Homework:
Signalment: Cola, male Shi-tzu age 7 months old with 4.68 kg.
Chief complaint: Depression and anorexia
History Taking: Decreased feed intake about 3 - 4 days and stopped eating for a day,
increased water intake, increased urination in both volume and
frequency, diarrhea with brown stool
Physical Examination:
- Lateral recumbency
Vital sign
- Body temperature
100.6 °F
- Hypersalivation
- Heart rate
168
beats/min
- Oral ulcer
breaths/min
- Heavy dental tartar
- Respiratory rate
60
- CRT
3
sec.
- Gingivitis
- Dehydration
7
%
- Purulent ocular discharge
- Pale mucous membrane
- Panting
- Abdominal pain when palpate
Problem lists
Non-specific signs
Specific signs
1. Depression

Heavy dental tartar

Dehydration 7%
2. Anorexia

Hypersalivation

CRT > 3 sec
3. Abdominal pain

Gingivitis

Tachycardia

Ulcer in mouth

Tachypnea

Diarrhea with mucous

Purulent ocular discharge

Pale MM

Polydipsia

Polyuria
Differential Diagnosis:
1. Acute renal failure
2. Chronic renal failure
3. Uremic syndrome due to prerenal azotemia
4. Periodontal disease
5. Psychological PU/PD
Laboratory Test
1. CBC
2. Serum biochemistry: BUN, serum creatinine, ALT, AST, total protein
3. Blood gas & Electrolyte analysis
4. Urinalysis
5. Radiography
Results
Hematology
Value
Normal Range
Packed cell volume (%)
29
37 – 55
Hb (g/dl)
9
11.9 – 18.1
RBC
4.52
4.95 – 7.87
MCV (fl)
64
60 – 77
MCHC (%)
31
32 – 36
WBC count (cells/µl)
23,400
5,000 – 14,000
Band form (cells/µl)
3,042
0 – 450
Segmented Neutrophil (cells/µl)
18,486
2,900 – 12,000
Lymphocyte (cells/µl)
1,638
400 – 2,900
Monocyte (cells/µl)
234
100 – 1,400
Plasma protein (g/dl)
9.0
6.0 – 7.5
Blood Chemistry
Value
Normal Range
BUN (mg/dl)
238
8 – 24
Creatinine (mg/dl)
21.62
0.5 – 1.7
AST (IU/L)
30
5 – 35
ALT (IU/L)
42
5 - 35
Blood Gas & Electrolyte Analysis
Value
Normal Range (Venous)
Na (mEq/L)
149
142 – 152
K (mEq/L)
5.1
3.9 – 5.1
Cl (mEq/L)
115
98 – 109
pH
7.355
7.31 – 7.41
pCO2 (mm Hg)
27.2
41 – 51
Complete blood count
Differential WBC count
Blood Gas & Electrolyte Analysis
Value
Normal Range (Venous)
BUN (mg/dl)
>140
8 – 24
Glu (mg/dl)
59
78 - 119
Hct (%PCV)
Hb (g/dl)
TCO2
30
10.4
16
38 – 51
12 -17
24 – 29
HCO3 (mEq/L)
BEecf (mEq/L)
Anion Gap
15.2
-10
24
23 – 28
(-2) – (+3)
15 - 25
Urinalysis
Gross appearance

Collect method: Catheterization

Urine color : No color

Turbidity : Clear

Urine Specific Gravity (Refractometer) : 1.010
Dipstick: Combur® test
Urine sedimentation

Specific Gravity
1.010

Cellular casts 5-10/lpf

pH
7

Granular cast 10-15/lpf

Leukocyte
75 (+2)

RBC
5-10/hpf

Nitrite
Neg

WBC
10-15/hpf

Protein (mg/dl)
30 (+1)

Sperm

Glucose
Normal (negative)

Urobilinogen (mg/dl)
1

Bilirubin
+1

Blood (erythro/µl)
5 – 10
Radiography:

Kidneys were 3.5 times of L2 size
Question:
1. What is your diagnosis?
2. Set the treatment plan for this dog?
3. Are the Labs data adequate for the final diagnosis?
4. What is the Prognosis?
Guide lines for oral antimicrobial treatment of urinary tract infection
Drug
Ampicillin
Suggested minimum inhibitory
concentration cutoff for susceptibility
≤64 µg/ml
Dosage
Frequency
25 mg/kg
Every 8 h
Amoxicillin
≤64 µg/ml
12 mg/kg
Every 8 h
Trimethoprim-
≤16 µg/ml
15 mg/kg
Every 12 h
Cephalexin
≤32 µg/ml
18 mg/kg
Every 8 h
Tetracycline
≤32 µg/ml
18 mg/kg
Every 8 h
Amoxycillin with
≤32 µg/ml
16.5 mg/kg
Every 8 h
≤8 µg/ml
2.5 mg/kg
Every 12 h
sulfonamide
clavulanic acid
Enrofloxacin
From Lees GE, Forrester SD. Update: Bacterial urinary tract infections. In: Kirk RW, Bonagura
JD, eds. Kirk’s Current veterinary Therapy XI. Philadelphia, WB Saunders, 1992:909-914
Homemade Diets for Dogs and Cats with CRF
DOGS
CATS
¼ lb ground beef
¼ lb liver
1 large egg, hard-boiled
2 large egg, hard-boiled
2 cups cooked rice
2 cups cooked rice
3 slices white bread, crumbled
1 T vegetable oil
1 tsp calcium carbonate
1 tsp calcium carbonate
Brown meat and retain fat. Combine all
Dice and braise liver, retaining fat. Combine all
ingredients and mix well. Can add some water ingredients and mix well. Can add some water
to improve palatability.
to improve palatability.
Makes 1¼ lbs (750 kcal/lb)
Yields 1¼ lbs (635 kcal/lb)
Dosage of androgens used to treat anemia of CRF
Drug
Canine dosage
Stanozolol (Winstrol-V) 1-4 mg/dog, PO every 12 h
25-50 mg/dog, IM weekly
Oxymetholone (Anadrol) 1-5 mg/kg, PO daily
Nandrolone (DecaDurabolin)
Feline dosage
1 mg/cat, PO every 12h
25 mg/cat, IM weekly
1-5 mg/kg, PO daily
1-1.5 mg/kg, IM every 7-10 d 1 mg/kg, IM every 7-10 d