-6 year old DSH on chronic (every 5-6 weeks) Depo-medrol injections to control steroid-responsive airway disease
-presented for 1 day history of inappetance, subsequently devleoped fever
-bloodwork unremarkable, liver enzymes normal (on more than one occasion)
-severely lipemic blood
-blood glucose has varied from 120 – 305, has significant glucosuria
-She has responded well to therapy and is eating well now on her own (she has been hospitalized for 5 days). I anticipate releasing her tomorrow.
-6 year old DSH on chronic (every 5-6 weeks) Depo-medrol injections to control steroid-responsive airway disease
-presented for 1 day history of inappetance, subsequently devleoped fever
-bloodwork unremarkable, liver enzymes normal (on more than one occasion)
-severely lipemic blood
-blood glucose has varied from 120 – 305, has significant glucosuria
-She has responded well to therapy and is eating well now on her own (she has been hospitalized for 5 days). I anticipate releasing her tomorrow.
Questions are about long-term management:
-I was convinced she was developing fatty liver disease but the enzymes never matched up. Is that more likely steroid hepatopathy (I know you need a needle to know for sure…)
-How much do you think the chronic steroid use contributed to her current problems?
-My plan is to try oral steroids when she needs them (has already started coughing a little) and see about getting her on inhaled fluticasone.
Thanks!
Suzanne
Comments
I dont like th efree fluid
I dont like th efree fluid and reactive omentum around that thickened bowel. Watch for underlying lymphoma or complicated ibd and the pancreatitis may be secondary. SAp half life is < 12 hours in a cat (72 hours in a dog) so clinical lipidosis always has rising sap in cats. Mild non clinical lipidosis can be there but any time liver-lipidosis is a clinical player expect the sap to be up. The depomedrol may have been masking an intestinal lymphoma here. With that bowel in your second video and the reactive fat I would be going in for a shipping spree of bx or tap the fluid and spin it down looking for bacteria-peritonitis or lymphoma/carcinoma cells. Bowel infarctions can look like this if focally painful as well as spontaneous necrosis. Much more than a simple pancreatitis here unfortunately.Fna of the left panc limb in video one would be helpful too.
Depo-Medrol can cause
Depo-Medrol can cause diabetes but this cat’s blood glucose not typical for diabetes but can be pre-diabetic. I would attribute the lipemia to the Depo. Safer in the long run to use short acting prednisone and better to go for the inhaled cortisone. Can also consider using cyclosporin for the airway disease.
Just for the record, I did
Just for the record, I did not initiate the depo-medrol treatment.
I am going to recheck her on Friday and see how her pancreas looks. Then we will consider when/whether to biopsy the small bowel.
Thanks again!
Suzanne