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Old 08-20-2014, 11:21 PM   #1 (permalink)
marbury
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Join Date: Apr 2012
Location: WA
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Default Medical Mystery!

OK, guys! How about a challenge?

4 year 4 month old female spayed GSD. Known history of enlarged spleen. Ultrasound performed, aspirates taken with unremarkable findings (secondary inflammation of the spleen). All other systems normal.

On Sunday (8/17) she was given a tiny 0.3cc bump of torb (torbugesic) as a prep drug for a blood donation. CBC normal, exam normal. Slightly distended soft abdomen which is normal for her. 33.6kg, TPR normal. She donated just over 475ml of whole blood. She received 700ml SQ LRS and was eating and drinking normally an hour after her donation. Appeared normal, happy, slightly tired as would be expected from a donor.

Monday (8/18) normal, happy, active, eating and drinking readily. After dinner bedtime was normal. No apparent physical changes.

Tuesday (8/19) asks to go out in morning to vomit, emesis is substantial quantity of undigested kibble from previous night. Waist is pinched with distended abdomen. Begins refusing food mid-day and refuses water mid-afternoon. Vomiting continues, transitions from undigested food to food and bile and finally to clear liquid with light white foam. Visible discomfort in abdomen, pacing, restless. TPR normal. Lethargic, begins showing signs of dehydration.
We went into work and did a full blood panel and an ultrasound. Weight was 30.6kg. Everyone who knew her remarked that she looked awful. At this point she was fairly skeletal with a pendulous distended abdomen. Blood panel was unremarkable. Ultrasound came back with an extremely enlarged spleen, enlarged splenic lymph node, and enlarged blood supply to spleen. Small (1cm) pocket of fluid along the spleen. Pyloris functional, small amount of food in small bowel. Large bowel normal but completely empty. We did a SQ Cerenia inj. and 600ml SQ LRS.
She perked up after the meds but would not eat or drink when we got home. She vomited twice after her Cerenia.

Today, 8/20 short choppy breathing while sleeping. Temp normal, resp shallow, pulse decreased. Marked discomfort, multiple attempts to vomit, urgency to pass stool. No stool; passing clear mucous jelly. Trouble laying down but marked lethargy. No interest in food or water.
In afternoon we headed back to work. Weight down to 29.2kg. Put on IV fluids and some buprenex to keep her comfortable. I left her there for a second ultrasound, radiographs, and repeat bloodwork. Bloodwork again unremarkable save for the expected dehydration, ultrasound increased size of spleen, increased amount of fluid. Abdominal x-ray shows food in the colon but she continues to only pass the clear jelly with urgency (5-10 minute intervals). Fluid tap glucose compared to blood glucose suggests sepsis.

No exposure to raw fish, no known exposure to pesticides or rodenticides, no change in environment or new places, no medications, flea and hw prevention last given 8/1.

Current theories are intermittent torsion, either splenic or colonic, that we're just not catching in action.

We've successfully stumped two radiologists, four ER doctors, two surgeons, two Internal Medicine specialists, and a whole batch of interns. She's continuing on IV drip for dehydration overnight for a reassessment tomorrow or emergency surgery overnight. She's stable but darn it if we can't find an explanation for what's happening.

Ideas? Anything out of the box is welcome.
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