(2014-01-05 16:10:19)
小犬的8周龄,食欲不振,持续昏睡,兽医8毫克甲硝唑每12小时一次口服,益生菌罐头,第2天小狗继续昏睡,体温低,36.1,血糖(hypoglycemic (67 mg/dl),第2天检查细小病毒感染.严重脱水,转院至此.
体温:35.2
bpm:140
pr:20
血压:110
体重:0.78kg
超声波检查:肠管内充满液体
诊断治疗1-7天以下治疗和检测过程.
Day 1(第一天)
Blood glucose: 57 mg/dL (glucometer). Administered 1 mL 50% dextrose bolus IV
Hospitalization,Plasmalyte* + 5% dextrose + 40 mEq/L potassium chloride IV,dolasetron (0.5 mg q24h IV),ampicillin (20 mg q8h IV),famotidine (1 mg q24h IV)
Blood analysis (after 6 hr of fluids,dextrose CRI)
Sodium: 131 mEq/L (range,142–150)
Potassium: 2.8 mEq/L (range,3.4–4.9)
Chloride: 91 mEq/L (range,106–127)
Glucose: 114 mg/dL (range,60–115)
Blood urea nitrogen: 13 mg/dL (range,10–26)
Hematocrit: 31% (range,35–50)
A multiple electrolyte intravenous solution
pH: 7.34 (range,7.35–7.45)
Packed cell volume/total solids: 33%/3.9 (ranges,36–60/5.0–7.4)
White blood cells: 4.5 × 103/μL (range,6–17)
Platelets: 42.6 × 104/μL (range,20–50)
Blood type: DEA 1.1 positive
Day 2(第二天)
The puppy was recumbent and dull throughout the morning. At about midnight,blood values as reported above remained the same. New values:
Creatinine: 0.2 mg/dL (range,0.3–1.2)
Albumin: 1.7 g/dL (range,2.1–3.6)
Alanine aminotransferase: 78 U/L (range,8–75)
Lymphocytes: 1.1 X 103/μL (range,0 .9–5)
At 3:00 AM,the first transfusion of hyperimmune plasma (8 mL DEA negative over 3 hours) was administered.
8:00 AM exam
Temperature: 99.4⁰F
Heart rate: 200 bpm
Painful abdomen
Bloody diarrhea,regurgitation overnight
Administered bolus of 18 mL crystalloid fluids IV,1 mL 25% dextrose IV. Recheck:
Heart rate 90 bpm
Blood pressure: 95
Started metoclopramide CRI (1 mg/kg/d; 1 mL/hr).
9:00 AM blood values
Sodium: 132 mEq/L (range,142–150)
Potassium: 2.9 mEq/L (range,3.4–4.9)
Chloride: 99 mEq/L (range,106–127)
Glucose: 42 mg/dL (range,60–115)
Blood urea nitrogen: 8 mg/dL (range,10–26)
Hematocrit: 24% (range,35–50)
pH: 7.30 (range,7.35–7.45)
10:00 AM: Hyperimmune plasma (2nd transfusion) 8 mL DEA negative over 2 hours
4:00 PM blood values
Sodium: 132 mEq/L (range,3.4–4.9)
Chloride: 101 mEq/L (range,106–127)
Glucose: 55 mg/dL (range,60–115)
Blood urea nitrogen: 5 mg/dL (range,10–26)
Hematocrit: 26% (range,35–50)
pH 7.38 (range,7.35–7.45)
Administered 1 mL 25% dextrose bolus; increased dextrose CRI to 7.5%. In the afternoon,puppy was brighter,with minimal diarrhea and one episode of regurgitation. No interest in eating.
Treatment:
Medications
Ampicillin (20 mg q8h IV)
Dolasetron (0.5 mg IV)
Enrofloxacin (8 mg q24h IV)
Metronidazole (8 mg q12h IV)
Famotidine (1 mg q24h IV)
Maropitant (0.8 mg q 24h SC)
Metoclopramide (1 mg/kg/day at 1 mL/hr)
Hetastarch (0.6 mL/hr IV)
Buprenorphine 0.007 mg IV (8:00 AM and 4:00 PM)
Fluids
Plasmalyte (5 mL/hr) + 7.5% dextrose and 50 mEq/L potassium chloride––all IV
第三天
Day 3
Throughout the morning the puppy was brighter,with no interest in food,although he tolerated syringe feeding. Hemorrhagic diarrhea had been seen overnight,with one episode of regurgitation. Maintained normoglycemia overnight. Abdomenwas comfortable.
2:00 AM blood values
Sodium: 130 mEq/L (range,142–150)
Potassium: 3.8 mEq/L (range,3.4–4.9)
Glucose: 101 mg/dL (range,60–115)
Hematocrit: 27% (range,35–50)
pH: 7.336 (range,7.35–7.45)
Ionized calcium: 1.06 mmol/L (range,1.12–1.4)
9:00 AM blood values
Sodium: 129 mEq/L (range,3.4–4.9)
Chloride: 100 mEq/L (range,60–115)
Blood urea nitrogen: <3 mg/dL (range,10–26)
Hematocrit: 28% (range,35–50)
pH: 7.37 (range,7.35–7.45)
Treatment:
Medications
Ampicillin (20 mg q8h IV)
Dolasetron (0.5 mg q24h IV)
Enrofloxacin (8 mg q24h IV)
Metronidazole (8 mg q12h IV)
Famotidine (0.4 mg q24h IV)
Maropitant (0.3 mg q24h SC)
Metoclopramide (1 mg/kg/d at 2 mL/hr CRI)
Hetastarch: (0.6 mL/h IV)
Fluids
Plasmalyte (3 mL/hr) + 2.5% dextrose and 20 mEq/L potassium chloride IV. Changed IV fluids to 0.9% sodium chloride + 2.5% dextrose and 30 mEq/L potassium chloride at 6:00 PM.
Syringe fed throughout the day.
Day 4
3:00 AM: Puppy was weak and ataxic.
Glucose: 21 mg/dL (range,60-115)
Administered 0.8 mL bolus of 25% dextrose; increased dextrose CRI to 5%.
6:00 AM blood values
White cells: 400/μL (range,6,000–17,000)
Lymphocytes: 300/μL (range,900–5,000)
Platelets: 88/μL (range,200,000–500,000)
Glucose: 40 mg/dL (range,60–115)
Packed cell volume/total protein: 23%/3.2 g/dL (ranges,36–60/5.0–7.4)
8:00 AM: Puppy was dull and weak.
Temperature: 97.6⁰F
Heart rate: 160 bpm
Blood pressure: 90 bpm
Blood values
Sodium: 137 mEq/L (range,142–150)
Potassium: 2.0 mEq/L (range,3.4–4.9)
Chloride: 102 mEq/L (range,106–127)
Glucose: <20 mg/dL (range,60–115)
Blood urea nitrogen: 6 mg/dL (range,10–26)
Hematocrit: 19% (range,35–50)
pH: 7.389 (range,7.35–7.45)
Administered 1 mL 25% dextrose bolus; increased dextrose CRI to 7.5% and potassium chloride supplementation to 60 mEq/L––all IV.
11:00 AM treatment
Hyperimmune plasma (3rd transfusion; 8 mL DEA negative over 2 hours)
Additional bolus of dextrose after completing transfusion
Started partial parenteral nutrition,at 70% of puppy’s resting energy requirement
4:00 PM blood values
Sodium: 133 mEq/L (range,142–150)
Potassium: 2.2 mEq/L (range,3.4–4.9)
Chloride: 105 mEq/L (range,106–127)
Glucose: 28 mg/dL (range,60–115)
Blood urea nitrogen: 5 mg/dL (range,10–26)
Hematocrit: 20% (range,35–50)
pH: 7.492 (range,7.35–7.45)
Administered fresh frozen plasma (4th transfusion; 8 mL DEA positive over 2 hours). Posttransfusion blood glucose: 32 mg/dL
Treatment throughout day:
Medications
Ampicillin (20 mg q8h IV)
Enrofloxacin (8 mg q24h IV)
Metronidazole (8 mg q12h IV)
Famotidine (0.8 mg q24h IV)
Dolasetron (0.5 mg q24h SC)
Metoclopramide (2 mg/kg/d IV CRI)
Fluids
Sodium chloride (0.9%; 3 mL/hr) + 7.5% dextrose and 60 mEq/L potassium chloride IV
Hetastarch: (0.6 mL/hr IV)
Nutrition
Partial parenteral nutrition (4 mL/hr IV)
Day 5
8:00 AM: Puppy was quiet,alert,responsive; brighter and stronger. Blood glucose was normal; there had been continued regurgitation and diarrhea overnight.
Blood Values
Sodium: 132 mEq/L (range,142–150)
Potassium: 3.4 mEq/L (range,106–127)
Gucose: 99 mg/dL (range 60–115)
Blood urea nitrogen: 10 mg/dL (range,10–26)
Hematocrit: 15% (range,35–50)
Packed cell volume/total solids: 19%/2.6 (ranges,36–60/5.0–7.4)
pH: 7.316 (range,7.35–7.45)
Decreased potassium chloride supplementation to 40 mEq/L; decreased dextrose CRI to 5% IV.
Treatment throughout the day:
Medications
Ampicillin (20 mg q8h IV)
Enrofloxacin (8 mg q24h IV)
Metronidazole (8 mg q12h IV)
Famotidine (0.4 mg q24h IV)
Day 6
8:00 AM: Puppy had clear regurgitation and began to appear icteric throughout the day; tolerated syringe feedings. Temperature and blood pressure were normal.
Increased potassium chloride supplementation to 60 mEq/L; dextrose CRI decreased to 2.5%; partial parenteral nutrition decreased and then discontinued (due to concern for causing fluid shift and contributing to hyponatremia); saline CRI increased to 3 mL/hr. Laboratory work showed a low osmolality of 265.
Blood values
Sodium: 127 mEq/L (range,142–150)
Potassium: 2.5 mEq/L (range,3.4–4.9)
Chloride: 90 mEq/Ll (range,106–127)
Glucose: 23 mg/dL (range,60–115)
Blood urea nitrogen: 11 mg/dL (range,10–26)
Hematocrit: 13% (range,35–50)
Packed cell volume/total solids: 14%/2.6 g/dL (range,36–6-/5.0–7.4)
pH: 7.544 (range,7.35–7.45)
Administered packed red blood cells (5th transfusion) 6 mL DEA negative over 3 hours. Due to continued hypoglycemia despite dextrose boluses,dextrose CRI was maintained at 5% and continued during the transfusion.
8:00 PM blood values
Sodium: 129 mEq/L (range,142–150)
Potassium: 2.4 mEq/L (range,3.4–4.9)
Chloride: 94 mEq/L (range,106–127)
Glucose: 49 mg/dL (range,60–115)
Blood urea nitrogen: 16 mg/dL (range,10–26)
Hematocrit: 11% (range,35–50)
Packed cell volume/total solids: 12%/3 g/dL (ranges,36–60/5.0–7.4)
pH: 7.64 (range,7.35–7.45)
Total bilirubin: 3.6 mg/dL (range,0–0.8)
Treatment throughout the day:
Medications
Ampicillin (20 mg q8h IV)
Enrofloxacin (8 mg q24h IV)
Metronidazole (8 mg q12h IV)
Famotidine (0.4 mg q24h IV)
Maropitant (0.3 mg q24h SC)
Metoclopramide (2 mg/kg/d at 2 mL/hr)
Fluids
0.9% sodium chloride (3 mL/hr) + dextrose and 60 mEq/L potassium chloride) IV
Hetastarch (0.5 mL/h IV)
Nutrition
Partial parenteral nutrition (4 mL/hr)
