The Clinical Club

May 7th 2020

Fergus Allerton and Andrew Kent

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Jasper

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Jasper

It’s Christmas Eve and Jasper, a 4-year-old

castrated Labrador has been vomiting (with
haematemesis) for 3 days. He is now completely
off food and lethargic.

The owners report he has a tendency to eat

anything and everything.

He is on long-term NSAID medication for arthritis

associated with elbow dysplasia.

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Physical examination

● QAR
● mms pink but tacky
● Heart rate 140bpm
● Abdominal palpation uncomfortable
● Hyperdynamic peripheral pulses

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Jasper
● Jasper is azotaemic
– Urea 44mmol/L and creatinine 530umol/L
– Urine specific gravity is 1.018

● Is this pre-renal, renal or post-renal?

● A rapid electrolyte panel is run:

– Sodium 130mmol/L
– Potassium 6.7mmol/L

● What differentials are you considering now?

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Jasper
Urea 44 mmol/L (2.0-9.0)
Creatinine 530 umol/L (40.0 - 106)

ALT 210 U/L (0-80)

ALP 167 U/L (0-50)
Bilirubin 5 umol/L (0-9)

Calcium 3.0mmol/L (2.0-3.0)

Phosphate 2.2mmol/L (0.8-1.6)

Cholesterol 3.6mmol/L (3.8-7.0)

Albumin 30g/L (24-40)
Total protein 64g/L (52-77)

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www.theclinicalclub.co.uk
Jasper
● What further blood test(s) would you like to run now?

● With no post collection for the next 4 days, could imaging help?

● What would you do about the hyperkalaemia?

● What is your short-term treatment plan?

● What is your long-term treatment plan?

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Ruby

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Ruby
Ruby, an 11 year old, speyed Miniature Schnauzer
has a several month history of PU/PD and urinary
incontinence overnight.

Your colleague performed an ACTH stimulation

test 3 weeks ago:

● Basal cortisol 104.0 nmol/L (20-250)

● Post stim. cortisol 234nmol/L

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Ruby
The ACTH stim test was performed 3 weeks ago.
What is abnormal in the photo below?

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Ruby
● After extensive Google-based research the owner is
convinced her dog has hyperadrenocorticism

● Routine haematology and biochemistry and urinalysis

are performed…..

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Fill in
the
blanks…
(higher
or lower
than the
ref.
range?)
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Fill in
the
blanks…
(higher
or
lower!)
Fill in
the
blanks…
 LDDST Can you provide a diagnosis
for the dogs represented
by:
Cortisol 1. Blue line?
2. Purple line?
nmol/L
3. Green line?

40nmol/L

Time (h)
TO T4 T8

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LDDST

● Basal cortisol 141nmol/L

● T4 214nmol/L
● T8 276nmol/L

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What differentials do you have for adrenomegaly?
Anything else you want to look at during the US?
Ruby
● What treatment options would you discuss with
the owner now?

● What is the prognosis for Ruby?

● How would you monitor your treatment?

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 Thank you for participating!

Feedback is welcome

chair@samsoc.org

Any topics you’d like covered in the future?

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