PU/PD CBL (added a few more 10/1)

PU, PD, none, or both: hot weather?

both

PU, PD, none, or both: diarrhea and dehydration?

PD

PU, PD, none, or both: vomiting and dehydration?

PD

PU, PD, none, or both: Chronic kidney disease?

both

PU, PD, none, or both: high salt intake?

both

PU, PD, none, or both: iron deficient anemia?

none

A 6-year old dog presents with polyuria and polydipsia. Which diagnostic test is the most appropriate first step in the diagnostic approach?

urinalysis

3 multiple choice options

What is the mechanism of PU/PD in chronic kidney disease?

decrease renal concentrating ability

What is the mechanism of PU/PD in hyperparathyroidism?

hypercalcemia which impairs renal concentrating ability

What is the mechanism of PU/PD in central diabetes insipidus?

decrease ADH production

What is the mechanism of PU/PD in nephrogenic diabetes insipidus?

decrease renal response to ADH

What is the mechanism of PU/PD in glucocorticoid administration?

decrease renal response to ADH

What is the mechanism of PU/PD in hyperglucosuria?

osmotic diuresis

The owner reports that Jasmine goes outside to urinate approximately 3-4 times per day. However, each time she urinates, she produces a large volume or urine, noticeably more than the other dog in the household. What is the appropriate terminology to describe these findings?

polyuria

3 multiple choice options

What is cortisols effect on the liver?

1. increase weight from glycogen and fat

2. increase ALP

What is cortisols effect on muscle tissue?

decreases muscle tissue from protein breakdown

What is cortisols effect of fat tissue?

decreases fat tissue from lipolysis and redistribution

What is cortisols effect on hematology?

1. increase neutrophils

2. decrease lymphocytes

3. decrease eosinophils

4. increase monocytes

5. stress leukogram

What is cortisols effect on blood pressure?

increases sensitization to norepinephrine and epinephrine

What is cortisols effect on blood glucose?

hyperglycemia and hyperlipidemia

What is cortisols effect on GI?

1. polyphagia

2. increase stomach HCl

3. decrease mucus production

What is the mechanism of cortisols effect on blood pressure?

1. increases sodium and water retention which expands intravascular volume

2. increases sensitivity of blood vessels to catecholamines and angiotensin II causing vasoconstriction

3. enhances RAAS activity

4. reduces nitric oxide production and increase oxidative stress impairing vasodilation and stiffens vessels

What is the issue with lipemic samples?

can interfere with laboratory assays

What three things can interfere with endocrine test results?

1. lipemia

2. hemolysis

3. icterus

What is the mechanism of trilostane?

inhibits cortisol synthesis

What is the mechanism of mitotane?

destroys adrenal cortex

Which HAC drug is FDA approved?

trilostane

What is the most important thing we need to discuss with our client about the treatment of HAC?

1. ongoing/lifelong treatment

2. treatment is expensive

3. side effects

4. monitoring

What are the most common side effects of trilostane treatment for HAC?

lethargy, inappetence, vomiting, diarrhea, death

Which endocrine test is used to monitor treatment response in dogs with hyperadrenocorticism?

ACTH stimulation test

What is the prognosis for HAC with treatment?

generally good

A negative urine ketone test does completely rule out ketosis.

False

1 multiple choice option

Why do negative urine ketone tests not rule out ketosis?

urine dipsticks primarily detect acetoacetate but in DKA beta-hydroxybutyrate may predominate

What makes DKA less likely?

if the patient is clinically stable and has no signs of metabolic decompensation

If the patient is sick but urine ketones are negative, what other tests should we run?

1. blood beta-hydroxybutyrate

2. blood gas/acid-base status

3. electrolytes

What signs should make you consider DKA?

1. vomiting

2. anorexia

3. lethargy

4. dehydration

5. PU/PD

6. weight loss

7. tachypnea/Kussmaul respiration

8. abdominal discomfort

What do we need in order to diagnose DKA?

ketosis and metabolic acidosis

What are other causes of ketosis?

1. starvation

2. prolonged vomiting

3. severe systemic illness

4. sepsis

5. pancreatitis

6. pregnancy/lactation with inadequate intake

7. very low-carb diet

8. glucocorticoid associated insulin resistance

What are the most common complications of poorly controlled or untreated diabetes mellitus?

1. liver disease

2. diabetic ketoacidosis

3. pancreatitis

4. kidney injury

5. blindness

What is the blood glucose in DM and DKA?

1. DM: increased

2. DKA: usually increased

What is the blood beta-hydroxybutyrate in DM and DKA?

1. DM: normal or mildly increased

2. DKA: markedly increased

What is the urine ketones in DM and DKA?

1. DM: may be positive

2. DKA: often positive ++/+++

What is the urine glucose in DM and DKA?

1. DM: usually positive

2. DKA: usually positive

What is the USG in DM and DKA?

1. DM: variable

2. DKA: often decreased due to osmotic diuresis/dehydration

What is the clinical status in DM and DKA?

1. DM: often stable

2. DKA: usually clinically ill