DOCSLIB.ORG

Sweet Success. Int J Health Sci Res

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Sweet Success. Int J Health Sci Res International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Case Report Recurrent Diabetic Ketoacidosis in Pregnancy: Sweet Success Bandar Naim Alamri1, Ali A A Y Mahmoud2, Shipra Kunwar3, Tamkin Khan4 1Intern, College of Medicine King Khalid University, KSA. 2Consultant, Abha Maternity and Children’s Hospital, MOH, Abha, KSA 3Associate Professor, Dept. of Obstetrics and Gynaecology, Era’s Lucknow Medical College, Lucknow, India. 4Associate Professor, Department of OBG, College of Medicine, King Khalid University, KSA. Corresponding Author: Shipra Kunwar Received: 19/01/2015 Revised: 14/02/2015 Accepted: 26/02/2015 ABSTRACT Diabetic pregnancy is a high risk pregnancy associated with poor feto-maternal outcome. When poorly controlled it leads to Diabetic Ketoacidosis (DKA). A pregnant woman is more prone to develop DKA even at lower glucose levels. DKA increases the maternal and fetal morbidity and mortality by manifolds. Immediate recognition and aggressive management are essential to improve the feto-maternal outcome. Treating the underlying cause is important to prevent recurrence. Here we present a case of recurrent DKA [9 episodes] in pregnancy fortunately with a good outcome. Key words: Diabetes in pregnancy, diabetic ketoacidosis, lipohypertrophy. INTRODUCTION CASE REPORT Diabetic pregnancy is a high risk A 22 year old Saudi female, G4P2+1, pregnancy associated with poor feto- live one and previous one IUFD , admitted maternal outcome. When poorly controlled, through ER with 29 weeks pregnancy with it leads to Diabetic Ketoacidosis (DKA) which the complaint of 5-6 episodes vomiting per increases feto-maternal morbidity and day for 2 days. Patient was a known case of mortality. DKA episodes in pregnancy may type 1 DM for past 12years, on insulin and be caused by hyperemesis, infections, non- had been admitted 9 times for DKA in the compliance, drugs etc. Here we report a case present pregnancy. The present pregnancy of recurrent DKA secondary to improper was a planned pregnancy. All admissions in administration of insulin. The case is this pregnancy were due to vomiting and reported for its rarity [9 episodes of DKA in pain abdomen under different consultants. same pregnancy], good feto-maternal The first admission was for hyperemesis and outcome by proper and aggressive DKA at 7 weeks gestation and subsequently management and for reiterating the there were 7 more admissions at 2-3 weekly importance of clinical examination in all intervals. She was noncompliant, always patients. presented to the ER, attended the endocrine clinic infrequently and was presumed to be International Journal of Health Sciences & Research (www.ijhsr.org) 414 Vol.5; Issue: 3; March 2015 negligent regarding her diabetes control and the cause of repeated episodes of antenatal care. However, on history she hyperemesis and DKA. denied missing any of her insulin doses or As she presented with vomiting we any dietary indiscretion. The husband were looking for a cause of hyperemesis and appeared to be supportive and both were recurrent DKA but could not get any extremely anxious for fetal wellbeing. There satisfactory explanation. Meanwhile, we was no history suggestive of any infective were joined by a new team member- an focus in the body or fever. intern who was asked to work up the case. Obstetric history: Her first pregnancy During examination of upper limbs he was a spontaneous abortion at 4 weeks. discovered bilateral lumps measuring 5×4 Second pregnancy was terminated by centimeters, firm, non tender in the deltoid caesarean section at 36 weeks for fetal muscles at site of insulin injections in both bradycardia, when a live girl, 2.5 kg was the arms. The patient had been self- delivered. Third pregnancy was IUFD at 36 administering insulin at the same site week due to DKA, delivered vaginally. continuously since her diagnosis of DM 12 On admission her examination years ago. Subsequently, the injection site revealed that patient was dehydrated, had was changed to abdomen and she was kept tachypnea 20/min, tachycardia 143 bpm and hospitalized for close feto-maternal hypotension 90/61 mmHg. The systemic monitoring. She received a course of examination was normal and obstetric steroids for fetal lung maturity. At 33 weeks examination revealed a 28 weeks sized she developed mild hypertension with uterus, relaxed, FHS normal. increasing albuminuria but did not have any Hb-11gm%, TLC-8200/cumm, DLC- new episode of DKA. Neutrophils-76%, lymphocytes-20%, Elective caesarean was done at 34 monocytes -04%, LFT –Normal, RFT- weeks and a live male baby was delivered. normal, blood glucose was 253 mg/dl , urine The baby weight was 1.9kg, placenta for sugar 3+, urine for ketones-3+. Urine for weighed 300 grams and no congenital albumin was1+, Blood urea 19 mg/ dl, anomaly was present. Baby had an episode serum creatinine 0.9 mg\dl, sodium of mild respiratory distress and was admitted 132.3mmol/l, potassium 4.6 mmol/l, in NICU for two days. Mother and baby bicarbonate18.3mmol/l,O2 saturation was were doing well and discharged on request 94%, ABG revealed pH 7.3, PCO219mmHg, on 4th post-operative day. PO2 93.3 mmHg. HbA1C was 9.The fundus examination, chest radiograph and ECG DISCUSSION were normal, urine and blood cultures were The incidence of DKA has been negative. Cardiotocography was normal. reported as 1% to 10% from different Ultrasound revealed a live fetus, adequate studies. [ 1] While Cousins [ 2] reported an liquor and gestation age corresponding to incidence of 9.3% during 1965-85, recent her LMP. There was no fetal anomaly. and larger case series [ 3] reported it to be Thyroid function tests normal 1.2%.A pregnant diabetic is more prone to She was hospitalized in the high develop DKA as compared to a non- dependency unit and resuscitation started pregnant diabetic as normal metabolic with oxygen, aggressive intravenous fluids changes during pregnancy predispose to and insulin infusion. After maternal DKA. Majority of cases in pregnancy occur stabilisation and reversal of acidosis, patient in 2nd or 3rdtrimester, develop rapidly, at a was subjected to proper work up to explore lower blood glucose level and may not International Journal of Health Sciences & Research (www.ijhsr.org) 415 Vol.5; Issue: 3; March 2015 always manifest with the classic symptoms Correct injection technique is or laboratory findings. Maternal mortality important for insulin to be effective in from DKA has been reported between 4%– achieving glycemic control. Non-rotation of 15% from different studies. [ 4- 6] injection sites may result in localized Fetal loss rates may be as high as lipohypertrophy, degeneration or atrophy 10–25% for a single episode of DKA despite causing unpredictable and delayed substantial improvements in perinatal and absorption. Patient counseling regarding neonatal care. [ 7] injection technique at first visit and audit at Hyperemesis, infection, non- each subsequent visit is essential. [ 12, 13] compliance, insulin pump failure, β- Insulin injection site amyloidosis and zinc sympatheto-mimetic and corticosteroids for granulomas have also been reported preterm labor alongwith poor management affecting absorption kinetics. [ 14- 16] may be the precipitating factors. [ 8] Making a diagnosis is a step wise Symptoms of DKA are polyuria, process involving information gathering and polydipsia, nausea, vomiting, abdominal generating a hypothesis. Data acquisition pain, weakness, weight loss. Signs include begins with history, clinical examination and hyperventilation, ketotic breath, tachycardia, investigations. [ 16] hypotension, disorientation or coma. [ 7- 9] However in recent times we have Prompt recognition and management forgotten this stepwise approach –the of this medical emergency is essential in investigations are ordered without order to optimize feto-maternal outcome. examination and many a times the diagnosis Finding the underlying cause is important. A is missed or delayed because of this. careful history and physical examination We were able to find the underlying may elicit the precipitating cause or may cause of recurrent DKA as lipohypertrophy identify non-compliance with medical on examination. This reiterates the therapy. [ 9] importance of physical examination in Our case of DKA presented as making a diagnosis. nausea and vomiting as early as 7 weeks and Importance of physical diagnosis has been was labelled as hyperemesis gravidarum emphasized right from the time of [HG]. Each time she was admitted we were Hippocrates [460-370 B.C] to Laennec looking for a cause of HG investigating her [1816] to Osler. [ 17] for the same even in later pregnancy though A study found that 90% of HG rarely persists beyond 20 weeks. [ 10] physicians believed that physical The differential diagnosis of examination is important in patients of hyperemesis gravidarum includes urinary hypertension and rheumatology but only tract infection, uremia, thyrotoxicosis, laboratory tests were enough for diagnosis diabetic ketoacidosis, Addison disease, and management of diabetes mellitus and hypercalcemia, gastritis, peptic ulcer hyper-cholesterolemia. [ 18] However cases disease, pancreatitis, bowel obstruction, like ours prove that physical exam is and hepatitis drug-induced vomiting, central will remain important for diagnosing disease nervous system (CNS) disease, and and developing the patient-doctor vestibular disease. [ 11] relationship. [ 19] Inspite of all investigations and USG In Osler's words “Learn to see, learn we could not find a cause which was later to hear, learn to feel, learn to smell and elicited by history and examination. know that by practice alone can you become experts”. [ 20] The combination of a good International Journal of Health Sciences & Research (www.ijhsr.org) 416 Vol.5; Issue: 3; March 2015 history, thorough physical examination Gravidarum, Rev Obstet Gynecol. along with the correct use of investigations 2012;5(2):78-84. can help us become better diagnosticians to 11. Kalra S, Balhara YP, Baruah MP. provide the best care to our patients. Forum for Injection Techniques, India: The First Indian REFERENCES Recommendations for Best Practice 1. Parker J A, Conway D L.
Load more

Recommended publications
  • Opens in a New Tab As a Pdf Download
    FOR CATS FOR DOGS DIAGNOSIS AND MANAGEMENT OF GASTROINTESTINAL DISORDERS INTRO INTRODUCTION YOUR PARTNER Hill’s is here to support you to help your patients You can visit our professional website (www.hillsvet.co.uk or www.hillsvet.ie) for a wealth of useful information: PRODUCTS – Detailed product information, nutritional profiles, indications and contra-indications of Hill’s products. QUICK RECO – Do you want to make a written (or email) recommendation You can use this booklet as a concise reference to aid in the diagnosis and management for a particular patient? You can do so in just a few clicks. of gastrointestinal (GI) problems in cats and dogs, brought to you by Hill’s Pet Nutrition, your partner in education and nutritional excellence. ENQUIRIES – Our team of dietary consultants and Hill’s Veterinary Staff Clinicians are available to answer questions from veterinary staff and pet owners: CONTENTS INCLUDE: • Hill’s Customer Services Department 0800 282 438 / 1–800 626 002 (ROI) A broad overview of the normal anatomy and function of the GI tract. • Technical enquiries 01483464641 The signalment, symptoms and clinical signs, diagnostic tests, treatment and nutritional management of commonly encountered GI disorders. HILL’S VETERINARY NUTRITION ACADEMY is a unique online educational GENERAL POINTS: experience and is available at no cost to every member of the veterinary health care team. This booklet does not attempt to cover all GI diseases and is not a full diagnostic and management overview.* For more detailed information, please refer to veterinary text books.1 GI symptoms are concerning for caring owners and are a common reason for seeking a HILL’S DIGESTIVE INDEX APP - Score the severity of the signs of chronic veterinary consultation.
    [Show full text]
  • Diabetes Mellitus (Part One)
    JOURNAL OF CHINESE MEDICINE NUMBER 58 SEPTEMBER 1998 MODERN MEDICINE AND TRADITIONAL CHINESE MEDICINE DIABETES MELLITUS (PART ONE) by Clinton J. Choate 1. Background the conventional medical approach of simply using insulin There is nothing new about diabetes; it has been a medical or oral drugs to treat diabetes is incomplete and the person problem since antiquity. The name which was originated relying on them to prevent long-term complications re- by Aretaeus (30-90 CE) came from the Greek words mean- mains at risk. ing ‘siphon’ and ‘to run through’, signifying the chronic excretion of an excessive volume of urine. About Blood Sugar Diabetes mellitus, because of its frequency, is probably Carbohydrate is the active fuel of the body and is ordinarily the single most important metabolic disease and is widely the main source of energy of the tissue cell. In the normal recognized as one of the leading causes of death and disabil- digestive process, food sugars and starches (carbohydrates) ity in the United States. It affects every cell in the body and are changed into sugar glucose. This is stored in the form of the essential biochemical processes that go on there. glycogen (animal starch) in the liver and muscles for later Diabetes has been linked to the western lifestyle, as it is use as a body fuel, at which time it is reconverted into uncommon in cultures consuming a more primitive diet. glucose. Blood sugar rises somewhat after eating, and in As cultures switch from their native diets to more commercial healthy individuals returns to normal levels in about an foods, their rate of diabetes increases, eventually reaching hour or two.
    [Show full text]
  • Nutrition Strategies for Managing Diabetes in Healthcare 2.0
    Nutrition Strategies for Managing Diabetes in Healthcare 2.0 1 Overview Part 1 The 4 Goals of the American Diabetes Association’s Nutrition Therapy Recommendations Part 2 Stages of Change Motivational Interviewing AADE7 Self-Care Behaviors™ 2 Part 1 3 Review ………… ………… Outline 4 Types of Diabetes 4 ADA Nutrition 1. Pre-diabetes Recommendations 2. Gestational Diabetes 1. Eating patterns 3. Type 1 diabetes 2. Enjoy food 4. Type 2 diabetes 3. Individual needs 4. Tools and resources Carbohydrate Counting 1. What are carbohydrate foods? 2. How much is one choice? 3. How many choices to have at each meal and snack? 4 ADA Nutrition Recommendations: Goal 1 A. Promote and support healthful eating patterns, emphasizing a variety of nutrient-dense foods in appropriate portion sizes specifically to: Attain individualized glycemic, blood pressure, and lipid goals Achieve and maintain body weight goals Delay or prevent complications of diabetes Diabetes Diagnosis Lipid Healthy Glucose Hypertension Complications Disorders Lifestyle ADA Nutrition Recommendations, Diabetes Care (2013) ADA Standards of Care, Diabetes Care (2016) 5 Medical Nutrition Therapy (MNT): Impact on A1c Hemoglobin A1c is a blood measurement that reflects the level of glucose in the blood over the past 2-3 months MNT is effective in lowering A1c Type 1: 0.3 - 1% Type 2: 0.5 - 2 % Evidence The amount of carbohydrates and available insulin may be the most important factor influencing glycemic response after eating (A) Monitoring carbohydrate intake, whether by carbohydrate
    [Show full text]
  • Obesity: When to Consider Medication
    Obesity: When to consider medication These 4 cases illustrate how weight loss drugs—including the 4 newest— can be integrated into a treatment plan that includes diet, exercise, and behavior modification Katherine H. Saunders, MD; Alpana P. Shukla, MD, MRCP; Leon I. Igel, MD; and Louis J. Aronne, MD odest weight loss of 5% to 10% Until recently, there were few pharma- among patients who are overweight cologic options approved by the US Food M or obese can result in a clinically and Drug Administration (FDA) for the relevant reduction in cardiovascular (CV) management of obesity. The mainstays of disease risk.1 This amount of weight loss can treatment were phentermine (Adipex-P, Ion- increase insulin sensitivity in adipose tissue, amin, Suprenza) and orlistat (Alli, Xenical). liver, and muscle, and have a positive impact Since 2012, however, 4 agents have been on blood sugar, blood pressure, triglycerides, approved as adjuncts to a reduced-calorie 1,2 and high-density lipoprotein cholesterol. diet and increased physical activity for long- IN THIS All patients who are obese or overweight term weight management.8,9 Phentermine/ ARTICLE with increased CV risk should be counseled topiramate extended-release (ER) (Qsymia) on diet, exercise, and other behavioral inter- and lorcaserin (Belviq) were approved Antiobesity 3 10,11 ventions. Weight loss secondary to lifestyle in 2012, and naltrexone sustained re- medication details modification alone, however, leads to adap- lease (SR)/bupropion SR (Contrave) and page 42 tive physiologic responses, which increase liraglutide 3 mg (Saxenda) were approved appetite and reduce energy expenditure.4–6 in 201412,13 (TABLE9,14–39).
    [Show full text]
  • Gastroenteritis in Dogs
    Dog Diseases & Conditions A-Z - Page 1/2 Gastroenteritis in Dogs Overview A complete blood count to evaluate Gastroenteritis is an irritation of the stomach and inflammation, infection, anemia, and other intestines; it usually results in vomiting and diarrhea blood-related conditions . There are several causes of gastroenteritis: metabolic Electrolyte tests to ensure your dog is neither disorders, dietary indiscretion (this means ingesting dehydrated nor suffering from an electrolyte inappropriate things, like garbage or the feces of other imbalance animals), inflammatory bowel disease, parasites, X-rays of the abdomen to evaluate for foreign bacteria, viruses, or allergies can all cause vomiting and material and/or obstruction of the diarrhea. gastrointestinal tract Ultrasound imaging of your dog’s digestive tract One of the leading causes of gastroenteritis is feeding a and other major abdominal organs pet “people” food or table scraps. An obstruction in the An endoscopy to evaluate the lining of the digestive tract can also trigger gastroenteritis, so a stomach and intestinal tract missing sock or favorite holiday ornament could also be Specific tests to rule out viral infections, such as the culprit. parvovirus Fecal tests to identify if fecal parasites could be Risk and Signs the cause All dogs and puppies are at risk for gastroenteritis, Special fecal tests, such as cultures and which can cause extreme vomiting and diarrhea, polymerase chain reaction (PCR) testing leading to dehydration and an electrolyte imbalance. Contact your veterinarian immediately if the vomiting Dogs with gastroenteritis, regardless of the cause, are and diarrhea persist. often dehydrated and sometimes need to be given fluids under the skin (subcutaneously) or directly into a In addition to vomiting and diarrhea, your pet may vein (intravenously).
    [Show full text]
  • Diabetic Ketoacidosis Management Protocol
    DIABETIC KETOACIDOSIS MANAGEMENT PROTOCOL Table of Contents I. Introduction ………………………………………………………………………... 2 II. Goals ………………………………………………………………………………. 3 III. General Evaluation ………………………………………………………………... 4 Physical signs/Coma scale ………………………………………………… 4 Assessment of dehydration ………………………………………………... 6 Assessment of acidosis ……………………………………………………. 7 Initial laboratory studies …………………………………………………... 8 Serial laboratory monitoring ………………………………………………. 9 IV. Treatment ………………………………………………………………………….. 10 Fluid therapy ………………………………………………………………. 10 Glucose ……………………………………………………………………. 12 Bicarbonate ………………………………………………………………... 13 Sodium …………………………………………………………………….. 15 Potassium ………………………………………………………………….. 15 Phosphorous ………………………………………………………………. 17 Calcium …………………………………………………………………… 18 Magnesium …………………………………………………………………18 Insulin ………………………………………………………………………19 Continuous low dose insulin infusion …….……………………………19 Intermittent subcutaneous insulin …..…………………………………. 22 Intramuscular insulin ………………………………………………….. 24 V. Follow-up ………………………………………………………………………….. 25 VI. Complications of DKA therapy …………………………………………………… 27 Cerebral edema ……………………………………………………………. 27 Other ………………………………………………………………………. 29 VII. Nuts and Bolts …………………………………………………………………….. 30 VIII. Bibliography ………………………………………………………………………. 34 1 DIABETIC KETOACIDOSIS MANAGEMENT PROTOCOL “The key to successful management of DKA is….CAREFUL ATTENTION TO DETAIL!” I. INTRODUCTION/DEFINITION: Diabetes Ketoacidosis is one of two serious, acute life-threatening complications of Type I, insulin deficient
    [Show full text]
  • Dealing with Diarrhea in Dogs & Cats
    What to Do About “The Trots” Dealing with Diarrhea In Dogs & Cats Wendy Blount, DVM • Contents of the gut are actually outside the body • This illustrates the importance to the integrity of the mucosal GI barrier, which must be selectively permeable • GALT (gut associated lymphoid tissue) monitors what and what does not enter into the body Gut Tissue Layers 1. Mucosa 2. Submucosa/Lamina Propria 3. Muscularis – Longitudinal smooth muscle – Submucosal nerve plexus – Circular smooth muscle – Myenteric nerve plexus – Longitudinal smooth muscle 4. Serosa - connects to mesentery, everywhere but esophagus and rectum Gut Tissue Layers Memory Aid: “The Sun is Bright • Submucosa is white • Serosa is white • S#!t is white And it’s Dark at Midnight.” • Mucosa is black • Muscularis is black DDx Diarrhea • Extra-intestinal causes (13%) – Everything that causes vomiting – Exocrine pancreatic insufficiency • Intra-intestinal causes (87%) – 52% are food responsive – 12% IBD – 9% antibiotic responsive diarrhea – 3% prednisone responsive but no inflammation on histopath – 12% GI parasites (Volkmann et al, 2012) Acute vs. Chronic Diarrhea • Most cases of acute diarrhea respond to empirical therapy • HGE is a particular clinical picture that responds well if treated early • We will spend most of the hour talking about chronic diarrhea Diagnostics for Diarrhea 1. Empirical Treatment 2. MDB – CBC, panel, electrolytes – Urinalysis – Fecal flotation and direct smear (repeated) – Heartworm test for dogs, FeLV/FIV for cats – T4 and free T4 for cats (55% v, 30%
    [Show full text]
  • Gastroenteritis/Colitis
    Gastroenteritis/Colitis What is gastroenteritis and colitis? Gastroenteritis is a medical term referring to inflammation of the gastrointestinal tract, usually the stomach and intestines. Colitis refers to inflammation of the colon (aka the large intestine). It can be caused by infection with bacteria (or abnormal growth of bacteria which normally inhabit the GI tract), viruses, parasites, or reactions to medications or new foods. It often involves abdominal discomfort or pain, diarrhea and/or vomiting. When the colon is involved the diarrhea may be streaked with bright red blood. What are the signs of gastroenteritis/colitis? Most dogs with gastroenteritis will have intermittent episodes of vomiting and diarrhea. The vomit may contain foamy, yellowish bile, especially after the stomach has been emptied. Many owners will observe "dry heaving" or "gagging" after their pet eats or drinks. The diarrhea can range from soft “ice cream” consistency to very watery, and may be frequent. Some owners will observe their dogs straining to defecate with no stool produced after earlier episodes of diarrhea – this is called tenesmus and indicates inflammation of the colon, not constipation. Many dogs will be tender when picked up around the abdomen or will resist handling of the stomach and hindquarters. Most dogs will appear less active and have a decreased appetite. A low-grade fever is common. Dehydration can occur quickly if the vomiting and diarrhea persists for more than twenty-four hours What causes gastroenteritis/colitis? There are many causes
    [Show full text]
  • Sudden (Acute) Vomiting
    Customer Name, Street Address, City, State, Zip code Phone number, Alt. phone number, Fax number, e-mail address, web site Sudden (Acute) Vomiting Basics OVERVIEW • “Vomiting” is the forceful ejection of stomach contents up through the mouth • “Acute” is an adjective used in medical writing to indicate a sudden or rapid onset and short course of a disease or medical condition • Sudden (acute) vomiting is defined as vomiting of short duration (less than 5–7 days) and of variable frequency • The gastrointestinal tract includes the stomach, small intestines, and large intestines (known as the “colon”) SIGNALMENT/DESCRIPTION OF PET Species • Dogs • Cats SIGNS/OBSERVED CHANGES IN THE PET • Variable vomiting of food and/or fluid (may be clear, yellow- tinged [containing bile from the upper small intestine], or blood-stained) • Ingestion of foreign material may be observed in some pets • Variable sluggishness (lethargy) and appetite loss; may see diarrhea and/or black, tarry stools (due to the presence of digested blood; condition known as “melena”) • May include signs of dehydration, such as dry gums and normally moist tissues of the body (moist tissues are known as “mucous membranes”); reduced skin turgor (turgor is the normal fullness or tension of tissues resulting from fluid content); sunken eyes; pale mucous membranes; rapid heart rate (known as “tachycardia”); and weak pulses; other findings on physical examination may include fluid-filled bowel loops; excessive gut sounds; abdominal pain, which may be localized (such as from a foreign
    [Show full text]
  • Pancreatitis? Acute Pancreatitis Is Defined As a Sudden Onset of Inflammation of the Pancreas
    THE BARRACKS VET SURGERY MOSMAN A C U T E P A N C R E A T I T I S What is acute pancreatitis? Acute pancreatitis is defined as a sudden onset of inflammation of the pancreas. It is usually with associated cranial abdominal pain (seen by a bowing posture) and persistent vomiting. Often it follows a “dietary indiscretion” such as raiding a bin or being given rich food. What causes pancreatitis? The amylase and lipase enzymes that digest food are normally stored in the pancreas as inactive zymogens until they are released as needed for food digestion. However sometimes, characteristically after a high fat meal, the enzymes activate whilst still inside the pancreas, causing painful self-digestion. Other causes of pancreatitis include infection, injury to the abdomen, ingestion of medications, and insecticides to control fleas and ticks, such as organophosphates. Pancreatitis may accompany inflammatory bowel disease (IBD), diabetes, or liver disease. What are some symptoms of pancreatitis? Many pets will hide the symptoms lest they appear vulnerable to competitors or predators. If you notice any of the following symptoms, you should visit a Vet without delay. • Persistent vomiting. • Anorexia (lack of appetite, not eating). • Cranial abdominal pain (may crouch or bow down). • Dehydration (the skin may “tent” when lifted, eyes may appear sunken, gums tacky). • Shock - which is when the body reduces blood flow to extremities. Signs include: cold extremities/ears, rapid heart rate, slow shallow breathing, slow capillary refill time, (the time it takes pinkness to return when you press your finger against the pet’s gum), cold dry mucous membranes, possibly collapse and convulsions.
    [Show full text]
  • Pancreatitis in Cats
    Getting Nutrition into a Cat Craig Webb, DVM, DACVIM Colorado State University Fort Collins, CO Our understanding of feline nutrition has advanced significantly from the day when we simply considered them small dogs, and the number of options we now have for dietary intervention in this species has expanded exponentially. But neither the knowledge of feline metabolism nor the number of available diets helps us, or the cat, one bit, if we can’t get the stuff into them. When a Labrador retriever refuses to eat we know the prognosis is grave: when a cat refuses to eat it may well be that they have decided that the presentation of their latest meal was not up to standards. Unlike Labrador retrievers, cats are one-trial learners, so make the mistake of trying sneak a medication into the one particular flavor of food the cat will tolerate, and that may well be the last time you get anything into that cat’s mouth. Try to switch diets on a Labrador and you might get a brief pause as the dog considers the phrase “fool me once, please!”. Try to switch diets on a cat, for its own good mind you, and suffer an expression of disdain and an attitude of incredulous indignation. So of course, what is perhaps the single most common clinical expression of almost anything wrong with a cat? A decreased-to-absent appetite. And what are the consequences of anorexia in a cat compared to a Labrador? Well cats have their own specific condition for just that – hepatic lipidosis.
    [Show full text]
  • The Treatment of Obesity : a Review of the Literature and a Follow-Up Study of Fasted Patients Steven Arthur Schwartz Yale University
    Yale University EliScholar – A Digital Platform for Scholarly Publishing at Yale Yale Medicine Thesis Digital Library School of Medicine 1975 The treatment of obesity : a review of the literature and a follow-up study of fasted patients Steven Arthur Schwartz Yale University Follow this and additional works at: http://elischolar.library.yale.edu/ymtdl Recommended Citation Schwartz, Steven Arthur, "The treatment of obesity : a review of the literature and a follow-up study of fasted patients" (1975). Yale Medicine Thesis Digital Library. 3147. http://elischolar.library.yale.edu/ymtdl/3147 This Open Access Thesis is brought to you for free and open access by the School of Medicine at EliScholar – A Digital Platform for Scholarly Publishing at Yale. It has been accepted for inclusion in Yale Medicine Thesis Digital Library by an authorized administrator of EliScholar – A Digital Platform for Scholarly Publishing at Yale. For more information, please contact [email protected]. YALE MEDICAL LIBRARY Permission for photocopying or microfilming of " I I (TITLE OF THESIS) for the purpose of individual scholarly consultation or reference is hereby granted by the author. This permission is not to be interpreted as affect¬ ing publication of this work or otherwise placing it in the public domain, and the author reserves all rights of ownership guaranteed under common law protection of unpublished manuscripts. Signature of Author Digitized by the Internet Archive in 2017 with funding from The National Endowment for the Humanities and the Arcadia Fund https://archive.org/details/treatmentofobesiOOschw THE TREATMENT OF OBESITY A Review of the Literature and a Follow-up Study of Fasted Patients Steven Arthur Schwartz, B.
    [Show full text]