun 153
a/g ratio 1.0
b/c ratio 23.6
triglyc 375
Na/K ratio 40
T4 1.3
WBC 13.0
RBC 10.06
HGB 17.4
HCT 57.3
Retic 80
RBC indeces WNL
Neuts 11089 / 85.3%
Lymphs 1274 / 9.6 % Reactive lymphocytes present
Monos 442 / 3.4%
Eos 195 / 1.5 %
Auto Plate 220 (clumos seen on slide)
Owner declined further diagnostics. Decided on a two week course of Clavomox. !/10/13
1/18/13 phone report...doing well will finish antibiotics.
1/31/13 phone report...crying for food every 2 hours. Owner has been feeding more.
2/4/13 recheck blood work. Penny had gained about 1 pound.
owner only allowed recheck chem profile. the following changes ocurred.
ALT dropped to 263
AST dropped to 56
Lipase and Albumin unchanged
Glucose at Idexx 165
Potassium 4.2
Sodium 161
2/14/13
Phone conversation with owner....still wants to eat all the time. But otherwise seems to be fine. Active, normal litter box usage and drinking normally.
2/28/13
Phone : Urinating outside the bix. Drinking normally, but still seeing color change on urine strips.
3/4/13
Urinalysis: sp.grav 1.030
Glucose 250
Protein 500 (+++)
NSF on sediment.
Sorry for the long story...trying to answer all questions before you ask them.
Physical exam is completely unremarkable except for obesity.
I am quite confused. Has this cat come out of remission? Urine glucose but no signs of hyperglycemia? Am I missing something else? Liver? Still wants to eat non-stop, but owner does not think she is drinking more than normal.
Any suggestions would be appreciated.
Thanks, ☼ | What was the bg on the idexx chem screen at the beginning of january? | Do you mean that the canine tooth has been extracted? |
Hello,
I would appreciate any input I can get...I am a bit confused.
Penny is a 12.5 year old spayed female DSH. Penny initally was presented in April 2012 for signs consistant with a UTI. I diagnosed Diabetes as well as a UTI. She was (and is) obese, with no other complaints. The owner had a hard time being convinced that her cat had diabetes so initially delayed treatment while she monitored urine glucose strips. During this time...only a week or two...she started describing an increase in thirst. She finally agreed to treatment, but was only able/willing to treat once a day. We put her on m/d diet and glargine SID. Initially, she was a bit difficult to regulate, but we were able to get her regulated and she acutally went into remission. We slowly decreased the insulin and kept monitoring fructosamine levels. She has been off insulin since 9/6/12. Fructosamine 9/28/12 was 239. The owner has been monitoring urine strips off and on since then.
At the beginning of January, the owner called with a report that Penny was voracious and kept begging and crying for food. She noted that the urine strips were changiing color again. A urinalysis was negative for glucose, but had a small amount of RBC's and occassional WBC's (cysto sample) Sp. Grav 1.25. BG done in house was 133 and 124 (we are in the process of comparing glucometers--Alpha trak 2 and One Touch, respectively). CBC/Chem results follow: (sent to Idexx)
Alk Phos 23
ALT 426
AST 120
CK 620
GGT 2
Amylase 1554
Lipase 264
Albumin 4.0
T.Prot 7.9
Glob 3.9
T bili 0.1
Dir bili 0.0
BUN 33
Creat 1.4
Chol 260
Calc 10.0
Phos 4.3
TCO2 22
Potass 3.6
sodiun 153
a/g ratio 1.0
b/c ratio 23.6
triglyc 375
Na/K ratio 40
T4 1.3
WBC 13.0
RBC 10.06
HGB 17.4
HCT 57.3
Retic 80
RBC indeces WNL
Neuts 11089 / 85.3%
Lymphs 1274 / 9.6 % Reactive lymphocytes present
Monos 442 / 3.4%
Eos 195 / 1.5 %
Auto Plate 220 (clumos seen on slide)
Owner declined further diagnostics. Decided on a two week course of Clavomox. !/10/13
1/18/13 phone report...doing well will finish antibiotics.
1/31/13 phone report...crying for food every 2 hours. Owner has been feeding more.
2/4/13 recheck blood work. Penny had gained about 1 pound.
owner only allowed recheck chem profile. the following changes ocurred.
ALT dropped to 263
AST dropped to 56
Lipase and Albumin unchanged
Glucose at Idexx 165
Potassium 4.2
Sodium 161
2/14/13
Phone conversation with owner....still wants to eat all the time. But otherwise seems to be fine. Active, normal litter box usage and drinking normally.
2/28/13
Phone : Urinating outside the bix. Drinking normally, but still seeing color change on urine strips.
3/4/13
Urinalysis: sp.grav 1.030
Glucose 250
Protein 500 (+++)
NSF on sediment.
Sorry for the long story...trying to answer all questions before you ask them.
Physical exam is completely unremarkable except for obesity.
I am quite confused. Has this cat come out of remission? Urine glucose but no signs of hyperglycemia? Am I missing something else? Liver? Still wants to eat non-stop, but owner does not think she is drinking more than normal.
Any suggestions would be appreciated.
Thanks, ☼ | I take it she doesn't have a palpable thyroid nodule? | Has food allergies been ruled out? |
I recently saw a 6 year old N/M dsh that has had chronic allergies. Every few weeks especially in the winter he scratches and licks alot and gets severe excoriations on his abdomen. blood allergy testing showed he was allergic to dust mites. he has had food trials with no improvement. He is Fiv +. He intermittently takes 2.5 mg prednisilone which clears it up in a few weeks, but then it returns. I talked to the owners about atopica, but I know we have to be careful about immunosuppresion. I'm wondering what would be safer, the atopica or long term low dose pred or do you have any other suggestions? thanks | Have you already tried allergy immunotherapy based on the allergy test? | Who is taking care of the owner on weekends when there is no aide - could they give the insulin? |
Hello,
I have three 'at home' blood glucose curves on a patient - 12 year old lab MC Jake, 86# and overweight, on W/D
He has been on insulin since12/19/11.
currently using humulin n nph
Glucose curve 2/14/13 30u BID
time-----fed-----glucose
8:30-----+-------428
10:30-------------363
12:30-------------389
2:30---------------313
4:30---------------330
6:30---------------244
6:35------+
8:30---------------360
Glucose curve 2/21/13 32u BID
time------fed----glucose
8:30-------+-------332
10:30--------------226
12:30--------------237
2:45----------------329
4:30----------------174
6:30-----------------240
7:00--------+
8:30-----------------228
Glucose curve 3/7/13 33u BID
time ----- fed-----glucose
8:30 ---------------- 200
8:35 --------+
10:30---------------216
12:00---------------212
2:00-----------------206
4:30-----------------175
6:30-----------------151
7:00---------+
8:30---------------- 49, 24, 32 Jake was slightly subdued but playing with companion
8:30---------+ 3 y carrots, and a piece of orange
9:00-----------------60
9:15-----------------68
my questions / areas I could use some clarification / response are:
1) I don't understand the degree of postprandial nadir, and pm only.
2) best approach to altering insulin as the values in the previous curve seemed to high.
3) Would an alternate diet or weight loss help?
4) best snacks to treat hypoglycemia if patient is not symptomatic.
5) Jake typically has a daytime nadir at 5 pm. Is this not typical?
6) although 12 hour glucose curves seem to be the recommendation for monitoring - in this case without the astute observation of the owner I would proly have left Jake on the final dose of insulin which is a little bit scary to consider.
Thank you for your time and consideration!
☼ | Has the owner's glucometer been checked for accuracy? | Does she pant a lot? |
Hello,
I have three 'at home' blood glucose curves on a patient - 12 year old lab MC Jake, 86# and overweight, on W/D
He has been on insulin since12/19/11.
currently using humulin n nph
Glucose curve 2/14/13 30u BID
time-----fed-----glucose
8:30-----+-------428
10:30-------------363
12:30-------------389
2:30---------------313
4:30---------------330
6:30---------------244
6:35------+
8:30---------------360
Glucose curve 2/21/13 32u BID
time------fed----glucose
8:30-------+-------332
10:30--------------226
12:30--------------237
2:45----------------329
4:30----------------174
6:30-----------------240
7:00--------+
8:30-----------------228
Glucose curve 3/7/13 33u BID
time ----- fed-----glucose
8:30 ---------------- 200
8:35 --------+
10:30---------------216
12:00---------------212
2:00-----------------206
4:30-----------------175
6:30-----------------151
7:00---------+
8:30---------------- 49, 24, 32 Jake was slightly subdued but playing with companion
8:30---------+ 3 y carrots, and a piece of orange
9:00-----------------60
9:15-----------------68
my questions / areas I could use some clarification / response are:
1) I don't understand the degree of postprandial nadir, and pm only.
2) best approach to altering insulin as the values in the previous curve seemed to high.
3) Would an alternate diet or weight loss help?
4) best snacks to treat hypoglycemia if patient is not symptomatic.
5) Jake typically has a daytime nadir at 5 pm. Is this not typical?
6) although 12 hour glucose curves seem to be the recommendation for monitoring - in this case without the astute observation of the owner I would proly have left Jake on the final dose of insulin which is a little bit scary to consider.
Thank you for your time and consideration!
☼ | E.g. has one curve been done in the hospital, so we can check the numbers on the owner's machine vs those on a machine that we know to be accurate in-house? | Does the pred normalize the calcium? |
I have an interesting case that I would appreciate some advise. In Nov 2012 owner reports her 12 yr old female spayed australian is drinking a lot of water and that she is having to fill the bowl 2-3 times daily. Owner also stated at the time she is panting more than normal. On physical exam Hr: 70 RR: pant; T:101.4; wt: 36 pounds; Immature cataracts OU. Dog has had a history of urinary tract infections in the past
Bloodwork: lows and highs are indicated
alk 41
alt 46
ast 22
ck 246 High
ggt 9
alb 3.9
tp 7.1
glob 3.2
TBili 0.0
bun 9
ct 0.9
chol 249
glu 105
calcium 10.3
phos 4.5
tco2 21
chlor 110
pot 4.2
sodium 150
a/g ratio1.2
b/c ratio 10.0
trigly 307
na/k ratio 36
t4 0.9 LOW
wbc 7.4
rbc 8.9 HIGH
hgb 21.0 HIGH
hct 59.0 HIGH
plate 324
eos 0.9 LOW
baso 0.1
lymph 18.0
neutro 75.2
% ret 0.6
Urinalysis: freecatch ran in house
color: yellow
appear: clear
sp gr: 1.008
pH: 7
glu:neg
ket:neg
bili:neg
protein: +30
leuk: neg
blood:neg
rbc:neg
wbc:neg
epith: occ
bact:neg
casts:neg
crystals:neg
Called talked to owner and she said the drinking and peeing seemed to have gotten better and she will keep an eye on the dog.
Owner came in 3-7-13 (4 months later) and owner said she is drinking excessively again and she is starting to have accidents in the house which is not like her. Owner feeds her BLUE. Dog now weighs 41 pounds which is 5 more pounds than in november. Owner says she is eating well and owner has not incsed feed. Hr:72, abdomen was tense so not able to palpate well.
Owner brought another urine sample and the dog USG was 1.003 with 30+ protein.
Owner is concerned about her drinking so much.
My ruleouts are glomerular disease, diabetes insipidus, psychogenic polysipsia, cushings disease, addison's disease, neoplasia, open
What would be the next best diagnostic step?
If it comes to doing a water deprivation test, I have never done one before, how should it be properly done?
How do you diagnose psychogenic polydipsia?
What would make a dog be intermittently polydipsic?
Thank you,
☼ | Can you post the normal ranges for all your values? | Did you do a 4 hour sample? |
First time posting, but I will try to be concise.
Kitty ~13# f/s, almost 14 yo DSH torti who has been diabetic for approximately 6 yrs, being managed on Glargine at 2 units bid. Kitty refuses to eat anything but Iams Digestive care kibble, hates all wet food. She was having some difficulty with constipation and inappetance, had a hypoglycemic incident, we got it under control with 24 hours of IVF Dextrose 2.5% with 1 dose of diazepam. Restarted on glargine 1U bid, did glucose curves all things went back to normal once we got her cleaned out and eating a mixture of the Iams and Royal Canin's fiber response diet to help keep her regular. She was being monitored and eating pretty well. A few weeks have passed, roll ahead to Thursday 7March...normal routine is for O to feed, watch her eat some and then give insulin while she's still eating and then off to work, this was around 7am, at 5pm O found in status epilepticus, gave her a tube of glucose and came to the clinic. On presentation non-responsive, hypothermic at 98.6 f, pupils dilated, and rigid. Got her on IVF of Dextrose 2.5%, gave a dose of Diazepam 0.3cc for seizure. +PLR d/c OU, no menace present OU, front legs hyperextended even after dose of diazepam. Ear twitching and turning head toward sounds, licking lips, was unable to stand, glucose at time of presentation was 106, thanks to Dad's quick thinking with glucose tube. All blood work was wnl, best I've seen in a diabetic cat in my short time of doing this. O can't afford 24hr care, which our clinic doesn't offer anyway, but the family is one of my favorites and I've grown very fond of the kitty since I see her so much...I volunteered to bring her home with me since I have the weekend off. So now kitty has been staying with me on IVF dextrose 2.5%, she's gotten about 1.25 liters now. Glucose levels have been running 180, 224, 178, 194, 276...nothing above 300, so she hasn't been getting any insulin (read this off of a VIN post, don't give insulin unless a full 24 hours over 300).
Kitty is having constant tremors of the head and she never stops licking her tongue, her poor tongue has gotten a little swollen from all this, still has +plr d/c OU, no menace OU, still twitches her ears and turns her head toward noise, doesn't blink much (i'm using purlube to keep eyes protected), will stand with assitance and has taken steps, she has postured to urinate, will eat a/d with assitance (she eats it off my fingers). She has spasms at times when she senses a lot of activity in the room where she is kenneled. last night while i was sitting with her she was having forelimb spasms about every 50-60s, to help calm her I gave 0.2 cc diazepam IV, she rested comfortably for a few hours.
So these are my questions or dilemmas
1. I didn't know how long she had been seizing and I didn't think to give mannitol until I read it on a post last night...is it ill advised to give now, as her neurological issues seem to be persisting.?
2. I've read countless posts that advised neuro signs can persist for a long time and that giving Kitty at least 2 weeks to recover is not extreme or wishful thinking...she is making progress except for the little spasms and head tremor, and licking thing...or am I getting my hopes up for her?
3. I've given occassional diazepam to help relax her...should I be doing higher? every 8 hours? or switch to Phenobarb to help relax her, keep her comfortable?
4. Should I stop the IVF 2.5% dextrose? switch to another IVF?
5. When should I be giving insulin..is the older post still a pearl of wisdom?
I apologize for the length and if I seem a bit addled...I haven't gotten a lot of good sleep past few nights worrying about this kid. any advice is greatly appreciated as I am still a baby vet of under 2 yrs. Thanks so much
☼ | What fluid rate do you have her on? | Has the dog been normothermic/normotensive? |
First time posting, but I will try to be concise.
Kitty ~13# f/s, almost 14 yo DSH torti who has been diabetic for approximately 6 yrs, being managed on Glargine at 2 units bid. Kitty refuses to eat anything but Iams Digestive care kibble, hates all wet food. She was having some difficulty with constipation and inappetance, had a hypoglycemic incident, we got it under control with 24 hours of IVF Dextrose 2.5% with 1 dose of diazepam. Restarted on glargine 1U bid, did glucose curves all things went back to normal once we got her cleaned out and eating a mixture of the Iams and Royal Canin's fiber response diet to help keep her regular. She was being monitored and eating pretty well. A few weeks have passed, roll ahead to Thursday 7March...normal routine is for O to feed, watch her eat some and then give insulin while she's still eating and then off to work, this was around 7am, at 5pm O found in status epilepticus, gave her a tube of glucose and came to the clinic. On presentation non-responsive, hypothermic at 98.6 f, pupils dilated, and rigid. Got her on IVF of Dextrose 2.5%, gave a dose of Diazepam 0.3cc for seizure. +PLR d/c OU, no menace present OU, front legs hyperextended even after dose of diazepam. Ear twitching and turning head toward sounds, licking lips, was unable to stand, glucose at time of presentation was 106, thanks to Dad's quick thinking with glucose tube. All blood work was wnl, best I've seen in a diabetic cat in my short time of doing this. O can't afford 24hr care, which our clinic doesn't offer anyway, but the family is one of my favorites and I've grown very fond of the kitty since I see her so much...I volunteered to bring her home with me since I have the weekend off. So now kitty has been staying with me on IVF dextrose 2.5%, she's gotten about 1.25 liters now. Glucose levels have been running 180, 224, 178, 194, 276...nothing above 300, so she hasn't been getting any insulin (read this off of a VIN post, don't give insulin unless a full 24 hours over 300).
Kitty is having constant tremors of the head and she never stops licking her tongue, her poor tongue has gotten a little swollen from all this, still has +plr d/c OU, no menace OU, still twitches her ears and turns her head toward noise, doesn't blink much (i'm using purlube to keep eyes protected), will stand with assitance and has taken steps, she has postured to urinate, will eat a/d with assitance (she eats it off my fingers). She has spasms at times when she senses a lot of activity in the room where she is kenneled. last night while i was sitting with her she was having forelimb spasms about every 50-60s, to help calm her I gave 0.2 cc diazepam IV, she rested comfortably for a few hours.
So these are my questions or dilemmas
1. I didn't know how long she had been seizing and I didn't think to give mannitol until I read it on a post last night...is it ill advised to give now, as her neurological issues seem to be persisting.?
2. I've read countless posts that advised neuro signs can persist for a long time and that giving Kitty at least 2 weeks to recover is not extreme or wishful thinking...she is making progress except for the little spasms and head tremor, and licking thing...or am I getting my hopes up for her?
3. I've given occassional diazepam to help relax her...should I be doing higher? every 8 hours? or switch to Phenobarb to help relax her, keep her comfortable?
4. Should I stop the IVF 2.5% dextrose? switch to another IVF?
5. When should I be giving insulin..is the older post still a pearl of wisdom?
I apologize for the length and if I seem a bit addled...I haven't gotten a lot of good sleep past few nights worrying about this kid. any advice is greatly appreciated as I am still a baby vet of under 2 yrs. Thanks so much
☼ | Can she drink water? | Any exogenous corticosteroids, including topical mications or mications the owners may be using on themselves? |
Livia is a 8 1/2 year ols F/S Italian Greyhound who is diabetic. April 2010, she was very PU/PD and a liver mass was found on abd US as well as hypoglycemia. The mass was removed surgically and her hypoglycemia resolved. The mass was a hepatocellular adenoma. A couple of weeks later the owners brought dog back to Univ. of Penn for recheck. She was found to be a borderline diabetic and was put on WD. In May she was started on Insulin, NPH and switch to Purina OM because the WD was making her defecate 6-7 times daily. SHe was eventually put on 3 units BID. SOme of her glucose curves showed a low BG in am but increased throught the day so she was instructed to feed more in am and stay on 3 units.
2/18/13 the owner reported that Liovia had a hypoglycemic seizure which lasted 5 minutes. They did not bring her into the clinic. They decreased her insulin to 2 units BID but the owner reports she is severely PU/PD. I recommended BG curve ASAP. 2/21 she came in for a curve.
8:20 43
10:20 83
!2:20 230
2:20 319
4:30 296.
She came with food and no insulin on board, so we did not give her the insulin in am and fed her. Due to the curve results. I had them give her 1 unti BID of NPH ( NOVOLIN). Livia had started intermittently wetting her bed at night in her crate , and large amounts of urine. We increased to 2 units at night and 1 unit in am. The owner has difficulty getting BG's at home but got a couple readings.
3/6 8:30 am BG was 213
3/7 BG ws 134 and o had given 1 unit at night and 2 units in am around 9:30
I just got a cysto today with 4 + glucose in urine. I am sending off for C/S. And the 12:30 BG was 75 and she had gotten 2 units of insulin in am at 9:30. I recommended o increase food in am to 2/3 cup and 1/2 cup at night ( was at 1/2 cup BID).
I am wondering if her PU/PD is due to low BG's and i need to go back to 1 unit BID ( but she was still PU/PD on this dose) or if I need to switch insulin?
any help is much appreciated!!!
Thanks, ☼ | Any plans to re-ultrasound the abdomen to see if the mass recurs? | Can the owner accurately measure and then inject the insulin? |
Hi everyone!
Sesi is a 9.5ish year old FS 60# Husky that I recently diagnosed as diabetic (initially BG 663 and 3+ glucosuria). Started her on 7U NPH BID and checked a curve about 10 days later:
8:30am- 387
10:30am- 443
12:30pm- 438
2:30pm- 583
4:44pm- 440
Increased to 9U BID and 7 days later her BG was 500 on Alphatrak at 2:30pm. Increased her to 13U BID and rechecked her curve about 14 days later:
9:35am- 275
10:35am- 248
12:45pm- 295
2:30pm- 354
4:30pm- 378
6:30pm- 400
Increased to 15U and 7 days later rechecked BG on Alphatrak- 507 at around 3:30pm. Ran a Fructosamine and that came back elevated at 622 (>614 = poor regulation). Per owner Sesi is eating well and not having as many urinary accidents.
Did I increase the insulin too much too fast? Or haven't I gone high enough?
Any suggestions are always appreciated :)
Thanks!!!!!
☼ | Is the owner giving the food/insulin at home the morning of the curve, at the normal time? | What did he weigh at this exam? |
Hi everyone!
Sesi is a 9.5ish year old FS 60# Husky that I recently diagnosed as diabetic (initially BG 663 and 3+ glucosuria). Started her on 7U NPH BID and checked a curve about 10 days later:
8:30am- 387
10:30am- 443
12:30pm- 438
2:30pm- 583
4:44pm- 440
Increased to 9U BID and 7 days later her BG was 500 on Alphatrak at 2:30pm. Increased her to 13U BID and rechecked her curve about 14 days later:
9:35am- 275
10:35am- 248
12:45pm- 295
2:30pm- 354
4:30pm- 378
6:30pm- 400
Increased to 15U and 7 days later rechecked BG on Alphatrak- 507 at around 3:30pm. Ran a Fructosamine and that came back elevated at 622 (>614 = poor regulation). Per owner Sesi is eating well and not having as many urinary accidents.
Did I increase the insulin too much too fast? Or haven't I gone high enough?
Any suggestions are always appreciated :)
Thanks!!!!!
☼ | What time does she get the food/insulin? | Weight? |
Hi everyone!
Sesi is a 9.5ish year old FS 60# Husky that I recently diagnosed as diabetic (initially BG 663 and 3+ glucosuria). Started her on 7U NPH BID and checked a curve about 10 days later:
8:30am- 387
10:30am- 443
12:30pm- 438
2:30pm- 583
4:44pm- 440
Increased to 9U BID and 7 days later her BG was 500 on Alphatrak at 2:30pm. Increased her to 13U BID and rechecked her curve about 14 days later:
9:35am- 275
10:35am- 248
12:45pm- 295
2:30pm- 354
4:30pm- 378
6:30pm- 400
Increased to 15U and 7 days later rechecked BG on Alphatrak- 507 at around 3:30pm. Ran a Fructosamine and that came back elevated at 622 (>614 = poor regulation). Per owner Sesi is eating well and not having as many urinary accidents.
Did I increase the insulin too much too fast? Or haven't I gone high enough?
Any suggestions are always appreciated :)
Thanks!!!!!
☼ | What about teaching the owner to generate the curves at home? | Are you sure that the client was reliably pilling this kitty? |
Hi ,
I am about to give up on my wonderful 3 year old cat, you all are my last hope....
My cat is 3 years old castrated when he was about 5-6 month age.
He is a huge cat used to weigh 9 kg. A year ago i began relating to his obesity and he was on restricted diet and DM and nothing helped he would eat less then the recommended ratio and did not loose weight . 3 months ago he stopped eating and blood work showed glucose around 600, ALT AST 2-3 times the normal, Ketones +3, (DKA....)
Ever since he has had 2 US nothing abnormal found, FNA from spleen and liver , NA but the problem is that he has been in and out of critical care 5 times. He goes home on AB(metronidazole, clavamox, batryl clindamicyn)not all at once of course but through out this period ,fluids, insulin(lantos 4 units+ regular 1 unit both bid) ,Same, Ursolit, famotidine. Eats DM and fancy feast chicken. He has lost weight he is now 6 kg.
He gets better at home for 3 weeks and then comes the next crisis.
I have done glucose curves and he keeps on btw 320 to 450 he never gets lower then that.
Yesterday I hospitalized him again , he was doing well putting some weight back on , glucose 320-400, blood work done last week showed liver enzymes down to normal but GGT was above normal(first time). I collected urine on Thursday no ketones but since friday he seemed to be not the same , though this time he kept on eating till yesterday evening, on Saturday I found vomit and yesterdays urine was +2 ketones, for some reason he did not stop eating and glucose was 309 the lowest I had seen lately.
He was hospitalized and we begin again. I think for some reason we are not finding out what is the real story behind the diabetes.
Waiting for your advice,
Thank you,
☼ | Are you using im injections for the regular insulin, or a cri? | Where did this cat's bp start? |
I have been working wih 12 yr old cat 12# . Jan 13 Her fructosamine was at 519(range 142-450). She was given insulin 8 am and 9 pm unitis of lantus. We increased by 1 units. 5 days later her glucose curve was 9 am 338 4pm 200 9pm 230 on 9 units twice a day. They forgot to send me more readings.
3/11 Her glucose cuve 9 am 390, 1pm 415, 5pm 434, 9pm 478. she is on 9 units am and 9 units pm.
I am worried about her insulin dose and her glucose readings. We had the same problem with PZI in 2009. We switched to Lantus and gradually have been increasing her insulin dose...
Any suggestions?
Inputs?
Thanks | What diet is she on? | What about cytopoint for the itching? |
I have been working wih 12 yr old cat 12# . Jan 13 Her fructosamine was at 519(range 142-450). She was given insulin 8 am and 9 pm unitis of lantus. We increased by 1 units. 5 days later her glucose curve was 9 am 338 4pm 200 9pm 230 on 9 units twice a day. They forgot to send me more readings.
3/11 Her glucose cuve 9 am 390, 1pm 415, 5pm 434, 9pm 478. she is on 9 units am and 9 units pm.
I am worried about her insulin dose and her glucose readings. We had the same problem with PZI in 2009. We switched to Lantus and gradually have been increasing her insulin dose...
Any suggestions?
Inputs?
Thanks | A canned low carb, high protein diet? | (could explain some changes on cbc, a bone marrow could be considered) did her exocrine pancreatic insufficiency "relapse"? |
Hello,
Any insight to this curious case would be helpful. "Bruce" is a 4yo MN DSH that first presented to the clinic about a year ago with a strange ulcer on his tongue. We went through the various treatments for fleas/URIs/allergies and with a bit of work we found a diet that has calmed down the ulcer and seems to keep it a bay. Unfortunately with all our interventions we've made Bruce a very difficult cat to medicate.
An additional finding for Bruce is that he gets quite worked up during exams and he occasionally will open mouth breathe after too much handling; his owners also noted some congestion and wheezing at home starting late summer/early fall of this year (tongue ulcer still under control). His owners declined radiographs, but bloodwork at the time was normal except for mild elevations in TP and globulins which was attributed to whatever chronic antigen stimulation had been going on in the mouth. For his congestion and respiratory signs he received depo shots 2 weeks apart (the short interval was discussed with the owner and cautioned about risk of diabetes, etc). Bruce did great for 3 months and then returned with a complaint of being PU/PD and mild wt loss.
I examined him this week and found a relatively normal cat with mild wt loss and muscle wasting along his topline. His lungs and upper respiratory congestion were completely resolved and the tongue ulcer was stable and not bothering him. Blood and urine results the following day showed no diabetes (yay!), stable elevations in total protein and globulins seen previously, and reactive lymphocytes on CBC. His WBC was normal at 14 K/uL. His urine had a quiet sediment but USG was 1.006. Since he is hard to medicate I decided to get him back in to get a urine culture and start him on convenia in the meantime for reactive lymphocytes and poss UTI. A recheck USG was again 1.006. I'm not ready to call this diabetes insipidus and my culture is still pending, but I get the feeling I'm not going to grow anything. Anything else to work up here first? There have been no new stressors in the home, the environment and food are the same, and the owner does not use any steroid containing lotions, etc. This cat has been weird from the start, but I want to make sure I'm not missing something more obvious here.
Thanks for the advice,
☼ | Was the lingual ulcer ever diagnosed (as an eosinophilic plaque, for example)? | Don't give up, you're doing great! would this owner consider home curves? |
Rui, a 4 1/2 yr old, M/N, indoor, DSH cat presented 1/24/13 for anual PE and Rabies vaccine. PE was unremarkable except grade 1/6 heart murmur (Last year an echo was done that showed septal hypertrophty, especially thick at left ventricular outflow tract, with normal left ventricular contractility, and no evidence of left atrial enlargement. Diagnosis: HCM with outflow obstruction. No cardiac meds prescribed)
Anual bloodwork was done showing mild hyperalbuminemia (4.1 g/dL...normal is 2.5-3.9), and hypercalcemia (corrected calcium 12.3 mg/dL, normal is 8.2-10.8). T4 was wnl (1.5). UA was wnl...sp. gr. 1.046, no crystals, casts, blood, etc. CBC results: decreased WBC (3.2. Normal is 3.5-16), and decreased neutrophils (1184; normal is 2500-8500)
Two days later we rechecked the calcium after a 12 hour fast. It was still high . Corrected Calcium was 12.1 at the lab, and 12.5 on our machine.
Rectal exam was WNL. (Full anal sacs, easily expressed)
Two days later we did an abdominal US...spleen slightly enlarged. Kidneys slightly enlarged. Parenchyma normal. Normal liver. Normal gall bladder. Normal urinary bladder. No evidence of adrenal gland enlargement or neoplasia. Normal GI system. No evidence of lymph node enlargement. No evidence of inflammation or neoplasia involving the pancreas.
Chest rads were WNL.
So we sent blood to the lab to check PTH and ionized calcium.
PTH was 0.00 (normal is 0.40-2.50)
Ionized Calcium was high at 1.62 (Normal is 1.16-1.34)
Calcium was high at 12.1 (Normal is 8.2-10.8)
(During one of the venipunctures, the blood seemed slow to clot, and a Prothrombin time and PTT were run and came back normal.)
On 3/8/13 we rechecked blood. Calcium is still hih (Corrected Ca 12.4.)
He is doing well. He weighs 12#10oz.
5 months ago he weighed 14#9oz. In September he presented with chief complaint of urinating very little. His urinary bladder was small and was easily expressed, with a good stream. UA results: Ca Oxalate crystals (11-20/hpf), amorphous phosphate crystals 2-3/hpf, sp. gr. 1.054, pH 7.0. Everything else normal. He was placed on Royal Canin S/O and clavamox. He presented in October for spending a lot of time in litter box. We were able to express the bladder but the stream was not very good. UA dipstick showed 2+ blood and protein.Owner was going on vacation, so boarded cat with us for observation. He was put on prednisolone 1.25 mg BID. He did fine.
So, what now? Do I rush into a bone marrow biopsy? Just monitor his weight and calcium and re-ultrasound if something changes? I don't want to panic these owners since he seems to be doing well (but I am concerned about the weight loss), and I don't want to miss anything either. They will do a bone marrow biopsy if necessary, but are hesitant to do it because of the invasiveness of it.
Any recomendations are greatly appreciated!!!!!!
Thank you. br/ | Has he been tested for felv/fiv? | Weight loss? |
Rui, a 4 1/2 yr old, M/N, indoor, DSH cat presented 1/24/13 for anual PE and Rabies vaccine. PE was unremarkable except grade 1/6 heart murmur (Last year an echo was done that showed septal hypertrophty, especially thick at left ventricular outflow tract, with normal left ventricular contractility, and no evidence of left atrial enlargement. Diagnosis: HCM with outflow obstruction. No cardiac meds prescribed)
Anual bloodwork was done showing mild hyperalbuminemia (4.1 g/dL...normal is 2.5-3.9), and hypercalcemia (corrected calcium 12.3 mg/dL, normal is 8.2-10.8). T4 was wnl (1.5). UA was wnl...sp. gr. 1.046, no crystals, casts, blood, etc. CBC results: decreased WBC (3.2. Normal is 3.5-16), and decreased neutrophils (1184; normal is 2500-8500)
Two days later we rechecked the calcium after a 12 hour fast. It was still high . Corrected Calcium was 12.1 at the lab, and 12.5 on our machine.
Rectal exam was WNL. (Full anal sacs, easily expressed)
Two days later we did an abdominal US...spleen slightly enlarged. Kidneys slightly enlarged. Parenchyma normal. Normal liver. Normal gall bladder. Normal urinary bladder. No evidence of adrenal gland enlargement or neoplasia. Normal GI system. No evidence of lymph node enlargement. No evidence of inflammation or neoplasia involving the pancreas.
Chest rads were WNL.
So we sent blood to the lab to check PTH and ionized calcium.
PTH was 0.00 (normal is 0.40-2.50)
Ionized Calcium was high at 1.62 (Normal is 1.16-1.34)
Calcium was high at 12.1 (Normal is 8.2-10.8)
(During one of the venipunctures, the blood seemed slow to clot, and a Prothrombin time and PTT were run and came back normal.)
On 3/8/13 we rechecked blood. Calcium is still hih (Corrected Ca 12.4.)
He is doing well. He weighs 12#10oz.
5 months ago he weighed 14#9oz. In September he presented with chief complaint of urinating very little. His urinary bladder was small and was easily expressed, with a good stream. UA results: Ca Oxalate crystals (11-20/hpf), amorphous phosphate crystals 2-3/hpf, sp. gr. 1.054, pH 7.0. Everything else normal. He was placed on Royal Canin S/O and clavamox. He presented in October for spending a lot of time in litter box. We were able to express the bladder but the stream was not very good. UA dipstick showed 2+ blood and protein.Owner was going on vacation, so boarded cat with us for observation. He was put on prednisolone 1.25 mg BID. He did fine.
So, what now? Do I rush into a bone marrow biopsy? Just monitor his weight and calcium and re-ultrasound if something changes? I don't want to panic these owners since he seems to be doing well (but I am concerned about the weight loss), and I don't want to miss anything either. They will do a bone marrow biopsy if necessary, but are hesitant to do it because of the invasiveness of it.
Any recomendations are greatly appreciated!!!!!!
Thank you. br/ | Did you have them check the vit d analogue level at msu? | Have you spoken to your lab about this? |
Hello,
-Emma is a 14 yo F/S DLH. Two years ago was diagnosed w/ DM, treated for 6 months glargine and commerciual canned cat food (previous vet, so not sure which - owner can't remember) and went into remission.
-21 days ago the other cat in the house presents for URI signs.
-14 days ago Emma has URI signs. Started on Benadryl, steam and TLC.
-3 days later she's anorexic. 3.75mg dose Mirtazapine - no effect.
-Blood panel = mild ALT/ALP elevations w/ spec FPL = 8. Normal BG's throughout entire 14 days of treatment, so still in remission.
She also has high-normal tT4 so we do fT4 and it 45, mildly elevated.
-Tx buprenorphine bid - seems more comfortable but still anorexic
-5 days anorexic now so we place esophagostomy tube and feed a/d slurry.
-This goes on for 7 days and she vomits 2 times. Owner is upset, wants to euthanize so I suggest we pull the tube in case she has esophagitis. At least she'll get a few days comfort at home then we can euth.
-2 days later she's eating lean ground beef. (maybe my tube was bothering LES, causing reflux? Rads showed close proximity to LES, but not through).
-today she's eating commercial canned cats food.
My nutritional questions:
We have a previously diabetic cat who I would love to have on low-carbs, but she needs low fat. Got to get energy somewhere; protein can't do it all, or can it?
1- Should I even bother trying Hill's y/d for hyperthyroidism?
2- What veterinary diets can you recommend?
3- What commercial canned foods can you recommend?
*Keeping in mind, I'd like to keep her in remission.
Thank you.
☼ | Could it all be protein? | Any diagnostic imaging? |
I own two hospitals and employ three vets in addition to myself. As a general rule, things run smoothly and we all share the same practice philosophy. We have all noticed in recent months that we seem to have slightly different approaches when it comes to handling more chronic medical cases, specifically renal disesase and diabetes. None of us are so stuck in our ways that we refuse to bend on how we manage things, but we all agree that there needs to be more continuity when it comes to managing our current patients, as well as those newly diagnosed. So, my question is- Does anyone out there have a protocol that all there vets follow with respect to diagnosing and managine diabetics and renal patients(i.e do you start off with urine cultures for both, microalbumin or UPCRs for renal patients, blood pressure monitoring, etc. etc.). We are looking to develop a reasonable protocol that would serve to provide the best care possible without being so cost prohibitive that people would refuse to treat. Thanks in advance,
/p | For example, with renal failure patients: is this a young or an old animal? | Any thoracic rads? |
I own two hospitals and employ three vets in addition to myself. As a general rule, things run smoothly and we all share the same practice philosophy. We have all noticed in recent months that we seem to have slightly different approaches when it comes to handling more chronic medical cases, specifically renal disesase and diabetes. None of us are so stuck in our ways that we refuse to bend on how we manage things, but we all agree that there needs to be more continuity when it comes to managing our current patients, as well as those newly diagnosed. So, my question is- Does anyone out there have a protocol that all there vets follow with respect to diagnosing and managine diabetics and renal patients(i.e do you start off with urine cultures for both, microalbumin or UPCRs for renal patients, blood pressure monitoring, etc. etc.). We are looking to develop a reasonable protocol that would serve to provide the best care possible without being so cost prohibitive that people would refuse to treat. Thanks in advance,
/p | Acute or chronic? | You read this? |
I own two hospitals and employ three vets in addition to myself. As a general rule, things run smoothly and we all share the same practice philosophy. We have all noticed in recent months that we seem to have slightly different approaches when it comes to handling more chronic medical cases, specifically renal disesase and diabetes. None of us are so stuck in our ways that we refuse to bend on how we manage things, but we all agree that there needs to be more continuity when it comes to managing our current patients, as well as those newly diagnosed. So, my question is- Does anyone out there have a protocol that all there vets follow with respect to diagnosing and managine diabetics and renal patients(i.e do you start off with urine cultures for both, microalbumin or UPCRs for renal patients, blood pressure monitoring, etc. etc.). We are looking to develop a reasonable protocol that would serve to provide the best care possible without being so cost prohibitive that people would refuse to treat. Thanks in advance,
/p | Is the patient sick or not? | How long did he have diarrhea after the neuter before metronidazole was started? |
I own two hospitals and employ three vets in addition to myself. As a general rule, things run smoothly and we all share the same practice philosophy. We have all noticed in recent months that we seem to have slightly different approaches when it comes to handling more chronic medical cases, specifically renal disesase and diabetes. None of us are so stuck in our ways that we refuse to bend on how we manage things, but we all agree that there needs to be more continuity when it comes to managing our current patients, as well as those newly diagnosed. So, my question is- Does anyone out there have a protocol that all there vets follow with respect to diagnosing and managine diabetics and renal patients(i.e do you start off with urine cultures for both, microalbumin or UPCRs for renal patients, blood pressure monitoring, etc. etc.). We are looking to develop a reasonable protocol that would serve to provide the best care possible without being so cost prohibitive that people would refuse to treat. Thanks in advance,
/p | Anemic or not? | Cbc/chem/ua results? |
I own two hospitals and employ three vets in addition to myself. As a general rule, things run smoothly and we all share the same practice philosophy. We have all noticed in recent months that we seem to have slightly different approaches when it comes to handling more chronic medical cases, specifically renal disesase and diabetes. None of us are so stuck in our ways that we refuse to bend on how we manage things, but we all agree that there needs to be more continuity when it comes to managing our current patients, as well as those newly diagnosed. So, my question is- Does anyone out there have a protocol that all there vets follow with respect to diagnosing and managine diabetics and renal patients(i.e do you start off with urine cultures for both, microalbumin or UPCRs for renal patients, blood pressure monitoring, etc. etc.). We are looking to develop a reasonable protocol that would serve to provide the best care possible without being so cost prohibitive that people would refuse to treat. Thanks in advance,
/p | Other concurrent diseases or clinical signs? | What did biopsies show? |
I own two hospitals and employ three vets in addition to myself. As a general rule, things run smoothly and we all share the same practice philosophy. We have all noticed in recent months that we seem to have slightly different approaches when it comes to handling more chronic medical cases, specifically renal disesase and diabetes. None of us are so stuck in our ways that we refuse to bend on how we manage things, but we all agree that there needs to be more continuity when it comes to managing our current patients, as well as those newly diagnosed. So, my question is- Does anyone out there have a protocol that all there vets follow with respect to diagnosing and managine diabetics and renal patients(i.e do you start off with urine cultures for both, microalbumin or UPCRs for renal patients, blood pressure monitoring, etc. etc.). We are looking to develop a reasonable protocol that would serve to provide the best care possible without being so cost prohibitive that people would refuse to treat. Thanks in advance,
/p | Since you have a congenial group of colleagues, do you think that you can sit down together to go over your ideas and philosophies and come up with some guidelines on which you can all agree? | What should he weigh? |
Cat was presented to us after grooming, tail degloving, hyperemic skin, fragile capillaries, We are still pending labs, but probably more news in 1hour
Normothermic, depressed, tachipneic and
Can you put some ideas?
Dr. ☼ | Is the cat taking any medications? | What should he weigh? |
Dodge is an approx. 14 year old MN DSH, BCS 2/5. No recent history of obesity (adopted from shelter 1 year ago).
Feb 13, 13: Diagnosed with diabetes.
CBC, Chem 17, lytes, T4 all within normal range except hyperglycemia (31.9 mmol/L). 1000 mg/dL glucosuria.
Treated UTI, started on glargine 1.5 units bid. and Purina DM canned.
Owner started home bg measurement.
Feb 21, 13: am blood glucose just prior to insulin injection= 27.7 mmol/L. Still pu/pd. Increased dose to 2 units bid.
Feb 25, 13: am blood glucose just prior to insulin injection= 26.6 mmol/L. Still pu/pd. Increased dose to 3 units bid.
Feb 28, 13: no longer pu/pd
8:45 - gave 3 units of insulin and fed
9:45 - bg= 8.9 Reduced dose to 2.5 units bid.
Mar 4, 13:
8:00 am bg= 9.9. Gave 2.5 units glargine
noon= 2.2
4 pm= 1.8
6 pm= 4.2
8 pm= 10.3
Reduce to 2 units glargine bid
March 7, 13: 2 units bid
8am: bg= 11.9, Gave 2 units glargine
1pm bg=2 units
Decrease to 1 unit bid
March 8, 13: 1 unit bid
1pm: bg = 15
Increase dose to 1.5 units bid
March 11, 13 1.5 units bid This curve was done overnight as owners away during day.
7:30 am = 6.1
11 pm = 4.1
3 am= 7.8
7 am = 12.9
Sorry, these are all home curves, with it being difficult for owners to get as they both work. Dodge does best at home. Are overnight curves accurate? Am I seeing symogi?
Do I go lower with the dose? | Has the glucometer been checked for accuracy? | Uh-oh.....i'm worried that the pad lesions are the hepatocutaneous syndrome---can you post pictures? |
Dodge is an approx. 14 year old MN DSH, BCS 2/5. No recent history of obesity (adopted from shelter 1 year ago).
Feb 13, 13: Diagnosed with diabetes.
CBC, Chem 17, lytes, T4 all within normal range except hyperglycemia (31.9 mmol/L). 1000 mg/dL glucosuria.
Treated UTI, started on glargine 1.5 units bid. and Purina DM canned.
Owner started home bg measurement.
Feb 21, 13: am blood glucose just prior to insulin injection= 27.7 mmol/L. Still pu/pd. Increased dose to 2 units bid.
Feb 25, 13: am blood glucose just prior to insulin injection= 26.6 mmol/L. Still pu/pd. Increased dose to 3 units bid.
Feb 28, 13: no longer pu/pd
8:45 - gave 3 units of insulin and fed
9:45 - bg= 8.9 Reduced dose to 2.5 units bid.
Mar 4, 13:
8:00 am bg= 9.9. Gave 2.5 units glargine
noon= 2.2
4 pm= 1.8
6 pm= 4.2
8 pm= 10.3
Reduce to 2 units glargine bid
March 7, 13: 2 units bid
8am: bg= 11.9, Gave 2 units glargine
1pm bg=2 units
Decrease to 1 unit bid
March 8, 13: 1 unit bid
1pm: bg = 15
Increase dose to 1.5 units bid
March 11, 13 1.5 units bid This curve was done overnight as owners away during day.
7:30 am = 6.1
11 pm = 4.1
3 am= 7.8
7 am = 12.9
Sorry, these are all home curves, with it being difficult for owners to get as they both work. Dodge does best at home. Are overnight curves accurate? Am I seeing symogi?
Do I go lower with the dose? | E.g. has one curve been done in-house so that we can compare numbers on the owner's machine vs those on a machine that we know to be accurate in-house? | Any particular place? |
"Madison" is a 10 year old 20lb poodle cross, who has been getting insulin for about 15mos. For most of this she has been on 8U Caninsulin bid, and has been doing clinically well; wt is stable, not pupd or pp. However, her fructosamines have consistently indicated poor control, and the results of today's curve are below:(insulin given 8:30am)
9 - 30.6
11 - 18.6
1pm-20.2
2 - 19.6
3 - 18.6
4 - 17.6
5 - 16.9
6 - 15.7
Discharged. The owner has not noted any symptoms of hypoglycemia. Somogyi? Should I change the insulin dose based on this curve?
Thanks
☼ | Is she a spayed female? | Can i see some of his bg curves? |
13yo MN DSH diagnosed with diabetes mellitus based on pu/pd, weight loss, ++ appetite, marked hyperglycemia and elevated fructosamine. Started on glargine BID and with regular BG curves came to 3U BID. At 2U BID BG still flatlined in low 20s mmol/L.
He is on Purina DM diet and clinically has improved (see below).
BG curve at 3U BID looked like this:
Ate at home just prior to drop off
8:30- 6.2 (no insulin given)
10:30-10.9
12:30-12.7
2:30-12.8
Stopped curve at this time given results and rec decrease to 2.5U BID based on normal BG in a.m.
BG curve at 2.5U 7-10 days later (clinically much more energetic, no significant pu/pd)
8:30- 5.5 (did not give insulin)
10:30-11.1 >> gave 2.5 units Lantus to assess impact while in clinic
12:30-13.0
2:30-11.2
5:00- 9.2
Curve is upside down. Seems like no impact of insulin but maybe kept BG elevation at bay (would have inc further without it?). And why so low in the morning.
We are going to try to ask about feeding patterns more as maybe he doesn't eat well at night.
Our current plan is to stop insulin o/n and recheck a BG in a.m prior to feeding to see what has happened over 24h without insulin.
I appreciate any thoughts and help of how at least to approach this. Based on lack of response throughout the day I would love to increase his insulin. But with a normal BG in the a.m. I certainly wouldn't want to give him anymore at that time with what looks like it would be a normal BG. I am wondering how likely it is this hyperglycemia is stress and maybe he is in remission or on his way. | Canned or dry? | Is that the confusion perhaps? |
I have a dog with newly diagnosed dry eye that I want to start on a fatty acid supplement. My question is is there any contraindication for doing this when a dog is already on insulin (is currently being successfuly managed for diabetes).
Thank you very much in advance.
/p | Are you looking to add omega-3 pufa specifically? | The owner moves the insulin injections around on his body every day? |
Hello,
My patient is a 16.2 lb (7.36 kg) FS JRT that is diabetic and recently diagnosed with cushing's syndrome. My question is regarding a starting dose of trilostane for this dog. It seems the consensus is to start at 2 mg/kg daily but his dog would require approximately 15mg. I want to use the Vetoryl capsules rather than have trilostane compounded. Would 10 mg daily be inappropriately low or 30 mg daily be inappropriately high for initial dosing? They are hoping they can administer 1 size capsule daily due to the high cost of the med.
Thanks! | How was this diagnosis made...acth stim? | Is the cat still febrile? |