宠物常见代谢急诊疾病诊疗（英文版）.ppt

Common Metabolic Emergencies in Small Animal PracticeRonald S. Walton, DVM,MSDiplomate ACVIM and ACVECCColorado Springs, CO OutlineIntroductionDiabetic Ketoacidosis (DKA)Hyperosmolar Diabetes (HDM)HypoglycemiaHypoadrenocorticism (Addison’s)HypocalcemiaHypercalcemia You see only what you look for, you recognize only what you knowMerrill C. Sosman, MD Introduction to Metabolic EmergenciesCommon in clinical practiceFrequently missed (not-looking)Minimal support requiredPrognosis usually good. DKAMost common in small animal practiceEtiology and pathogenesisDiagnosisTreatment Etiology and PathogenesisAbsolute or relative lack of insulinExcess of counter regulatory hormones:(glucagon, catecholamines, cortisol, and growth hormone)HyperglycemiaGlucose production exceeds utilizationGlucosuria (renal threshold exceeded 180-225 mg/dL) Etiology and PathogenesisKetoacidosis due to stimulation of hormone-sensitive lipase by decreased insulin to counter-regulatory hormone ratio fatty acids become triglycerides or ketones acetoacetone and b-hydroxybutyrate (BHB**) Ketones accumulate in plasma due to decreased utilizationRenal threshold exceeded then spill into urineOrganic acids accumulation exceeds buffering capacityMetabolic acidosis Etiology and PathogenesisIncreased osmolarityH20 moves from intracellular to extracellular spaceMedullary washout secondary to osmotic diuresis occurs leading to isosthenuria Loss of glucose water and electrolytes(1o Na+ and K+) DiagnosisPhysical exam:PU/PD and wt. Loss, dehydration, hepatomegaly, cataracts, hyperventilation (Kussmaul breathing), a fruity odor to the breath +/-non specific: “sick” depression, anorexia, adipsia, vomiting, and diarrhea Fever (infection or pancreatitis) DiagnosisLab:Hyperglycemia, ketosis, and glucosuria Only Acetoacetate and acetone are detected on urine dipstick or nitro-prusside test?HB highest concentration (False negative) DiagnosisMinimum laboratory data base:PCV, total protein, urine specific gravity, blood