一只2个月大的家养短小小猫被提出来评估弱点,步态异常,以及创伤后疼痛的迹象.一入场,发现患者侧卧位,明显步态异常:坐位困难和明显的单侧左后肢跛行。在骨科检查中,剧烈疼痛,心事,并检测到左后肢肿胀。首次诊断检查结果均符合低钠血症,低氯血症和Salter-HarrisI型骨折。小猫最初接受等渗液体,镇痛,和止吐治疗。入院后十二小时,镇痛计划被认为是不充分的,一般病人的病情恶化,表现出严重的精神抑郁。收集血液和尿液样本以进行更深入的诊断评估;患者表现为低钠血症恶化(113mmol/L;[RR:146,2-156,2]),重度血浆低渗透压(218.2mOsm/kg;[RR:287-307mOsm/kg]),高利钠(Na:74.9mmol/L;[RR:<40mmol/L]),和尿高渗透压(630mOsm/kg;[RR:<150mOsm/kg])。根据这些新的临床发现,诊断出抗利尿激素(SIADH)分泌不当综合征。然后开始使用高渗盐水进行紧急治疗,开始恒速输注3%高渗盐水以增加血浆钠,并使用loop利尿剂,呋塞米(1mg/kg/IV),以12小时的间隔给药以诱导利尿。入院后4天发生出院,因为患者临床稳定,低钠血症逐渐消退。据作者所知,这是有关小猫发展与骨科创伤相关的SIADH疼痛的第一份报告。
A 2-month-old domestic shorthair kitten was presented for evaluation of weakness, gait abnormalities, and signs of pain after trauma. On admission, the patient was found laterally recumbent with obvious gait abnormalities: difficulty rising from sitting and marked unilateral left hind limb lameness. On orthopedic examination, severe pain, crepitations, and swelling of the left hind limb were detected. Results of the first diagnostic work-up were all consistent with hyponatremia, hypochloremia and a Salter-Harris type I fracture. The kitten initially received isotonic fluids, analgesia, and antiemetic treatment. Twelve hours after admission, the analgesic plan was considered insufficient, and the general patient\'s condition worsened, showing severe mental depression. Blood and urine samples were collected for a more in-depth diagnostic evaluation; the patient showed worsening hyponatremia (113 mmol/L; [RR: 146,2-156,2]), severe plasma hypoosmolality (218.2 mOsm/kg; [RR: 287-307 mOsm/kg]), high natriuresis (Na: 74.9 mmol/L; [RR: <40 mmol/L]), and urinary hyperosmolality (630 mOsm/kg; [RR: <150 mOsm/kg]). Based on these new clinical findings syndrome of inappropriate antidiuretic hormone (SIADH) secretion was diagnosed. Emergency treatment with hypertonic saline was then instituted, a constant rate infusion of 3% hypertonic saline infusion to increase plasma sodium was initiated and a loop diuretic, furosemide (1 mg/kg/IV), was administered at 12-hour intervals to induce diuresis. Discharge occurred 4 days after admission as the patient was clinically stable and the hyponatremia progressively resolved. To the author\'s knowledge this is the first report of a kitten developing pain related SIADH associated to orthopedic trauma.