Case 18 — Resp. Distress

Primary clinician: Aaron Wey, DVM, DACVIM (Cardiology)
Supervising clinician: Mark D. Kittleson, DVM, PhD, DACVIM (Cardiology)

Signalment

  • Species: Feline
  • Breed: Domestic shorthair
  • Age: 10 years
  • Sex: Male castrated
  • Weight: 5 kg
  • Name: Grey

Presenting Complaints

  • Diabetes mellitus / Fluid in abdomen and chest

Pertinent History

  • Client has had Grey since he was a kitten.
  • Approximately 1.5 years ago, he had a four-month period of chylothorax requiring intermittent thoracocentesis.
  • Restrictive cardiomyopathy diagnosed 16 months ago. Started on enalapril 2.5 mg PO q24h, aspirin 20 mg PO q3d, Tumil-K 2 tablets PO q24h, and Lasix 6.25 mg PO q8h.
  • Previously diagnosed with diabetes mellitus; resolved July 1997.
  • Rediagnosed with diabetes mellitus six weeks ago. Started on insulin 4 U SQ BID six days ago. Lasix decreased to 6.25 mg PO q12h. Last received insulin this morning.
  • Decreased activity for the last eight weeks, particularly the last 1–2 weeks.
  • Yesterday became lethargic and anorexic with vomiting after urination and apparent straining.
  • Taken to referring DVM this evening: increased respiratory effort noted. Thoracic radiographs showed pleural effusion. Ascites also evident.
  • Vomited once after eating. No coughing, sneezing, or diarrhea.

Physical Examination

  • Depressed but responsive. T = 93.8°F; P = 120; R = 68.
  • Ears clean. Eyes clear. MM pink; CRT 1 sec.
  • Breath sounds audible dorsally; absent ventrally. Heart difficult to auscultate.
  • Ascites present; abdominal palpation difficult. No masses or organomegaly detected.
  • Lymph nodes <½ cm.

Problems

  • Pleural effusion (most likely secondary to heart failure)
  • Diabetes mellitus
  • Hypothermia
  • Bradycardia
  • Ascites

Plans and Progress Notes

Problem 1: Pleural Effusion

  • S: Restrictive cardiomyopathy diagnosed 16 months ago after chylothorax treatment.
  • O: On presentation, dyspneic. 230 mL red-colored fluid removed (200 mL left, 30 mL right).
  • A: Most likely congestive heart failure.
  • P: Lasix 20 mg IM. Stabilize overnight on 40% O2. Monitor respiratory rate/effort. Tomorrow: pleural fluid analysis and echocardiogram.

Problem 2: Diabetes Mellitus

  • S: Rediagnosed six weeks ago; insulin 4 U SQ q12h.
  • O: Blood glucose at referring DVM: 240 mg/dL.
  • A: Must be addressed after heart failure stabilization to prevent diabetic ketoacidosis.
  • P: Stabilize overnight. Assess blood glucose in the morning. Offer w/d diet.
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