PDF(Pubmed)
Abstract：
A 6-year-old castrated male Labradoodle was referred in uncompensated hypovolemic shock, with a 72-h history of lethargy, vomiting and diarrhea that had acutely worsened with subsequent development of profuse hemorrhagic diarrhea in the last 24 h after a visit to the groomer. In most respects this case was classic for a patient with a primary hypoadrenocortical crisis. After initial attempts to address hypovolemia and refractory hypotension, no clinical improvement was seen, and the respiratory rate had increased acutely to 80 bpm with crackles detected on thoracic auscultation and serosanguineous fluid began draining from the nose and mouth. An arterial blood gas sample while breathing room air revealed moderate hypoxemia (PaO2 59.9: RI 95-100 mmHg), an elevated alveolar-arterial (A-a) gradient at 54.7 (RI < 15 mmHg) and a PaO2:FiO2 ratio of 285 mmHg. Thoracic radiographs revealed severe bilateral alveolar lung pattern largely limited to the perihilar and caudodorsal lung fields. The radiographic findings, along with signs of ongoing hypovolemia, the lack of evidence of typical long-standing acquired cardiac disease, and the rapid resolution of the pulmonary edema without the need for diuretics or long-term cardiac medications supported non-cardiogenic pulmonary edema. The proposed cause of the non-cardiogenic pulmonary edema was speculated to be neurogenically mediated. Oxygen supplementation along with mineralocorticoid and glucocorticoid replacement therapy was sufficient for the management of the non-cardiogenic pulmonary edema in this case.
摘要：
一名6岁cast割的男性拉布拉多犬在未补偿的低血容量性休克中被转诊，有72小时的嗜睡史，在拜访美容师后的最后24小时内，呕吐和腹泻急剧恶化，随后出现大量出血性腹泻。在大多数方面，这种情况对于原发性肾上腺皮质发育不全的患者来说是经典的。在最初尝试解决低血容量和难治性低血压后，没有看到临床改善，呼吸频率急剧增加至80bpm，在胸部听诊时发现了裂纹，浆血液开始从鼻子和嘴巴排出。呼吸室内空气时的动脉血气样本显示中度低氧血症（PaO259.9：RI95-100mmHg），肺泡动脉（A-a）梯度升高，为54.7（RI<15mmHg），PaO2：FiO2比为285mmHg。胸部X光片显示严重的双侧肺泡肺模式主要限于肺门周围和后背肺野。射线照相的发现,伴随着持续低血容量的迹象，缺乏典型的长期获得性心脏病的证据，和肺水肿的快速消退，而不需要利尿剂或长期心脏药物支持非心源性肺水肿。推测非心源性肺水肿的拟议原因是神经源性介导的。在这种情况下，补充氧气以及盐皮质激素和糖皮质激素替代疗法足以治疗非心源性肺水肿。
