Download Discharge Summary - InSync Exotics Killers

Veterinary Medical Teaching Hospital
Texas A&M University
(979) 845-2351
www.cvm.tamu.edu
Zoological Medicine & Surgery Discharge Summary
Owner:
Vicky Keahey
3430 Sky View Dr.
Wylie, TX 75098
Home Phone: 972-442-6888
Admission Date: August 26, 2010
Patient: #194387, Cody
DOB: 00/00/0
Weight: 122.14 lbs
Attending Clinician: Sharman Hoppes, DVM
Discharge Date: August 26, 2010
Senior Clinician: Sharman Hoppes, DVM
Student: Megan Ohlenforst, 4VM
Referring Veterinarian:
Cody was admitted to the Texas A&M University Veterinary Medical Teaching Hospital
on August 26, 2010 .
Presenting complaint: labored breathing
History: Cody, an eleven year old male cougar, presented to the Zoo Medicine service
on 8/26/10 for labored breathing of four days duration. On 4/13/10, Cody was taken to
the rDVM for anorexia and vomiting; thoracic radiographs were taken and were clear
and bloodwork (CBC/Chemistry) showed no significant abnormalities. Since then, he
has had recurrent episodes of anorexia. In June 2010 Cody had a soft tissue abscess
on his chin which was treated with amoxicillin. The abscess returned in July 2010 and
was treated successfully with amoxicillin again. On 8/23/10 he was taken to the rDVM
for acting aggressively towards Ms. Keahey, which is unusual for Cody. Cody was
anesthetized for chest films, which revealed a large mass and pleural fluid. Since
waking up from anesthesia on 8/23/10, he has had very labored breathing. On 8/24/10
he was started on 2ml of Furosemide twice daily and has been drinking lots of water
since. Since Monday, he has been more lethargic than normal, and has been laying
down much more than normal but is still responsive and easily roused. He was referred
to Texas A&M for further diagnostics and possible surgery. Since April, he has lost
approximately 40 lbs.
Cody is housed outside in a large enclosure with two other cougars and shares
fencing with nine more big cats. He eats 1.5 lbs of a vitamin fortified ground beef, 3
strips of horse meat, and 2 chicken drumsticks daily. He was vaccinated in 10/09 with
rabies and FVRCP vaccines. He has not been tested for FIV/FeLV. Cody received his
monthly Frontline and Capstar approximately 2 weeks ago. Ms. Keahey has had Cody
since 2005 and he has had no prior illnesses or surgeries since then. He was
reportedly intact when Ms. Keahey obtained Cody, but he appears to have been
neutered. The previous owners had Cody declawed in all four paws.
Physical Examination: R: 64 rpm
Wt: 123 lbs
BCS:4/9
On physical exam, Cody is quiet, alert, and responsive. Breathing is very rapid and
labored, with an abdominal component. Eyes, ears, and nostrils all appear clear. Cody
is thin, and his spine and pelvic bones are easily visible. Respiration increased with
activity (up to ~96rpm after the first IM injection). Flow by oxygen was provided upon
arrival and continued until anesthetic induction
Diagnostic Tests & Results:
FIV/FeLV combo test:
Code
Name
Result
FIV/FELV COMBO
FIV/FELV COMBO
Negative
Thoracic Fluid Cytology:
CYTOLOGIC FINDINGS: A direct and concentrated smear prepared from the pleural
fluid are examined. The smears are highly cellular and contain numerous nucleated
cells and occasional erythrocytes in a highly proteinaceous and granular background
with frequent lysed cells and extracellular bacterial rods and cocci. The nucleated cells
are composed predominantly of markedly degenerate neutrophils with occasional
macrophages. The neutrophils often contain phagocytized bacterial cocci and/or rods
that range from small, short rods to long, thin, filamentous rods. The macrophages are
often moderately vacuolated but do not appear to display cytophagia. No neoplastic
cells are identified.
INTERPRETATION: Marked septic suppurative exudate.
COMMENTS: The markedly elevated nucleated cell count and protein concentration are
consistent with an exudate that is characterized mainly by degenerate neutrophils. The
mixed population of bacteria is consistent with infection secondary to a foreign body or a
bite wound. A Gram stain reveals that the cocci and both forms of rods are Gram
positive. Due to the highly proteinaceous background of the smear, Gram negative
bacteria are not recognized but cannot be ruled out entirely. Filamentous rod shaped
bacteria are often concerning for anaerobic bacteria, Nocardia spp, or Actinomyces spp;
however, this cannot be determined based on cytology and thus aerobic and anaerobic
bacterial culture and sensitivity testing is indicated.
Test
Result
Reference
Unit
Pre-Centrifugation Color
Volume Submitted
Pre-Centrifugation
Transparency
Light red
1.5
ml
Opaque
WBC (/ul)
134000
ul
RBC (/ul)
34000
ul
Post-Cent. Supernant Color
Straw
Post-Cent. Supernant
Transparency
Slightly hazy
Total Protein (TS-g/dl)
7.2
g/dl
Fibrinogen-Heat
300
mg/dl
Chest Radiographs: 3-view study
Pleural fluid and free gas visible; large mass visible in the left caudal lung lobe.
Irregular margins of lung lobes.
ICU NOVA arterial analysis:
BUN- error, high (too high to read)
Creatinine- 10.2
ICU NOVA venous analysis:
BUN- error, high (too high to read)
Creatinine- 10.5
Abaxis vetscan analysis:
BUN- 170
Creatinine- 10.2
Chemistry profile:
Test
Result
Glucose
180.
Reference
Unit
mg/dl
Lactic Acid
46.3
mg/dl
Cholesterol
64.
mg/dl
Blood Urea Nitrogen
178.
mg/dl
Creatinine
10.0
mg/dl
Magnesium
2.7
mg/dl
Calcium
7.4
mg/dl
Phosphorus
12.7
mg/dl
Total Protein
5.1
g/dl
Albumin
1.4
g/dl
Globulin
3.7
g/dl
Alanine Aminotransferase
10.
U/L
Alkaline Phosphatase
20.
U/L
Gamma Glutamyltransferase
<10.
U/L
Total Bilirubin
<.1
mg/dl
Sodium
143.
mmol/L
Potassium
3.5
mmol/L
Chloride
106.
mmol/L
Enzymatic Carbon Dioxide
15.
mmol/L
Anion Gap (Calculated)
25.
mmol/L
Diagnosis: Septic suppurative exudate with mixed bacterial cell population; likely due
to cat bite; possible foreign body.
Treatment: Sedated with midazalam, dexdormator and Ketamine with pole syringe,
intubated and placed on Sevoflurane, placed two 18 guage IV cathetors and placed on
a respiratory ventilator. Blood colected for FELV, FIV and Chemistry profile.
Radiographs revealed pleural effusion, collapsed lungs and masses in lungs. 2.5 liters
of bloody purulant fluid was removed from the thoracic cavity per thoracocentesis. Blood
work revealed negative Felv and FIV testing, but acute renal failure was present.
Azotemia present after > 2 liters of fluids given IV. Discussed thoracic surgery and
possible lung lobectomy, but very grave prognosis, especially with renal failure present.
Due to grave prognosis, owner elected euthanasia. Necropsy revealed severe
abscessation of both caudal lung lobes with fibrous adhesions.
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Clinician
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Student