Wendy Blount, DVM Practical Clinical Pathology Ups

Transcript:Wendy Blount, DVM Practical Clinical Pathology Ups:
Wendy Blount, DVM Practical Clinical Pathology Ups and Downs of Blood Sugars Attendee 1 – City TX Glucose Danger values - <40 g/dl; >1000 g/dl Hyperglycemia Brain dehydration due to hyperosmosis CNS signs (cerebral, brain stem) and seizures DDx Hyperglycemia other than DM and stress (especially in prediabetics): Beta adrenergics (terbutaline, albuterol, etc.) Glaucoma treatments – acetazolamide, etc. Corticosteroids, levothyroxine, progestagens, estrogens (Thiazide diuretics, Diazoxide) Near death experience Ticked off Cat Glucose Danger values - <40 g/dl; >1000 g/dl Hyperglycemia Brain dehydration due to hyperosmosis CNS signs (cerebral, brain stem) and seizures DDx Hyperglycemia other than DM and stress (especially in prediabetics): Beta adrenergics (terbutaline, albuterol, etc.) Glaucoma treatments – acetazolamide, etc. Corticosteroids, levothyroxine, progestagens, estrogens (Thiazide diuretics, Diazoxide) Near death experience Ticked off Cat DM - Clinical Presentation Most dogs & cats >5 years History PU-PD – bigger clumps in the litter box weight loss, polyphagia Vomiting, illness of DKA Recent administration of corticosteroids History of triaditis, pancreatitis Recent heat Vision problems (cataracts) Skin problems – infections, alopecia DM - Clinical Presentation Exam Endocrine alopecia, pyoderma, poor grooming in the cat Pot bellied – hepatomegaly Cranial abdominal mass – pancreatitis + pain 10% Diabetic neuropathy in the cat Pregnancy, vulvar discharge, coming out of heat, abdominal distension Cats are more likely to be overweight with recent weight loss Dogs more likely to be underweight Stress Hyperglycemia or DM? Stressed cats can have transient hyperglycemia (200-400) Critically ill non-diabetic dogs can have marked hyperglycemia (>400) Stress hyperglycemia due to glucocorticoids, epinephrine and insulin resistance Acute hyperglycemia has adverse effects on the immune system, coagulation, heart and brain Chronic hyperglycemia is toxic to beta cells Treat with judicious insulin PRN – time will tell Hyperglycemia due to DM can be intermittent at first Stress Hyperglycemia or DM? “No glycosuria” makes untreated DM unlikely Stressed cats can have glycosuria Renal threshold 180-220 mg/dl in the dog 200-300 mg/dl in the cat Ketones in the urine indicate catabolism – investigate DKA DKA = Diabetic ketoacidosis Any sick cat who has not eaten for days can have ketonuria If all else fails, run a fructosamine Fructosamine elevated with DM >> a few other systemic diseases Decreased with a number of systemic diseases Normal with stress hyperglycemia Fructosamine glycosylated serum protein Averages blood glucose levels over the past 1-3 weeks Not affected by acute stress hyperglycemia Falsely decreased by - pancreatitis Hypoproteinemia, Hemolysis Hyperlipidemia Azotemia