Case Presentation
- Signalment: 6 year old female Rottweiler, Miss Pooples, weighing 40 kg
- Presenting complaint: Vomiting, collapse, acutely painful distended abdomen
- Last normal: 1 week ago
- Past Pertinent History: Increased urinations and water consumption for 1 week, vomiting for 3 days, complete
anorexia for 24 hours. Acutely unwilling to rise this am.
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Other medical conditions and pertinent history
- Past UTI 1 year ago, responded to antibiotics, cranial cruciate rupture 2 years ago, 2 normal litters of
puppies, last pregnancy 2.5 years ago, last estrus 1 month ago, vaccines current
- Medications: glycoflex, glucosamine, Aspirin PRN last given 1 week ago
- Systems review: no coughing, no sneezing, no diarrhea, no naso-ocular discharge, no seizures, vomiting and
PU/PD present
Physical examination findings
- Temperature: 105.5°F,
- Pulse: 180 bpm, pulses weak with occasional irregularity
- Respirations: 50 bpm
- Airway and Breathing: airway patent, breath sounds increased in all fields
- Circulation: CRT 2.5 sec, mucous membranes pale and tacky, cardiac auscultation – no murmurs, limbs cold,
7% dehydrated
- Neurologic: dull and depressed
- Abdomen: distended, painful, tense, no obvious fluid wave
- Urogenital: no vulvar discharge, mammary glands normal, unable to palpate bladder
- Lymph nodes: within normal limits
- EENT: no additional abnormalities
- Musculoskeletal: nonambulatory, recumbent
- Rectal examination: enlarged firm cervix, possible fluctuant uterine body
Initial therapeutic and diagnostic plan
- Flow-by oxygen, IV catheter
- ECG: tachycardia with occasional VPC
- Blood pressure: mean 58 mm Hg 79/43
- Pulse oximeter: 92%
- IV fluids
Tissue oxygenation
The first question is whether defects in tissue oxygenation are a result of poor pulmonary function or poor oxygen delivery.
To determine pulmonary function in Miss Pooples calculate the A-a gradient:
- Alveolar gas equation = Patm – PH2O (713mmHg) x FIO2 (.21) – PaCO2 (39 mmHg)/R (.8)
- PAO2=150 – 49 = 101
- PaO2 - PAO2 Gradient = 101 – 68 = gradient 33
Plan: supplemental O2
- Alveolar gas equation = Patm – PH2O (713mmHg) x FIO2 (.40) – PaCO2 (41 mmHg)/R (.8)
- PAO2=236 – 51 = 185
- a-A gradient = 185-171 = 14
