一只家养短毛猫在低血糖和低血压后出现对血管加压素有反应的短期严重多尿。

IF 0.7 Q3 VETERINARY SCIENCES Journal of Feline Medicine and Surgery Open Reports Pub Date : 2024-11-04 eCollection Date: 2024-07-01 DOI:10.1177/20551169241283294
Federica Porcarelli, Carla Asorey Blazquez, Ferran Valls Sanchez, Elena Scarpante, Giacomo Stanzani
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引用次数: 0

摘要

病例摘要:一只 8 个月大的雄性阉割短毛猫因急性呕吐就诊。腹部超声波检查发现空肠异物,通过肠切开术将异物取出。术前患者血糖过低,术中需要输注多巴胺以维持平均动脉压大于 60 mmHg。尽管补充了葡萄糖,但猫咪恢复后仍然严重低血糖。术后 24 小时内,尽管出现了优格血症,心血管状况也恢复正常,但患者仍出现了进行性多尿(高达 14 毫升/千克/小时)。这与提示弥漫性脑部疾病的神经系统体征有关,但没有氮质血症或过度脱水的体征。在住院的头四天里,任何减少静脉输液治疗的尝试都会导致低血压、体重下降和临床脱水。在此期间,尿比重(USG)在 1.005-1.010 之间,在输液挑战中也没有增加。推测诊断为中枢性糖尿病,并在住院第 5 天给它注射了去氨加压素(1 µg/ 猫 SC)。结果,猫咪的尿量在 4 小时内减少了,体重也增加了。患者在住院期间总共需要注射四次去氨加压素,但出院后就没有再注射过。出院时的尿量为 3 毫升/千克/小时。三个月后,猫的神经症状和多尿症状完全消失,USG>1.050:在本病例中,临床进展、神经症状和对去氨加压素的反应支持了中枢性糖尿病的推定诊断。据我们所知,这是首例弥漫性脑损伤后继发低血压和低血糖导致的可逆性糖尿病。
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Short-term severe polyuria responsive to vasopressin after hypoglycaemia and hypotension in a domestic shorthair cat.

Case summary: An 8-month-old male neutered domestic shorthair cat presented for acute vomiting. Abdominal ultrasound examination revealed a jejunal foreign body, which was removed via enterotomy. Preoperatively, the patient was hypoglycaemic and, intraoperatively, a dopamine infusion was required to maintain a mean arterial pressure >60 mmHg. Despite glucose supplementation, the cat remained severely hypoglycaemic on recovery. Within 24 h postoperatively, despite euglycaemia and normalisation of the cardiovascular status, the patient developed progressive polyuria (up to 14 ml/kg/h). This was associated with neurological signs suggestive of diffuse brain disease, and absence of azotaemia or signs of overhydration. During the first 4 days of hospitalisation, any attempts to decrease intravenous fluid therapy were associated with hypotension, weight loss and clinical dehydration. Urine specific gravity (USG) during this time was in the range of 1.005-1.010 and failed to increase during fluid challenges. A presumptive diagnosis of central diabetes insipidus was made, and desmopressin (1 µg/cat SC) was administered on day 5 of hospitalisation. Consequently, the cat's urinary output decreased and his weight increased within 4 h. The patient required a total of four doses of desmopressin during hospitalisation, but no further doses since discharge. Urinary output on discharge was 3 ml/kg/h. Three months later, the cat's neurological signs and polyuria had completely resolved, and the USG was >1.050.

Relevance and novel information: In this case, a presumptive diagnosis of central diabetes insipidus was supported by clinical progression, neurological signs and the response to desmopressin. To our knowledge, this is the first report of reversible diabetes insipidus after diffuse brain injury secondary to hypotension and hypoglycaemia.

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来源期刊
CiteScore
1.30
自引率
14.30%
发文量
57
审稿时长
15 weeks
期刊最新文献
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