1. George 9y MN West Highland White Terrier 4 weeks of PU/PD 3 days vomiting Collapsed this morning

2. Physical examination Stuporous Cardiovascular examination – HR 150 bpm – Bounding pulses – Pink mucous membranes No abdominal distension/pain

3. George PCV/TS 58%/80g/l Ketonaemic BUN 15mmol/l Creatinine 180µmol/l Glucose 25mmol/l

4. George - Electrolytes and blood gas K 3.5mmol/l pH 7.2mmol/l

5. George – Problem list Dehydration Severe hyperglycaemia Azotaemia Hypokalaemia Metabolic acidosis

6. George Considerations – Inappropriate insulin storage/handling/admin – Inappropriate dosage – Concurrent disease Urinary tract infection (sediment exam + urine culture) Pancreatitis (u/s + cPLI) Hyperadrenocorticism Other

7. George - diagnostics Urinalysis – Glucosuric (4+) – Ketonuric (3+) – WBCs on sediment examination Abdominal ultrasound – Unilateral pyelectasia

8. George Moderate hypovolaemia Dehydration Hypokalaemia ? Fluid plan

9. George Correct hypovolaemia first Bolus crystalloid 20ml/kg over 20 minutes Improvement in clinical signs On going fluid plan?

10. George Started intravenous insulin protocol Supplemented potassium after resuscitation Supplemented phosphorus

11. George Intravenous antibiosis whilst culture pending – Augmentin 20mg/kg q8h Slowly improved over 48 hours Started on s/c insulin protocol

12. George George had pyelonephritis George’s owner had withheld insulin whilst he was anorexic