DL: Endocrine 4 Cases Flashcards
is 2+ protein in reasonably concentrated urine worrying?
No can be normal
Causes of malutilisation
- DM
- Neoplasia
- LIver dz
- CHF
- Hyperthyroidism
3 broad causes of hepatomegaly
- infiltration
- accumulation
- congestion
Why may DM cause an azotaemia?
Produces a catabolic state -> ^ urea and creatininte
Neutrophilia in the abscnce of a stress leucogram indicates what?
- focus of inflame/infection somewhere
What can cause ^ urine pH ?
- UTI (urease producing bacteria -> ammonia NH3 collects H= -> alkalination)
- ^ veg content diet
Empirical tx or diagnostics for a suspected UTI?
urine culture
tx amoxyclav
What endocrine causes of wt loss despite ^ appetite and CV changes are possible?
- hypersomatotropism (expect concurrent DM, r/o with UA)
- hyperthyroidism
What does azotaemia with appropriately concentrated USG tell you?
Pre-renal azotaemia
How does phosphate change in diabetic cats?
decreases
-> haemolysis (cuase or effect? not sure look up)
If unsure whether apparent hyperglycaemia is d/t stress or DM, how can this be differentiated?
> fructosamine poss to r/o immediate stress at time of sample (pooled average of 10-14d)
- BUT if stress hyperglycaemia more chronic d/t stress of chronic disease then this will not differentiate and stress still poss cause
When can IGF-1 levels not be used to test for acromegaly?
- on admittance of an uncontrolled diabetic
- liver has no insulin to make IGF1
- need to give insulin 1st for a few days then retest when insulin in system
What IGF1 levels indicate hyperosmatotrophism?
> 90 (32-90 normal)
How can hyperthyroidism be dx?
Serum T4 conc (20-45)
What can falsely increase the TSP/ TPP count?
Lipaemic serum
What can cause a relative insulin deficiency in the dog?
- pancreatitis
> not typical type 1 DM seen commonly in the dog - if not improved in few days try insulin but give time for pancreas to recover first
What may cause bilirubin to be present in the urine?
- pancreatitis
> bile duct runs through pancreas to get to SI
What does a significantly increased amylase suggest? (>2-3x upper limit) What finding would support this finding?
Exocrine pancreatic disease
- PANCREATITIS -> fasting lipaemia
Why may liver enzymes be raised with pancreatitis?
2* dmagae to liver
Will you expect to see an inflammatory profile with pancreatitis?
YES and left shift likely
What tests could you perform to further clarify suspicions of pancreatitis?
> cPLI (canine pancreatic lipase immunoreactivity)
- SNAP test (^ risk false +, yes/no)
rads/ultrasound for structural change
- spec tet (lab IDEX numerical, 25% false -ves)
Tx for pancreatitis?
- fluids, pain relief
- Nil per os until stops vomming
- v dietary fat
- antiemetic (ensure tx nausea as well as emesis: maropitant potensh not very good, ondansetron better)
Describe the typical presentation of DM with acute ketoacodiosis
- 3d V+ and inappetance
- rapidly progressive lethargy, V+, anorexia
- months hx PD, ravenous apetitie with wt loss
- hepatomegaly
Will all DM animals become ketotic?
NO severe insulin deficiency needed for this
What are the functions/actions of insulin?
Best at v peripheral lipolysis -> v ketone body production -> ^ lipogenesis
- v mm catabolism -> v hepatic gluconeogenesis
- ^ intracellular K+ flux
Worst at ^ peripheral glucose uptake
~ hence why very low insulin levels needed for ketosis to occour
How can acidosis affect other biochemical parameters?
- will see v HCO3 as trying to compensate
- casues Hyperkalaemia (^H+ taken into cells to be converted by carbonic anhydrase to CO2 + H20, K+ pumped out to balance charges as most permeable ion)
- UNLESS vomiting
> K+ lost in vomit and with PU (^tubular flow -> ^ K+ loss)
> No insulin to encourage reuptake into cells
-> ALL K+ LOST FROM BODY, VERY BAD - if IVFT started K+ concentration drops even more -> cardiac arrest
What should be thought about as a priority with diabetic ketoacidosis?
POTASSIUM
- don’t correct acidosis too quickly
- always spike fluids
What are the features of diabetic ketoacidosis?
- metabolic acidosis
- v total body K+ (even if normal on bloods, reserves likely to be low, assume total body K+ is low)
- ketonuria
Tx diabetic ketoacidosis
- Fluids spiked with K+ (phosphate or chloride)
- 2x maintainance rate
- soluble insulin CRI/IM q1hr
- Avoid fluids with Ca (K phosphate spike will mineralise with Ca P - bad)
> then tx as standard DM
How will glucose and ketone levels respond to insulin tx?
- hepatic ketogenesis continues despite lipolysis being inhibited so glucose will v faster than ketones -> HYPOGLYCEAMIA
- at this point v insulin and start glucose/dextrose infusion for 1-3d
