{"id":6308,"date":"2023-07-05T14:00:41","date_gmt":"2023-07-05T17:00:41","guid":{"rendered":"https:\/\/www.ufrgs.br\/lacvet\/?p=6308"},"modified":"2024-02-15T15:04:24","modified_gmt":"2024-02-15T18:04:24","slug":"caso-clinico-1763i","status":"publish","type":"post","link":"https:\/\/www.ufrgs.br\/lacvet\/cc_interativos\/caso-clinico-1763i\/","title":{"rendered":"Caso Cl\u00ednico 1763I"},"content":{"rendered":"
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Identifica\u00e7\u00e3o<\/strong><\/p>\n\t\t\t

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Esp\u00e9cie: Canina
Ra\u00e7a: Scott Terrier
Idade: 8 anos
Sexo: f\u00eamea
Peso: 6,3 kg<\/p>\n\n<\/div>\n\t\t<\/div>\n\n

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Anamnese<\/strong><\/p>\n\t\t\t

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No dia 0 apresentava perda de apetite, anorexia h\u00e1 10 dias e adipsia h\u00e1 1 dia. Teve um epis\u00f3dio s\u00fabito de dificuldade respirat\u00f3ria recentemente. O tutor relatou que a paciente n\u00e3o \u00e9 castrada, n\u00e3o \u00e9 vacinada e n\u00e3o toma verm\u00edfugo regularmente.<\/p>\n\n<\/div>\n\t\t<\/div>\n\n

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Exame f\u00edsico<\/strong><\/p>\n\t\t\t

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Escore corporal: 5 (ref.: 1-9, ideal=5)
Tempo de preenchimento capilar: <2 s (ref.: < 2)
Frequ\u00eancia card\u00edaca: 120 bpm (ref.: 70-160);
Apatia; desidrata\u00e7\u00e3o; mucosas hipocoradas e cian\u00f3ticas; ausculta pulmonar evidencia esfor\u00e7o respirat\u00f3rio; taquipneia; ulcera\u00e7\u00e3o da mucosa oral; halitose ur\u00eamica; epis\u00f3dio de v\u00f4mito durante a consulta (amarelado e sem sangue).<\/p>\n\n<\/div>\n\t\t<\/div>\n\n

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Exames complementares<\/strong><\/p>\n\t\t\t

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Dia 2-Teste de soro-aglutina\u00e7\u00e3o para detec\u00e7\u00e3o de leptospirose:<\/strong> n\u00e3o reagente para os sorovares L.\u00a0andamana; L.\u00a0australis, L.\u00a0autumnalis, L.\u00a0batavie, L.\u00a0balun, L.\u00a0canicola, L.\u00a0castelonnis, L.\u00a0celledoni, L.\u00a0cynopteri, L.\u00a0copenhageni, L.\u00a0djasiman, L.\u00a0grippothyphosa, L.\u00a0hardjo, L.\u00a0hebdomadis, L.\u00a0icterohaemorragiae, L.\u00a0javanica, L.\u00a0panam\u00e1, L.\u00a0patoc, L.\u00a0pomona, L.\u00a0pyrogenes, L.\u00a0sejroe, L.\u00a0shermani, L.\u00a0tarassovi e L.\u00a0wolffi.<\/em><\/p>\n\n\n\n

Dia 4-Ultrassonografia:<\/strong> hepatomegalia leve com contornos irregulares, sugerindo uma hepatopatia inflamat\u00f3ria\/congest\u00e3o. Ba\u00e7o com ecogenicidade diminu\u00edda, indicando congest\u00e3o\/toxemia. Est\u00f4mago com espessamento de parede, sugestivo de gastrite. Rins com contornos irregulares, ecogenicidade aumentada e cortical heterog\u00eanea, sugestivo de nefropatia.<\/p>\n\n<\/div>\n\t\t<\/div>\n\n

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Tratamento e evolu\u00e7\u00e3o<\/strong><\/p>\n\t\t\t

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Dia 0 a dia 11<\/strong> – Paciente foi submetida a cateterismo vesical e sonda nasoesof\u00e1gica. Apresentou epis\u00f3dios de dispneia e v\u00f4mito. Houve uma discreta melhora no quadro an\u00eamico, por\u00e9m as altera\u00e7\u00f5es bioqu\u00edmicas permaneceram. Foram administrados os seguintes f\u00e1rmacos durante a interna\u00e7\u00e3o:<\/p>\n\n\n\n

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  • Fluidoterapia intensiva com Ringer lactato;<\/li>\n\n\n\n
  • Ampicilina (antibi\u00f3tico e bactericida derivado da penicilina);<\/li>\n\n\n\n
  • Enrofloxacina (antibi\u00f3tico de largo espectro);<\/li>\n\n\n\n
  • Metronidazol (antimicrobiano que age exclusivamente em microrganismos anaer\u00f3bios);<\/li>\n\n\n\n
  • Citrato de maropitant (antiem\u00e9tico);<\/li>\n\n\n\n
  • Sucralfato (protetor g\u00e1strico);<\/li>\n\n\n\n
  • Spray de isotionato de hexomedina e tetraca\u00edna (spray antiss\u00e9ptico e anest\u00e9sico);<\/li>\n\n\n\n
  • Cloridrato de tramadol (analg\u00e9sico opioide).
    <\/li>\n<\/ul>\n\n\n\n

    A paciente foi a \u00f3bito no dia 11 da interna\u00e7\u00e3o.<\/p>\n\n<\/div>\n\t\t<\/div>\n\n

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    Hemogasometria<\/strong><\/p>\n\t\t\t

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    Sangue VENOSO<\/strong><\/td>Dia 4<\/strong><\/td>Dia 7<\/strong><\/strong><\/td><\/tr>
    pCO2<\/sub> (33,6-41,2 mmHg)<\/td>31,2\u2193<\/mark><\/td>35,1<\/td><\/tr>
    pO2<\/sub> (47,9-56,3 mmHg)<\/td>63<\/td>27\u2193<\/mark><\/td><\/tr>
    BE (-3 a 2 mmol\/L)<\/td>-11\u2193<\/mark><\/mark><\/td>-2<\/td><\/tr>
    HCO3<\/sub> (21-25 mmol\/L)<\/td>15,6\u2193<\/mark><\/mark><\/td>22,6<\/td><\/tr>
    iCa (1,3-1,5 mmol\/L)<\/td>0,44\u2193<\/mark><\/mark><\/td>0,65\u2193<\/mark><\/mark><\/td><\/tr>
    sO2<\/sub> (%)<\/td>90<\/td>52<\/td><\/tr><\/tbody><\/table><\/figure>\n\n<\/div>\n\t\t<\/div>\n\n
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    Hemograma<\/strong><\/p>\n\t\t\t

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    Par\u00e2metro (val. ref.)<\/strong><\/td>Dia 0<\/strong><\/td>Dia 2<\/strong><\/td>Dia 7<\/strong><\/td>Dia 9<\/strong><\/td><\/tr>
    Eritrograma<\/strong><\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td><\/tr>
    Eritr\u00f3citos (5,5-8,5 milh\u00f5es\/\u00b5L)<\/td>3,94\u2193<\/mark><\/td>3,54\u2193<\/mark><\/td>1,97\u2193<\/mark><\/td>1,47\u2193<\/mark><\/td><\/tr>
    Hemat\u00f3crito (37-55%)<\/td>27\u2193<\/mark><\/td>25\u2193<\/mark><\/td>15\u2193<\/mark><\/td>12\u2193<\/mark><\/td><\/tr>
    Hemoglobina (12-18 g\/dL)<\/td>9,3\u2193<\/mark><\/td>8,2\u2193<\/mark><\/td>4,9\u2193<\/mark><\/td>3,7\u2193<\/mark><\/td><\/tr>
    VCM (60-77 fL)<\/td>68,5<\/td>70,6\u00a0<\/td>76,1\u00a0<\/td>81,6\u2191<\/mark><\/td><\/tr>
    CHCM (32-36%)<\/td>34,4<\/td>32,8<\/td>32,7<\/td>30,8\u2193<\/mark><\/td><\/tr>
    RDW (14-17%)<\/td>12,7\u2193<\/mark><\/td>12,9\u2193<\/mark><\/td>11,7\u2193<\/mark><\/td>11,1\u2193<\/mark><\/td><\/tr>
    Plaquetas<\/strong><\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td><\/tr>
    Quantidade (200-500 \u00d7103<\/sup>\/\u00b5L)<\/td>542\u2191<\/mark><\/td>400<\/td>195\u2193<\/mark><\/td>195\u2193<\/mark><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
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    Leucograma<\/strong><\/td>Dia 0<\/strong><\/td>Dia 2<\/strong><\/td>Dia 7<\/strong><\/td>Dia 9<\/strong><\/td><\/tr>
    Leuc\u00f3citos totais (6.000-17.000\/\u00b5L)<\/td>28.000\u2191<\/mark><\/td>39.600\u2191<\/mark><\/td>40.800\u2191<\/mark><\/td>28.800\u2191<\/mark><\/td><\/tr>
    Miel\u00f3citos (0\/\u00b5L)<\/td>0\u00a0<\/td>0\u00a0<\/td>0\u00a0<\/td>0\u00a0<\/td><\/tr>
    Metamiel\u00f3citos (0\/\u00b5L)<\/td>0\u00a0<\/td>0\u00a0<\/td>0\u00a0<\/td>0\u00a0<\/td><\/tr>
    Neutr. bast. (<300\/\u00b5L)<\/td>0\u00a0<\/td>396\u2191<\/mark><\/td>0\u00a0<\/td>0\u00a0<\/td><\/tr>
    Neutr. seg. (3.000-11.500\/\u00b5L)<\/td>24.640\u2191<\/mark><\/td>36.432\u2191<\/mark><\/td>36.312\u2191<\/mark><\/td>25.632\u2191<\/mark><\/td><\/tr>
    Bas\u00f3filos (<200\/\u00b5L)<\/td>0\u00a0<\/td>0\u00a0<\/td>0\u00a0<\/td>0\u00a0<\/td><\/tr>
    Eosin\u00f3filos (100-1.250\/\u00b5L)<\/td>280\u00a0<\/td>0\u2193<\/mark><\/td>1.224\u00a0<\/td>1.152\u00a0<\/td><\/tr>
    Mon\u00f3citos (150-1.350\/\u00b5L)<\/td>2.240\u2191<\/mark><\/td>1.584\u2191<\/mark><\/td>2.856\u2191<\/mark><\/td>576\u00a0<\/td><\/tr>
    Linf\u00f3citos (1.000-4.800\/\u00b5L)<\/td>840\u2193<\/mark><\/td>1.188\u00a0<\/td>408\u2193<\/mark><\/td>1.440\u00a0<\/td><\/tr><\/tbody><\/table><\/figure>\n\n<\/div>\n\t\t<\/div>\n\n
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    Bioqu\u00edmica sangu\u00ednea<\/strong><\/p>\n\t\t\t

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    <\/td>Dia 0<\/strong><\/td>Dia 2<\/strong><\/td>Dia 7<\/strong><\/td>Dia 9<\/strong><\/td><\/tr>
    Amostra<\/td>soro<\/td>soro<\/td>soro<\/td>soro<\/td><\/tr>
    Hem\u00f3lise<\/td>ausente<\/td>ausente<\/td>ausente<\/td>ausente<\/td><\/tr>
    AnticoagulanteA<\/sup><\/td>nenhum<\/td>nenhum<\/td>nenhum<\/td>nenhum<\/td><\/tr>
    Prote\u00ednas totaisB<\/sup> (60-80 g\/L)<\/td>96\u2191<\/mark><\/td>82\u2191<\/mark><\/td>76\u00a0<\/td>72\u00a0<\/td><\/tr>
    Prote\u00ednas totaisC<\/sup> (54-71 g\/L)<\/td>n.d.\u00a0<\/td>n.d.\u00a0<\/td>n.d.\u00a0<\/td>n.d.\u00a0<\/td><\/tr>
    Albumina (26-33 g\/L)<\/td>21\u2193<\/mark><\/td>n.d.\u00a0<\/td>n.d.\u00a0<\/td>n.d.\u00a0<\/td><\/tr>
    Globulinas (27-44 g\/L)<\/td>75\u2191<\/mark><\/td>n.d.\u00a0<\/td>n.d.\u00a0<\/td>n.d.\u00a0<\/td><\/tr>
    Ureia (21-60 mg\/dL)<\/td>n.d.\u00a0<\/td>410\u2191<\/mark><\/td>348\u2191<\/mark><\/td>361\u2191<\/mark><\/td><\/tr>
    Creatinina (<1,4 mg\/dL)<\/td>11,5\u2191<\/mark><\/td>11,9\u2191<\/mark><\/td>7,6\u2191<\/mark><\/td>7,4\u2191<\/mark><\/td><\/tr>
    FA (<156 U\/L)<\/td>246\u2191<\/mark><\/td>328\u2191<\/mark><\/td>706\u2191<\/mark><\/td>1.094\u2191<\/mark><\/td><\/tr>
    ALT (<102 U\/L)<\/td>125\u2191<\/mark><\/td>142\u2191<\/mark><\/td>178\u2191<\/mark><\/td>141\u2191<\/mark><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

    B<\/sup>Estimadas por refratometria; C<\/sup>Determinadas por espectrofotometria<\/p>\n\n<\/div>\n\t\t<\/div>\n\n

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    Urin\u00e1lise<\/strong><\/p>\n\t\t\t

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    <\/td>Dia 2<\/strong><\/td><\/tr>
    M\u00e9todo de coletaA<\/sup><\/td>cat<\/td><\/tr>
    Sedimento urin\u00e1rioB<\/sup><\/strong><\/td>\u00a0<\/td><\/tr>
    C\u00e9lulas epiteliais<\/td>escamosas (1), transi\u00e7\u00e3o (1)<\/td><\/tr>
    Cilindros<\/td>n.d.<\/td><\/tr>
    Hem\u00e1cias<\/td>15\u2191<\/mark><\/td><\/tr>
    Leuc\u00f3citos<\/td><5<\/td><\/tr>
    Bacteri\u00faria<\/td>ausente<\/td><\/tr>
    Outros<\/td>n.d.<\/td><\/tr>
    Exame qu\u00edmico<\/strong><\/td>\u00a0<\/td><\/tr>
    pH (5,5-7,0)<\/td>6,0\u00a0<\/td><\/tr>
    Corpos cet\u00f4nicosC<\/sup><\/td>n.d.\u00a0<\/td><\/tr>
    GlicoseD<\/sup><\/td>+\u2191<\/mark><\/td><\/tr>
    BilirrubinaE<\/sup><\/td>n.d.\u00a0<\/td><\/tr>
    Urobilinog\u00eanio (<1 mg\/dL)<\/td>\u22480,2\u00a0<\/td><\/tr>
    Prote\u00ednaF<\/sup><\/td>+++\u2191<\/mark><\/td><\/tr>
    SangueG<\/sup><\/td>+++\u2191<\/mark><\/td><\/tr>
    RPCUH<\/sup><\/td>n.d.<\/td><\/tr>
    Exame f\u00edsico<\/strong><\/td>\u00a0<\/td><\/tr>
    Dens. espec. (1,015-1,045)<\/td>1,012\u2193<\/mark><\/td><\/tr>
    Cor<\/td>amarelo p\u00e1lido<\/td><\/tr>
    Consist\u00eancia<\/td>fluida<\/td><\/tr>
    Aspecto<\/td>discretamente turvo<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

    A<\/sup>mic, mic\u00e7\u00e3o natural \u25cf cat, cateteriza\u00e7\u00e3o \u25cf cist, cistocentese \u25cf out, outros (especificar em \u201cObserva\u00e7\u00f5es\u201d)
    B<\/sup>N\u00famero m\u00e9dio de elementos por campo de 400 x
    C<\/sup>tra\u00e7os, \u22485 mg\/dL \u25cf +, \u224815 mg\/dL \u25cf ++, \u224840 mg\/dL \u25cf +++, \u224880 md\/dL \u25cf ++++, \u2265160 mg\/dL
    D<\/sup>tra\u00e7os, \u2248100 mg\/dL \u25cf +, \u2248250 mg\/dL \u25cf ++, \u2248500 mg\/dL \u25cf +++, \u22481000 mg\/dL \u25cf ++++, \u22652000 mg\/dL
    E<\/sup>+, leve \u25cf ++, moderada \u25cf +++, alta
    F<\/sup>+, \u224830 mg\/dL \u25cf ++, \u2248100 mg\/dL \u25cf +++, \u2248300 mg\/dL \u25cf ++++, \u22652000 mg\/dL
    G<\/sup>nh, n\u00e3o hemolisado \u25cf h, hemolisado \u25cf +, leve \u25cf ++, moderada \u25cf +++, alto
    H<\/sup>RPCU, rela\u00e7\u00e3o prote\u00edna\/creatinina urin\u00e1ria (na aus\u00eancia de sedimento ativo)
    – Caninos: <0,2, n\u00e3o protein\u00farico \u25cf 0,2 a 0,5, protein\u00faria lim\u00edtrofe \u25cf >0,5, protein\u00farico
    – Felinos: <0,2, n\u00e3o protein\u00farico \u25cf 0,2 a 0,4, protein\u00faria lim\u00edtrofe \u25cf >0,4, protein\u00farico
    – Equinos: <0,93, n\u00e3o protein\u00farico
    n.d.: n\u00e3o determinado<\/p>\n\n<\/div>\n\t\t<\/div>\n\n

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    Necropsia e histopatologia<\/strong><\/p>\n\t\t\t

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    Necropsia<\/strong><\/p>\n\n\n\n