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George

George. 9y MN West Highland White Terrier 4 weeks of PU/PD 3 days vomiting Collapsed this morning. Physical examination. Stuporous Cardiovascular examination HR 150 bpm Bounding pulses Pink mucous membranes No abdominal distension/pain. George. PCV/TS 58%/80g/l Ketonaemic

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George

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  1. George • 9y MN West Highland White Terrier • 4 weeks of PU/PD • 3 days vomiting • Collapsed this morning

  2. Physical examination • Stuporous • Cardiovascular examination • HR 150 bpm • Bounding pulses • Pink mucous membranes • No abdominal distension/pain

  3. George • PCV/TS 58%/80g/l • Ketonaemic • BUN 15mmol/l • Creatinine 180µmol/l • Glucose 25mmol/l

  4. George - Electrolytes and blood gas • K 3.5mmol/l • pH 7.2mmol/l

  5. George – Problem list • Dehydration • Severe hyperglycaemia • Azotaemia • Hypokalaemia • Metabolic acidosis

  6. George • Considerations • Inappropriate insulin storage/handling/admin • Inappropriate dosage • Concurrent disease • Urinary tract infection (sediment exam + urine culture) • Pancreatitis (u/s + cPLI) • Hyperadrenocorticism • Other

  7. George - diagnostics • Urinalysis • Glucosuric (4+) • Ketonuric (3+) • WBCs on sediment examination • Abdominal ultrasound • Unilateral pyelectasia

  8. George • Moderate hypovolaemia • Dehydration • Hypokalaemia • ? Fluid plan

  9. George • Correct hypovolaemia first Bolus crystalloid 20ml/kg over 20 minutes Improvement in clinical signs • On going fluid plan?

  10. George • Started intravenous insulin protocol • Supplemented potassium after resuscitation • Supplemented phosphorus

  11. George • Intravenous antibiosis whilst culture pending • Augmentin 20mg/kg q8h • Slowly improved over 48 hours • Started on s/c insulin protocol

  12. George • George had pyelonephritis • George’s owner had withheld insulin whilst he was anorexic

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