10 simple but essential tests - Veterinary Medicine
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10 simple but essential tests


VETERINARY MEDICINE SUPPLEMENT


8 At-home glucometer use

Glucometers can now be routinely used for at-home monitoring of diabetic patients. At-home testing is advantageous because stress-induced increases in blood glucose concentrations are especially a concern in hospitalized cats and may confound the results of in-hospital glucose curves. Such results may prompt inappropriate increases in insulin dose, potentially resulting in hypoglycemic crises or the Somogyi effect. Most owners are able to easily perform blood glucose curves at home, and the results are as effective for managing diabetic patients as glucose curves performed in the hospital.9

9 Preanesthetic testing

Preanesthetic testing (CBC, serum chemistry profile, urinalysis) is unfortunately often overlooked or declined, particularly in geriatric but overtly healthy patients presenting for elective procedures such as dental prophylaxis. These patients may have occult diseases, and a diagnosis before anesthesia will minimize the occurrence of unforeseen complications. Additionally, preanesthetic testing is an opportunity to detect disease processes early when they may be more treatable. Finally, liver or kidney disease will affect anesthetic protocols, the intensity of intraprocedural monitoring, and intravenous fluid type and rate.

10 Neurologic examination

Performing a complete neurologic examination is often overlooked in patients presenting with possible neurologic abnormalities. As with a standard physical examination, a good neurologic examination requires practice and comfort with knowing what is normal. Localizing a neurologic lesion is required for formulating a differential diagnosis list and dictates the appropriate diagnostic test and treatment plan. For example, in a patient with cranial nerve abnormalities, prognosis and treatment strategies for forebrain disease, cervical disease, Horner's syndrome, or peripheral vestibular disease are all vastly different. Only proper lesion localization will allow you to discuss the next best steps with owners. Even when a referral is sought, the initial presenting neurologic examination results are extremely useful for documenting the progression of clinical signs, as neurologic status can change quickly and the rapidity of change may alter a patient's prognosis and management strategy.

Final thought

Some of these 10 essential tests have simply been underused in veterinary practice, and others are newly available. Improve the quality of your patient care and increase your success rate for obtaining diagnoses and appropriately treating patients by adding these tests to your armamentarium.

Editors' note: Dr. Pressler is a paid consultant for IDEXX and has received funding from HESKA.

Barrak Pressler, DVM, DACVIM, and Alice A. Huang, VMD, Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, West Lafayette, IN 47907.

REFERENCES

1. Silverstein DC, Wininger FA, Shofer FS, et al. Relationship between Doppler blood pressure and survival or response to treatment in critically ill cats: 83 cases (2003-2004). J Am Vet Med Assoc 2008;232(6):893-897.

2. Brady CA, Otto CM, Van Winkle TJ, et al. Severe sepsis in cats: 29 cases (1986-1998). J Am Vet Med Assoc 2000;217(4):531-535.

3. Fantoni DT, Auler Junior JO, Futema F, et al. Intravenous administration of hypertonic sodium chloride solution with dextran or isotonic sodium chloride solution for treatment of septic shock secondary to pyometra in dogs. J Am Vet Med Assoc 1999;215(9):1283-1287.

4. Adler JA, Drobatz KJ, Hess RS. Abnormalities of serum electrolyte concentrations in dogs with hypoadrenocorticism. J Vet Intern Med 2007;21(6):1168-1173.

5. Thompson AL, Scott-Moncrieff JC, Anderson JD. Comparison of classic hypoadrenocorticism with glucocorticoid-deficient hypoadrenocorticism in dogs: 46 cases (1985-2005). J Am Vet Med Assoc 2007;230(8):1190-1194.

6. Jacob F, Polzin DJ, Osborne CA, et al. Evaluation of the association between initial proteinuria and morbidity rate or death in dogs with naturally occurring chronic renal failure. J Am Vet Med Assoc 2005;226(3):393-400.

7. Lees GE, Brown SA, Elliott J, et al. Assessment and management of proteinuria in dog and cats: 2004 ACVIM Forum Consensus Statement (small animal). J Vet Intern Med 2005;19(3):377-385.

8. Morley PS, Apley MD, Besser TE, et al. Antimicrobial drug use in veterinary medicine. J Vet Intern Med 2005;19(4):617-629.

9. Reusch CE, Kley S, Casella M. Home monitoring of the diabetic cat. J Feline Med Surg 2006;8(2):119-127.


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