Académique Documents
Professionnel Documents
Culture Documents
Dog
Brian Caserto
Cornell College of Veterinary Medicine
Class of 2007
May 9, 2007
Hypercalcemia
Hyperproteinemia
Hyperglobulinemia
Hypothyroid
Hyperadrenocorticism
PROBLEMS
Differential Diagnosis
Purulent ocular
discharge (right
eye)
Right side
mucopurulent
nasal discharge
PU/PD
Differential Diagnosis
mucopurulent Neoplasia
nasal discharge
PU/PD
Differential Diagnosis
Purulent ocular
discharge (right
eye) Keratoconjunctivitis
Purulent ocular
Hypercalcemia
discharge (right
eye) Diabetes Mellitus
Right side Hyperadrenocorticism
mucopurulent Pyelonephritis
nasal discharge Liver disease
PU/PD Renal disease
PROBLEMS
ocular
discharge
Lethargy PU/PD
KCS
Nasal
Discharge
Diagnostic Plan
Schirmer tear test Ophthalmology consult
CBC
Serum chemistry
Ionized calcium
Urinalysis
Abdominal ultrasound
Thoracic radiographs
Results
Below normal tear production OU
– Ophthalmology consult
Bilateral KCS
Neutrophilia 10.5 thou/uL Mild/ stress related
Hyperproteinemia 8.1 g/dL Mild/ hydration)
Hypernatremia 154 mEq/L (142-151)
Hyperchloremia 119 mEq/L (107-117)
Hypercalcemia (iCa) 1.38 mmol/l Mild/hydration
Elevated Alk Phos 123 U/L Mild/hydration/stress
Hyposthenuria (1.003)
Normal chest radiographs
Results
Below normal tear production OU
– Ophthalmology consult
Bilateral KCS
Neutrophilia 10.5 thou/uL
Hyperproteinemia 8.1 g/dL
Hypernatremia 154 mEq/L (142-151)
Hyperchloremia 119 mEq/L (107-117)
Hypercalcemia 1.38 mmol/l
Elevated Alk Phos 123 U/L
Hyposthenuria (1.003)
Normal chest radiographs
US
Liver
– Hypoechoic nodule
(right)
Spleen
– Nodule deforming
the capsule
Conclusions from Lab Work
Hyposthenuria (1.003)
No evidence of systemic infection
Mild Hypercalcemia
Mild Hypernatremia
Additional Problem List
Hyposthenuria
Hypercalcemia
Hypernatremia
KCS
Additional DDX List
KCS insipidus
Diabetes Mellitus
Psychogenic polydipsia
Additional DDX List
Hyposthenuria
Hyperparathyroidism
Hypercalcemia
VitaminD toxicity
Hypernatremia
Hypercalcemia of
KCS Malignancy
Hemoconcentration
Spurious
Additional DDX List
KCS
Simplify
PU/PD
RepeatNORMAL
ionized calcium
Hypercalcemia
Hyperadrenocorticism NORMAL
Baseline Cortisol
Hypoadrenocorticism
Renal Failure ACTH
NORMAL
stimulation
Diabetes Insipidus
Psychogenic Polydipsia Technecium
NORMALGFR
PU/PD
Diabetes Insipidus
– Nephrogenic Desmopressin Response Test
– Central
Psychogenic Polydipsia
Diabetes Insipidus
What is it?
Anatomy
Physiology
Clinical aspects
Evans and DeLahunta, 2000
Pitutary Gland
Mammillary Infundibulum
Bodies
WATER
Central
Diabetes Insipidus
Nephrogenic Diabetes Insipidus
Psychogenic Polydipsia
PU/PD
Central Diabetes Insipidus
– Neoplasia
Primary pituitary
Craniopharyngioma
Meningioma
Metastatic tumor
– Inflammatory disease
– Trauma
Nephrogenic Diabetes Insipidus
Psychogenic Polydipsia
PU/PD
Central Diabetes Insipidus
Nephrogenic Diabetes
Insipidus – Pyometra
– Primary- Huskies – Pyelonephritis
– Hypercalcemia – Liver disease
– Diabetes Mellitus – Renal disease
– Hyperadrenocorticism – Hyperthyroidism
– Hypoadrenocorticism – Medullary washout
Psychogenic Polydipsia
PU/PD
Central
Diabetes Insipidus
Nephrogenic Diabetes Insipidus
Psychogenic Polydipsia
– Young dogs that are kept alone for long
periods of time
Clinical signs of DI
PU/PD
Hyposthenuria
Hypernatremia
– Water Deprived
Clinical signs of DI
PU/PD
– Reduced water reabsorption in the kidney
Hyposthenuria
Hypernatremia
Clinical signs of DI
PU/PD
Hyposthenuria
– Salt reabsorption and lack of water reabsorption
PU/PD
Hypernatremia
Clinical signs of DI
PU/PD
Hyposthenuria
Hypernatremia
– Result of severe dehydration due to water
loss
– Occurs in animals without access to free water
Back to Princess
PU/PD
Diabetes Insipidus
– Nephrogenic Desmopressin Response Test
– Central
Psychogenic Polydipsia
Desmopressin Response Test
DDAVP
– Decreased water intake over 24 hrs
– Urine SG increased from 1.003- 1.029
Water intake
eSG
Ur i n
Desmopressin
Time
Diagnosis
CentralDiabetes Insipidus
KCS (OU)
Possible rhinitis
Treatment
Treatment
– DDAVP (Desmopressin) Synthetic vasopressin
used to treat the symptoms, concentrate urine,
stop PU/PD
Optimmune (cyclosporine) and NeoPolyDex
ointment, and paralube
Follow up
DeLahunta, 1983
Princess Pituitary
Normal
MRI
T1 T1
Princess Normal
MRI
T1 T1
Princess Normal
MRI
Princess Normal
Sphenoid
CT Complex
Princess Normal
Basisphenoid
CT Bone Lysis
Princess Normal
CT
?
Princesses depression and lethargy continues and euthanasia was
elected
Necropsy findings
Gross findings
Skull- locally extensive basioccipital bone density
irregularity
Liver- multifocal hepatoma (presumptive)
Kidney (R)- multifocal chronic infarcts
Spleen- focal nodular hyperplasia
Masseter muscle- moderate chronic diffuse muscle
atrophy
Right AV valve- focal hematocyst
Pituitary
Necropsy Findings
Histopathology
– Liver- vacuolar
hepatopathy
– spleen- Focal leiomyoma
– Basioccipital bone
Thinning
– focal medullary cavity
fibroplasia
Evans and DeLahunta, 2000
Histopathology 4X
Cementing Lining
Blood Vessels
Spindle Cells
4X
4X
Cementing Lining
Spindle Cells
Evans and DeLahunta, 2000
Conclusions