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Case Studies in Clinical Biochemistry

Sally Lester Canada

Case 1

Fifteen-year-old S/F DSH cat has progressive anorexia with lethargy and modest weight loss. PE: slightly pale mucous membranes, tense abdomen, nodular mass in anterior abdomen, and fecal material in colon. PR normal, no fever. Abnormalities on chemistry:

Reference

US

BUN

14.1 nmol/l

H

5.0 –12.5

[39.5]

Creatinine

248 umol/l

H

83 – 181

[2.8]

Lipase

1610 IU

H

0 – 205

T4

8 nmol/l

L

18 – 40

[0.6]

SG

1.028

 Additional information required?

 What would be a reasonable list of differentials given this data and history?

 If the TP was 54 g/l (reference 62-85) would that provide more insight?

 Albumin – 23 g/l (reference 28-39).

 What if the TP was 62, albumin 29?

 What other parameters could be abnormal if albumin was low?

Case 2

A 10-year-old neutered male Labrador cross dog was presented for a routine health examination in conjunction with annual vaccinations. As part of this program a routine chemistry was preformed and the following abnormal parameters were found:

Reference

US

BUN

9.9 nmol/l

H

1.8 – 8.3

[28]

Creatinine

150 umol/l

H

38 – 140

[1.7]

Albumin

48 g/l

H

27 – 38

[4.8]

Total Protein

110 g/l

H

50 – 82

[11.0]

Calcium

4.5 mol/l

H

2.1 – 3.3

[18.0]

 Additional information required?

 What would you do next?

 Differential diagnoses would include?

Case 3

A 4-year-old N/M dog was presented for inappetance and weight loss over the previous two weeks. The dog had current vaccinations and had been seen eight months previously for vaccinations. PE: moderately thin dog with fever (40.0 C), respirations OK, and heart rate modestly increased.

Reference

US

WBC

23.6 x 109/l

H

6.5 – 17.0

Polys

18.5

H

2.80 – 10.56

Bands

0.700

H

0.00 – 0.100

Total Protein

85 g/l

H

52 – 82

[8.5]

Globulin

54 g/l

H

18 – 40

[5.4]

Total Bili

20 umol/l

H

0 – 12

[1.2]

 What would be a reasonable differential list at this point?

 What if the albumin was actually 20 g/l (Reference 23–40)

 What is the first question to ask when evaluating bilirubin?

Case 4

A 9-month-old S/F Australian Cattle Dog was presented with a history of vomiting and diarrhea for the past seven days. The dog had initially been seen at another clinic and the diagnosis was made of Addison’s disease and the animal treated with fluids and steroids. The animal appeared to respond to treatment and was released. The animal relapsed within three days and was presented at your hospital. Previous laboratory values were:

Reference

US

Sodium

135 mmol/l

L

143 – 156

Potassium

8.2 mmol/l

H

4.0 – 5.4

BUN

70 mmol/l

H

3.5 – 10.0

[196]

Creatinine

800 umol/l

H

80 – 160

[9.0]

Amylase

2500 U/L

H

280 – 1250

Lipase

>4000 U/L

H

20 – 240

 Interpretation of these results?

 Differentials could include?

 What would be the next step?

Your repeat chemistry results indicate:

Sodium

146 mmol/l

N

140 - 148

Potassium

7.4 mmol/l

H

4.0 – 5.7

BUN

160 mmol/l

H

3.5 – 11.0

[448]

Creatinine

2121 umol/l

H

88 – 177

[24.0]

Calcium

1.43 mmol/l

L

2.11 – 2.86

[5.7]

Phosphorus

9.00 mmol/l

H

0.96 – 2.25

[27.8]

ALP

890 IU/L

H

10 – 84

Anion gap

50

H

13 – 25

Lipase

784

H

0 – 300

 How do you calculate anion gap?

 What does an elevated gap suggest?

 What other calculated parameter might be helpful?   

Case 5

A 19-year-old N/M domestic longhaired cat was presented for weight loss of one month’s duration. Appetite is good. Cat is bright and alert, no fever. Mild dental tartar, coat is matted. Abnormalities on blood work include

Reference

US

PCV

0.293 %

L

0.320 – 0.490

BUN

31.5 mmol/l

H

5.0 – 12.0

[96.9]

Creatinine

333 umol/l

H

145 – 160

[3.8]

Calcium

2.69 mmol/l

H

2.06 – 2.62

[10.8]

Phosphorus

2.40 mmol/l

H

1.16 – 2.25

[7.4]

Amylase

1805 U

H

450 – 1220

Lipase

271 U

H

0 – 195

Urine SG

1.020

Feline TLI

>200 ug/L

H

17 - 49

 What are your differentials on this group of tests?

 What other parameters would be helpful in assessing this case?

 Why is this cat losing weight?

Case 6

A 4-year-old indoor/outdoor S/F domestic shorthair cat was presented for depression and anorexia. The cat had an elevated temperature, 41C; a non-painful abdomen with “ropey” feeling intestinal tract.

Reference

US

WBC

4.4  x 109/l

L

5.5 – 19.0

Polys

3.6

2.7 – 10.56

Bands

0.3

H

0.0 – 0.100

Glucose

7.2 mmol/l

H

3.8 – 6.9

[130]

Potassium

3.3 mmol/l

L

4.0 – 5.8

Phosphorus

1.29 mmol/l

L

1.31 – 2.25

[3.99]

Total Protein

86 g/l

H

60 – 81

[8.6]

Albumin

43 g/l

H

26 – 40

[4.3]

Chloride

111 mmol/l

L

117 – 128

TCO2

12 mmol/l

L

17 – 24

Amylase

1900 U

H

450 – 1220

 What are the appropriate differentials?

 Further tests required?

 Simple tests to access the GIT tract that might be helpful?

Case 7

A 5-year-old intact male Sheepdog was presented initially for inappropriate urination. An evaluation of a free catch urine sample revealed 4+ rods and WBC that were TNTC, rbcs were also present, and scattered squamous epithelial cells. The animal was treated with Baytril awaiting culture results. The organism was E.coli and it was sensitive to Baytril. The animal appeared to respond to the therapy (three weeks of antibiotics) but resumed symptoms, seven days after the antibiotics were finished. The animal was returned to the hospital. The dog appeared depressed, dehydrated (5%), had a fever (40C); and was reluctant to move. The owner reported that the dog had not eaten for 48 hours.

Reference

US

WBC

52.5 x  109/l

H

6.5 – 17.0

Polys

48.0

H

2.80 – 10.56

Bands

0.4

H

0.00 – .100

Lymph

0.6

L

0.960 – 4.800

Mono

3.5

H

0.000 – 0.980

BUN

31.0 mmol/L

H

2.5 – 9.2

[88]

Creatinine

540 umol/l

H

68 – 141

[6.1]

Sodium

138 mmol/l

L

140 – 151

Potassium

5.7 mmol/l

H

4.0 – 5.4

Calcium

2.88 mmol/l

H

2.24 – 2.83

[11.52]

Chloride

79 mmol/l

L

108 – 118

TCO2

27 mmol/l

H

15 – 26

Albumin

43 g/l

H

31 – 42

[4.3]

Globulin

44 g/l

H

20 – 40

[4.4]

Amylase

4063 U

H

206 – 1250

Lipase

6680 U

H

40 – 560

Urine SG 1020; WBC – TNTC, rods +++; RBC 10-20/hpf

REFERENCES

1.   Burtis CA; Ashwood ER; Tietz Textbook of Clinical Chemistry; 3rd Edition; WB Saunders. 1999.

2.   Willard MD, Tvedten H; Turnwald, GH; Small Animal Clinical Diagnosis by Laboratory Methods. WB Saunders. 1989


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