Emma Holt

Hi Scott,

How are you? This sounds like an interesting case 🙂

My problem list would include:
-Lethargy and partial anorexia; vague clinical signs
-Lymphopaenia
-Monocytosis
-Regenerative anaemia
-Mild increase in total bilirubin
-Hypoalbuminaemia
-Hypocalcaemia, likely secondary to the hypoalbuminaemia
-Hyperkalaemia
-Hypoglycaemia

Ddx for the main problems include:

Ddx hypoalbuminaemia:
• Chronic inflammatory disease
• Hepatic failure
• Malabsorption/digestion/nutrition
• Haemorrhage (coagulopathy, GI ulceration/neoplasia/parasites)
• PLE
• PLN
• Body cavity effusion

Regenerative anaemia ddx:
• Haemorrhage
• Coagulopathy
• Parasites
• Haemolysis (oxidative damage due to toxicity)
• Haemolysis due to genetic defects ie: PKD
• Immune mediated HA (primary, secondary to infection/neoplasia)

Hyperkalaemia Ddx:
• Artefact
• AKI/post renal obstruction/failure
• Addisons
• Perforated duodenal ulcer
• Toxicity
• No history of reperfusion injury/Aortic TE, tumour lysis syndrome, DM etc

Hypoglycaemia Ddx:
• Sepsis
• Artefact
• Drug toxicity (no history of this)
• Addisons
• Hepatic failure
• Idiopathic
• Neoplastic
• Glycogen storage deficiency

I think my next steps would be (after re-checking my glucose and potassium measurements and I’m presuming there is no problem with urination), would be an A and T-Fast to exclude effusions, blood smear and possibly an ACTH stim/basal cortisol to exclude addisons (even though not completely consistent I think I would want to exclude) and may be a BAST (again not everything matches with hepatic insufficiency, but I would want to exclude that as a cause for the hypoalbuminaemia and the hypoglycaemia before looking further. After that I’d probably do a full abdominal ultrasound scan 🙂

What did you do next and what did you find?

Replying to Andy Bell 23/03/2023 - 13:30

Thanks Andy 😊

Replying to Liz Bode 05/03/2023 - 19:39

Thanks Liz.

I will see how grumpy the cat is and avoid if possible, just to be safe 🙂

Replying to Liz Bode 26/02/2023 - 20:53

Thanks Liz, that was a really interesting case.

What breeds would you normally expect to see a PE in? And what sedation do you normally choose when draining pericardial effusions?

Thanks again

Emma

Hi Liz,

I would put the Problem list as:
-progressive lethargy and weakness
-Hyporexia
-Fluid abdomen, which on examination has a fluid thrill
-Hypodynamic pulses

Possible ddx could include:
-Progressive lethargy/weakness and hyporexia are quite non-specific clinical signs and could be attributed to a number of body systems (including CV, respiratory, metabolic, MSK).
-Full abdominal appearance could be due to an abdominal mass, peritoneal effusion, overweight/HAC
-Fluid thrill: We would need to get more info to know if it was a transudate, modified transudate, exudate includind haemorrhage etc.
-Hypodynamic pulses could be due to a partial thrombi/obstruction, reduced cardiac output or hypovolaemia

As a next step for further investigations I would like the following to start with:
-blood pressure
-Haematology, biochemistry and electrolytes
-Abdominal and thoracic POCUS and if effusions are confirmed sampling these and sending for analysis would be helpful.
-Depending on the POCUS findings full abdominal or echo scans may be indicated.

🙂

Hi Helen,

I’m really enjoying the course thank you, I can’t get the video link to work that you added to this post,but have downloaded Brene’s podcast episode for my next car journey.

Within some teams I work in, I find there are occasionally some ‘negative’ people, who seem to respond to most things with barriers and negative comments, how would you approach trying to get these people on side?

Thanks

Emma