{"id":6329,"date":"2023-07-05T14:51:36","date_gmt":"2023-07-05T17:51:36","guid":{"rendered":"https:\/\/www.ufrgs.br\/lacvet\/?p=6329"},"modified":"2024-02-15T15:05:23","modified_gmt":"2024-02-15T18:05:23","slug":"caso-clinico-176y5","status":"publish","type":"post","link":"https:\/\/www.ufrgs.br\/lacvet\/cc_interativos\/caso-clinico-176y5\/","title":{"rendered":"Caso Cl\u00ednico 176Y5"},"content":{"rendered":"
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Identifica\u00e7\u00e3o<\/strong><\/p>\n\t\t\t

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Esp\u00e9cie: Canina
Ra\u00e7a: Basset Hound
Idade: 5 anos
Sexo: macho
Peso: 39,8 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 foi relatado hist\u00f3rico de quatro meses de dificuldade para defecar, polidipsia e poli\u00faria, al\u00e9m de abd\u00f4men distendido. J\u00e1 havia realizado duas ecografias, onde foi poss\u00edvel observar o aumento da gl\u00e2ndula adrenal. Recebeu tratamento pr\u00e9vio com amoxicilina+\u00e1cido clavul\u00e2nico (antibi\u00f3tico e bactericida) e suplemento vitam\u00ednico.<\/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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Dia 15<\/p>\n\n\n\n

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  • Temperatura retal: 40,2 \u00b0C\u2191<\/mark> (ref.: 37,9\u201339,9).<\/li>\n\n\n\n
  • Mucosas: hiper\u00eamicas (r\u00f3seo-avermelhadas).<\/li>\n\n\n\n
  • Respira\u00e7\u00e3o ofegante.<\/li>\n<\/ul>\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 13 – Teste de supress\u00e3o com baixa dose de dexametasona (0,01 mg\/kg ):<\/p>\n\n\n\n

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    • Cortisol plasm\u00e1tico basal: 33 \u03bcg\/dL\u2191<\/mark> (ref.: 0,5-6,0).<\/li>\n\n\n\n
    • Cortisol ap\u00f3s administra\u00e7\u00e3o de dexametasona:\n
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      • Ap\u00f3s 4 h de supress\u00e3o – n\u00e3o foi observada presen\u00e7a de cortisol na amostra (<1,4 \u00b5g\/dL).<\/li>\n\n\n\n
      • Ap\u00f3s 8 h – 10,6 \u00b5g\/dL\u2191<\/mark> (ref.: <1,4).<\/li>\n<\/ul>\n<\/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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        Dia 12: tratado com suplemento vitam\u00ednico e \u00e1cido ursodesoxic\u00f3lico (colagogo). O tutor relatou falta de apetite e poli\u00faria.<\/p>\n\n\n\n

        Dia 15: poli\u00faria, diarreia e seguia sem se alimentar, apesar de estar ingerindo \u00e1gua. Animal foi internado para administra\u00e7\u00e3o dos medicamentos e alimenta\u00e7\u00e3o facilitada. Durante o per\u00edodo de interna\u00e7\u00e3o, foram administrados suplemento vitam\u00ednico e \u00e1cido ursodesoxic\u00f3lico.<\/p>\n\n\n\n

        Dia 16: \u00f3bito.<\/p>\n\n<\/div>\n\t\t<\/div>\n\n

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

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        Eritrograma<\/strong><\/strong><\/td>Dia <\/strong>13<\/strong><\/td><\/tr>
        Eritr\u00f3citos (5,5-8,5 milh\u00f5es\/\u00b5L)<\/td>6,16\u00a0<\/td><\/tr>
        Hemat\u00f3crito (37-55%)<\/td>43\u00a0<\/td><\/tr>
        Hemoglobina (12-18 g\/dL)<\/td>15\u00a0<\/td><\/tr>
        VCM (60-77 fL)<\/td>69,8\u00a0<\/td><\/tr>
        CHCM (32-36%)<\/td>34,9\u00a0<\/td><\/tr>
        Plaquetas<\/strong><\/td>\u00a0<\/td><\/tr>
        Quantidade (200-500 \u00d7103<\/sup>\/\u00b5L)<\/td>391<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
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        Leucograma<\/strong><\/td>Dia 13<\/strong><\/td><\/tr>
        Leuc\u00f3citos totais (6.000-17.000\/\u00b5L)<\/td>21.200\u2191<\/mark><\/td><\/tr>
        Miel\u00f3citos (0\/\u00b5L)<\/td>0\u00a0<\/td><\/tr>
        Metamiel\u00f3citos (0\/\u00b5L)<\/td>0\u00a0<\/td><\/tr>
        Neutr. bast. (<300\/\u00b5L)<\/td>636\u2191<\/mark><\/td><\/tr>
        Neutr. seg. (3.000-11.500\/\u00b5L)<\/td>18.868\u2191<\/mark><\/td><\/tr>
        Bas\u00f3filos (<200\/\u00b5L)<\/td>0\u00a0<\/td><\/tr>
        Eosin\u00f3filos (100-1.250\/\u00b5L)<\/td>0\u2193<\/mark><\/td><\/tr>
        Mon\u00f3citos (150-1.350\/\u00b5L)<\/td>424\u00a0<\/td><\/tr>
        Linf\u00f3citos (1.000-4.800\/\u00b5L)<\/td>1.272\u00a0<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

        Observa\u00e7\u00f5es: n.d.: n\u00e3o determinado.<\/p>\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 13<\/strong><\/td><\/tr>
        Amostra<\/td>soro<\/td><\/tr>
        Hem\u00f3lise<\/td>ausente<\/td><\/tr>
        AnticoagulanteA<\/sup><\/td>nenhum<\/td><\/tr>
        Prote\u00ednas totaisB<\/sup> (60-80 g\/L)<\/td>n.d.\u00a0<\/td><\/tr>
        Prote\u00ednas totaisC<\/sup> (54-71 g\/L)<\/td>88\u2191<\/mark><\/td><\/tr>
        Albumina (26-33 g\/L)<\/td>40\u2191<\/mark><\/td><\/tr>
        Globulinas (27-44 g\/L)<\/td>48\u2191<\/mark><\/td><\/tr>
        Glicose (65-118 mg\/dL)<\/td>118\u00a0<\/td><\/tr>
        Colesterol total (135-270 mg\/dL)<\/td>948\u2191<\/mark><\/td><\/tr>
        Ureia (21-60 mg\/dL)<\/td>25\u00a0<\/td><\/tr>
        Creatinina (<1,4 mg\/dL)<\/td>0,5\u00a0<\/td><\/tr>
        C\u00e1lcio (9,0-11,3 mg\/dL)<\/td>10,34\u00a0<\/td><\/tr>
        Frutosamina (170-338 \u00b5mol\/L)<\/td>305\u00a0<\/td><\/tr>
        Triglicer\u00eddeos (32-138 mg\/dL)<\/td>127\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 13<\/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 (3), transi\u00e7\u00e3o (8)\u2191<\/mark>, caudatas (2)<\/td><\/tr>
        Cilindros<\/td>hialinos (2)\u2191<\/mark><\/td><\/tr>
        Hem\u00e1cias<\/td>60<\/td><\/tr>
        Leuc\u00f3citos<\/td><5<\/td><\/tr>
        Bacteri\u00faria<\/td>moderada\u2191<\/mark><\/td><\/tr>
        Outros<\/td>cristais de bilirrubina (1+); got\u00edculas de gordura)\u2191<\/mark><\/td><\/tr>
        Exame qu\u00edmico<\/strong><\/td>\u00a0<\/td><\/tr>
        pH (5,5-7,0)<\/td>6,5\u00a0<\/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>+++\u2191<\/mark><\/td><\/tr>
        RPCUH<\/sup><\/td>0,64\u2191<\/mark><\/td><\/tr>
        Exame f\u00edsico<\/strong><\/td>\u00a0<\/td><\/tr>
        Dens. espec. (1,015-1,045)<\/td>1,018\u00a0<\/td><\/tr>
        Cor<\/td>amarela<\/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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        Necropsia e histopatologia<\/strong><\/p>\n\t\t\t

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        Histopatologia<\/strong><\/p>\n\n\n\n