Sunday, October 23, 2011

Ai, Chihuahua!

I got to have my very own high-maintenance CCU inpatient during the second half of my week of CCU day shifts. (A little clarification: most of the patients in CCU are under the "primary care" of another service -- like surgery, medicine, or oncology -- meaning that the doctor in charge of that patient's care comes from one of those services, and the patient's "primary student" also comes from that specialty service. The primary student is responsible for all of the communication with the clients [or making sure the DVM is giving the client updates], doing a physical exam on the patient every morning, writing new CCU orders, obtaining all drugs needed for that patient while in CCU, and, most fun of all, writing a daily "SOAP" which is an assessment of the patient's current status and a discussion of all of the patient's medical problems. Occasionally, however, a patient in CCU is under the primary care of one of the CCU clinicians, so one of the CCU day students "gets" to be the primary student on the case, meaning you "get" to take over all of the above responsibilities in addition to your already "action-packed" and "fun-filled" day of menial CCU tasks. So no, I was not overly excited to have my own CCU patient.)

Aside from the bureaucratic nonsense and busywork, though, I really liked my sad little patient, a middle-aged Chihuahua who presented in acute oliguric renal failure.

"Renal failure" means your kidneys have stopped working, or are close to it. "Acute" means it happened all of a sudden, versus being a drawn out process over months or years. "Oliguric" means "small urine," in that the kidneys have lost their ability to produce a normal amount of urine, so it's extraordinarily difficult for the body to remove excess fluid and waste/byproducts that are normally peed out. (However, "oliguric" is better than "anuric," which means no urine production.)

After many diagnostics, we determined the most likely cause for Mr. Chihuahua's acute renal failure to be leptospirosis, a nasty bacterial infection usually spread through contact with urine or contaminated standing water.

In addition to his renal failure, Mr. Chihuahua also had ongoing liver disease (also possibly caused by leptospirosis), unhappy muscles, complete loss of appetite, nausea and occasional vomiting, intermittent seizures, and diarrhea.

Since leptospirosis can be spread to people Mr. Chihuahua got his very own "isolation" area requiring people handling him and his urine/stools to wear a plastic gown, latex gloves, a cloth face mask, and plastic goggles. He also got 2 IV catheters (since he was on so many IV medications that many of them could not be combined into the same IV line because they didn't mix well), a urinary catheter, and a nasoesophageal feeding tube (which we fed down his throat through one of his nostrils, then stapled to his face. With a staple gun. While he was awake.).

Anyhow, Mr. Chihuahua was a pathetic mess for the longest time (okay, only about 4 days, but it felt like forever). Finally, he started producing massive amounts of urine (thus transitioning from oliguric ["small urine"] to polyuric ["many urine"] renal failure). Seriously, normal urine production is about 1-2 milliliters of urine per kilogram of body weight per hour, and Mr. Chihuahua got up to 25 ml/kg/hr. Yeesh.

Finally, after 9 days in the hospital, Mr. Chihuahua went home with a tiny appetite, no recent seizures, only a handful of medications, daily subcutaneous fluids to be given at home, and normal kidney values on his bloodwork! It's a testament to what we all need to be reminded of periodically: though the odds may be small, some animals can pull through even the most severe disease conditions if given a chance (and 9 days in CCU, and about $7000).

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