Case 4

At a follow-up visit two weeks later, the owner reports that Miss Kitty is doing well but still seems to be drinking more than normal. The owner also reports that she is having difficulty giving the medication consistently because Miss Kitty is a "pill to pill." Her physical examination findings are unchanged, and her hydration status is normal.

These are the abnormal findings on her laboratory tests:

CBC

Patient values

Reference range

HCT (%)

26

29-48

Absolute reticulocytes (/µl)

33,000

> 45,000

Serum chemistry panel

Patient values

Reference range

BUN (mg/dl)

41

14-36

Creatinine (mg/dl)

2.6

0.6-2.4

Phosphorus (mg/dl)

8

2.4-8.2

T4 (µg/dl)

4.6

1-4

Urinalysis

Patient values

Reference range

Specific gravity

1.014

1.015-1.060

pH

6.5

5.5-7

Sediment

Negative  

QUESTION 4

Which of the following plans would be LEAST appropriate in the further management of Miss Kitty?

a) Increase her current methimazole dose to 2.5 mg orally twice daily and initiate subcutaneous fluid therapy every other day at home.

b) Leave the current dose of methimazole the same, but discuss other medication administration options with the owner such as pill pockets or a liquid formulation of methimazole to make it easier to give the medication consistently. Recheck Miss Kitty in two to three weeks.

c) Leave the current dose of methimazole the same, but consider switching her to a transdermal formulation and rechecking her again in two to three weeks.

d) Recommend that the owner try giving Miss Kitty 2.5 mg orally once a day instead of 1.25 mg orally twice a day and see if she is able to consistently give the medication that way.

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