CHAPTER 10 Emergency and Critical Care Issues
Laboratory Values (See Chapter 30)
Young puppies and kittens have a lower HCT than adults (Boxes 10-1 and 10-2). The HCT decreases from 47.5% at birth to 29.9% by day 28 in puppies. This decrease is normal and is thought to be the result of the change from a relatively hypoxic environment to an oxygen-rich environment. The HCT will start to increase by the end of the first month of life in healthy neonates. Kittens also have a HCT nadir at 4 to 6 weeks of 27%. Knowledge of this normal decrease in HCT is essential during treatment of any neonate, and during this time period, a rise in the HCT is usually indicative of significant dehydration.
BOX 10-1 Complete blood count: pediatric canine
From Silverstein DC, Hopper K (eds): Small animal critical care medicine, St Louis, 2008, Saunders/Elsevier.
BOX 10-2 Complete blood count: pediatric feline
From Silverstein DC, Hopper K (eds): Small animal critical care medicine, St Louis, 2008, Saunders/Elsevier.
Knowledge of the slight increases in bilirubin (0.5 mg/dl; normal adult range 0 to 0.4) and dramatic increases in liver enzymes at birth in puppies is essential when creating a differential diagnoses list (Boxes 10-3 and 10-4). In puppies, serum alkaline phosphatase (ALP; 3845 IU/L, normal adult range 4 to 107) and gamma-glutamyl transferase (GGT; 1111 IU/L, normal adult range 0 to 7) are over 20 times greater than adult values. In kittens, the ALP (123 IU/L, normal adult range 9 to 42) is 3 times that seen in adults. Serum blood urea nitrogen (BUN), creatinine, albumin, cholesterol, and total protein are lower in neonates than adults. Lower creatinine is thought to be due to decreased muscle mass, and lower BUN and cholesterol are due to immature liver function. Knowledge of these values is crucial to prevent a misdiagnosis of liver disease in the neonate (elevated liver enzymes and low levels of BUN, cholesterol, and albumin can all mimic liver dysfunction).
BOX 10-3 Biochemistry profiles: pediatric canine*
From Silverstein DC, Hopper K (eds): Small animal critical care medicine, St Louis, 2008, Saunders/Elsevier.
BOX 10-4 Biochemistry profiles: pediatric feline*
From Silverstein DC, Hopper K (eds): Small animal critical care medicine, St Louis, 2008, Saunders/Elsevier.