PATHOLOGY - Metabolic Collapse Flashcards
What are the potential causes of metabolic collapse?
Diabetic ketoacidosis (DKA)
Hypoglycaemia
Hyper-/hypokalaemia
Hyper-/hypocalcaemia
Hyper-/hyponatraemia
Hepatic encephalopathy
Pheochromocytoma
Hyperviscosity syndrome
Thyrotoxicosis
Myxoedema coma
How do you approach the investigation of collapse?
History and clinical signs
Clinical examination
Initial laboratory tests
What is important to determine in the history when investigating collapse?
It is important to determine if the collapse was syncope, a seizure or falling over
What is indicated by a syncope episode?
Syncope indicates a cardiovascular abnormality
What is indicated by a seizure?
A seizure indicates a neurological abnormality. This can be a primary neurological disease or neurological disease secondary to a metabolic abnormality
What is indicated by falling over?
Falling over indicates generalised weakness which can be metabolic, haematological, orthopaedic or neurological
What should you look for on clinical examination when investigating collapse?
Evidence of cardiovascular disease
Which initial laboratory tests should you do when presented with a collapsed animal?
Blood glucose
Blood calcium
Electrolytes
Which form of collapse is seen with hypocalcaemia?
Hypocalcaemia causes twitching which can be misinterpreted as a seizure
What are the differential diagnoses for hypocalcaemia?
Postpartum hypocalcaemia
Hypoparathyroidism
Pancreatitis
Severe renal disease
Lymphangiectasia
Laboratory error
What is another name for postpartum hypocalcaemia?
Eclampsia
What is postpartum hypocalcaemia?
Postpartum hypocalcaemia is hypocalcaemia as a result of loss of calcium into the milk and inadequate dietary calcium intake
What is the typical signalement for postpartum hypocalcaemia?
Up to 4 weeks postpartum in small bitches with large litters (heavy lactational demand)
What are the clinical signs of postpartum hypocalcaemia?
Panting
Trembling
Weakness
Tachycardia
Ataxia
Seizures
Facial pruritis
Hypersalivation
Hyperthermia
This clinical signs will progress rapidly and can be fatal
What are the potential causes of hypoparathyroidism?
Iatrogenic
Lymphocytic parathyroiditis
What can cause iatrogenic hypoparathyroidism?
Thyroidectomy
What are the clinical signs of hypoparathyroidism?
Panting
Trembling
Weakness
Ataxia
How do you treat hypocalcaemia in an emergency?
1ml of slow intravenous (IV) calcium gluconate
How do you manage hypocalcaemia long term?
Calcium gluconate
Vitamin D analogues
Reduce stressors
Which form of collapse is seen with hypercalcemia?
Hypercalcaemia causes seizures
Which form of collapse is seen with hypoglycaemia?
Hypoglycaemia causes seizures and episodic collapse
Which form of collapse is seen with diabetic ketoacidosis (DKA)?
Diabetic ketoacidosis (DKA) causes generalised weakness and falling over
Which form of collapse is seen with hypernatraemia?
Hypernatraemia causes generalised weakness and falling over
Which form of collapse is seen with hypokalaemia?
Hypokalaemia causes generalised weakness and falling over
What are the potential consequences of metabolic collapse?
Pancreatitis
Acute renal failure
Urinary tract infections (UTIs)
Sepsis
Gastrointestinal haemorrhage
Pulmonary thromboembolism
Disseminated intravascular coagulation (DIC)
What are the potential causes of hypoglycaemia?
Laboratory error
Insulin overdose
Hypoadrenocorticism
Insulinoma
Hepatic neoplasia
Severe hepatic failure
Xylitol toxicity
Inflammation
What are the clinical signs of hypoglycaemia?
Polyphagia
Hyperaesthesia
Tremling
Atazia
Seizures
Collapse
Which diagnosis should you suspect if a diabetic dog begins to seize?
Hypoglycaemia
How do you manage hypoglycaemia in a diabetic patients?
Stop insulin administration
Feed patient (not if seizing)
Adminsiter Hypostop (not if seizing)
Reduce subsequent insulin dose
What is an insulinoma?
An insuloma is a tumour derived from the beta cells of the pancreas and produces excessive insulin
What are the clinical signs of an insulinoma?
General weakness
Episodic collapse (usually associated with exercise, excitement etc and improved with eating)
Ataxia
Lethargy
Muscle tremors
Seizures
Weight gain
Neuropathies
What is whipple’s triad?
Whipple’s triad is a collection of three signs which suggest that a patient’s clinical signs result from hypoglycaemia due to an insulinoma
What are the components of whipple’s triad?
Clinical signs of hypoglycaemia
Hypoglycaemia on bloods
Relief of clinical signs when plasma glucose is increased
What should you do to get a definitive diagnosis of an insulinoma?
Insulinomas are very small tumours and thus are very challenging to diagnose on diagnostic imaging. The best way to gain a definitive diagnosis of an insulinoma is to do surgery to identify and remove it
How do you treat an insulinoma?
Medical management followed by surgical removal
How do you medically manage an insulinoma?
Frequent feeding of a high carbohyrate and fibre diet
Prednisolone
When should you refer patients for insulinoma removal?
If the insulinoma is located at the body of the pancreas and near the pancreatic ducts, refer the patient for surgical removal as there is risk of damaging the pancreatic ducts
What are the potential complications of insulinoma surgery?
Pancreatitis
Diabetes mellitus
