Case Presentation completed on clinical pathology week

2. CLINICAL HISTORY
Patient presents with a 2-3 week history of exercise intolerance and poor
appetite
Possible increased thirst
No recent GI signs but intermittent history of V+ and D+

3. CLINICAL EXAMINATION
Dehydrated
(?) Anterior abdominal pain
Temperature 39.4C
Referring vets’ biochemistry
 Increased BUN & Creatinine
 Na & K within normal reference range

4. BLOODS
Haematology
Biochemistry & Electrolytes
ACTH Stim test

5. HAEMATOLOGY
Test Result Unit Reference
Range
RBC 4.98 x10 E12/l 5.5-8.5
Hb 11.5 g/dl 12.0-18.0
HCT 35.6 % 37-55
Monocytes 1.515 x10 E9/l 0.15-1.35
PLT 178 x10 E9/l 200-500
Smear: The blood picture appears poorly regenerative with no aberrant
cells seen.
Comments:
• Normocytic normochromic anaemia
• Differentials for the anaemia could be anaemia of chronic disease,
decreased iron, IMHA, kidney failure (decreased EPO).
• Monocytosis can be caused by chronic renal failure, IMHA, trauma
• The decrease in platelets is very mild

6. BIOCHEMISTRY
Test Result Unit Reference Range
Chloride 118.4 mmol/l 95-115
Urea 34.6 mmol/l 2.5-8.5
Creatinine 402 umol/l 45-155
Cholesterol 7.58 mmol/l 2.0-7.0
Albumin 26 g/l 29-36
Comments:
• Differentials for increase in chloride could be retention of chloride through renal
failure or tubular acidosis
• The increased BUN & creatinine can be attributed to dehydration, kidney failure,
toxic injury to kidneys, or urinary blockage
• Increased cholesterol and triglyceride can cause GI signs such as the V+ and D+
as well as generalised abdominal pain. Hyperlipidaemia can be primary or
secondary to hypothyroidism, pancreatitis, hepatic disease, diabetes mellitus,
nephrotic syndrome, hyperadrenocorticism, or high-fat diets
• The low albumin can be due to inadequate fluid or food intake, amyloidosis,
inflammatory effusions (pancreatitis), lymphoma

7. ACTH STIM TEST
Test Result Units Reference
Range
Cortisol – resting 79 nmol/l 13-140
Cortisol – post
ACTH
403 nmol/l 200-500
Comments: The dog was not diagnosed to have Cushing’s or
Addison’s

8. DIFFERENTIAL DIAGNOSIS
Acute/chronic renal failure
 Toxic insult
 Pyelonephritis
Urinary tract blockage - Urolithiasis
Pancreatitis
Hypothyroidism
 Reduces GFR
Lymphoma (spleen)

9. DIAGNOSTICS
Urinalysis
Sediment exam
Ultrasound of abdomen (kidneys, pancreas, spkeen)
Contrast radiography
PLI and TLI

10. TREATMENT
Fluids and monitor urine output
Low protein and fat diet
Pain relief (opiod?)