Next Appointment: Sylvester Stone (Feline,

M)“Vomiting”

Vomiting

Foreign Body

Toxin/poison

Acute Renal Insult

Vomiting vs regurg?Vestibular

Otitis interna

Central

Gastrointestinal

stress

Abdominal

pancreatitis

dietary

Oesophagitis

gastritis

Dehydration Electrolytes imbalances metabolic alkalosis (non-ion gap)

Hepatic lipidosis

Gastric neoplasiahepatitis

Porto-systemic shunts

cholangiohepatitis

Central brain lesions

triaditisGall stones

intussusseption

pyelonephritishydronephrosis

Urolithiasis – renal vs blocked catperitonitis

endocrinopathiesDKA

hyperthyroid

3 year old cat Acute lethargy Vomiting Anorexia

History

Physical Exam

• Obese• Comatose

Prognosis

Haematology

Biochemistry

Bloods

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

Haematology

Vomiting = Dehydration?

What else?

Stress Leukogram vs infection

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

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 5.9-8.1 Dehydration? 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 Osmolality 394 290-310 Measured Osmolality 440 290-310 Osmolality Gap 46 >10

Biochemistry

Colour: yellow Transparency: cloudy USG 1.016 Protein + Gluc + Bilirubin – Blood + pH 5

WBCs 2-3 RBCs 2-3 Epithelial cells 1-3 Casts 0 Bacteria 0 Crystals: Calcium oxalate monohydrate

Sediment

TCO2 10 14-23

Anion gap 55 10-27 Calculated Osmolality 394 290-310 Measured Osmolality 440 290-310 Osmolality Gap 46 >10

Kill or Cure?

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

http://www.icatcare.org:8080/vets/practice-resources/ethylene-glycol-toxicity-cats

http://jaaha.org/doi/abs/10.5326/15473317-35-4-297?journalCode=aaha