Transcript Document

CASE B
HISTORICAL FINDINGS AND PRESENTING SIGNS
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4 year-old Warmblood mare (500kg)
No history of previous illness
Good vaccination and anthelmintic programmes
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One day prior to presentation - transvaginal ultrasound-guided needle aspiration
of a 45 day twin conceptus
On the day prior to and the day of the procedure, 30mg/kg
trimethoprim/sulphadiazine was administered orally twice daily
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One day following the procedure, the mare presented with depression and
moderate to severe colic
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CLINICAL FINDINGS (on day of presentation)
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Depressed
Moderate to severe abdominal pain (flank-watching / pawing / rolling)
Rectal temperature - 40.5˚C
Pulse rate - 76/min
Respiratory rate - 62/min
Prolonged skin tent, dry gingival mucous membranes, sunken
eyes, prolonged capillary refill time (3-4 seconds)
Hyperaemic conjunctival mucous membranes
Abdominal auscultation – absence of audible intestinal sounds
Rectal examination – fluid filled large intestine
Naso-gastric intubation – no reflux
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When you enter the examination room, you will be asked to
1. Interpret the individual presenting clinical problems and clinical
examination findings
2. Interpret the combined clinical examination findings to formulate a
differential diagnosis list, giving justification for the inclusion of each
differential diagnosis
3. Comment on how you would further differentiate between the main
differential diagnoses
From this stage onwards, further information (clinical and
laboratory data) will be provided either on your request or
automatically. You will be asked to comment on this data.
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PERITONEAL FLUID ANALYSIS
Appearance
straw coloured
Nucleated cell
count
1.63 x 109/L
Red blood cell
count
0 x 1012/L
Total protein
9.7g/L
Cytological
description
Primarily mature
polymorphs and reactive
mesothelial cells
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LABORATORY DATA ON PRESENTATION
Total Protein (g/L)
66.7
53-73
Albumin (g/L)
35.2
29-41
White blood cells (x109/l)
3.0
5.5–12.1
Globulin (g/L)
31.5
18-38
Segmented neutrophils (x109/l)
1.3
2.9–8.5
Plasma Fibrinogen (g/L)
3.7
2-4
0.3
0.0–0.1
Lymphocytes (x109/l)
374
102-350
1.2
1.2- 5.1
Aspartate amino
transferase (IU/L)
Monocytes (x109/l)
0.21
0 – 0.7
Gamma-glutamyl
transferase (IU/L)
22
1-40
Red blood cells (x1012/l)
12.86
6– 10.4
Bile acids (mmol/L)
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1-9
Packed cell volume (L/L)
0.57
0.30–0.45
Urea (mmol/L)
15
2.5-10.0
Haemoglobin (g/dl)
19.7
10.1–16.1
Creatinine (mmol/L)
183
85-165
Mean corpuscular volume (f/l)
44.3
37-49
Mean corpuscular haemoglobin
concentration (%)
34.6
35.3-39.3
Sodium (mmol/L)
129
134-142
Potassium (mmol/L)
2.78
3.0-5.0
92
95-103
Band neutrophils
(x109/l)
Chloride (mmol/L)
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Further information
• Later on the day of presentation, the mare developed marked
diarrhoea
• Arterial blood gas data
pH
7.28
7.36-7.44
pCO2 (mmHg)
23.7
37-49
pO2 (mmHg)
85.0
83-98
HCO3 (mmol)
13.7
20-34
TCO2 (mmol)
14
27-32
Base Excess (mmol)
-12
0- +4
sO2 (%)
96
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Further information
• Later on the day of presentation, the mare developed marked
diarrhoea
• Arterial blood gas data
pH
7.28
7.36-7.44
pCO2 (mmHg)
23.7
37-49
pO2 (mmHg)
85.0
83-98
HCO3 (mmol)
13.7
20-34
TCO2 (mmol)
14
27-32
Base Excess (mmol)
-12
0- +4
sO2 (%)
96
Anion gap calculation = 28 (normal = 12-16)
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Urinalysis
Specific Gravity
1.044
pH
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Protein
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Ketones
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Blood
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Glucose
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Urobilinogen
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Bilirubin
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Sediment exam
Numerous
crystals
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• Therapeutic aims that you would consider
at this stage?
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The mares progress over the following 6 days is provided below:
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Day 1 to 3
Mare remained clinically depressed
Diarrhoea profuse / 5% dehydration
i.v. hypertonic saline and Ringer’s solution
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Day 4 to 5
The mare was moderately depressed
Diarrhoea profuse / 5% dehydration
Mare willing to drink and maintain hydration
Fluid administration rate reduced (half maintainence)
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Days 6
The mare was clinically bright (heart rate – 44/min)
Diarrhoea still present but less profuse / no clinical dehydration detected
Noted to drink excessively (approximately 70 – 120L water per day)
Bedding very wet
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