Page 29 - Basic Monitoring in Canine and Feline Emergency Patients

and hemoglobin 12.6 g/dL (normal 12–17 g/dL). Her BG was monitored every 2 hours for the first 4
All of these abnormalities were consistent with the days then every 4 hours (the rate of the insulin CRI
VetBooks.ir DKA diagnosis. was adjusted based upon the measured BG). Blood
Additional diagnostic testing included submission
ketones were checked a minimum of once every 24
of blood for a complete blood count, chemistry
blood urea nitrogen, and creatinine were monitored
profile, and a pancreatic lipase level. Urine was hours. Other bloodwork including electrolytes,
submitted for a complete urinalysis and urine cul- every 4 hours in the first 24 hours then twice daily
ture. Thoracic and abdominal radiographs were thereafter. Adjustments were made to her fluid type
also performed with full diagnostic abdominal and fluid additives (primarily potassium, phospho-
ultrasound planned for the following day. rus, and dextrose) based on the results of the vari-
Initial therapy for Jazzy included a 20 mL/kg ous bloodwork results. Physical exam findings
bolus of isotonic crystalloid fluids, followed by a dictated her fluid rate.
rate of isotonic crystalloid fluid that would provide She remained in hospital for a total of 12 days
maintenance fluids plus correction of a 7% deficit but she was successfully discharged after treatment
over 12 hours. The fluids were supplemented with of both conditions.
potassium after the initial bolus since she was
found to be hypokalemic. She was started on maro- Case study 2: Hit by car
pitant, pantoprazole, and a fentanyl constant rate
infusion (CRI) for her abdominal pain. An insulin Duke, a 9-year-old male neutered Standard Poodle
CRI was initiated. (24 kg) presented to the emergency department 45
Results of the additional diagnostics revealed that minutes after being hit by a car. Prior to the acci-
the initial diagnoses made based on the PE and dent, Duke had previously been a healthy dog.
POCT were correct: Jazzy had DKA with severe Upon presentation Duke was laterally recumbent
concurrent pancreatitis. Monitoring for Jazzy and unable to stand. His vital signs were as follows:
included vital signs every 4 hours in the first 24 mentation dull but responsive, temperature 100.0°F
hours, then every 6 hours. Full physical exam was (37.78°C), pulse rate 190–200 beats per minute,
performed a minimum of twice a day for the first respiratory rate 50 breaths per minute, MM color
few days. Body weight was measured twice daily. pale, and CRT >3 seconds.

Box 1.2. Duke: Physical exam by body system.
● ● Integument: multiple abrasions and open wounds on the left rear leg, wound on right rear leg with open
wound and visible fracture, abrasions of ventral abdomen
● ● Cardiovascular:
● # Thoracic auscultation: no murmur ausculted
● # Rate: tachycardia
● # Rhythm: sinus tachycardia
● # Pulse quality/pulse pressure: weak and thread pulses, synchronous
● ● Respiratory:
● # Thoracic auscultation: harsh lung sounds ventrally, dull lung sounds in the dorsal lung fields
● # Rate: 50 breaths per minute
● # Pattern: tachypnea with mild increased respiratory effort
● ● Gastrointestinal:
● # Abdominal palpation: soft nonpainful abdomen
● # Rectal exam: small amount of blood noted on glove, normal stool present
● ● Genitourinary: normal
● ● Musculoskeletal:
● # Ambulation: unable to stand at presentation
● # Range of motion: normal range of motion and palpation of both forelimbs, left rear limb has normal range
of motion, right rear limb has open tibial fracture with bone protruding through the skin
Continued

Physical Examination and Point-of-care Testing 21