Page 735 - Small Animal Clinical Nutrition 5th Edition

762 Small Animal Clinical Nutrition

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Figure 3. M-mode echocardiography one year after the initial
admission for heart failure reveals normal left ventricular volume and
function.
dog was now drinking and ate the veterinary therapeutic food
that was offered (Prescription Diet k/d, one can). Fluid therapy
was discontinued and digoxin (0.006 mg/kg body weight per os,
twice daily), enalapril (0.5 mg/kg body weight per os, twice daily)
and furosemide (1 mg/kg body weight per os, twice daily) were
administered.
The dog improved and was able to go home four days after
entering the hospital. Five days later, the owner reported that the
patient was feeling better than it had in months. One and one-
third cans of the veterinary therapeutic food were fed to meet the
increased DER expected in the home environment. Three
months postadmission, an echocardiogram and chest radio-
graphs showed some improvement in fractional shortening, and
complete resolution of pulmonary edema and pulmonary venous
distention. Results of a serum biochemistry profile were normal.
Furosemide was discontinued at that time. Body weight was now
13.2 kg. Digoxin, enalapril, k/d Canine and taurine and L-carni-
tine supplementation were continued. The food was fed in the
same amount.
One year after the initial admission, an echocardiogram
(Figure 3) disclosed remarkable reduction in left ventricular size
and improved left ventricular systolic function (left ventricular
diastolic diameter 3.55 cm; left ventricular shortening fraction
24.75%). Thoracic radiographs revealed no cardiomegaly or pul-
monary edema (Figures 4A and 4B). The owner had discontin-
ued digoxin and enalapril approximately 10 months after the first
admission (he had gone out of town and not started therapy
again when he returned), although he continued to feed
Prescription Diet k/d Canine and administer the taurine and L- Figures 4A (top) and 4B (above). Lateral and ventrodorsal radi-
carnitine supplements.The dog weighed 13.6 kg and had a body ographs taken one year after the initial admission for heart failure
reveal normal cardiac size and no evidence of pulmonary edema.
condition score of 3/5. The dog did well for three additional
years, maintaining its improved ventricular function.
Four years after the initial diagnosis, the patient developed ascites. The heart and lungs were unchanged and the central venous
pressure was normal. Ultrasonographic evaluation of the abdomen revealed a mass originating in the left adrenal gland, with
intravascular invasion and extension into the right adrenal gland and obstruction of the caudal vena cava. Body weight was 10.5 kg
with cachexia (body condition score of 1/5). A pheochromocytoma was diagnosed at postmortem examination.