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HYPERGLYCEMIC HYPEROSMOLAR SYNDROME IN A DOG

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An 11 year old castrated male terrier mix dog was referred to the Cornell University Hospital for Animals Emergency and Critical Care Service for further evaluation of a 3 day history of lethargy, inappetence, and vomiting. The dog had been to his primary veterinarian earlier that day where initial blood tests revealed leukocytosis, hyperglycemia, azotemia, hyperphosphatemia, and elevated alkaline phosphatase activity. The patient was treated with intravenous fluid therapy prior to referral. The patient had a history of diabetes mellitus diagnosed and managed since 2009, and at the time of presentation was receiving 10 units of Novolin NPH insulin subcutaneously every 12 hours. A fructosamine level most recently performed 5 months prior to presentation was 444 umol/L, indicative of a fair to poorly controlled diabetic state. Previous medical history also included pseudophakia, chronic keratitis, and indolent ulcers, for which he was being treated with tacrolimus OU q12h, timolol/dorzolamide OS q12h, terramycin OS q12h, and eye lube OU q6-8h. Upon presentation to the CUHA ER, the patient was obtunded, laterally recumbent, tachycardic (130 bpm), normotensive (142/61 (mean 88 mmHg)), hypothermic (98.5F), and tachypneic (50 brpm). Physical examination also revealed 7% dehydration and a painful abdomen. During examination, the patient exhibited hematemesis, diarrhea, and hematochezia. Initial point of care bloodwork revealed azotemia, hyperglycemia (too high to read), hyperproteinemia, and mild anemia. Venous blood gas analysis revealed a high anion gap metabolic acidosis with hyperlactatemia and ketonemia. Initial electrolyte abnormalities included hyponatremia, hypochloremia, hyperkalemia, and hypocalcemia. Point of care urinalysis revealed trace ketones and a urine specific gravity of 1.028. The patient was normotensive. The problem list included hyperglycemic hyperosmolar syndrome resulting in hypovolemic shock and electrolyte abnormalities, as well as azotemia, hematemesis, hematochezia, and diarrhea. After 6 days of intensive hospitalization and treatment provided by the Critical Care Service, aimed principally at resolving his dehydration, hyperglycemia, and hyperosmolarity, the patient was discharged to the care of his owners. This presentation will discuss the challenges of treating a hyperosmolar patient.

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2016-01-27

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hyperglycemic hyperosmolar syndrome, diabetes mellitus, hyperosmolar nonketotic diabetes

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case study

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