转-小狗的细小病毒感染

Day 1(第一天)

• Blood glucose: 57 mg/dL (glucometer). Administered 1 mL 50% dextrose bolus IV
• Hospitalization, Plasmalyte* + 5% dextrose + 40 mEq/L potassium chloride IV, dolasetron (0.5 mg q24h IV), ampicillin (20 mg q8h IV), famotidine (1 mg q24h IV)
• Blood analysis (after 6 hr of fluids, dextrose CRI)
• • Sodium: 131 mEq/L (range, 142–150)
  • Potassium: 2.8 mEq/L (range, 3.4–4.9)
  • Chloride: 91 mEq/L (range, 106–127)
  • Glucose: 114 mg/dL (range, 60–115)
  • Blood urea nitrogen: 13 mg/dL  (range, 10–26)
  • Hematocrit: 31% (range, 35–50)
• A multiple electrolyte intravenous solution
• • pH: 7.34 (range, 7.35–7.45)
  • Packed cell volume/total solids: 33%/3.9 (ranges, 36–60/5.0–7.4)
  • White blood cells: 4.5 × 103/μL (range, 6–17)
  • Platelets:  42.6 × 104/μL (range, 20–50)
• Blood type: DEA 1.1 positive

Day 2(第二天)
The puppy was recumbent and dull throughout the morning. At about midnight, blood values as reported above remained the same. New values:

• Creatinine: 0.2 mg/dL (range, 0.3–1.2)
• Albumin: 1.7 g/dL (range, 2.1–3.6)
• Alanine aminotransferase: 78 U/L (range, 8–75)
• Lymphocytes:  1.1 X 103/μL (range, 0 .9–5)

At 3:00 AM, the first transfusion of hyperimmune plasma (8 mL DEA negative over 3 hours) was administered.

• 8:00 AM exam
• • Temperature: 99.4⁰F
  • Heart rate: 200 bpm
  • Painful abdomen
  • Bloody diarrhea, regurgitation overnight
• Administered bolus of 18 mL crystalloid fluids IV, 1 mL 25% dextrose IV. Recheck: 
• • Heart rate 90 bpm
  • Blood pressure: 95

Started metoclopramide CRI (1 mg/kg/d; 1 mL/hr).

• 9:00 AM blood values
• • Sodium: 132 mEq/L (range, 142–150)
  • Potassium: 2.9 mEq/L (range, 3.4–4.9)
  • Chloride: 99 mEq/L (range, 106–127)
  • Glucose: 42 mg/dL (range, 60–115)
  • Blood urea nitrogen: 8 mg/dL (range, 10–26)
  • Hematocrit: 24% (range, 35–50)
  • pH: 7.30 (range, 7.35–7.45)
• 10:00 AM:  Hyperimmune plasma (2nd transfusion) 8 mL DEA negative over 2 hours
• 4:00 PM blood values
• • Sodium: 132 mEq/L (range, 142–150)
  • Potassium: 2.9 mEq/L (range, 3.4–4.9)
  • Chloride: 101 mEq/L (range, 106–127)
  • Glucose: 55 mg/dL (range, 60–115)
  • Blood urea nitrogen:  5 mg/dL (range, 10–26)
  • Hematocrit: 26% (range, 35–50)
  • pH 7.38 (range, 7.35–7.45)
• Administered 1 mL 25% dextrose bolus; increased dextrose CRI to 7.5%. In the afternoon, puppy was brighter, with minimal diarrhea and one episode of regurgitation. No interest in eating.
• Treatment:
• • Medications
  • • Ampicillin (20 mg q8h IV)
    • Dolasetron (0.5 mg IV)
    • Enrofloxacin (8 mg q24h IV)
    • Metronidazole (8 mg q12h IV)
    • Famotidine (1 mg q24h IV)
    • Maropitant (0.8 mg q 24h SC)
    • Metoclopramide (1 mg/kg/day at 1 mL/hr)
    • Hetastarch (0.6 mL/hr IV)
    • Buprenorphine 0.007 mg IV (8:00 AM and 4:00 PM)
  • Fluids
  • • Plasmalyte (5 mL/hr) + 7.5% dextrose and 50 mEq/L potassium chloride––all IV
• 第三天

• Day 3
  Throughout the morning the puppy was brighter, with no interest in food, although he tolerated syringe feeding. Hemorrhagic diarrhea had been seen overnight, with one episode of regurgitation. Maintained normoglycemia overnight. Abdomenwas comfortable.

  • 2:00 AM blood values
  • • Sodium: 130 mEq/L (range, 142–150)
    • Potassium: 3.8 mEq/L (range, 3.4–4.9)
    • Glucose: 101 mg/dL (range, 60–115)
    • Hematocrit: 27% (range, 35–50)
    • pH: 7.336 (range, 7.35–7.45)
    • Ionized calcium: 1.06 mmol/L (range, 1.12–1.4)
  • 9:00 AM blood values
  • • Sodium: 129 mEq/L (range, 142–150)
    • Potassium: 3.8 mEq/L (range, 3.4–4.9)
    • Chloride: 100 mEq/L (range, 106–127)
    • Glucose: 114 mg/dL (range, 60–115)
    • Blood urea nitrogen: <3 mg/dL (range, 10–26)
    • Hematocrit: 28% (range, 35–50)
    • pH: 7.37 (range, 7.35–7.45)
  • Treatment:
  • • Medications
    • • Ampicillin (20 mg q8h IV)
      • Dolasetron  (0.5 mg q24h IV)
      • Enrofloxacin  (8 mg q24h IV)
      • Metronidazole (8 mg q12h IV)
      • Famotidine (0.4 mg q24h IV)
      • Maropitant (0.3 mg q24h SC)
      • Metoclopramide (1 mg/kg/d at 2 mL/hr CRI)
      • Hetastarch: (0.6 mL/h IV)
    • Fluids
    • • Plasmalyte (3 mL/hr) + 2.5% dextrose and 20 mEq/L potassium chloride IV. Changed IV fluids to 0.9% sodium chloride + 2.5% dextrose and 30 mEq/L potassium chloride at 6:00 PM.
      • Syringe fed throughout the day.

   Day 4

  • 3:00 AM:  Puppy was weak and ataxic.
  • • Glucose:  21 mg/dL (range, 60-115)
    • Administered  0.8 mL bolus of 25% dextrose; increased dextrose CRI to 5%.
  • 6:00 AM blood values
  • • White cells: 400/μL (range, 6,000–17,000)
    • Lymphocytes: 300/μL (range, 900–5,000)
    • Platelets: 88/μL (range, 200,000–500,000)
    • Glucose: 40 mg/dL (range, 60–115)
    • Packed cell volume/total protein:  23%/3.2 g/dL (ranges, 36–60/5.0–7.4)
  • 8:00 AM: Puppy was dull and weak.
  • • Temperature: 97.6⁰F
    • Heart rate: 160 bpm
    • Blood pressure: 90 bpm
    • Blood values
    • • Sodium: 137 mEq/L (range, 142–150)
      • Potassium: 2.0 mEq/L (range, 3.4–4.9)
      • Chloride: 102 mEq/L (range, 106–127)
      • Glucose: <20 mg/dL (range, 60–115)
      • Blood urea nitrogen: 6 mg/dL (range, 10–26)
      • Hematocrit: 19% (range, 35–50)
      • pH: 7.389 (range, 7.35–7.45)

  Administered 1 mL 25% dextrose bolus; increased dextrose CRI to 7.5% and potassium chloride supplementation to 60 mEq/L––all IV.

  • 11:00 AM treatment
  • • Hyperimmune plasma (3rd transfusion; 8 mL DEA negative over 2 hours)
    • Additional bolus of dextrose after completing transfusion
    • Started partial parenteral nutrition, at 70% of puppy’s resting energy requirement
  • 4:00 PM blood values
  • • Sodium: 133 mEq/L (range, 142–150)
    • Potassium: 2.2 mEq/L (range, 3.4–4.9)
    • Chloride: 105 mEq/L (range, 106–127)
    • Glucose: 28 mg/dL (range, 60–115)
    • Blood urea nitrogen: 5 mg/dL (range, 10–26)
    • Hematocrit: 20% (range, 35–50)
    • pH: 7.492 (range, 7.35–7.45)

  Administered fresh frozen plasma (4th transfusion; 8 mL DEA positive over 2 hours). Posttransfusion blood glucose: 32 mg/dL

  • Treatment throughout day:
  • • Medications
    • • Ampicillin (20 mg q8h IV)
      • Enrofloxacin (8 mg q24h IV)
      • Metronidazole (8 mg q12h IV)
      • Famotidine (0.8 mg q24h IV)
      • Dolasetron (0.5 mg q24h SC)
      • Metoclopramide (2 mg/kg/d IV CRI)
    • Fluids
    • • Sodium chloride (0.9%; 3 mL/hr) + 7.5% dextrose and 60 mEq/L potassium chloride IV
      • Hetastarch: (0.6 mL/hr IV)
    • Nutrition
    • • Partial parenteral nutrition (4 mL/hr IV)

  Day 5

  • 8:00 AM: Puppy was quiet, alert, responsive; brighter and stronger. Blood glucose was normal; there had been continued regurgitation and diarrhea overnight.
  • • Blood Values
    • • Sodium: 132 mEq/L (range, 142–150)
      • Potassium: 3.4 mEq/L (range, 3.4–4.9)
      • Chloride: 101 mEq/L (range, 106–127)
      • Gucose: 99 mg/dL (range 60–115)
      • Blood urea nitrogen: 10 mg/dL (range, 10–26)
      • Hematocrit: 15% (range, 35–50)
      • Packed cell volume/total solids: 19%/2.6 (ranges, 36–60/5.0–7.4)
      • pH: 7.316 (range, 7.35–7.45)

  Decreased potassium chloride supplementation to 40 mEq/L; decreased dextrose CRI to 5% IV.

  • Treatment throughout the day:
  • • Medications
    • • Ampicillin (20 mg q8h IV)
      • Enrofloxacin (8 mg q24h IV)
      • Metronidazole (8 mg q12h IV)
      • Famotidine (0.4 mg q24h IV)

  Day 6

  8:00 AM: Puppy had clear regurgitation and began to appear icteric throughout the day; tolerated syringe feedings. Temperature and blood pressure were normal.

  Increased potassium chloride supplementation to 60 mEq/L; dextrose CRI decreased to 2.5%; partial parenteral nutrition decreased and then discontinued (due to concern for causing fluid shift and contributing to hyponatremia); saline CRI increased to 3 mL/hr. Laboratory work showed a low osmolality of 265.

  • Blood values
  • • Sodium: 127 mEq/L (range, 142–150)
    • Potassium: 2.5 mEq/L (range, 3.4–4.9)
    • Chloride: 90 mEq/Ll (range, 106–127)
    • Glucose: 23 mg/dL (range, 60–115)
    • Blood urea nitrogen: 11 mg/dL (range, 10–26)
    • Hematocrit: 13% (range, 35–50)
    • Packed cell volume/total solids: 14%/2.6 g/dL (range, 36–6-/5.0–7.4)
    • pH: 7.544 (range, 7.35–7.45)

  Administered packed red blood cells (5th transfusion) 6 mL DEA negative over 3 hours. Due to continued hypoglycemia despite dextrose boluses, dextrose CRI was maintained at 5% and continued during the transfusion.

  • 8:00 PM blood values
  • • Sodium: 129 mEq/L (range, 142–150)
    • Potassium: 2.4 mEq/L (range, 3.4–4.9)
    • Chloride: 94 mEq/L (range, 106–127)
    • Glucose: 49 mg/dL (range, 60–115)
    • Blood urea nitrogen: 16 mg/dL (range, 10–26)
    • Hematocrit: 11% (range, 35–50)
    • Packed cell volume/total solids: 12%/3 g/dL (ranges, 36–60/5.0–7.4)
    • pH: 7.64 (range, 7.35–7.45)
    • Total bilirubin: 3.6 mg/dL (range, 0–0.8)  
  • Treatment throughout the day:
  • • Medications
    • • Ampicillin (20 mg q8h IV)
      • Enrofloxacin (8 mg q24h IV)
      • Metronidazole (8 mg q12h IV)
      • Famotidine (0.4 mg q24h IV)
      • Maropitant (0.3 mg q24h SC)
      • Metoclopramide (2 mg/kg/d at 2 mL/hr)
    • Fluids
    • • 0.9% sodium chloride (3 mL/hr) + dextrose and 60 mEq/L potassium chloride) IV
      • Hetastarch (0.5 mL/h IV)
    • Nutrition
    • • Partial parenteral nutrition (4 mL/hr)