Blood Results Flashcards
Define in terms of daily water consumption, polydipsia in the cat
Normal water intake for cats is <45mls/kg/d
What are the practical challenges when measuring water consumption in cats
Many cats are both inside and outside therefore difficult to know if sourcing water elsewhere – eg puddles/ponds.
Need to consider wet cat food
An 18 year old male cat, Timmy, has a history of increased thirst and weight loss (0.3kg since a visit 6 months ago). The owner reports he is becoming increasingly lethargic but his appetite is OK.
On examination he has a body condition score of 2/5 and his kidneys feel a bit small and irregular. You can’t find any other abnormalities.
List your top 4 differentials
CKD
DM
Hepatic disease
GI problem causing malabsorption within SI
An 18 year old male cat, Timmy, has a history of increased thirst and weight loss (0.3kg since a visit 6 months ago). The owner reports he is becoming increasingly lethargic but his appetite is OK.
You perform a biochemistry screen, PCV, a blood smear and a urine dipstick and sediment exam
USG: 1.016 (refractometer)
Urine protein:creatinine ratio: 0.8
Sediment exam: A few struvite crystals but otherwise NAD
Blood pressure (systolic) – 160mmHg
List the clinical pathology abnormalities and for each abnormality discuss the differential diagnoses that may cause these changes.
Increased creatinine – muscle breakdown, indicated in dehydration, CKD indicates IRIS stage III
Increased BUN –CKD, due to functional loss of nephrons
Hyperglycaemia – Diabetes Mellitus, stress,
Hyperphosphataemia – CKD
Hypokalaemia can be increased or decreased in CKD, might be due to decreased intake due to anorexia
Decreased PCV with normocytic normochromic anaemia – often mild non-regen anaemia in CKD, due to decreased EPO production
Proteinuria – CKD (marker for glomerular capillary hypertension)
Trace of blood –UTI secondary to CKD
Trace of glucosuria -DM
Refractometer USG: 1.016 – hyposthenuric, unable to concentrate urine, CKD
UPC ratio 0.8 – proteinuria, CKD
Few struvite crystals – UTI secondary to CKD
Blood pressure 160mmHg – CKD (moderate risk of target organ damage), hypertension?
pH 6.8 – if >7 might indicate cystitis, secondary to CKD?
With CKD on the list we have done bloods and urinalysis what should we do next?
Urine culture – to identify any bacterial cause of UTI
SDMA? – although only useful for early CKD
Diagnostic imaging – unhelpful as kidneys both already small
An 18 year old male cat, Timmy, has a history of increased thirst and weight loss (0.3kg since a visit 6 months ago). The owner reports he is becoming increasingly lethargic but his appetite is OK.
On examination he has a body condition score of 2/5 and his kidneys feel a bit small and irregular. You can’t find any other abnormalities.
= CKD!
How do we treat?
Fluid therapy – Hartmanns? restore deficit, provide maintenance, cover ongoing losses
Correct hyperkalaemia – low phosphate diet, +/- phosphate binders
Anti-emetics – maropitant
Gastroprotectant – sucralfate
Treat secondary underlying UTI – as a cat likely to not be infection?
Manage anaemia (might be responsible for lethargy CS)– darbepoietin and iron supplements
Barney is an overweight (38kg, BCS 4/5) male neutered Labrador Retriever. His owner has presented him to you because he is urinating in the kitchen overnight. Prior to the appointment you ask his owner to collect a urine sample and measure how much he drinks in a 24hour period.
The owner thinks he drinks about 3 litres and has a mixture of dry and wet food
You elect to do blood biochemistry, PCV, and blood smear (Barney was starved before he was brought in this morning)
The urine results are:
List the clinical pathology abnormalities and for each abnormality discuss the differential diagnoses that may cause these changes.
USG 1.020 – ok?!
PU/PD – HAC, Addisons, pyelonephritis, kidney disease, hepatic disease, DM
Urea high – renal disease, hepatic disease, dehydration?
ALP/ALT high hepatic disease, HAC
Cholesterol high – DM, HAC, nephrotic syndrome, acute pancreatitis, hypothyroidism
Bile acids – high end of normal HAC
Increased number of neutrophils on blood smear – inflammatory response, stress response? - HAC
Barney is an overweight (38kg, BCS 4/5) male neutered Labrador Retriever. His owner has presented him to you because he is urinating in the kitchen overnight. Prior to the appointment you ask his owner to collect a urine sample and measure how much he drinks in a 24hour period.
Is this polydipsic?
40-60ml/kg/d is normal
Barney is 38kg so 2.28 litres would be normal, 3 litres = polydipsic
Barney is an overweight (38kg, BCS 4/5) male neutered Labrador Retriever. His owner has presented him to you because he is urinating in the kitchen overnight. Prior to the appointment you ask his owner to collect a urine sample and measure how much he drinks in a 24hour period
An ACTH stim is done. How is this done?
Fast animal for 12h
Collect 5ml heparinised/clotted blood
Inject synacthen (synthetic ACTH) 0.25mg
Collect 5ml blood 1h later
Separate serum/plasma
Perform cortisol assay on both samples
Interpret these ACTH stim results
Pre-stimulation cortisol: 194 nmol/l (range 28-250)
Post-stimulation cortisol: 835 nmol/l (range 200-600)
As post stimulation cortisol high, indicates HAC
- cannot determine whether ADH or PDH, and if under chronic stress may develop adrenal hyperplasia that can lead to abnormal ACTH response until Tx of underlying disease
What is the effect of dehydration on BUN?
This is increased in animals which are dehydrated. This is because the perfusion of the kidneys is lower = less BUN gets filtered out and so remains in the blood
What is the effect of dehydration on creatinine?
Waste product which originates from muscles. This is increased in dehydrated patients because, like BUN, the perfusion of kidneys is lower in dehydration, so less is filtered and excreted out of blood.
What is the effect of dehydration and sodium?
May or may not be increased in dehydrated patients.
Why is total protein increased with dehydration?
Increase due to relative increase in albumin levels.
What is the effect of dehydration on calcium?
Increase due to increased albumin associated with dehydration (calcium is usually bound to albumin.