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Polyuria / Polydipsia In A Dog

by jamlines09 - September 29, 2014 View Case Report

Sophie is a 4 1/2 yr old female desexed Bichon Frise who initially presented with a significant polydipsia ( and subsequent polyuria ) which progressed to what I became suspicious of an overflow - type incontinence with dysuria around the house. Clinical findings included a weak but stabbing pulse ( thin & wiry ) - did not notice the tongue
( was prior to starting the TCM course! ) and a mild systolic murmur on auscultation with no other symptoms relating to a heart condition.Urine tests revealed a dilute urine with blood, suggestive of an active cystitis. She seemed to respond to antibiotics. I initially advised a change of diet from processed dry food to a raw meat & bones - based diet with added fish oils and cranberry.
Blood tests at this time revealed an elevated ALT ( 700 ) with normal ALKP and TBIL levels and normal renal enzymes and blood glucose. I started on Si Miao San formula for cystitis and suspected hepatitis. Dysuria immediately improved but polydipsia continued.
Today - 2 months later - she presented with drastically reduced drinking and urinating ( looks more concentrated according to Owner ) but lethargic / depressed and inappetant. Clinically she feels cool to cold and dry - definitely deficient, cold and dry. Tongue is pale pink with pale pink gums and quite small with no white coating. Pulse is wiry, thin but pronounced. She has been developing a hyperpigmentation over her body gradually over last few months.
I have repeated bloods - ALT is down to 300 ( still elevated ) and GGT, TBIL, ALKP are all normal. BUN is marginally low. Bile acids are very elevated, despite previous meal being over 24 hrs ago.
I have started on Xiao Yao San for a suspected chronic active hepatitis condition ( possibly microvascular shunts? ).
Owner is also reporting a kind of 'shortness of breath' that she seems to have intermittently ( ?? )
My question is - help! What do you think is my main concern here & am I on the right track with a mover of blood in this instance?

by naturevet

October 6, 2014

Hi there,

I think Xiao Yao San is a good choice here. You mention in your visit notes some neurological behaviours which, together with the elevated bile acids, could reflect a shunt. Given the pulse you describe, tongue color, and the overall deficient picture, a microvascular shunt seems probable and should be amenable to Xiao Yao San.

If the dog is not eating well, I'd consider teaching the owner to give granular extract mixed in a low volume of warm water as an enema high up in the transverse colon. Most of it should get absorbed and despite the shunt should go straight to the liver to help kick things in gear.

Regarding the low platelet count you mention in the case record, any chance those are just clumped? Regardless, Xiao Yao San may stimulate the bone marrow to boost platelet production

Steve

by jamlines09

October 6, 2014

Thanks Steve - I really look forward to your input - absolutely invaluable to a beginner like myself!
Quick question - what about the high WCC? It is possible the platelets were clumped ( low count was repeated on two occasions 1 day apart though - with some improvement after initiating steroid tx ). Could there be an active hepatitis going on here? And why does this dog seem to respond so quickly to corticosteroids? Currently she is on antibiotics and pred - should I stop the pred?
I will see if she is eating now and if not, I will get the owner in and try and demonstrate the enema delivery you mentioned of the herbs in the hope it reaches the liver quickly. Do you think the Xiao Yao San can help at this stage despite the rapidly progressive nature of the neuro signs?
Also - what is the TCM explanation for her absolute obsession with drinking water - she is almost trying to get into the water bowl itself!

by naturevet

October 7, 2014

Hi there,

You don't mention how high the WBC is, but it seems consistent with stress.

With an increased ALT, I'm sure there is a hepatitis going on, but the XYS should help with that.

A rapid response to corticosteroids, especially modest doses, suggests a Blood or Yin deficiency.

I wouldn't stop anything you feel is currently helping her. Long term, though, the pred use will raise liver enzyme levels and potentially the WBC count. So it may obscure how complete the improvement is

The only thing that would make me reach for the Chai Hu Jia Long Gu Mu Li Tang that you suggested instead of Xiao Yao San is the very high thirst. That plus the head pressing would suggest too much Yang energy trapped in the head, so I'm wondering if you should use it in addition to the XYS, until things get going.

Hopefully that gets you somewhere

Steve

by jamlines09

October 8, 2014

Thanks Steve - you're a champion - I hope I get to meet you one day. I will give those formulas a try.

cheers, Jamie

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