{"id":7470,"date":"2023-10-30T15:59:58","date_gmt":"2023-10-30T18:59:58","guid":{"rendered":"https:\/\/www.ufrgs.br\/lacvet\/?p=7470"},"modified":"2023-11-01T11:01:09","modified_gmt":"2023-11-01T14:01:09","slug":"caso-clinico-17d1a","status":"publish","type":"post","link":"https:\/\/www.ufrgs.br\/lacvet\/cc_interativos\/caso-clinico-17d1a\/","title":{"rendered":"Caso Cl\u00ednico 17D1A"},"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: 14 anos
Sexo: macho
Peso: 10,6 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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O tutor relatou que h\u00e1 tr\u00eas dias o paciente apresentava-se ap\u00e1tico, com dor abdominal, n\u00e3o estava comendo e nem caminhando. Tutor forneceu tramadol e buscopam composto (butilbrometo de escopolamina e dipirona), tendo o paciente melhorado em um primeiro momento, mas no dia seguinte n\u00e3o reagiu mais. N\u00e3o apresentava v\u00f4mito e nem diarreia. O animal reside em casa, mas sai para passeio todos os dias com o tutor. Se alimenta apenas de frango cozido, o qual o tutor prepara para ele. Bebe \u00e1gua normalmente. O paciente n\u00e3o possui hist\u00f3rico de vacinas. Tutor relata hist\u00f3rico de doen\u00e7a renal cr\u00f4nica, hidronefrose em um dos rins, tendo acompanhamento veterin\u00e1rio h\u00e1 alguns meses. Possui tamb\u00e9m DDIV (doen\u00e7a do disco intervertebral), espondilose e doen\u00e7a card\u00edaca. Faz uso de pimobendan (inotr\u00f3pico positivo, n\u00e3o-simpatomim\u00e9tico, n\u00e3o-glicos\u00eddeo e com propriedades vasodilatadoras) e benazepril (inibidor da enzima de convers\u00e3o da angiotensina).<\/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 0<\/strong>
Temperatura retal: 38,7 C\u00b0 (ref.: 37,5-39,2)
Frequ\u00eancia card\u00edaca: 160 bpm\u2191<\/mark> (ref.: 70-130)
Frequ\u00eancia respirat\u00f3ria: 24 mrpm (ref.: 10-40)
Mucosas: hipocoradas
Tempo de perfus\u00e3o capilar: 2 s (ref.: <2 s)
Glicemia (glicos\u00edmetro): 85 mg\/dL (ref.: 65-118)
Press\u00e3o arterial sist\u00f3lica: 180 mmHg\u2191<\/mark> (ref.: <140 mmHg)
Desidrata\u00e7\u00e3o: 6%
Escore corporal: 4 (ref.: 1-9, ideal=5)
Palpa\u00e7\u00e3o abdominal: rigidez, possui tremores
Ausculta card\u00edaca: sopro card\u00edaco<\/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: fluidoterapia de reposi\u00e7\u00e3o com Ringer lactato, dipirona (analg\u00e9sico e antipir\u00e9tico), tramadol (analg\u00e9sico), cobamamida (coenzima da vitamina B12), ondansetrona (antiem\u00e9tico).<\/p>\n\n\n\n

Dia 1: paciente apresentou v\u00f4mito. Acrescentadas as seguintes medica\u00e7\u00f5es: enrofloxacina (antibi\u00f3tico), citrato de maropitant (antiem\u00e9tico).<\/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 4<\/strong><\/td><\/tr>
Eritr\u00f3citos (5,5-8,5 milh\u00f5es\/\u00b5L)<\/td>5,7<\/td>3,5\u2193<\/mark><\/mark><\/td><\/tr>
Hemat\u00f3crito (37-55%)<\/td>39<\/td>25\u2193<\/mark><\/mark><\/td><\/tr>
Hemoglobina (12-18 g\/dL)<\/td>13,6<\/td>8,2\u2193<\/mark><\/mark><\/td><\/tr>
VCM (60-77 fL)<\/td>68,4<\/td>71,0<\/td><\/tr>
CHCM (32-36%)<\/td>34,9<\/td>32,8<\/td><\/tr>
RDW (14-17%)<\/td>13\u2193<\/mark><\/mark><\/td>13\u2193<\/mark><\/mark><\/td><\/tr>
HCM (19-23 pg))<\/td>23,9\u2191<\/mark><\/td>23,3\u2191<\/mark><\/td><\/tr>
Plaquetas<\/strong><\/td>\u00a0<\/td>\u00a0<\/td><\/tr>
Quantidade (200-500 \u00d7103<\/sup>\/\u00b5L)<\/td>330<\/td>264<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
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Leucograma<\/strong><\/td>Dia <\/strong>0<\/strong><\/td>Dia <\/strong>4<\/strong><\/td><\/tr>
Leuc\u00f3citos totais (6.000-17.000\/\u00b5L)<\/td>10.300<\/td>15.500<\/td><\/tr>
Miel\u00f3citos (0\/\u00b5L)<\/td>0<\/td>0<\/td><\/tr>
Metamiel\u00f3citos (0\/\u00b5L)<\/td>0<\/td>0<\/td><\/tr>
Neutr. bast. (<300\/\u00b5L)<\/td>0<\/td>0<\/td><\/tr>
Neutr. seg. (3.000-11.500\/\u00b5L)<\/td>7.210<\/td>12.400\u2191<\/mark><\/td><\/tr>
Bas\u00f3filos (<200\/\u00b5L)<\/td>0<\/td>0<\/td><\/tr>
Eosin\u00f3filos (100-1.250\/\u00b5L)<\/td>1.751\u2191<\/mark><\/td>930<\/td><\/tr>
Mon\u00f3citos (150-1.350\/\u00b5L)<\/td>309<\/td>930<\/td><\/tr>
Linf\u00f3citos (1.000-4.800\/\u00b5L)<\/td>1.030<\/td>1.240<\/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 4<\/strong><\/td><\/tr>
Amostra<\/td>soro<\/td>soro<\/td><\/tr>
Hem\u00f3lise<\/td>ausente<\/td>ausente<\/td><\/tr>
AnticoagulanteA<\/sup><\/td>nenhum<\/td>nenhum<\/td><\/tr>
Prote\u00ednas totaisB<\/sup> (60-80 g\/L)<\/td>84\u2191<\/mark><\/td>64\u00a0<\/td><\/tr>
Prote\u00ednas totaisC<\/sup> (54-71 g\/L)<\/td>n.d.<\/td>n.d.<\/td><\/tr>
Albumina (26-33 g\/L)<\/td>32<\/td>n.d.<\/td><\/tr>
Globulinas (27-44 g\/L)<\/td>n.d.<\/td>n.d.<\/td><\/tr>
Ureia (21-60 mg\/dL)<\/td>162\u2191<\/mark><\/td>198\u2191<\/mark><\/td><\/tr>
Creatinina (<1,4 mg\/dL)<\/td>2,6\u2191<\/mark><\/td>3,4\u2191<\/mark><\/td><\/tr>
F\u00f3sforo (2,6-6,2 mg\/dL)<\/td>4,1<\/td>n.d.<\/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>cist<\/td><\/tr>
Sedimento urin\u00e1rioB<\/sup><\/strong><\/td>\u00a0<\/td><\/tr>
C\u00e9lulas epiteliais<\/td>ausente<\/td><\/tr>
Cilindros<\/td>ausente<\/td><\/tr>
Hem\u00e1cias<\/td><5<\/td><\/tr>
Leuc\u00f3citos<\/td>60\u2191<\/mark><\/td><\/tr>
Bacteri\u00faria<\/td>leve\u2191<\/mark><\/td><\/tr>
Outros<\/td>\u00a0\u00a0\u00a0\u00a0\u00a0<\/td><\/tr>
Exame qu\u00edmico<\/strong><\/td>\u00a0<\/td><\/tr>
pH (5,5-7,0)<\/td>7,5\u2191<\/mark><\/td><\/tr>
Corpos cet\u00f4nicosC<\/sup><\/td>ausente<\/td><\/tr>
GlicoseD<\/sup><\/td>ausente<\/td><\/tr>
BilirrubinaE<\/sup><\/td>ausente<\/td><\/tr>
Urobilinog\u00eanio (<1 mg\/dL)<\/td>\u22480,2<\/td><\/tr>
Prote\u00ednaF<\/sup><\/td>+\u2191<\/mark><\/td><\/tr>
SangueG<\/sup><\/td>ausente<\/td><\/tr>
RPCUH<\/sup><\/td>0,73\u2191<\/mark><\/td><\/tr>
Exame f\u00edsico<\/strong><\/td><\/td><\/tr>
Dens. espec. (1,015-1,045)<\/td>1,017<\/td><\/tr>
Cor<\/td>amarela<\/td><\/tr>
Consist\u00eancia<\/td>fluida<\/td><\/tr>
Aspecto<\/td>l\u00edmpida<\/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