{"id":6362,"date":"2023-07-06T13:53:51","date_gmt":"2023-07-06T16:53:51","guid":{"rendered":"https:\/\/www.ufrgs.br\/lacvet\/?p=6362"},"modified":"2025-08-05T08:48:04","modified_gmt":"2025-08-05T11:48:04","slug":"caso-clinico-177pp","status":"publish","type":"post","link":"https:\/\/www.ufrgs.br\/lacvet\/cc_interativos\/caso-clinico-177pp\/","title":{"rendered":"Caso Cl\u00ednico 177PP"},"content":{"rendered":"
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Identifica\u00e7\u00e3o<\/strong><\/p>\n\t\t\t

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Esp\u00e9cie: Canina
Ra\u00e7a: SRD
Idade: 11 anos
Sexo: f\u00eamea
Peso: 11,3 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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Em atendimento anterior ao Dia 0 foram achados n\u00f3dulos de mama e um aumento em regi\u00e3o da esc\u00e1pula direita com l\u00edquido dentro que regride e volta esporadicamente. O exame citol\u00f3gico dos n\u00f3dulos da mama foi sugestivo de adenoma mam\u00e1rio. Em eletrocardiograma e ecodopplercardiografia foi evidenciada uma insufici\u00eancia mitral discreta devido, provavelmente, \u00e0 idade. Radiografia de t\u00f3rax apresentou evid\u00eancias de met\u00e1stase pulmonar. No dia anterior ao dia 0 foi realizada interven\u00e7\u00e3o cir\u00fargica para a retirada da cadeia mam\u00e1ria direita. O processo cir\u00fargico ocorreu sem intercorr\u00eancias e a paciente recebeu alta para a recupera\u00e7\u00e3o em casa. O laudo do histopatol\u00f3gico foi de carcinoma s\u00f3lido mam\u00e1rio p\u00f3s-mastectomia unilateral direita.<\/p>\n\n\n\n

No dia 0 a paciente foi atendida com queixa de an\u00faria, anorexia, adipsia, v\u00f4mitos, apatia, ronquid\u00e3o ao respirar e espasmos musculares durante a noite.<\/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 7\u2191<\/mark> (escala de 1 a 9, valor ideal 5).<\/li>\n\n\n\n
  • Estado mental alerta.<\/li>\n\n\n\n
  • Normo-hidratada.<\/li>\n\n\n\n
  • Mucosas normocoradas.<\/li>\n\n\n\n
  • Temperatura retal: 37,3 \u00b0C\u2193<\/mark> (ref.: 37,5\u2013 39,2).<\/li>\n\n\n\n
  • Tempo de preenchimento capilar: \u02c22 s (ref.: 1-2).<\/li>\n\n\n\n
  • Frequ\u00eancia card\u00edaca: 120 bpm (ref.: 60\u2013160).<\/li>\n\n\n\n
  • Frequ\u00eancia respirat\u00f3ria: 35 mpm\u2191<\/mark> (val. ref.: 16\u201330).<\/li>\n\n\n\n
  • Pulso fraco.<\/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 120-Ultrassonografia abdominal total: rela\u00e7\u00e3o cortical\/medular renal levemente aumentada com par\u00eanquima medular com aumento difuso de ecogenicidade. Apresentou nefrocalcinose moderada em bordos da pelve renal, com forma\u00e7\u00e3o de sombra ac\u00fastica importante.<\/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 ao 10: per\u00edodo de interna\u00e7\u00e3o, durante o qual recebeu fluidoterapia com Ringer-lactato (reposi\u00e7\u00e3o eletrol\u00edtica e hidrata\u00e7\u00e3o). Ao decorrer da interna\u00e7\u00e3o teve epis\u00f3dios de hipertens\u00e3o e v\u00f4mitos. Teve alta hospitalar no Dia 10.<\/p>\n\n\n\n

    Dia 15: consulta de revis\u00e3o, apresentando hiporexia, polidipsia e poli\u00faria. Foram prescritos: hidr\u00f3xido de alum\u00ednio (quelante de f\u00f3sforo), cloridrato de ondansetrona (antiem\u00e9tico), cloridrato de benazepril e besilato de amlodipina (anti-hipertensivos), \u00f4mega 3 (redu\u00e7\u00e3o de perda proteica) e fluidoterapia duas vezes por semana.<\/p>\n\n\n\n

    Dia 37: em nova revis\u00e3o, a paciente mostrava normofagia, normodipsia, normo\u00faria, normoquesia, com aus\u00eancia de \u00eamese e regurgita\u00e7\u00e3o, apresentando bom estado geral.<\/p>\n\n\n\n

    Dia 44:\u00a01\u00aa sess\u00e3o de quimioterapia com carboplatina (quiomioter\u00e1pico). A quimioterapia foi realizada mensalmente a partir dessa data.<\/p>\n\n\n\n

    Dia 121: 3\u00aa sess\u00e3o de quimioterapia, encerramento do tratamento com fluidoterapia.<\/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 29<\/strong><\/td>Dia 121<\/strong><\/td><\/tr>
    pH (7,351-7,443)<\/td>7,31\u2193<\/mark><\/td>7,45\u2191<\/mark><\/td><\/tr>
    pCO2<\/sub> (33,6-41,2 mmHg)<\/td>31,6\u2193<\/mark><\/td>33,6<\/td><\/tr>
    pO2<\/sub> (47,9-56,3 mmHg)<\/td>54,0<\/td>22\u2193<\/mark><\/td><\/tr>
    BE (-3 a 2 mmol\/L)<\/td>-10\u2193<\/mark><\/td>-1<\/td><\/tr>
    HCO3<\/sub> (21 a 25 mmol\/L)<\/td>15,9\u2193<\/mark><\/td>23,3<\/td><\/tr>
    tCO2<\/sub> (mmol\/L)<\/td>n.d.<\/td>n.d.<\/td><\/tr>
    sO2<\/sub> (%)<\/td>85<\/td>44<\/td><\/tr>
    Na (140-155 mmol\/L)<\/td>147<\/td>148<\/td><\/tr>
    K (3,5-5,7 mmol\/L)<\/td>2,6\u2193<\/mark><\/td>4,4<\/td><\/tr>
    iCa (1,3-1,5 mmol\/L)<\/td>1,32<\/td>1,32<\/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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    Eritrograma<\/strong><\/strong><\/td>Dia 7<\/strong><\/td>Dia 14<\/strong><\/td>Dia 55<\/strong><\/td>Dia 93<\/strong><\/td>Dia 121<\/strong><\/td><\/tr>
    Eritr\u00f3citos (5,5-8,5 milh\u00f5es\/\u00b5L)<\/td>4,51\u2193<\/mark><\/td>5,70<\/td>6,32\u00a0<\/td>6,81\u00a0<\/td>6,43\u00a0<\/td><\/tr>
    Hemat\u00f3crito (37-55%)<\/td>32\u2193<\/mark><\/td>40\u00a0<\/td>45\u00a0<\/td>49\u00a0<\/td>45\u00a0<\/td><\/tr>
    Hemoglobina (12-18 g\/dL)<\/td>12<\/td>14<\/td>16<\/td>17<\/td>16\u00a0<\/td><\/tr>
    VCM (60-77 fL)<\/td>71<\/td>70<\/td>71<\/td>72\u00a0<\/td>70\u00a0<\/td><\/tr>
    CHCM (32-36%)<\/td>37\u2191<\/mark><\/td>35\u00a0<\/td>36\u00a0<\/td>35\u00a0<\/td>36\u00a0<\/td><\/tr>
    Plaquetas<\/strong><\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td><\/tr>
    Quantidade (200-500 \u00d7103<\/sup>\/\u00b5L)<\/td>360<\/td>424<\/td>180\u2193<\/mark><\/td>n.d.\u00a0<\/td>60\u2193<\/mark><\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
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    Leucograma<\/strong><\/td>Dia 7<\/strong><\/td>Dia 14<\/strong><\/td>Dia 55<\/strong><\/td>Dia 93<\/strong><\/td>Dia 121<\/strong><\/td><\/tr>
    Leuc\u00f3citos totais (6.000-17.000\/\u00b5L)<\/td>15.600\u00a0<\/td>13.400\u00a0<\/td>7.900\u00a0<\/td>3.900\u2193<\/mark><\/td>4.000\u2193<\/mark><\/td><\/tr>
    Miel\u00f3citos (0\/\u00b5L)<\/td>0\u00a0<\/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>0\u00a0<\/td><\/tr>
    Neutr. bast. (<300\/\u00b5L)<\/td>0\u00a0<\/td>0\u00a0<\/td>0\u00a0<\/td>0\u00a0<\/td>0\u00a0<\/td><\/tr>
    Neutr. seg. (3.000-11.500\/\u00b5L)<\/td>11.700\u2191<\/mark><\/td>9.380\u00a0<\/td>5.451\u00a0<\/td>1.989\u2193<\/mark><\/td>1.880\u2193<\/mark><\/td><\/tr>
    Bas\u00f3filos (<200\/\u00b5L)<\/td>0\u00a0<\/td>0\u00a0<\/td>0\u00a0<\/td>0\u00a0<\/td>0\u00a0<\/td><\/tr>
    Eosin\u00f3filos (100-1.250\/\u00b5L)<\/td>312\u00a0<\/td>536\u00a0<\/td>711\u00a0<\/td>234\u00a0<\/td>520\u00a0<\/td><\/tr>
    Mon\u00f3citos (150-1.350\/\u00b5L)<\/td>468\u00a0<\/td>1.206\u00a0<\/td>79\u2193<\/mark><\/td>351\u00a0<\/td>0\u2193<\/mark><\/td><\/tr>
    Linf\u00f3citos (1.000-4.800\/\u00b5L)<\/td>3.120\u00a0<\/td>2.278\u00a0<\/td>1.659\u00a0<\/td>1.326\u00a0<\/td>1.600\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 0<\/strong><\/td>Dia 2<\/strong><\/td>Dia 14<\/strong><\/td>Dia 29<\/strong><\/td>Dia 121<\/strong><\/td><\/tr>
    Amostra<\/td>soro<\/td>soro<\/td>soro<\/td>soro<\/td>soro<\/td><\/tr>
    Hem\u00f3lise<\/td>ausente<\/td>ausente<\/td>ausente<\/td>ausente<\/td>ausente<\/td><\/tr>
    AnticoagulanteA<\/sup><\/td>nenhum<\/td>nenhum<\/td>nenhum<\/td>nenhum<\/td>nenhum<\/td><\/tr>
    Ureia (21-60 mg\/dL)<\/td>187\u2191<\/mark><\/td>302\u2191<\/mark><\/td>334\u2191<\/mark><\/td>297\u2191<\/mark><\/td>76\u2191<\/mark><\/td><\/tr>
    Creatinina (<1,4 mg\/dL)<\/td>5,40\u2191<\/mark><\/td>9,93\u2191<\/mark><\/td>6,95\u2191<\/mark><\/td>2,29\u2191<\/mark><\/td>1,02\u00a0<\/td><\/tr>
    F\u00f3sforo (2,6-6,2 mg\/dL)<\/td>n.d.\u00a0<\/td>n.d.\u00a0<\/td>12,0\u2191<\/mark><\/td>7,2\u2191<\/mark><\/td>6,0<\/td><\/tr>
    ALT (<102 U\/L)<\/td>n.d.\u00a0<\/td>n.d.\u00a0<\/td>95\u00a0<\/td>n.d.\u00a0<\/td>n.d.\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 2<\/strong><\/td>Dia 15<\/strong><\/td>Dia 29<\/strong><\/td>Dia 121<\/strong><\/td><\/tr>
    M\u00e9todo de coletaA<\/sup><\/td>mic<\/td>mic<\/td>mic<\/td>cist<\/td><\/tr>
    Sedimento urin\u00e1rioB<\/sup><\/strong><\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td><\/tr>
    C\u00e9lulas epiteliais<\/td>escamosas (1); transi\u00e7\u00e3o (1)<\/td>escamosas (2); transi\u00e7\u00e3o (3)<\/td>escamosas (1)<\/td>escamosas (1)<\/td><\/tr>
    Cilindros<\/td>granulosos (2)\u2191<\/mark><\/td>ausentes<\/td>ausentes<\/td>ausentes<\/td><\/tr>
    Hem\u00e1cias<\/td>20\u2191<\/mark><\/td>ausentes<\/td>ausentes<\/td>20\u2191<\/mark><\/td><\/tr>
    Leuc\u00f3citos<\/td><5<\/td><5<\/td>ausentes<\/td><5<\/td><\/tr>
    Bacteri\u00faria<\/td>leve\u2191<\/mark><\/td>leve\u2191<\/mark><\/td>leve\u2191<\/mark><\/td>moderada\u2191<\/mark><\/td><\/tr>
    Exame qu\u00edmico<\/strong><\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td><\/tr>
    pH (5,5-7,0)<\/td>7,0\u00a0<\/td>5,0\u2193<\/mark><\/td>6,0\u00a0<\/td>7,0\u00a0<\/td><\/tr>
    Corpos cet\u00f4nicosC<\/sup><\/td>ausente\u00a0<\/td>ausente\u00a0<\/td>ausente\u00a0<\/td>ausente\u00a0<\/td><\/tr>
    GlicoseD<\/sup><\/td>ausente\u00a0<\/td>ausente\u00a0<\/td>ausente\u00a0<\/td>ausente\u00a0<\/td><\/tr>
    BilirrubinaE<\/sup><\/td>ausente\u00a0<\/td>ausente\u00a0<\/td>ausente\u00a0<\/td>ausente\u00a0<\/td><\/tr>
    Urobilinog\u00eanio (<1 mg\/dL)<\/td>\u22480,2\u00a0<\/td>\u22480,2\u00a0<\/td>\u22480,2\u00a0<\/td>\u22480,2\u00a0<\/td><\/tr>
    Prote\u00ednaF<\/sup><\/td>ausente\u00a0<\/td>ausente\u00a0<\/td>ausente\u00a0<\/td>+\u2191<\/mark><\/td><\/tr>
    SangueG<\/sup><\/td>+\u2191<\/mark><\/td>ausente\u00a0<\/td>ausente\u00a0<\/td>++\u2191<\/mark><\/td><\/tr>
    RPCUH<\/sup><\/td>n.d.<\/td>n.d.<\/td>n.d.<\/td>0,22<\/td><\/tr>
    Exame f\u00edsico<\/strong><\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td><\/tr>
    Dens. espec. (1,015-1,045)<\/td>1,010\u2193<\/mark><\/td>1,016\u00a0<\/td>1,014\u2193<\/mark><\/td>1,026\u00a0<\/td><\/tr>
    Cor<\/td>amarelo claro<\/td>amarelo claro<\/td>amarelo claro<\/td>amarelo claro<\/td><\/tr>
    Consist\u00eancia<\/td>fluida<\/td>fluida<\/td>fluida<\/td>fluida<\/td><\/tr>
    Aspecto<\/td>l\u00edmpido<\/td>l\u00edmpido<\/td>l\u00edmpido<\/td>l\u00edmpido<\/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