{"id":6447,"date":"2023-09-24T16:02:58","date_gmt":"2023-09-24T19:02:58","guid":{"rendered":"https:\/\/www.ufrgs.br\/lacvet\/?p=6447"},"modified":"2025-08-05T10:49:23","modified_gmt":"2025-08-05T13:49:23","slug":"caso-clinico-1796e","status":"publish","type":"post","link":"https:\/\/www.ufrgs.br\/lacvet\/cc_interativos\/caso-clinico-1796e\/","title":{"rendered":"Caso Cl\u00ednico 1796E"},"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: 14 anos
Sexo: f\u00eamea
Peso: 2,310 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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Queixa de agita\u00e7\u00e3o, maior frequ\u00eancia dos miados, hiporexia, polidipsia, desidrata\u00e7\u00e3o e espirros, associados com emagrecimento progressivo h\u00e1 dois anos. A paciente \u00e9 castrada, possui teste de FIV\/FeLV negativo, exame sangu\u00edneo pr\u00e9vio de 40 dias que indicavam leucopenia por neutropenia, acentuados n\u00edveis s\u00e9ricos de ureia e ALT, al\u00e9m de um exame de ultrassom indicando uma dimens\u00e3o normal da tireoide.<\/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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Estado mental: ativa
Escore de condi\u00e7\u00e3o corporal: entre 2 e 3\u2193<\/mark> (1 a 9; ideal=5).
Temperatura retal: 40 \u00b0C\u2191<\/mark><\/strong><\/mark><\/strong> (ref.: 37,5-39,5)
Mucosas normocoradas
Grau de desidrata\u00e7\u00e3o: 7%\u2191<\/mark><\/strong><\/mark><\/strong> (moderado)
Frequ\u00eancia card\u00edaca: 180 bpm (ref.: 120-240)
Frequ\u00eancia respirat\u00f3ria: 80 mpm\u2191<\/mark><\/strong><\/mark><\/strong> (ref.: 10-30)
Outros achados do exame f\u00edsico foram gengivite e suspeita de altera\u00e7\u00e3o na massa tireoidiana. Na palpa\u00e7\u00e3o n\u00e3o foram identificadas altera\u00e7\u00f5es nos linfonodos.<\/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 6 – Radiografia de t\u00f3rax<\/span><\/b><\/p>\n\n\n\n

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  • Campos pulmonares dentro dos padr\u00f5es de normalidade para a idade.<\/span><\/li>\n\n\n\n
  • Silhueta cardiogr\u00e1fica: dentro dos padr\u00f5es de normalidade radiogr\u00e1fica para a idade (mensura\u00e7\u00e3o feita pelo m\u00e9todo VHS de 7,5 corpos vertebrais).<\/span><\/li>\n\n\n\n
  • L\u00famen traqueal aumentado.<\/span> Trajeto deslocado dorsalmente em toda sua extens\u00e3o, com limite dorsal tangenciando a coluna vertebral.<\/span><\/li>\n\n\n\n
  • Forma\u00e7\u00e3o com aumento de radiopacidade n\u00e3o homog\u00eanea, ventral \u00e0s 6\u00aa e 7\u00aa v\u00e9rtebras cervicais, sobrepondo-se \u00e0 imagem traqueal, delimitado por limites irregulares \u2013 visualiza\u00e7\u00e3o dificultada pela sobreposi\u00e7\u00e3o das esc\u00e1pulas.<\/span><\/li>\n\n\n\n
  • Mineraliza\u00e7\u00e3o das cartilagens costais (processo senil).<\/span><\/li>\n\n\n\n
  • Conte\u00fado alimentar e g\u00e1s na cavidade g\u00e1strica.<\/span><\/li>\n<\/ul>\n\n\n\n

    Dia 24 – Exame FIV\/FeLV:<\/span><\/b> negativo<\/span><\/p>\n\n\n\n

    Tabela 1. Mensura\u00e7\u00e3o da concentra\u00e7\u00e3o s\u00e9rica de T4 e escore de condi\u00e7\u00e3o corporal.<\/strong><\/p>\n\n\n\n

    Par\u00e2metro (int. ref.)<\/strong><\/td>Dia 3<\/strong><\/td>Dia 44<\/strong><\/td>Dia 95<\/strong><\/td>Dia 149<\/strong><\/td><\/tr>
    Exames hormonais*<\/strong><\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td><\/tr>
    T4 livre (0,8-3,5 ng\/dL)<\/td>n.d.<\/td>5,27\u2191<\/mark><\/strong><\/mark><\/strong><\/td>n.d.<\/td>n.d.<\/td><\/tr>
    T4 total (1,5\u20133,0 \u00b5g\/dL)<\/td>15,0\u2191<\/mark><\/strong><\/mark><\/strong><\/td>n.d.<\/td>5,43\u2191<\/mark><\/strong><\/mark><\/strong><\/td>5,0\u2191<\/mark><\/strong><\/mark><\/strong><\/td><\/tr>
    Outros<\/strong><\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td><\/tr>
    Condi\u00e7\u00e3o corporal (1-5, ideal=3)<\/td>2\u2193<\/mark><\/td>2\u2193<\/mark><\/td>3<\/td>3<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

    *determinados por Radioimunoensaio; n.d.: n\u00e3o determinado.<\/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:<\/strong> iniciada antibioticoterapia e silimarina.<\/p>\n\n\n\n

    Dia 20:<\/strong> paciente apresenta melhora e se alimentando bem, mas ainda com baixo escore corporal. In\u00edcio do tratamento com metimazol (antitireoidiano) em gel de lecitina plur\u00f4nica (pomada transd\u00e9rmica) com aplica\u00e7\u00e3o nas orelhas.<\/p>\n\n\n\n

    Dia 45:<\/strong> paciente inquieta e ind\u00f3cil, com polidipsia, sem comer h\u00e1 2 dias e com v\u00f4mitos. \u00c9 suspenso o uso do metimazol at\u00e9 o paciente voltar a se alimentar normalmente. Realizada fluidoterapia e prescrito mirtazapina (estimulante de apetite) e ondansetrona (antiem\u00e9tico).<\/p>\n\n\n\n

    Dia 59:<\/strong> paciente apresenta melhora e tratamento com metimazol \u00e9 retomado.<\/p>\n\n\n\n

    Dia 91:<\/strong> paciente retornou mais calma, se alimentando melhor, mas com v\u00f4mitos ocasionais. Aumento da dose de metimazol.<\/p>\n\n\n\n

    Dia 139:<\/strong> paciente apresentou-se prostrada, aceitando pouco alimento, baixo escore corporal. Realizada fluidoterapia.<\/p>\n\n\n\n

    Dia 155:<\/strong> aumento da dose de metimazol.<\/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><\/td>Dia 0<\/strong><\/td>Dia 41<\/strong><\/td>Dia 91<\/strong><\/td>Dia 140<\/strong><\/td>Dia 204<\/strong><\/td><\/tr>
    Eritr\u00f3citos (5-10 milh\u00f5es\/\u00b5L)<\/td>9,80<\/td>11,06\u2191<\/mark><\/strong><\/mark><\/strong><\/td>8,58<\/td>8,86<\/td>9,21<\/td><\/tr>
    Hemat\u00f3crito (24-45%)<\/td>41<\/td>46\u2191<\/mark><\/strong><\/mark><\/strong><\/td>35<\/td>37<\/td>39<\/td><\/tr>
    Hemoglobina (8-15 g\/dL)<\/td>13,2<\/td>15,0<\/td>11,7<\/td>11,7<\/td>12,6<\/td><\/tr>
    VCM (40-60 fL)<\/td>41,8<\/td>41,6<\/td>40,8<\/td>41,8<\/td>42,3<\/td><\/tr>
    CHCM (31-35%)<\/td>32,2<\/td>32,6<\/td>33,4<\/td>31,6<\/td>32,3<\/td><\/tr>
    RDW (17-22%)<\/td>n.d.<\/td>27,6\u2191<\/mark><\/strong><\/mark><\/strong><\/td>n.d.<\/td>n.d.<\/td>n.d.<\/td><\/tr>
    Plaquetas<\/strong><\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td><\/tr>
    Quantidade (200-600 \u00d7103<\/sup>\/\u00b5L)<\/td>308<\/td>400<\/td>380<\/td>200<\/td>445<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
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    Leucograma<\/strong><\/td>Dia 0<\/strong><\/td>Dia 41<\/strong><\/td>Dia 91<\/strong><\/td>Dia 140<\/strong><\/td>Dia 204<\/strong><\/td><\/tr>
    Leuc\u00f3citos totais (5.000-19.500\/\u00b5L)<\/td>6.600<\/td>7.100<\/td>17.000<\/td>14.600<\/td>14.400<\/td><\/tr>
    Miel\u00f3citos (0\/\u00b5L)<\/td>0<\/td>0<\/td>0<\/td>0<\/td>0<\/td><\/tr>
    Metamiel\u00f3citos (0\/\u00b5L)<\/td>0<\/td>0<\/td>0<\/td>0<\/td>0<\/td><\/tr>
    Neutr. bast. (<300\/\u00b5L)<\/td>0<\/td>0<\/td>0<\/td>0<\/td>0<\/td><\/tr>
    Neutr. seg. (2.500-12.500\/\u00b5L)<\/td>5.016<\/td>2.769<\/td>11.560<\/td>7.446<\/td>8.064<\/td><\/tr>
    Bas\u00f3filos (0\/\u00b5L)<\/td>0<\/td>0<\/td>0<\/td>0<\/td>0<\/td><\/tr>
    Eosin\u00f3filos (100-1.500\/\u00b5L)<\/td>330<\/td>284<\/td>0<\/td>1.168<\/td>864<\/td><\/tr>
    Mon\u00f3citos (<850\/\u00b5L)<\/td>198<\/td>0<\/td>0<\/td>584<\/td>432<\/td><\/tr>
    Linf\u00f3citos (1.500-7.000\/\u00b5L)<\/td>1.056\u2193<\/mark><\/td>4.047<\/td>5.440<\/td>5.402<\/td>5.040<\/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 41<\/strong><\/td>Dia 43<\/strong><\/td>Dia 91<\/strong><\/td>Dia 204<\/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>
    Albumina (21-33 g\/L)<\/td>34\u2191<\/mark><\/strong><\/mark><\/strong><\/td>32<\/td>n.d.<\/td>30<\/td>33<\/td><\/tr>
    Ureia (43-64 mg\/dL)<\/td>42<\/td>50<\/td>n.d.<\/td>62<\/td>64<\/td><\/tr>
    Creatinina (<1,6 mg\/dL)<\/td>1,17<\/td>1,40<\/td>n.d.<\/td>1,20<\/td>1,10<\/td><\/tr>
    C\u00e1lcio (6,2-10,2 mg\/dL)<\/td>n.d.<\/td>n.d.<\/td>9,6<\/td>n.d.<\/td>n.d.<\/td><\/tr>
    F\u00f3sforo (2,7-6,2 mg\/dL)<\/td>n.d.<\/td>n.d.<\/td>6,3\u2191<\/mark><\/strong><\/mark><\/strong><\/td>n.d.<\/td>n.d.<\/td><\/tr>
    FA (<93 U\/L)<\/td>133\u2191<\/mark><\/strong><\/mark><\/strong><\/td>145\u2191<\/mark><\/strong><\/mark><\/strong><\/td>n.d.<\/td>n.d.<\/td>59<\/td><\/tr>
    ALT (<83 U\/L)<\/td>187\u2191<\/mark><\/strong><\/mark><\/strong><\/td>103\u2191<\/mark><\/strong><\/mark><\/strong><\/td>n.d.<\/td>88\u2191<\/mark><\/strong><\/mark><\/strong><\/td>24<\/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>Dia 41<\/strong><\/td>Dia 91<\/strong><\/td>Dia 142<\/strong><\/td><\/tr>
    M\u00e9todo de coletaA<\/sup><\/td>cist<\/td>cist<\/td>cist<\/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) e transi\u00e7\u00e3o (1)<\/td>Escamosas (1) e transi\u00e7\u00e3o (2)<\/td>Escamosas (2)<\/td>Escamosas (1) e transi\u00e7\u00e3o (1)<\/td><\/tr>
    Cilindros<\/td>ausente<\/td>ausente<\/td>n.d.<\/td>ausente<\/td><\/tr>
    Hem\u00e1cias<\/td>ausente<\/td>ausente<\/td>ausente<\/td>ausente<\/td><\/tr>
    Leuc\u00f3citos<\/td>ausente<\/td>ausente<\/td>ausente<\/td>presen\u00e7a\u2191<\/mark><\/strong><\/mark><\/strong><\/td><\/tr>
    Bacteri\u00faria<\/td>ausente<\/td>moderada\u2191<\/mark><\/strong><\/mark><\/strong><\/td>leve\u2191<\/mark><\/strong><\/mark><\/strong><\/td>leve\u2191<\/mark><\/strong><\/mark><\/strong><\/td><\/tr>
    Exame qu\u00edmico<\/strong><\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td><\/tr>
    pH (6,0-7,0)<\/td>7,0<\/td>6,0<\/td>6,0<\/td>6,5<\/td><\/tr>
    Corpos cet\u00f4nicosC<\/sup><\/td>ausente<\/td>ausente<\/td>ausente<\/td>ausente<\/td><\/tr>
    GlicoseD<\/sup><\/td>ausente<\/td>ausente<\/td>ausente<\/td>ausente<\/td><\/tr>
    BilirrubinaE<\/sup><\/td>ausente<\/td>ausente<\/td>ausente<\/td>ausente<\/td><\/tr>
    Prote\u00ednaF<\/sup><\/td>ausente<\/td>ausente<\/td>tra\u00e7os\u2191<\/mark><\/strong><\/mark><\/strong><\/td>tra\u00e7os\u2191<\/mark><\/strong><\/mark><\/strong>\u00a0<\/td><\/tr>
    SangueG<\/sup><\/td>ausente<\/td>ausente<\/td>ausente<\/td>tra\u00e7os (nh)\u2191<\/mark><\/strong><\/mark><\/strong><\/td><\/tr>
    RPCUH<\/sup><\/td>0<\/td>0,4<\/td>0,11<\/td>0<\/td><\/tr>
    Exame f\u00edsico<\/strong><\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td>\u00a0<\/td><\/tr>
    Dens. espec. (1,015-1,060)<\/td>1,014\u2193<\/mark><\/td>1,018<\/td>1,018<\/td>1,014\u2193<\/mark><\/td><\/tr>
    Cor<\/td>amarelo<\/td>amarelo p\u00e1lido<\/td>amarelo<\/td>amarelo p\u00e1lido<\/td><\/tr>
    Consist\u00eancia<\/td>fluida<\/td>fluida<\/td>fluida<\/td>fluida<\/td><\/tr>
    Aspecto<\/td>l\u00edmpido<\/td>turvo<\/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