18 Resp. Distress

Case Studies In Small Animal

10-year-old MC domestic shorthair cat weighing 5 kg ("Grey")

Diabetes mellitus/Fluid in abdomen and chest

	The client has had Grey since he was a kitten.
	Approximately one and a half years ago, he had a four month period of chylothorax, requiring intermittent thoracocentesis.
	Restrictive cardiomyopathy was diagnosed 16 months ago and he was started on enalapril 1 tablet (2.5 mg tablet) PO q 24 hours, aspirin 1/4 tablet (80 mg tablet) PO q 3 days, Tumil K 2 tablets PO q 24 hours, and Lasix 1/2 tablet (12.5 mg tablet) PO q 8 hours.
	He had previously been diagnosed with diabetes mellitus, but this resolved in July of 1997.
	Approximately six weeks ago, he was diagnosed with diabetes mellitus again; he was started on insulin (owner unsure of type) 4 U SQ BID six days ago, and his Lasix was decreased to 1/2 tablet (12.5mg tablet) PO 1 12 hours.
	He last received insulin this morning.
	The client feels that he has had decreased activity for the last eight weeks, particularly in the last 1-2 weeks.
	Yesterday, Grey became lethargic and anorexic. He has been vomiting after urination, and appears to have some straining associated with urination.
	He was taken to the referring DVM this evening, where an increased respiratory effort was noted.
	Thoracic radiographs were taken and showed pleural effusion.
	Abdominal effusion (ascites) was also evident.
	The client noted that Grey vomited once after eating, but there has been no coughing, sneezing, or diarrhea.

	On presentation, Grey is depressed but responsive.
	T=93.8, P=120, R=68.
	Ears are clean.
	Cornea, conjunctiva, anterior chamber, and sclera are clear.
	Mucous membranes are pink, with a CRT of 1 seconds.
	Breath sounds are audible dorsally and absent ventrally.
	Heart is difficult to auscult.
	Ascites is present, making abdominal palpation difficult.
	No masses or organomegaly detected.
	Mandibular, prescapular, and popliteal lymph nodes are less than 1/2 cm.

	Pleural effusion that is most likely secondary to heart failure
	Diabetes mellitus
	Hypothermia
	Bradycardia
	Ascites

Problem 1: Pleural effusion

	S: Grey was diagnosed with restrictive cardiomyopathy sixteen months ago, after being treated for chylothorax over 3-4 months.
	O: On presentation, Grey was dyspneic. A 21-gauge butterfly catheter was used to remove 230 mL of red-colored fluid (200 mL from the left; 30 mL from the right).
	A: Given the prior diagnosis of restrictive cardiomyopathy, it is most likely that this cat is in congestive heart failure.
	P: Administer Lasix 20 mg IM. Stabilize cat overnight on 40% oxygen, and continue to monitor respiratory rate and effort. Offer free choice food and water. Tomorrow, submit pleural fluid for analysis and perform echocardiogram to assess cardiac function.

Problem 2: Diabetes mellitus:

	S: Grey was diagnosed with diabetes previously, and this resolved in July of 1997. He was diagnosed with diabetes again approximately six weeks ago, and is receiving insulin 4U SQ q 12 hours.
	O: Blood glucose at the referring DVM this evening was 240 mg/dL.
	A: Diabetes mellitus will need to be addressed once the congestive heart failure has been dealt with. Failure to treat diabetes mellitus for a prolonged period of time can result in diabetic ketoacidosis.
	P: Stabilize Grey overnight and assess blood glucose in the morning. Offer free access to w/d.

Problem 3: Hypothermia

	O: Grey's temperature is very low.
	A: Severe hypothermia that is most likely primarily due to low cardiac output.
	P: Treat heart failure and place on a heating pad.

Problem 4: Bradycardia

	O: The heart rate is 120 beats/minute.
	A: The heart rate is not extremely low and may be mildly decreased because of the hypothermia.
	P: Evaluate the ECG

Problem 5: Ascites

	O: A brief ultrasound confirmed the presence of ascites and distended hepatic veins.
	A: The ascites appears to be due to right heart failure.
	P: Treat for heart failure. Perform echocardiogram.