CAL: Clinical Nutrition

Question 1

Tx urolithiasis in dogs

Answer 1

> reduce supersaturation urine
- promote diuresis ^ water intake
- most important regardless of type of urolith
charging pH
- not effective all types
tx UTIs
tx underlying causes (hyperPT, hyperadrenocorticism)

Question 2

Work up if lower UT dz suspected

Answer 2

• sterile sample (cystocentesis)

- abdo rads

Question 3

Most common urolith type for a middle aged, female Lhasa Apso with signs of LUT dz, radiographic apparent cystoliths, urine pH ^

Answer 3

Struvite

- responds well to diet management

Question 4

dietary management of struvite

Answer 4

• v urine concentration
• ^ diuresis
• Calculolytic diets available (use for 1 month beyond dissolution, not long term)
• v urine conc urea, ph and mg
• moderate protein content
• ^ digestible, low fibre
• aim to decrease urea for urease producing bacteria
• acidify urine
• Ensure UTI tx

Question 5

Monitoring resolution of struvite

Answer 5

• evaluate UTI
• serial abdo radiographs
• urine pH
• USG
• evidence of crystals

Question 6

What should be checked and monitored with a blocked cat ?

Answer 6

Serum potassium - take ECG CAN LEAD TO LIFE THREATENING dysrhythmias

Question 7

Tx hyperkalaemia

Answer 7

• calcium IV

- glucose and insulin

Question 8

What is seen on ECG with hyperkalaemia?

Answer 8

• tented T waves
• lack of P waves
• widened complex

Question 9

How do calcium oxalate calciums appear

Answer 9

square crystals

Question 10

management of calcium oxalate crystals

Answer 10

• avoid excessive dietary calcium and oxalate (but do not restrict)
• dietary phosphorus should NOT be restricted (severe restriction ^ urinary Ca excretion -> ^ rick urolith formation)
• NOT RENAL DIETS (very low protein/phsophorus)
• pH not very useful
• water intake and diuresis
• ## weight loss

Question 11

What uroliths are dalmations pdf?

Answer 11

Urate

- though dalmation individuals pdf tones have other changes (vGAGs and Tamm-Horsfall Protein)

Question 12

Tx urate urolths

Answer 12

• ^ urine pH
• lower conc uric acid (low purine diets, severe protein restriction)
• lower ammonium and hydrogen ions
• avoid fish and offal if not using calculolytic diet
• use vegetable proteins, eggs and dairy
• ^ diuresis
• xanthine oxidase inhibitors (eg. allopurinol) v uric acid [NB: this will ^ risk of xanthine uroliths)

Question 13

Which breed are pdf cystine stones?

Answer 13

English Bulldogs (though these type of uroliths are relatively uncommon)

• defective tubule -> ^ cystine and other amino acid concentration
• ^ risk of formation in acidic urine

Question 14

Tx/prevention cystine uroliths

Answer 14

• protein restriction
• ^ solubility of cytine by ^ pH
• thiol-containing drugs (react with cystine to make it more soluble)
  > eg. 2-MPG or N-2meta…-glycine
• CASTRATE