{"id":6381,"date":"2023-07-06T14:52:09","date_gmt":"2023-07-06T17:52:09","guid":{"rendered":"https:\/\/www.ufrgs.br\/lacvet\/?p=6381"},"modified":"2025-08-05T10:48:53","modified_gmt":"2025-08-05T13:48:53","slug":"caso-clinico-178hp","status":"publish","type":"post","link":"https:\/\/www.ufrgs.br\/lacvet\/cc_interativos\/caso-clinico-178hp\/","title":{"rendered":"Caso Cl\u00ednico 178HP"},"content":{"rendered":"
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Identifica\u00e7\u00e3o<\/strong><\/p>\n\t\t\t

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Esp\u00e9cie: Felina
Ra\u00e7a: SRD
Idade: 8 anos
Sexo: f\u00eamea
Peso: 2,5 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 havia queixa de inapet\u00eancia e prostra\u00e7\u00e3o h\u00e1 quatro dias. Tamb\u00e9m, foi relatada adipsia e constipa\u00e7\u00e3o. O animal j\u00e1 havia sido internado pelas mesmas raz\u00f5es em outra cl\u00ednica, h\u00e1 tr\u00eas semanas, durante cinco dias. Na ocasi\u00e3o, o animal testou positivo para FeLV. O felino \u00e9 adotado, vacinado, vermifugado regularmente, tem contato com outros animais e acesso \u00e0 rua. Foi recomendada a interna\u00e7\u00e3o da paciente.<\/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: 3\u2193<\/mark><\/mark> (escala de 1 a 9, valor ideal 5).<\/li>\n\n\n\n
  • Estado mental alerta.<\/li>\n\n\n\n
  • Agressiva e estressada.<\/li>\n\n\n\n
  • Desidrata\u00e7\u00e3o: 5%\u2191<\/mark> (leve).<\/li>\n\n\n\n
  • Tempo de preenchimento capilar: <2 s (ref.: 1-2).<\/li>\n\n\n\n
  • Frequ\u00eancia card\u00edaca: 210 bpm\u2191<\/mark> (ref.: 120\u2013140).<\/li>\n\n\n\n
  • Frequ\u00eancia respirat\u00f3ria: 28 mpm (ref.: 20\u201340).<\/li>\n\n\n\n
  • Linfonodos aumentados.<\/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 1-Ultrassonografia abdominal<\/p>\n\n\n\n

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    • Ba\u00e7o com dimens\u00f5es aumentadas, contorno regular, par\u00eanquima homog\u00eaneo e hipoecog\u00eanico com parede de vasos evidentes, compat\u00edvel com doen\u00e7a infiltrativa neopl\u00e1sica ou doen\u00e7a infecciosa.<\/li>\n\n\n\n
    • F\u00edgado com dimens\u00f5es levemente aumentadas, contornos regulares, par\u00eanquima homog\u00eaneo e hipoecog\u00eanico.<\/li>\n\n\n\n
    • Linfonodos aumentados e hipoecog\u00eanicos com linfonodos g\u00e1stricos e hep\u00e1ticos medindo cerca de 2,42 cm de comprimento e 1,4 cm de altura, compat\u00edvel com reatividade ou neoplasia.<\/li>\n<\/ul>\n\n\n\n

      Dia 1-Radiografia de t\u00f3rax<\/p>\n\n\n\n

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      • Aumento de radiopacidade dos campos pulmonares.<\/li>\n\n\n\n
      • Aumento de radiopacidade homog\u00eanea em regi\u00e3o cranial e ventral, compat\u00edvel com efus\u00e3o.<\/li>\n\n\n\n
      • Silhueta hep\u00e1tica ultrapassando os limites do rebordo costal.<\/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 0: foram administrados metronidazol (antibi\u00f3tico), ampicilina (antibi\u00f3tico) e ondansetrona (antiem\u00e9tico) que seguiram durante todos os dias de interna\u00e7\u00e3o. Tamb\u00e9m recebeu fluidoterapia com Ringer-lactato (reposi\u00e7\u00e3o eletrol\u00edtica e hidrata\u00e7\u00e3o) e mirtazapina (antiem\u00e9tico e estimulador de apetite).<\/p>\n\n\n\n

        Dia 1: foi inclu\u00edda a administra\u00e7\u00e3o di\u00e1ria de filgrastim (estimulante hematopoi\u00e9tico). Ainda n\u00e3o se alimentava voluntariamente.<\/p>\n\n\n\n

        Dia 2: transfus\u00e3o sangu\u00ednea.<\/p>\n\n\n\n

        Dia 5: alta hospitalar, com prescri\u00e7\u00e3o de amoxicilina+clavulanato de pot\u00e1ssio (antibi\u00f3tico) e mirtazapina.<\/p>\n\n\n\n

        Dia 12: tutor informou o \u00f3bito em casa.<\/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 0<\/strong><\/td>Dia 2<\/strong><\/td>Dia 5<\/strong><\/td><\/tr>
        Eritr\u00f3citos (5-10 milh\u00f5es\/\u00b5L)<\/td>4,23\u2193<\/mark><\/mark><\/td>2,39\u2193<\/mark><\/mark><\/td>5,64\u00a0<\/td><\/tr>
        Hemat\u00f3crito (24-45%)<\/td>23\u2193<\/mark><\/mark><\/td>12\u2193<\/mark><\/mark><\/td>26\u00a0<\/td><\/tr>
        Hemoglobina (8-15 g\/dL)<\/td>6,9\u2193<\/mark><\/mark><\/td>3,9\u2193<\/mark><\/mark><\/td>8,7\u00a0<\/td><\/tr>
        VCM (39-55 fL)<\/td>54,4\u00a0<\/td>50,2\u00a0<\/td>46,1\u00a0<\/td><\/tr>
        CHCM (31-35%)<\/td>30\u2193<\/mark><\/mark><\/td>32\u00a0<\/td>33<\/td><\/tr>
        Plaquetas<\/strong><\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td><\/tr>
        Quantidade (200-600 \u00d7103<\/sup>\/\u00b5L)<\/td>40\u2193<\/mark><\/mark><\/td><20\u2193<\/mark><\/mark><\/td>n.d.\u00a0<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

        Observa\u00e7\u00f5es: n.d., n\u00e3o determinado; Presen\u00e7a de 1 metarrubr\u00edcito\/campo no Dia 5 (val. ref.: <3\/campo).<\/p>\n\n\n\n

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        Leucograma<\/strong><\/td>Dia 0<\/strong><\/td>Dia 2<\/strong><\/td>Dia 5<\/strong><\/td><\/tr>
        Leuc\u00f3citos totais (5.000-19.500\/\u00b5L)<\/td>4.200\u2193<\/mark><\/td>11.400\u00a0<\/td>20.400\u2191<\/mark><\/td><\/tr>
        Miel\u00f3citos (0\/\u00b5L)<\/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><\/tr>
        Neutr. bast. (<300\/\u00b5L)<\/td>0\u00a0<\/td>114<\/td>204<\/td><\/tr>
        Neutr. seg. (2.500-12.500\/\u00b5L)<\/td>210\u2193<\/mark><\/td>3.306\u00a0<\/td>8.160\u00a0<\/td><\/tr>
        Bas\u00f3filos (<100\/\u00b5L)<\/td>0\u00a0<\/td>0\u00a0<\/td>0\u00a0<\/td><\/tr>
        Eosin\u00f3filos (100-1.250\/\u00b5L)<\/td>0<\/td>0<\/td>0<\/td><\/tr>
        Mon\u00f3citos (<850\/\u00b5L)<\/td>84\u00a0<\/td>456\u00a0<\/td>204\u00a0<\/td><\/tr>
        Linf\u00f3citos (1.500-7.000\/\u00b5L)<\/td>3.906\u00a0<\/td>7.524\u2191<\/mark><\/mark><\/mark><\/td>11.832\u2191<\/mark><\/mark><\/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 5<\/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>78\u00a0<\/td>62\u00a0<\/td>68\u00a0<\/td><\/tr>
        Prote\u00ednas totaisC<\/sup> (54-78 g\/L)<\/td>n.d.\u00a0<\/td>n.d.\u00a0<\/td>n.d.\u00a0<\/td><\/tr>
        Albumina (21-33 g\/L)<\/td>31\u00a0<\/td>n.d.\u00a0<\/td>n.d.\u00a0<\/td><\/tr>
        Globulinas (26-51 g\/L)<\/td>n.d.\u00a0<\/td>n.d.\u00a0<\/td>n.d.\u00a0<\/td><\/tr>
        Creatinina (<1,6 mg\/dL)<\/td>1,1\u00a0<\/td>n.d.\u00a0<\/td>n.d.\u00a0<\/td><\/tr>
        ALT (<83 U\/L)<\/td>155\u2191<\/mark><\/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; 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