D I A G N O S I S O F F E L I N E L O W E R U R I N A R Y T R A C T D I S E A S E ( F L U T D ) DIAGNOSTICS:
■ Obtain history■ Perform physical exam, complete urinalysis1 and serum chemistry panel■ If UTI, obtain urine culture and sensitivity (MIC if possible)■ Perform radiography2 and contrast studies
Urolith(s)/crystalluria detected? Unknown or mixed composition Calcium Oxalate Struvite or Ammonium Urate Struvite Urethral Plugs Consult Struvite Flowchart
■ Surgically remove uroliths or obtain by
■ Confirmed or suspected UTI; treat with
If no UTI, idiopathic cystitis is likely.
(Depending on patient’s age and history,
■ Contact Hill’s Veterinary Consultation
Hill’s Veterinary Consultation Service 1-800-548-8387 M E D I C A L M A N A G E M E N T O F A D U L T F E L I N E A M M O N I U M U R A T E U R O L I T H I A S I S Urolith(s)/crystalluria identified as possible ammonium urate Diagnostics
■ Radiography (double contrast2) or ultrasound
■ Fasting chemistry panel including liver enzymes and paired bile acids
Are bile acids and/or liver enzymes elevated?
■ Perform appropriate follow-up diagnostics for
suspected portosystemic shunt or other liver disease
■ If patient can withstand surgery, remove uroliths;
post-op radiography3; perform quantitative analysis4
■ Feed Prescription Diet® Feline l/d®■ Encourage water consumption5
■ If urine pH consistently <6.5, verify cat is eating
Prescription Diet® Feline l/d®; add potassiumcitrate8 to maintain urine pH 6.5-7.0
■ Re-evaluate every 3-6 months■ Follow-up diagnostics for liver disease as needed■ Perform complete UA1■ Double contrast radiography2
Hill’s Veterinary Consultation Service 1-800-548-8387 M E D I C A L M A N A G E M E N T O F A D U L T F E L I N E S T R U V I T E U R O L I T H I A S I S Urolith(s)/crystalluria or urethral plug detected; identified as possible struvite Cats that have: Cats that do not have: Struvite Crystalluria Struvite Urolith or Urethral Plug Feed Prescription Diet® Feline s/d® food exclusively. Discontinue all treats and supplements. Signalment will dictate the proper Prescription Diet® brand cat food to feed. Please contact Hill’s Veterinary Consultation Service for additional information.7
■ Treat UTI if present■ Encourage water consumption5■ Monitor UA1
Continued Hill’s Veterinary Consultation Service 1-800-548-8387 Continued M E D I C A L M A N A G E M E N T O F A D U L T previous F E L I N E S T R U V I T E U R O L I T H I A S I S Urine pH 5.9-7 Urine pH>7 Urine pH< 5.9 If average urine pH 5.9-7, If average urine pH>7, or if If average urine pH<5.9: no crystalluria and struvite crystalluria and/or asymptomatic cat clinical signs are present: Struvite Crystalluria Struvite Urolith
■ Continue Prescription Diet® Feline s/d® for two months
■ Monitor dissolution with monthly radiographs3
No change in stone(s) Stone(s) dissolving Probably NOT pure struvite; surgically remove and:
Feline s/d® food one monthbeyond apparent dissolution of
NOTE: Do not feed Prescription Diet®
complete UA,1 bloodchemistry and contrast studies
Hill’s Veterinary Consultation Service 1-800-548-8387 M E D I C A L M A N A G E M E N T O F A D U L T F E L I N E C A L C I U M O X A L A T E U R O L I T H I A S I S Urolith(s) detected; identified as possible calcium oxalate Concurrent renal disease
■ Treat secondary UTI if present■ Encourage water consumption5
■ Check serum calcium■ Obtain stone(s) by
urohydropropulsion if patientis female; surgically removeurolith(s) if patient is male or unable to void; perform
No other disease problems
reduced in protein, oxalatesand sodium. Feed canned foodif possible to increase waterconsumption and form a moredilute urine5
Concurrent fiber-responsive disease
■ Treat secondary UTI if present■ Encourage water consumption5
Continued Hill’s Veterinary Consultation Service 1-800-548-8387 M E D I C A L M A N A G E M E N T O F A D U L T F E L I N E C A L C I U M O X A L A T E U R O L I T H I A S I S Continued previous Recheck urinalysis after 2 weeks1 Urine pH< 6.5 Urine pH 6.5-7.5 Urine pH >7.5 Continue therapeutic food and monitoring Continue to monitor Continue to monitor Every 3-6 months:
■ Verify dietary compliance■ Perform complete UA1
Hill’s Veterinary Consultation Service 1-800-548-8387 M E D I C A L M A N A G E M E N T O F A D U LT C A N I N E S T R U V I T E U R O L I T H I A S I S Probable diagnosis of urolith(s)/crystalluria as struvite (MAP)
■ Perform complete urinalysis1■ Urine culture (MIC if possible)■ Obtain 12-hour fasting chemistry panel■ Perform radiography2
Does the dog have any of these conditions?
■ Cardiac, liver, renal disease or other sodium retention problems■ Pancreatitis, history of pancreatitis or other abnormalities of fat metabolism■ Obesity, diabetes or other fiber-responsive condition■ Heart failure or hypertension■ Hyperlipidemia■ For additional contraindications, contact Hill’s Veterinary Consultation Service7
Surgically Remove Stones:
■ Feed Prescription Diet® Canine w/d®5;6■ Obtain quantitative analysis4■ Culture stones or bladder wall
DETERMINE BEST OPTION:
■ Treat with antibiotics for at least one month following surgery
SURGERY OR DISSOLUTION For Long-Term Care:
■ Monitor urine pH weekly at home10; ideal pH is 6.0-6.5
■ Perform urinalysis monthly1; check for crystalluria and
Continued Hill’s Veterinary Consultation Service 1-800-548-8387 M E D I C A L M A N A G E M E N T O F A D U LT C A N I N E S T R U V I T E U R O L I T H I A S I S Continued previous DISSOLUTION PROTOCOL SURGICALLY REMOVE STONES If no change in stone size For long-term care: or density after eight weeks, surgically Is sand, gravel or remove sludge present (with or without stones)? Are stones dissolving? Monitor progress while on Prescription Diet® Canine s/d®* At Home: Check urine pH weekly10 At Clinic: Monthly urinalysis1; check
■ Urine Specific Gravity (USG) should be ≤1.020
while on Prescription Diet® Canine s/d®
Monitor Progress
■ If UTI present, treat with antibiotics
■ Check urine pH, ideal average is 6.0-6.5
Monitor Progress Urine pH>7.0 Urine pH>7.0 Urine pH 5.5-7.0 Urine pH<5.5 USG≥1.020 Struvite crystals:
*Total length of time fed should not exceed six months. Hill’s Veterinary Consultation Service 1-800-548-8387 M E D I C A L M A N A G E M E N T O F A D U L T C A N I N E A M M O N I U M U R A T E U R O L I T H I A S I S Probable diagnosis of urolith(s)/ crystalluria as ammonium urate
■ Feed Prescription Diet® Canine w/d® or
For long-term care:
■ Monitor urine pH weekly at home; ideal
■ Radiography (double contrast)2 or ultrasound
Urinalysis monthly1; check for crystalluria
Is dog overweight,hyperlipidemic, history of
Is dog a Dalmatian? Consider additional tests
■ Is liver function normal?
■ Feed Prescription Diet® Canine l/d®5;7
Continued Hill’s Veterinary Consultation Service 1-800-548-8387 M E D I C A L M A N A G E M E N T O F A D U L T C A N I N E Continued A M M O N I U M U R A T E U R O L I T H I A S I S previous DETERMINE BEST OPTION: SURGERY OR DISSOLUTION DISSOLUTION IS BEST CONTINUE DISSOLUTION PROTOCOL SURGERY IS BEST OPTION: Are stones dissolving? Go To: Monitor Progress If no change in stone size or density after 8 weeks, Go To: Monitor Progress surgically remove M O N I T O R P R O G R E S S
■ At home: Check urine Check urine pH Check USG At clinic: Monthly urinalysis1:
(feed Prescription Diet®Canine u/d® exclusively)
Check for ammonium Check BUN urate crystalluria
BUN should be ≤10mg/dl while onPrescription Diet®Canine u/d®
MONITOR PROGRESS LONG-TERM:
■ Continue monthly UA;1 every 6 months, fasting
(feed Prescription Diet® Canine u/d® exclusively)
■ Once past active phase of stone formation, change
■ Add low dose allopurinol13 if persistent
food to Prescription Diet® Canine k/d® indefinitely
Hill’s Veterinary Consultation Service 1-800-548-8387 M E D I C A L M A N A G E M E N T O F A D U L T C A N I N E C A L C I U M O X A L A T E U R O L I T H I A S I S Urolith(s) detected; identified as possible calcium oxalate
■ Perform quantitative stone analysis to
■ Obtain stones using urohydropropulsion in
both males and females if possible; if not,
High serum calcium levels Normal serum calcium levels Urolithiasis may be one consequence of Urolithiasis may be the result of increased hyperparathyroidism or other disease levels of calcium or oxalate, or decreased levels of citrate in the urine
■ Identify and treat underlying disease
Does the dog have any of these conditions?
Feed Prescription Diet® Canine w/d®6 or other
therapeutic food, and add potassium citrate8
■ Urinalysis monthly at clinic;1 USG should
be <1.020 on Prescription Diet® Canine u/d®
■ If average urine pH < 7, add or adjust dose of
USG<1.020 USG≥1.020 Every 3-6 months:
Verify dietary compliance (BUN <10 mg/dl;
USG <1.020 when on Prescription Diet®
If CaOx crystalluria persist or stones recur,
contact Hill’s Veterinary ConsultationService7; as last resort considerhydrochlorothiazide15
Hill’s Veterinary Consultation Service 1-800-548-8387 R E F E R E N C E N O T E S
to avoid pH drift and artifactual crystal
12. Lithostat® (acetohydroxamic acid) is a
cially if CaOx stones are suspected.
antibiotics. Re-evaluate in 2-3 weeks.
creatitis, or at risk of pancreatitis, and
Hill’s Key to Clinical Nutrition for addi-
dose: 50-100 mg/kg BID-TID. Taurinedose: 500 mg BID. Hill’s Veterinary Consultation Service 1-800-548-8387 L U T D F O R M U L A R Y Give potassium citrate to alkalinize urine. Dose for dogs and cats: 50-75 mg/kg BID with food. Urocit®-K‚ available in 540 mg or 1080 mg wax matrix tablets. For more information, contact Mission Pharmacal at 1-800-531-3333; www.missionpharmacal.com. Polycitra®-K‚ 220 mg/ml liquid, may be more convenient for cats and small dogs. For more information, contact Alza Corp. at 650-564-5000; www.alza.com NOTE: The above products are intended for use in humans; not approved for use in dogs or cats. Monitor serum potassium and renal function. Lithostat® (acetohydroxamic acid) is a urease inhibitor and may help decrease urine pH in patients with UTI caused by a urease-producing organism. Dose for dogs: 12.5 mg/kg BID, used in conjunction with appropriate antibiotics. Re-evaluate in 2-3 weeks. For more information, contact Mission Pharmacal at 1-800-531-3333; www.missionpharmacal.com. NOTE: Lithostat® is intended for use in humans; not approved for use in dogs. Allopurinol: Dose for dogs: 10-15 mg/kg BID for dissolution of ammonium urate uroliths. Beware of use in hepatic or primary renal failure, as allopurinol is metabolized to its active form in the liver and excreted via the kidney. Do not feed foods high in purines to patients on allopurinol as xanthine uroliths could result. Maintenance dose of allopurinol if indicated, 10 mg/kg once a day. NOTE: This drug is intended for use in humans; not approved for use in dogs. Hydrochlorothiazide: Dose for dogs: 2 mg/kg every 12 hours to inhibit calcium excretion in urine. NOTE: Side effects of this diuretic are many and significant. Use only as a last resort. Monitor for hypokalemia and hypercalcemia (found in patients with absorptive [intestinal] hypercalciuria) every 3-6 months. This drug is intended for use in humans; not approved for use in dogs. Hill’s Veterinary Consultation Service 1-800-548-8387 F E L I N E T A R G E T U R I N A R Y p H C O M P A R I S O N U R I N A R Y p H R A N G E S F O R T H E R A P E U T I C P R O D U C T S 5.8 5.9 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 7.0 7.1 7.2 7.3 7.4 7.5 7.6 7.7 Feline c/d®-s Feline c/d®-oxl Feline g/d® Feline d/d® Feline h/d® Feline i/d® Feline l/d® Feline k/d® Feline p/d® Prescription Diet Feline r/d® Feline s/d® Feline t/d® Feline w/d® Feline z/d™ Eukanuba Low pH/S™ 1 Eukanuba Moderate pH/O™ 2 IVD™ Select Care™ Control Formula, Canned IVD™ Select Care™ Modified Formula, Canned CNM UR-Formula® CNM NF-Formula® Waltham® Veterinary Diet S/O Control pHormula Diet™ Canned 9 Lives Plus Care, Canned (no min.) Friskies® Special Diet, Dry Purina® Special Care™ (no min.) 5.8 5.9 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 7.0 7.1 7.2 7.3 7.4 7.5 7.6 7.7
1 Eukanuba Veterinary Diets® Nutritional Urinary Formula™ Low pH/S™ 2 Eukanuba Veterinary Diets® Nutritional Urinary Formula™ Moderate pH/O™
Source: Hill’s® TechSource, 2001Eukanuba® Product Reference Guide, TIS Index No. 9,487. IVD™ Product Reference Guide, TIS Index No.13,205. Purina® Product Guide, 02/2001, TIS Index No. 10,530Waltham® S/O Product Sheet, TIS Index No. 9,246. 9 Lives® Plus Care: mfg contact, TIS Index No. 13,614
Hill’s Veterinary Consultation Service 1-800-548-8387
1) Alcohol is defined by what scheduled drug by F.S. Chapter 893 a) I b) II c) III d) IV e) Not scheduled 2) Evidence of use of alcohol is __________. a) empty or open alcohol cans or bottles nearby, smell of alcoholic beverage on clothes and breath, glassy, bloodshot, and watery eyes. b) crystals c) runny nose d) insomnia 3) What are the onset and duration of effects for orally drinking alcohol?
Stoffwechsel und Fitnessverbesserung bei Adipösen Die Verbesserung der Stoffwechsellage und der körperlichen Fitness bei adipösen Menschen mit Diabetes mellitus Typ-2 durch Schwimmtraining und Ernährungs- umstellung Medical and educational aspects of patient training with obese Typ-2 diabetics Lampe W Universität Hannover- Fachbereich Erziehungswissenschaften Zusammenfassung