|
| |
Case 32
Two months later
 | Mickey was diagnosed with dilated cardiomyopathy two
months ago. At that time, he had neurologic signs, and central retinal
degeneration as well. His shortening fraction at that time was around 18%.
He was severely taurine deficient with a whole blood
taurine concentration of 24 nmol/ml and a
plasma taurine concentration of
<2nmol/ml. The owner reports that Mickey is doing well at home. His neurologic
signs appear to have resolved. The owner thinks his vision may be slightly
improved. His activity level is greatly increased and no weakness or lethargy
are present. There has been no dyspnea, tachypnea,
or coughing seen. His appetite is good, and he is currently eating
baked chicken, Iams dry food,
and chicken baby food. He continues to vomit more than is normal for him, but
doesn't vomit every day. He has had some diarrhea
which resolved with decreasing his enalapril dose to SID. Renal parameters
have remained in the normal range at the referring
veterinarian's as of mid-September. He is currently on
enalapril, 1.25 mg PO SID, 6.25
mg furosemide SID, and 500mg taurine crystals PO SID-BID. |
| BAR. Approximately 5% dehydrated based on skin turgor and mucous
membrane moistness. T=101.6, P=220, RR=40. St=4.55 kg BCS 5/9. Very nervous in
exam room. Widely dilated pupils, bilaterally unresponsive to light. Menace
absent OU. Moderate gingivitis and calculus present. No ataxia seen, ambulates
well. No murmur ausculted. Regular cardiac rhythm. Soft gallop noted on
auscultation. Fair femoral pulses. No jugular pulses or pulse deficits.
Eupneic, but slightly tachypneic. Lungs auscult clear. Cranial abdomen
palpated full. No head tilt, falling, or leaning seen. The rest of the
physical exam was within normal limits. |
| Dilated cardiomyopathy |
| Central retinal degeneration |
| PE: No murmur ausculted. Regular rhythm. Soft gallop ausculted. Fair
femoral pulses. No jugular pulses or pulse deficits appreciated. Eupneic with
mild tachypnea. Lungs auscult clear. |
| Echo: IVS(d)=0.4 cm, IVS(s)=0.6 cm, LVEDD=1.9
cm, LVESD=1.4 cm, Ao:LA =0.7, LVFW(d)=0.4 cm, LVFW(s)=0.5 cm, SF=26%.
|
| Assessment: The ventricular end-systolic diameter
has decreased from 19 to 14 mm, which means myocardial function has improved.
The left ventricular end-diastolic diameter has also decreased, from 23 to 19
mm. Shortening fraction has increased from
18% to 26%. All of these indicate
that taurine supplementation is improving the cardiovascular portion of his
disease. Central retinal degeneration due to taurine deficiency is known to be
irreversible, so improvement in vision is unlikely. Continuing taurine may
further reverse the dilated cardiomyopathy in this
cat. |
| Plan: Continue with current therapy. Recheck in 6 weeks to assess
his condition. Educate owner about continued progress. |
Two weeks later
| Taurine levels:
| Taurine |
304 |
Plasma |
NMOL/ML |
|
| Taurine |
717 |
Whole Blood |
NMOL/ML |
|
|
| Assessment: The taurine concentrations are well
above the normal range. The owner is successfully supplementing Mickey with
taurine. |
|
