scott@vtx-cpd.com

Replying to Nichola C. 25/11/2021 - 21:23

Hello.

Hope you are OK. Blood pressure is definitely an important part of the monitoring in shock patients. It is best used as part of many other parameters that are important to keep an eye on too.

The treatment of shock can be distilled down to the idea of improving oxygen delivery as soon as possible; there is a narrow therapeutic window before cellular energetics become deranged and cannot be reversed. The goal is to normalize blood pressure, central venous pressure, and the physical parameters of heart rate, pulse quality, capillary refill time, mentation and urine output.

Systemic hypotension is defined as a systolic arterial blood pressure < 80 mm Hg and/or MAP < 60 mm Hg in either dogs or cats. Normal Arterial Blood Pressure Values in Adult Dogs & Cats BLOOD PRESSURE VALUES DOGS CATS Systolic arterial pressure 90 to 140 mm Hg 80 to 140 mm Hg Diastolic arterial pressure 50 to 80 mm Hg 55 to 75 mm Hg Mean arterial pressure 60 to 100 mm Hg 60 to 100 mm Hg I would ultimately be aiming for a mean pressure of 80mmHg when resuscitating with fluids. Hope that helps. Scott 🙂

Replying to emily a. 23/11/2021 - 23:11

Hello Emily.

I hope you are safe and well. Following on from Andy’s message, I am sorry about any confusion regarding these lessons.

I hope you are enjoying the course.

Let me know if you have any other questions.

Scott 🙂

Hello.

These are the most challenging cases, especially when family are involved!

I would say the priority is indeed to get the hyperthyroidism under stable control and keep a very close eye on what the kidneys are doing. Despite the increase in SDMA, I would be encouraged by the USG and the creatinine. This should be early in CKD progression, but obviously the hyperthyroidism can have an effect on how this looks from a blood and urine POV.

The main DDX for the haematuria have to be inflammation, infection, uroliths or something structural. Hopefully the imaging has helped rule many of these things out, but there are always subtleties that could be missed. I think the meloxicam idea is a good one and should not be too much of a risk:

https://pubmed.ncbi.nlm.nih.gov/21906984/

It is not that common to get lots of haematuria as a consequence of CKD alone. Other DDX I would consider would be a coagulopathy (assess platelets, PT and aPTT) and possibly idiopathic renal haematuria. Renal haematuria can be really challenging to diagnose in cats as it normally requires cystoscopy.

How has this urine been collected?

Scott 🙂

Replying to Elizabeth D. 20/11/2021 - 08:16

Hello!

Of course we can.

This will be done ASAP.

Scott 🙂

Replying to Emma Holt 17/11/2021 - 17:33

Really interesting.

I will ask the folks from Hills about the app. and I will be downloading.

Scott 🙂

Replying to Emma Holt 17/11/2021 - 11:21

Hello!

I would definitely agree that there is a real push towards medical management if possible. I would agree that doing what we can to predict stone type is a good thing. I must admit I do not use the app (I am old you knwo) but I must check it out.

The ACVIM consensus definitely reads very much with an emphasis of dissolution:

https://onlinelibrary.wiley.com/doi/full/10.1111/jvim.14559

Have you used the app?

Scott 🙂