{"id":6315,"date":"2023-07-05T14:12:23","date_gmt":"2023-07-05T17:12:23","guid":{"rendered":"https:\/\/www.ufrgs.br\/lacvet\/?p=6315"},"modified":"2025-08-05T08:52:38","modified_gmt":"2025-08-05T11:52:38","slug":"caso-clinico-1763k","status":"publish","type":"post","link":"https:\/\/www.ufrgs.br\/lacvet\/cc_interativos\/caso-clinico-1763k\/","title":{"rendered":"Caso Cl\u00ednico 1763K"},"content":{"rendered":"
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Identifica\u00e7\u00e3o<\/strong><\/p>\n\t\t\t

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Esp\u00e9cie: Equina
Ra\u00e7a: Crioula
Idade: 15 anos
Sexo: macho
Peso: 320 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 o animal vinha apresentando h\u00e1 uma semana incapacidade de se mover, membros posteriores e olhos inchados, marcas de coice na cocheira, al\u00e9m de urina escura. O propriet\u00e1rio administrou por conta pr\u00f3pria flunixina (anti-inflamat\u00f3rio n\u00e3o esteroidal) e hexametilenotetramina (diur\u00e9tico e antiss\u00e9ptico) logo no in\u00edcio do aparecimento dos sinais cl\u00ednicos, mas n\u00e3o obteve resposta ao tratamento. O paciente tinha como hist\u00f3rico envolvimento h\u00e1 20 dias em brigas com outros cavalos, causando les\u00e3o nos membros posteriores. O propriet\u00e1rio conta que como tratamento, na ocasi\u00e3o, administrou dipirona s\u00f3dica (anti-inflamat\u00f3rio n\u00e3o esteroidal, analg\u00e9sico e antipir\u00e9tico), que resultou em melhora nos sinais cl\u00ednicos. Ap\u00f3s o epis\u00f3dio, o animal n\u00e3o foi mais utilizado para nenhuma atividade.<\/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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  • Frequ\u00eancia card\u00edaca: 68 bpm\u2191<\/mark> (ref.: 30-40).<\/li>\n\n\n\n
  • Temperatura retal: 39 \u00baC\u2191<\/mark> (ref.: 37,5-38,5).<\/li>\n\n\n\n
  • Mucosa ocular: hiper\u00eamica.<\/li>\n\n\n\n
  • Mucosa oral: normocorada.<\/li>\n\n\n\n
  • Cascos mornos.<\/li>\n\n\n\n
  • Pulso digital positivo em todos os membros.<\/li>\n\n\n\n
  • Turgor: 2 s (ref.: \u2264 2).<\/li>\n\n\n\n
  • Tempo de preenchimento capilar: 2 s (ref.: \u2264 2).<\/li>\n<\/ul>\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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    Durante todo o per\u00edodo de interna\u00e7\u00e3o (dia 0 ao 40) foram administrados os seguintes f\u00e1rmacos ao paciente e realizados os seguintes procedimentos:<\/p>\n\n\n\n

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    • Polivitam\u00ednico (B1, B2, B6, B12, nicotinamida, inositol) dilu\u00eddo em Ringer lactato (reequil\u00edbrio eletrol\u00edtico e hidrata\u00e7\u00e3o);<\/li>\n\n\n\n
    • Fenilbutazona (anti-inflamat\u00f3rio n\u00e3o esteroidal com principal a\u00e7\u00e3o musculoesquel\u00e9tica);<\/li>\n\n\n\n
    • Dipirona s\u00f3dica (analg\u00e9sico e antipir\u00e9tico);<\/li>\n\n\n\n
    • Omeprazol (previne \u00falceras g\u00e1stricas);<\/li>\n\n\n\n
    • Crioterapia (aplica\u00e7\u00e3o de gelo nos cascos).<\/li>\n<\/ul>\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 34<\/strong><\/td><\/tr>
      Eritrograma<\/strong><\/td>\u00a0<\/td>\u00a0<\/td><\/tr>
      Eritr\u00f3citos (6,8-12,9 milh\u00f5es\/\u00b5L)<\/td>6,88<\/td>6,22\u2193<\/mark><\/td><\/tr>
      Hemat\u00f3crito (32-53%)<\/td>39\u00a0<\/td>41\u00a0<\/td><\/tr>
      Hemoglobina (11-19 g\/dL)<\/td>11,8\u00a0<\/td>13,2\u00a0<\/td><\/tr>
      VCM (37-58,5 fL)<\/td>57\u00a0<\/td>66\u2191<\/mark><\/td><\/tr>
      CHCM (31-37%)<\/td>30\u2193<\/mark><\/td>32\u00a0<\/td><\/tr>
      Plaquetas<\/strong><\/td>\u00a0<\/td>\u00a0<\/td><\/tr>
      Quantidade (100-350 \u00d7103<\/sup>\/\u00b5L)<\/td>120\u00a0<\/td>100\u00a0<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
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      Leucograma<\/strong><\/td>Dia 0<\/strong><\/td>Dia 34<\/strong><\/td><\/tr>
      Leuc\u00f3citos totais (5.400-14.300\/\u00b5L)<\/td>10.000\u00a0<\/td>4.700\u2193<\/mark><\/td><\/tr>
      Miel\u00f3citos (0\/\u00b5L)<\/td>0\u00a0<\/td>0\u00a0<\/td><\/tr>
      Metamiel\u00f3citos (0\/\u00b5L)<\/td>0\u00a0<\/td>0\u00a0<\/td><\/tr>
      Neutr. bast. (<70\/\u00b5L)<\/td>0\u00a0<\/td>0\u00a0<\/td><\/tr>
      Neutr. seg. (2.260-8.580\/\u00b5L)<\/td>8.500<\/td>2.021\u2193<\/mark><\/td><\/tr>
      Bas\u00f3filos (<290\/\u00b5L)<\/td>100<\/td>0\u00a0<\/td><\/tr>
      Eosin\u00f3filos (<1.000\/\u00b5L)<\/td>200\u00a0<\/td>0\u00a0<\/td><\/tr>
      Mon\u00f3citos (<1.000\/\u00b5L)<\/td>100\u00a0<\/td>235\u00a0<\/td><\/tr>
      Linf\u00f3citos (1.500-7.700\/\u00b5L)<\/td>1.100\u2193<\/mark><\/td>2.444\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 34<\/strong><\/td>Dia 40<\/strong><\/td><\/tr>
      Amostra<\/td>soro<\/td>soro<\/td>soro<\/td><\/tr>
      Hem\u00f3lise<\/td>ausente<\/td>ausente<\/td>ausente<\/td><\/tr>
      AnticoagulanteA<\/sup><\/td>nenhum<\/td>nenhum<\/td>nenhum<\/td><\/tr>
      Prote\u00ednas totaisB<\/sup> (60-80 g\/L)<\/td>64\u00a0<\/td>71\u00a0<\/td>n.d.\u00a0<\/td><\/tr>
      Prote\u00ednas totaisC<\/sup> (52-79 g\/L)<\/td>n.d.\u00a0<\/td>n.d.\u00a0<\/td>n.d.\u00a0<\/td><\/tr>
      Ureia (21-51 mg\/dL)<\/td>36\u00a0<\/td>76\u2191<\/mark><\/td>54\u00a0<\/td><\/tr>
      Creatinina (1,2-1,9 mg\/dL)<\/td>2,67\u2191<\/mark><\/td>2,68\u2191<\/mark><\/td>2,13\u2191<\/mark><\/td><\/tr>
      AST (<366 U\/L)<\/td>4.299\u2191<\/mark><\/td>n.d.\u00a0<\/td>225\u00a0<\/td><\/tr>
      Fibrinog\u00eanio (1-4 g\/L)<\/td>6\u2191<\/mark><\/td>2\u00a0<\/td>n.d.\u00a0<\/td><\/tr>
      CK (<540 U\/L)<\/td>3.691\u2191<\/mark><\/td>n.d.\u00a0<\/td>273\u00a0<\/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 0<\/strong><\/td><\/tr>
      M\u00e9todo de coletaA<\/sup><\/td>mic<\/td><\/tr>
      Sedimento urin\u00e1rioB<\/sup><\/strong><\/td>\u00a0<\/td><\/tr>
      C\u00e9lulas epiteliais<\/td>ausentes<\/td><\/tr>
      Cilindros<\/td>ausentes<\/td><\/tr>
      Hem\u00e1cias<\/td><5<\/td><\/tr>
      Leuc\u00f3citos<\/td><5<\/td><\/tr>
      Bacteri\u00faria<\/td>moderada\u2191<\/mark><\/td><\/tr>
      Outros<\/td>Muco: ++<\/td><\/tr>
      Exame qu\u00edmico<\/strong><\/td>\u00a0<\/td><\/tr>
      pH (7,0-8,0)<\/td>6,5\u2193<\/mark><\/td><\/tr>
      Corpos cet\u00f4nicosC<\/sup><\/td>ausente\u00a0<\/td><\/tr>
      GlicoseD<\/sup><\/td>ausente\u00a0<\/td><\/tr>
      BilirrubinaE<\/sup><\/td>++\u2191<\/mark><\/td><\/tr>
      Urobilinog\u00eanio (<1 mg\/dL)<\/td>\u22480,2\u00a0<\/td><\/tr>
      Prote\u00ednaF<\/sup><\/td>++\u2191<\/mark><\/td><\/tr>
      SangueG<\/sup><\/td>ausente\u00a0<\/td><\/tr>
      RPCUH<\/sup><\/td>n.d.<\/td><\/tr>
      Exame f\u00edsico<\/strong><\/td>\u00a0<\/td><\/tr>
      Dens. espec. (1,020-1,050)<\/td>1,048\u00a0<\/td><\/tr>
      Cor<\/td>amarela escura<\/td><\/tr>
      Consist\u00eancia<\/td>fluida<\/td><\/tr>
      Aspecto<\/td>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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      Discuss\u00e3o e refer\u00eancias bibliogr\u00e1ficas<\/strong><\/p>\n\t\t\t

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      Devem ser discutidos os achados laboratoriais alterados (referentes a urin\u00e1lise, bioqu\u00edmica sangu\u00ednea e hemograma), estabelecendo as correla\u00e7\u00f5es relevantes com o quadro cl\u00ednico do paciente. N\u00e3o deve ser discutido o tratamento realizado. As altera\u00e7\u00f5es nos achados laboratoriais devem ser justificadas com base nas informa\u00e7\u00f5es contidas na literatura especializada. \u00c9 sugerido organizar a discuss\u00e3o nos seguintes grandes t\u00f3picos:<\/p>\n\n\n\n