{"id":7839,"date":"2025-01-31T17:43:49","date_gmt":"2025-01-31T20:43:49","guid":{"rendered":"https:\/\/www.ufrgs.br\/lacvet\/?p=7839"},"modified":"2025-01-31T17:43:59","modified_gmt":"2025-01-31T20:43:59","slug":"caso-clinico-17d42","status":"publish","type":"post","link":"https:\/\/www.ufrgs.br\/lacvet\/cc_interativos\/caso-clinico-17d42\/","title":{"rendered":"Caso Cl\u00ednico 17D42"},"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: 11 anos
Sexo: f\u00eamea
Peso: 4 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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Tutora relata v\u00f4mito e m\u00edmica de v\u00f4mito h\u00e1 4 anos. Houve melhora ap\u00f3s administra\u00e7\u00e3o de “ra\u00e7\u00e3o gastrointestinal” (sic), mas os sinais cl\u00ednicos retornaram recentemente. Sem altera\u00e7\u00e3o de apetite, polidipsia. Castrada, mora em apartamento e n\u00e3o tem acesso \u00e0 rua, tem dois contactantes vacinados e vermifugados. Urina e fezes sem altera\u00e7\u00e3o. Animal considerado magro pela tutora, que relata perda de peso recente.<\/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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Linfonodos popl\u00edteos aumentados, gengivite, andar agachado (plant\u00edgrado).
Escore corporal: 5 (ref.: 1-9, ideal=5).
Temperatura retal: 39,1 \u00b0C (ref.: 37,5-39,3).
Press\u00e3o arterial sist\u00f3lica: 105 mmHg\u2193 (ref.: 140-160).
Frequ\u00eancia respirat\u00f3ria: 80 mrpm\u2191 (ref.: 20-40).
Frequ\u00eancia card\u00edaca: 160 bpm (ref.: 120-240), pulso s\u00edncrono e normal.
Mucosas normocoradas.
Desidrata\u00e7\u00e3o: 6%.
Tempo de preenchimento capilar: <2 s (ref.: 1-2).
Glicemia (glicos\u00edmetro): 85 mg\/dL (ref.: 73-134).<\/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 1 \u2013 Ultrassom abdominal<\/p>\n\n\n\n

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  • Rins com discreta perda da defini\u00e7\u00e3o corticomedular;<\/li>\n\n\n\n
  • F\u00edgado com par\u00eanquima normoecog\u00eanico e grosseiro. Altera\u00e7\u00e3o pode estar associada a hepatopatia e linfonodos c\u00f3licos evidentes, podendo estar associado a processo inflamat\u00f3rio.<\/li>\n<\/ul>\n\n\n\n

    Dia 329 \u2013 Ecodopplercardiograma: frequ\u00eancia card\u00edaca: 215 bpm (ref.: 120-240), ritmo regular, sem altera\u00e7\u00f5es significativas.<\/p>\n\n\n\n

    Tabela 1. Dosagens hormonais.<\/strong><\/p>\n\n\n\n

    \u00a0<\/td>Dia 4<\/strong><\/td>Dia 75<\/strong><\/td>Dia 312<\/strong><\/td>Dia 329<\/strong><\/td><\/tr>
    T4 livre (0,8-3,5 ng\/dL)<\/td>3,45<\/td>3,70\u2191<\/td>10,40\u2191<\/td>6,10\u2191<\/td><\/tr>
    T4 total (15-30 ng\/mL)<\/td>n.d.<\/td>n.d.<\/td>n.d.<\/td>74,3\u2191<\/td><\/tr>
    TSH (0,03-0,38 ng\/mL)<\/td>0,03<\/td>n.d.<\/td>n.d.<\/td>0,04<\/td><\/tr><\/tbody><\/table><\/figure>\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 \u2013 2\u00aa dose de verm\u00edfugo, inclus\u00e3o de alimenta\u00e7\u00e3o \u00famida na rotina.<\/p>\n\n\n\n

    Dia 69 \u2013 Tutora relatou que paciente presenta polifagia, poli\u00faria e polidipsia; al\u00e9m de agita\u00e7\u00e3o principalmente ao final do dia com miados altos (sic). Paciente segue perdendo peso (3,5 kg), apresenta-se alerta, escore corporal 5 (ref.: 1-9, ideal=5), hidratada, temperatura retal 38,2 \u00b0C (ref.: 37,5-39,3), mucosas normocoradas, doen\u00e7a periodontal, tempo de preenchimento capilar <2 s (ref.: 1-2), linfonodos normais, glicemia (glicos\u00edmetro) 104 mg\/dL (ref.: 73-134), tireoide aumentada bilateralmente, press\u00e3o arterial sist\u00f3lica 130 mmHg\u2193 (ref.: 140-160).<\/p>\n\n\n\n

    Dia 312 \u2013 Tutora relata as mesmas queixas principais das consultas anteriores, alimenta\u00e7\u00e3o \u00e0 vontade, urinando frequentemente fora da caixa. Relata que o pelo est\u00e1 mais opaco e pontiagudo (sic) e que onde havia sido depilado n\u00e3o cresceu mais. Continua perdendo peso (3,2 kg), alerta, escore corporal 4\u2193 (ref.: 1-9, ideal=5), hidratada, temperatura retal 38,3 \u00b0C (ref.: 37,5-39,3), mucosas normocoradas, tempo de preenchimento capilar <2 s (ref.: 1-2), linfonodos normais, tireoides palp\u00e1veis bilateralmente, frequ\u00eancia respirat\u00f3ria 32 mrpm (ref.: 20-40), frequ\u00eancia card\u00edaca 220 bpm (ref.: 120-240), pulso s\u00edncrono e normal.<\/p>\n\n\n\n

    Dia 329 \u2013 Prescrito metimazol de uso cont\u00ednuo.<\/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 1<\/strong><\/td>Dia 329<\/strong><\/td><\/tr>
    Eritr\u00f3citos (5-10 milh\u00f5es\/\u00b5L)<\/td>10,11\u2191<\/td>9,82<\/td><\/tr>
    Hemat\u00f3crito (24-45%)<\/td>47\u2191<\/td>45<\/td><\/tr>
    Hemoglobina (8-15 g\/dL)<\/td>15,7\u2191<\/td>14,9<\/td><\/tr>
    VCM (39-55 fL)<\/td>46,49<\/td>45,82<\/td><\/tr>
    CHCM (31-35%)<\/td>33,40<\/td>33,11<\/td><\/tr>
    RDW (17-22%)<\/td>28,1\u2191<\/td>28,5\u2191<\/td><\/tr>
    Reticul\u00f3citos (<0,4%)<\/td>n.d.<\/td>n.d.<\/td><\/tr>
    Eritr\u00f3citos nucleados (0-3\/100 leuc\u00f3citos)<\/td>1<\/td>0<\/td><\/tr>
    Plaquetas<\/strong><\/td><\/td><\/td><\/tr>
    Quantidade (200-600 \u00d7103<\/sup>\/\u00b5L)<\/td>333<\/td>440<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

    Observa\u00e7\u00f5es:
    Dia 0 – anisocitose (1+), presen\u00e7a de agrega\u00e7\u00e3o plaquet\u00e1ria.
    Dia 329 – anisocitose (+1).<\/p>\n\n\n\n

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    Leucograma<\/strong><\/td>Dia 1<\/strong><\/td>\u00a0Dia 329<\/strong><\/td><\/tr>
    Leuc\u00f3citos totais (5.000-19.500\/\u00b5L)<\/td>9.600<\/td>5.550<\/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. (2.500-12.500\/\u00b5L)<\/td>7.968<\/td>3.960<\/td><\/tr>
    Bas\u00f3filos (<100\/\u00b5L)<\/td>96<\/td>0<\/td><\/tr>
    Eosin\u00f3filos (100-1.250\/\u00b5L)<\/td>192<\/td>440<\/td><\/tr>
    Mon\u00f3citos (<850\/\u00b5L)<\/td>192<\/td>165<\/td><\/tr>
    Linf\u00f3citos (1.500-7.000\/\u00b5L)<\/td>1.152\u2193<\/td>935\u2193<\/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 1<\/strong><\/td>Dia 312<\/strong><\/td><\/tr>
    Amostra<\/td>soro<\/td>soro<\/td><\/tr>
    Hem\u00f3lise<\/td>ausente<\/td>ausente<\/td><\/tr>
    Anticoagulante<\/td>nenhum<\/td>nenhum<\/td><\/tr>
    Prote\u00ednas totaisB<\/sup> (60-80 g\/L)<\/td>n.d.<\/td>n.d<\/td><\/tr>
    Prote\u00ednas totaisC<\/sup> (54-78 g\/L)<\/td>n.d.<\/td>74<\/td><\/tr>
    Albumina (21-33 g\/L)<\/td>34\u2191<\/td>33<\/td><\/tr>
    Globulinas (26-51 g\/L)<\/td>n.d.<\/td>41<\/td><\/tr>
    Ureia (43-64 mg\/dL)<\/td>51<\/td>66\u2191<\/td><\/tr>
    Creatinina (<1,6 mg\/dL)<\/td>1,1<\/td>0,6<\/td><\/tr>
    F\u00f3sforo (2,7-6,2 mg\/dL)<\/td>n.d.<\/td>4<\/td><\/tr>
    FA (<93 U\/L)<\/td>50<\/td>147\u2191<\/td><\/tr>
    ALT (<83 U\/L)<\/td>99\u2191<\/td>327\u2191<\/td><\/tr>
    S\u00f3dio (145-157 mmol\/L)<\/td>n.d.<\/td>154,3<\/td><\/tr>
    Pot\u00e1ssio (4,0-4,5 mmol\/L)<\/td>n.d.<\/td>3,92\u2193<\/td><\/tr>
    C\u00e1lcio i\u00f4nico (1,07-1,50 mmol\/L)<\/td>n.d.<\/td>1,31<\/td><\/tr>
    Cloro (104-128 mmol\/L)<\/td>n.d.<\/td>115,5<\/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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    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