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Table 2.1.1 Causes of polyuria, polydipsia, and hyposthenuria Causes of polyuria and polydipsia Definition Causes of isosthenuria USG 1.008–1.030 Chronic renal failure Diabetes mellitus Hyperadrenocorticism Hypercalcemia Hypoadrenocorticism Hypokalemia Liver disease Pyelonephritis Pyometra Causes of hyposthenuria USG < 1.008 Diabetes insipidus Hyperadrenocorticism Hypercalcemia Liver disease Pyometra USG, urine specific gravity. Table 2.2.1 Clinical manifestations of canine hypothyroidism Metabolic Cardiovascular Lethargy Bradycardia Mental dullness Cardiac arrhythmias Unexplained weight gain Cold intolerance Ocular Corneal lipid deposits Dermatologic Keratoconjunctivitis sicca Alopecia Corneal ulceration Seborrhea sicca, oleosa, or dermatitis Uveitis Dry, brittle hair coat Gastrointestinal Changes in hair coat color Diarrhea Pyoderma Constipation Hyperpigmentation Hematologic Otitis externa Anemia Myxedema Hyperlipidemia Coagulopathy Neuromuscular Weakness Reproductive Ataxia Female cycle abnormalities Vestibular signs Testicular atrophy Facial nerve paralysis Hypo/azoospermia Seizures Source: Feldman EC, Nelson RW. Hypothyroidism/the thyroid gland. In: Canine and Feline Endocrinology and Reproduction, 3rd edition. St. Louis, MO: Saunders Elsevier; 2004, 86+, print. Table 2.2.2 Factors causing low T4 values in euthyroid animals Factor Example Concurrent drug therapy Prednisone, phenobarbital Nonthyroidal illness Hyperadrenocorticism Naturally occurring different reference ranges for specific breeds Greyhounds, whippets, basenjis, sled dogs Hourly fluctuations Circadian cycle changes Fasting over 48 h Anorexia Age An older dog is more likely to have lower TT4 values than a younger dog Ambient temperature Car ride on a hot summer day Stress Visit to the veterinary hospital Sources: Wilford C, DVM (Veterinary News columnist for the AKC Gazette). The enigmatic nature of hypothyroidism makes it difficult to distinguish from other diseases. AKC Gazette November, 1995; pp. 67–71; Neiger R, Prof. Dr. med. vet., PhD, DACVIM, DECVIM–CA. Canine hypothyroidism. In: 50° Congresso Nazionale Multisala SCIVAC, Rimini, Italy. Giessen, Germany: Small Animal Clinic, Justus-Liebig University; 2005. Table 2.2.3 Common signs associated with feline hyperthyroidism Weight loss Polyphagia Tachycardia Heart murmurs Palpable thyroid Increased ALT/SAP Polydipsia Polyuria Vomiting Diarrhea Unkempt appearance of skin and hair coat Behavioral changes (i.e., increased vocalization, restlessness, irritability) Table 2.4.1 Sensitivity and specificity of endocrine screening tests in dogs for the diagnosis of hyperadrenocorticism Test Sensitivity (%) Specificity (%) Basal cortisol 100 78.2 UC : CR 100 20 ACTH stimulation 60–85 85–90 LDDST 90–95 40–50 Source: Modified from Nelson RW, Feldman EC. Chapter 6: canine hyperadrenocorticism. In: Endocrinology and Reproduction. Philadelphia, PA: Elsevier Science 2004. Table 2.5.1 Causes of insulin resistance in cats Drug administration (progestagens/corticosteroids) Infection (urinary tract/oral cavity/sepsis/bronchopneumonia) Hyperthyroidism Acromegaly Pancreatic disease (pancreatitis, tumor) Renal disease Hepatic disease Cardiac insufficiency Hyperlipidemia Neoplasia Severe obesity Exocrine pancreatic insufficiency Hyperadrenocorticism Pheochromocytoma Source: Modified from Scott-Montcrieff JC. Insulin resistance in cats. Vet Clinics of North America, Small Animal Practice 2010;40(2):241–257. Table 2.5.2 Parameters for changing insulin dosage and frequency based on blood glucose measurements when using lente or NPH insulin in cats Blood glucose variable Recommendations Initial therapy If blood glucose ≥360 mg/dL (>20 mmol/L) Use of an initial dose of 0.5 U/kg of lean body weight BID If blood glucose ≤360 mg/dL (<20 mmol/L) Use of an initial dose of 0.25 U/kg of lean body weight BID Nadir response If nadir blood glucose concentration is <54 mg/dL (<3 mmol/L) Dose should be reduced by 50% If nadir blood glucose is 54–90 mg/mL (3–5 mmol/L) Dose should be reduced by 1 U if poor control of clinical signs of DM, otherwise no change in dose =If nadir blood glucose concentration is 91–180 mg/dL (6–9 mmol/L) Dose should remain the same If nadir blood glucose concentration is >180 mg/dL (>10 mmol/L) Dose should be increased by 1 U If nadir blood glucose concentration occurs at 8 h or later Once-daily administration may be used, although BID administration at a reduced dose is preferred Baseline response If blood glucose returns to baseline within 8 h Change to longer-acting insulin (e.g., glargine, detemir, or PZI) Or if nadir blood glucose concentration occurs within 3 h of insulin administration Source: Modified from Rand J, Marshall R. Management of feline diabetes mellitus: part I. Which insulin do I choose and how do I adjust the dose? ACVIM 2009 Proceedings, Quebec, Canada, June 3–6. Table 2.5.3 Parameters for changing insulin dosage and frequency based on blood glucose measurements when using glargine insulin in cats Blood glucose variable Recommendations Initial therapy If blood glucose ≥360 mg/dL (>20 mmol/L) Use of an initial dose of 0.5 U/kg of ideal body weight BID If blood glucose ≤360 mg/dL (<20 mmol/L) Use of an initial dose of 0.25 U/kg of ideal body weight BID Note: Do not increase the dose in the first week unless minimum response to insulin occurs, but decrease if necessary. Monitor response to therapy for first 3 days. If no monitoring occurs during the first week, begin with 1 U/cat BID Preinsulin blood glucose level and nadir response Preinsulin level Nadir response Recommendations If preinsulin blood glucose concentration is >216 mg/dL (>12 mmol/L) provided nadir is not in hypoglycemic range Or if nadir blood glucose concentration is >180 mg/dL (>10 mmol/L) Increase by 0.25–1.0 U If preinsulin blood glucose concentration is 180–216 mg/dL (10–12 mmol/L) Or if nadir blood glucose concentration is 90–160 mg/dL (5–9 mmol/L) Same dose If preinsulin blood glucose concentration is 198–252 mg/dL (11–14 mmol/L) Or if nadir glucose is 54–72 mg/dL (3–4 mmol/L) Use nadir glucose, water consumption, urine glucose, and next preinsulin glucose concentration to determine if insulin dose should be decreased or maintained If preinsulin blood glucose concentration is <180 mg/dL (<10 mmol/L) Or if nadir blood glucose is <54 mg/dL (<3 mmol/L) Dose should be reduced by 0.5–1.0 U or if total dose is 0.5–1.0 U SID, stop insulin and check for diabetic remission Note: If clinical signs of hypoglycemia are observed Reduce by 50% Source: Modified from Rand J, Marshall R. Management of feline diabetes mellitus: part I. Which insulin do I choose and how do I adjust the dose? ACVIM 2009 Proceedings Quebec Canada June 3-6. Table 2.5.4 Hormonal response to hypoglycemia Hormone Response Insulin Decreased secretion Glucagon Increased secretion Catecholamines Increased secretion ACTH, cortisol, growth hormone Increased secretion Source: Feldman EC, Nelson RW. Beta-cell neoplasia: insulinoma. In: Canine and Feline Endocrinology and Reproduction, 3rd edition, p. 618. St. Louis, MO: Elsevier Science; 2004. Table 2.5.5 Clinical signs of insulin-secreting tumors in dogs Sign Percentage (%) Seizures 56 Weakness 47 Collapse 30 Ataxia 19 Muscle tremors 18 Hind end weakness 16 Behavior changes 12 Source: Feldman EC, Nelson RW. Beta-cell neoplasia: insulinoma. In: Canine and Feline Endocrinology and Reproduction, 3rd edition, p. 621. St. Louis, MO: Elsevier Science; 2004. Table 2.5.6 Causes of hypoglycemia Insulin-secreting tumor Paraneoplastic Hypoadrenocorticism Hepatic failure–PSS, acquired Toxic–xylitol Sepsis Toy breed/fasting puppy Sampling artifact