HUNTER – 22894

MANHATTAN CENTER

Hunter 22894

Location: Manhattan

Intake Date: 3/15/18

Intake Type: Owner Surrender

Medical Behavior: Green

Sex: Neutered

Age: 6 years

Original Location: 10467

DVM Intake Exam

Estimated age: Reported to be 6 years old
Microchip noted on Intake? Scanned negative

History : Diagnosed with chronic kidney disease in March 2017. He currently takes:
Aphogel 64mg 1.0 ml PO q12
Benazapril 5mg 1/4 tablet PO q24
Previous owner also stated that he needs fluids.

Subjective: Alert, purring, walks around

Observed Behavior – Allows handling. Gets stressed with cystocentesis and blood draw.

Evidence of Cruelty seen – None

Evidence of Trauma seen – None

Objective
P = 240
R = 30
BCS 6/9 with mild muscle wasting. MMs pink.
EENT: Eyes clear, mild grey wax AU. No nasal or ocular discharge noted
Oral Exam: Moderate tartar.
PLN: No enlargements noted
H/L: Grade 2/6 systolic murmur on the left side, mid-parasternal, very mild spreading of PMI. NSR, CRT < 2, Lungs clear, eupnic
ABD: Non painful, no masses palpated
U/G: Male neutered
MSI: Seborrhea sicca – moderate flaky skin on coat. Ambulatory x 4, skin free of parasites, no masses noted.
CNS: Mentation appropriate – no signs of neurologic abnormalities
Rectal: Normal externally.

Assessment:
1. Known diagnosis of CKD, on benazepril and aphogel (aluminum hydroxide) and may need SQF
2. Heart murmur
3. Dental disease
4. Seborrhea
5. Muscle wasting

Prognosis: Fair

Plan:
1. Run CBC/chemistry/T4 and urinalysis (cysto)
2. Continue Aphogel 64 mg 1.0 ml PO BID and benazepril 5 mg tabs, 1/4 tab PO SID x14 days
3. Feed kidney diets such as k/d or NF only
4. Recommend cardiologist evaluation after placement
5. Recommend daily tooth brushing and regular dental cleanings
6. Consider multivitamin or fish oil to enhance coat

CBC:
Hct 46.2%
WBC slightly elevated (18.78 k/ul), neuts slightly elevated (10.39 k/ul)
Eos elevated (2.83)!!

Chemistry:
BUN elevated (45), creat normal 1.5
Albumin normal (3.5 g/dl)
Globulins normal (4.7)
**Na severely elevated (>180 mmol/l)
Cl severely elevated (150 mmol/l)

T4 low end of normal (1.3 ug/dl)

Urinalysis (cysto)
Clear, bright yellow
USG >1.050
Blood in sample
Neg bili, ketones, glucose
Protein 2+
Leu seen on dipstick but not in microscopic exam

Blood pressure: 160/Doppler

ASSESSMENT:
1. Electrolyte derangements – severe hypernatremia and hyperchloremia – R/O CKD vs. salt poisoning vs. hyperadrenocorticism vs. diarrhea vs. hyperaldosteronism vs….
2. Leukogram – R/O stress leukogram
3. Hypersthenuria, proteinuria – R/O severe dehydration (not appreciated on exam) vs. UTI vs. other
4. Elevated BUN, normal creatinine – R/O CKD and muscle wasting vs. protein-rich meal vs. other
5. Hypertension – R/O primary hypertension vs. secondary to CKD vs. secondary to heart disease vs. other
6. Heart murmur
7. Muscle wasting

PLAN:
1. Place IVC and start LRS at 21 ml/hr (should correct 0.35 mEq sodium/hour)
2. Continue meds as scheduled
3. Repeat chemistry tomorrow
4. Try to get medical records from previous vet

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