Endocrine cases (Schaer)

Question 1

Problem list

• Diabetic that had no insuline for 10 days
• Hyperglycemic, dehydrated, tachycardic
• 1286 glucose, azotemia, hypokalemic, metabolic acidosis
• urine: none available
• v-tach

Answer 1

• initial TX plan
  
  • delay insulin 12-24 hours
  • then begin SQ regular at 0.25 u/kg q6-8 or CRI at 0.1 u/kg/hr
  • rehydrate slowly with LRS cont K⁺ 30 mEq/L
    
    • reassess and inc K if necessary

Question 2

Don’t lower glucose more than….

Answer 2

100mg/dL/hr

Question 3

Brains source(s) of energy

Answer 3

• Glucose
• Ketones

Question 4

Hypoglycemia TX

Answer 4

1 mL/kg dextrose (50%) bolus

(I think you have to dilute this tho)

Question 5

Diabetic cats cat

Answer 5

• resemble type 2 diabetics
  
  • produce their own insulin sporadically
  • may have hypoglycemic episodes

Question 6

Insulin overdose TX

Answer 6

• Glucose: 0.5 g/kg
• Karo syrum orally: 1ml=1g=1/2ml/kg
• Dextrose 50% = 0.5 g/ml = 1ml/kg IV push
• Glucagon:
  
  • 0.25% to 1.0 mg IM or
  • 0.03 mg/kg IM: common used for dextrose resist insulinoma patients

Question 7

Hypoglycemia with long-acting insulin

Answer 7

may have to send owner home with dextrose

Question 8

12 yr old F/S dachs, prev. diagnosed cushings dog on OpDDD Tx

• Addison’s crisis
  
  • recent progressive depression, anorexia, vomiting
  • PE: mod dehydration, depressed, HR 50, CRT delayed
• ECG: slow, no p-waves, bradycardia => atrial standstill
• hypercalcemic, hyponatremic, hyperkalemic, some acidosis, azotemic

Answer 8

*insuline dextrose, Ca gluconate, IV fluids

• Initial treatment
  
  • 0.9% saline IV mod rate for MI (mitral insufficiency)
  • DOCP
    
    • mineralocorticoid
    • lasts 23-30 days
  • Dexamethasone and prednisolone Na succinate
  • 10% Ca gluconate IV
  • 3 units regular insulin and 6g D-50 IV

Question 9

Maintenance dose pred

Answer 9

0.25-0.3 mg/kg/day

Question 10

Eclampsia

(Postparturient hypocalcemia)

• Irritability, not nursing well
• neuromuscular irritability and febrile

Answer 10

• Immediate tx
  
  • 10% Calcium gluconate
    
    • 0.5-1.5 ml/kg IV over several minutes
    • titrate to effect
      
      • tetany stops or
      • vomit
• Maintain
  
  • 2ml/kg slowly over 6-8 hours or
  • 5ml/kg slowly per 24 hours

Question 11

hypocalcemia tx

Answer 11

• Vitamin D₂
  
  • 4000-6000 units/kg/day for 1-2 weeks then
  • 1000-2000 units/kg/day
• DHT-dihydrotachysterol
  
  • load 0.02-0.03 mg/kg/day for 4 days then 0.01 mg/kg/day
• Calcitriol (1,25 vit D)
  
  • 0.03-0.06 microg/kg/day

Question 12

Hypothyroid myxedema 6 yr old male husky progressive weakness, anesthetized for CSF and rads and didn’t wake up

• Not recovering from anesthesia
• Hypothermia
• PCV 26, hypercholesterolemia, inc CPK, low thyroid

Answer 12

• TX principles
  
  • slow re-warming
  • Give thyroixine IV or PO if conscious
  • Give glucocorticoids
  • Avoid IV fluid overload
    
    • tendency for edema

Question 13

Apathetic hyperthyroidism

Answer 13

• lacks usual features of hyperthyroidism
• signs of heart disease dominate
  
  • heart failure can supercede CS hyperthyroidism

Question 14

CHF and goiters on PE

Answer 14

• start treating heart
• start treating hyperthyroidism

Question 15

Apathetic hyperthyroidism

CS

Answer 15

• Mainly cardiac
  
  • tachycardia
  • dyspnea
  • abnormal lung sounds
• +/- palpably enlarged thyroid glands
• rarely seen b/c of earlier dx

Question 16

Common EKG changes thyrotoxic heart dz

Answer 16

• Tall R waves and sinus tachycardia

Question 17

Non-surgical Rx of hyperthyroidism

Answer 17

• Propranolol or atenolol
• Amlodipine if hypertensive
• Methimazole
• Radioiodine (I¹³¹)

Question 18

DKA + PYO 6yr F pointer

• dec appetite of 5 days, 2kg weighloss past month
• PU/PD for 4 weeks
• dehydrated, enlarged intra-abdominal structure, purulent vaginal d/c
• hyperglycemic

Answer 18

• TX
  
  • Rehydrate
  • Tad of insulin
  • OHE
  • blood glucose check after OHE

Question 19

9 yr F/S poodle

PU/PD, vomiting, depressed

• PU/PD prior month, past 5 days repeat vomiting, 103.5 temp, abdomen painful to palpation, epidermal atrophy, moderate dehydration
• left shift, DIC, coagulopathy, white cells, cocci, inc Liver enzymes, icteric, low proteins, azotemic, hyperglycemic

Answer 19

• Inital tx
  
  • IV NaCl
  • KCl 40 mEq/L
  • enrofloxacin and unasyn
  • metoclopramide
  • butorphanol PRN
  • regular insulin
    
    • 0.1 unit/kg after rehydration
    • 0.1 unit/kg/hr CRI
  • Insert foley for urine output measurement

Question 20

Poodle after 24 hours

• Persisting mental depression
• Urine output falling oliguric to anuric
• Blood glucose feel to 530 mg/dL
• Persisting abdominal pain

Answer 20

• Euthanized
• had pancreatitis