Next Appointment: Sylvester Stone (Feline, M)

“Vomiting”

Vomiting

Foreign Body Toxin/poisonAcute Renal Insult

Vomiting vs regurg?VestibularOtitis interna

Central

Gastrointestinal

stress

Abdominal

pancreatitis

dietary

Oesophagitis

gastritis

Dehydration Electrolytes imbalances metabolic alkalosis (non-ion gap)

Hepatic lipidosis

Gastric neoplasia

hepatitis

Porto-systemic shunts

cholangiohepatitis

Central brain lesions

triaditisGall stones

intussusseption

pyelonephritis

hydronephrosis

Urolithiasis – renal vs blocked catperitonitis

endocrinopathies

DKAhyperthyroid

History

• 3 year old cat

• Acute lethargy

• Vomiting

• Anorexia Physical Exam

• Obese• Comatose

Obese

Anorexia

Prognosis

Bloods

• Haematology

• Biochemistry

Haematology

• PCV (%) 50 24-45

• NCC (x 109/L) 24 5.5-19.5

• Segs (x 109/L) 23 2.5-12.5

• Monos (x 109/L) 0.7 0-0.88

• Lymphs (x 109/L) 0.3 1.5-7.0

• Platelets Adequate

Vomiting = Dehydration?

What else?

Stress Leukogram

ErythrocytosisAbsolute RelativePrimary DehydrationNeoplasia within bone marrow Splenic contractionSpleenLiverSecondaryHypoxiaCardiovascular diseaseAltitudeRenal neoplasia (EPO)

Biochemistry

• Glucose 285 67-124 Stress? • Urea 110 17-32

• Creatinine 7.5 0.9-2.1

• Calcium 6.5 8.5-11

• Phosphorus 14 3.3-7.8

• Total Protein 9.0 5.9-8.1Dehydration?

• Albumin 4.9 2.3-3.9• Globulin 4.1 2.9-4.4

• Total Bilirubin 0.3 0-0.3

• ALT 35 30-100

• ALP 45 11-210

• Sodium 165 146-160

• Potassium 6.8 3.7-5.4

• Chlorine 107 112-129

• TCO2 10 14-23

• Anion gap 55 10-27

• Calculated Osmolality394 290-310

• Measured Osmolality 440 290-310• Osmolality Gap 46 >10

• Serum Anion Gap: Its Uses and Limitations in Clinical Medicine (Jeffrey A, Kraut and Nicolaos E. Madias) http://cjasn.asnjournals.org/content/2/1/162.full