Liis

Hi again, thank you for discussing this topic.

I have an example case that maybe could be interesting to discuss….

18 yo MN toy poodle (2.7kg). Had an echo in December 2021 in Hong Kong – myxomatous change and incompetence of the mitral valve and tricuspid valve, trivial insufficiency of the pulmonic valve, boardeline left sided cardiomegaly and stage B2 valve disease, marked right sided cardiomegaly, moderate distention of the pulmonary artery and moderate pulmonary hypertension. He has been on pimobendan 0.675mg PO in AM, 1.25mg PO in PM, sildenafil 12.5mg PO BID, spironolactone 6.25mg PO SID since.

Was brought to the UK 4days ago from Hong Kong. Acute onset anorexia and lethargy started 4 days right after arrival to the UK ago.

Presented in lateral recumbency with altered mentation, HR 120x/min, grade 6/6 HM, MM pale pink, CRT 1.5sec, tacky, RR 20x/min, respiratory effort and depth normal, mild crackles bilaterally craniodorsally. Rectal temperature 35.3C. BCS 1/9, generalised muscle loss. Hard to assess skin tent due to age related loss of elasticity of skin but is significantly increased. Hair loss on trunk and tail. Bilateral cataracts and absent menace. Estimated dehydration 8-9%.
PCV 41% TS 90g/L
vBG: metabolic acidosis with pH of 7.293 (7.350-7.460), Base deficit -7.2 mmol/L (-5.0-1.0), lactate 1.4, glucose 6.3 mmol/L; Na 178mmol/L (140-150), iCa 1.17 (1.25-1.50), Cl 139 mmol/L (109-120).
CBC: leukocytosis with bend neutrophilia confirmed on smear
Biochemistry: creatinine 268 umol/L (44-159), urea >46.4 mmol/L (2.5-9,6), phosphorus 5.02mmol/L (0.81-2.20), glob 51g/L (25-45), ALT 152 U/L (10-125), ALP 502 U/L (23-212)
tPOCUS: coalescing B lines on the right side caudodorsally only in one small area; coalescing B lines on the left side caudodorsally only in one small area; right side of the heart enlarged, FS 44%, La:AO not measured but subjectively 1:1-1:1.2. No pericardial or pleural effusion.
aPOCUS: No peritoneal effusion, CVC not collapsing and subjectively large

What are everyones thoughts? How would you approach this? IVFT or no IVFT? How to tackle the hyperNa and renal +/- prerenal azotaemia? Anything else anyone would like to do at this point? I am very interested in everyone thoughts as this is definitely one of these heart disease + co-morbidity cases that I find very difficult to manage…

• This reply was modified 2 years ago by Liis.
• This reply was modified 2 years ago by Liis.
• This reply was modified 2 years ago by Liis.
• This reply was modified 2 years ago by Liis.
• This reply was modified 2 years ago by Liis.