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Geriatric Care

"Betty" had been healthy until two weeks prior to presentation. Her initial symptoms included sneezing, coughing and clear ocular discharge. She was also subdued for 2-3 days, sleeping most of the time and not getting up to eat, drink or visit the litter box. Betty seemed to recover after about two days, but then became ill a few days later. The owner assumed that it was another respiratory infection, but after it had not run its course in 5 days, brought Betty in for an examination.

SIGNALMENT:

Betty, 17-year-old spayed female domestic short hair cat.

HISTORY:

"Betty" had been healthy until two weeks prior to presentation. Her initial symptoms included sneezing, coughing and clear ocular discharge. She was also subdued for 2-3 days, sleeping most of the time and not getting up to eat, drink or visit the litter box. Betty seemed to recover after about two days, but then became ill a few days later. The owner assumed that it was another respiratory infection, but after it had not run its course in 5 days, brought Betty in for an examination.

PHYSICAL EXAMINATION:

Betty was subdued at presentation. She was 8% dehydrated and had a fever of 104.8 Fº. Her pulse and respiration were normal. Abdominal palpation revealed undersized kidneys and a nearly empty bladder

PROBLEM LIST:

Lethargy
Fever
Dehydration
Anorexia

Differential diagnoses included bacterial infections, viral infections, kidney disease, neoplasia

DIAGNOSTIC PLAN:

Because of Betty's severe dehydration and debilitation hospitalization was recommended. Prior to initiating therapy blood and urine samples were obtained. An intravenous catheter was placed and a bolus of 150ml lactated ringers solution was given followed by a continuous IV drip at 18 ml/hr. Injections of broad-spectrum antibiotics were also administered because Betty's high fever was suggestive of bacterial infection. Betty's temperature was monitored throughout the day and had dropped to 102.7 Fº 6 hours after initiation of therapy. LABORATORY RESULTS:

Complete Blood Count (CBC) revealed a mild anemia and a very elevated white cell count of 31,200 (normal <16,000).

Blood Urea Nitrogen (BUN)= 128mg/dl (<30mg/dl)
Creatinine = 7.4mg/dl (<2.4mg/dl)
Phosphorous= 16.1 mg/dl (<6.0 mg/dl)

URINALYSIS:

There was a mod plugins/editors/tinymce/jscripts/tiny_mce/themes/advanced/langs/en.js" type="text/javascript"> erate amount of blood and many white blood cells in the urine. Large numbers of rod-shaped bacteria were also present. The urine specific gravity was 1.020 indicating that Betty's kidneys were unable to concentrate urine in the face of her severe dehydration

FINAL DIAGNOSIS:

Pyelonephritis (bacterial kidney infections) and kidney failure

DISCUSSION:

This case illustrates several important points regarding the care of senior pets. In all likelihood, Betty's initial period of decline was due to an upper respiratory infection. In a young, healthy animal, this would have likely resolved and been the end of the problem. Because of Betty's advanced age, she developed severe life-threatening secondary complications.

Virtually all cats older than 12 years have some degree of kidney insufficiency. Because all mammals are born with 3-4 times as much kidney tissue as they need to survive, there needs to be a lot of kidney damage before we see any clinical sign of kidney disease. Even the blood tests we do will be normal in a pet with only 25-30% of normal kidney function. These animals are, however, exquisitely susceptible to any condition that decreases blood flow to the kidney and will go into full blown renal failure very easily. In Betty's case, the 2-3 day period of lethargy and poor appetite likely lead to dehydration bringing on her renal failure. The bacterial infection likely occurred because she failed to get up and empty her bladder regularly. Prolonged urine retention and incontinence are the most important factors in the initiation of urinary tract infections in geriatric patients.

patients. Remember that geriatric pets have special needs and cannot be treated the same as younger animals. We recommend semi-annual examinations and annual blood panels and urinalysis to make sure that we stay abreast of any developing conditions in your senior pet. If your senior is not himself for a day or more, he should be checked immediately in order to prevent serious complications such as those visited upon Betty.

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