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                         Central Diabetes Insipidus in FIV positive cat?                      Dr. Signe Cremer

Tom was first presented to Avondale Cat Hospital in early February 2010. He was a stray, intact male DSH cat of unknown age, that
had been taken in by Animal Lifeline of Iowa. Abnormalities on physical exam included clear nasal discharge, ear mites, small scabs
on ventral side of the neck, grade 1 tartar, and he tested positive for FIV (which was later confirmed with PCR FIV test). His age was
estimated at 1-2 years. He was started on Clavamox and a routine closed castration was performed. A week later, the shelter
reported severe PU/PD; he constantly had standing urine in his litter box. They reported no other concerns or abnormalities.

Primary polydispsia can be psychogenic or due to hepatic insufficiency and portosystemic shunts. Primary polyuria can be caused by
central diabetes insipidus (CDI) or nephrogenic diabetes insipidus (NDI). CDI is caused by either insufficient production or release of
Vasopressin (antidiuretic hormone or ADH) whereas in NDI it is the kidney’s ability to respond to ADH is compromised. Causes of
NDI can be either primary or secondary (see table 1).

Tom’s physical exam was unremarkable and abnormalities on CBC, complete chemistry panel and urinalysis revealed a mild non-
regenerative anemia, mild eosinophilia, severe thrombocytopenia with platelet aggregates detected, moderately elevated ALT (539)
and hypostenuric urine (SG of 1.004). BUN and creatinine was high normal (36 and 1.9), which was interpreted as either early mild
renal failure (possibly due to FIV) or mild pre-renal azotemia secondary to dehydration. A blood smear showed adequate platelets,
significant anisocytosis and possible Mycoplasma haemofelis. Abdominal radiographs revealed mild hepatomegaly but were
otherwise unremarkable. A large feline PCR tick and flea panel was submitted to the lab. Abdominal ultrasound showed a mildly
enlarged liver of normal echogenicity with no focal lesions, both kidneys were mildly enlarged but of normal structure and
echogenicity, pancreas and adrenals could not be visualized and the rest of the intraabdominal organs were within normal limits.
His blood pressure was 110 mmHg. Tom was tentatively started on k/d and Azithromycin and rechecked the following week. The
shelter reported diarrhea and no change in drinking and urination. The feline tick/flea panel came back positive for Mycoplasma
haemofelis and Mycoplasma heamominutum and only abnormalities on CBC, chemistry and UA were mild anemia, mild eosinophilia
and urine SG of 1.007. His medications were changed to Doxycycline , Flagyl and Fortiflora . At next recheck 2 weeks later his
diarrhea had resolved but he still had severe PU/PD. His CBC, chemistry and UA was largely unchanged from last visit with
persistent hypostenuric urine. PT and PTT were normal and Tom was anesthetized for
ultrasound-guided FNA of liver and kidneys. Both came back with no cytologic              Primary Polydipsia
abnormalities.                                                                            Psychogenic
                                                                                            Hepatic Insufficiency or portosytemic shunt
After three weeks with no improvement on Doxycycline, the Mycoplasma was
considered an incidental finding and the Doxycycline was discontinued. In the search        Primary Polyuria
                                                                                            Central diabetes insipidus (CDI)
for causes of secondary NDI, a bile acid profile, T4, urine culture and sensitivity and
                                                                                            Nephrogenic diabetes insipidus (NDI)
low dose dexamethasone suppression test were submitted; everything came back                    - Renal failure
normal. Having tested Tom for causes of secondary NDI, complete or partial CDI was              - Hyperadrenocorticism
suspected with etiologies including inflammatory-induced CDI (FIV or parasitic),                - Hypoadrenocorticism
pituitary tumor or idiopathic CDI. Differentials at this point still included psychogenic       - Hepatic insufficiency
                                                                                                - Hypercalcemia
polydipsia (so far only reported in young dogs) and primary NDI. Since it is no longer          - Hypokalemia
advised to perform a water deprivation test to differentiate CDI, NDI and psychogenic           - Postobstructive dieresis
polydipsia due to the risks associated with severe dehydration Tom was instead                  - Diabetes Mellitus
started on synthetic vasopressin - DDAVP (0.025mg PO BID). Within less than a week              - Normoglycemic
                                                                                                - Hyperthyroidism
Tom’s water intake and urination had decreased by at least 50%, but his urine has
                                                                                                - Iatrogenic or drug-induced
remained in the hypostenuric range. This indicates at least a partial response, and we          - Renal medullary solute washout
will continue treating Tom for CDI of unknown cause (knowing that it may or may not
be due to FIV).
                                         The History of Memorial Day

  Memorial Day, originally called Decoration Day, is a day of remembrance for those who have died in our nation's service.

 There are many stories as to its actual beginning, with over two dozen cities and towns laying claim to being the birthplace of
 Memorial Day. There is also evidence that organized women's groups in the South were decorating graves before the end of the
 Civil War. While Waterloo N.Y. was officially declared the birthplace of Memorial Day by President Lyndon Johnson in May
 1966, it's difficult to prove conclusively the origins of the day. It is more likely that it had many separate beginnings; each of those
 towns and every planned or spontaneous gathering of people to honor the war dead in the 1860's tapped into the general human
 need to honor our dead. Each contributed honorably to the growing movement that culminated in Gen. Logan giving his official
 proclamation in 1868. It is not important who was the very first, what is important is that Memorial Day was established.
 Memorial Day is not about division. It is about reconciliation; it is about coming together to honor those who gave their all.
 Memorial Day was officially proclaimed on 5 May 1868 by General John Logan, national commander of the Grand Army of the
 Republic, in his General Order No. 11, and was first observed on 30 May 1868, when flowers were placed on the graves of Union
 and Confederate soldiers at Arlington National Cemetery. The first state to officially recognize the holiday was New York in
 1873. By 1890 it was recognized by all of the northern states. The South refused to acknowledge the day, honoring their dead on
 separate days until after World War I (when the holiday changed from honoring just those who died fighting in the Civil War to
 honoring Americans who died fighting in any war). It is now celebrated in almost every State on the last Monday in May (passed
 by Congress with the National Holiday Act of 197) to ensure a three day weekend for Federal holidays.

 Since the late 50's on the Thursday before Memorial Day, the 1,200 soldiers of the 3d U.S. Infantry place small American flags at
 each of the more than 260,000 gravestones at Arlington National Cemetery. They then patrol 24 hours a day during the weekend
 to ensure that each flag remains standing. In 1951, the Boy Scouts and Cub Scouts of St. Louis began placing flags on the 150,000
 graves at Jefferson Barracks National Cemetery as an annual Good Turn, a practice that continues to this day. More recently,
 beginning in 1998, on the Saturday before the observed day for Memorial Day, the Boys Scouts and Girl Scouts place a candle at
 each of approximately 15,300 grave sites of soldiers buried at Fredericksburg and Spotsylvania National Military Park on Marye's
 Heights , and in 2004, Washington D.C. held its first Memorial Day parade in over 60 years.


Avondale would like to extend an invitation for you to refer
any cases that you feel would benefit from this mode of

The versatility of the laser allows our doctors to incise, ablate
and coagulate with one tool, decreasing the time the surgery
would take by traditional means. Laser surgeries provide less
bleeding, swelling, less pain, and faster recovery than
traditional scalpel.

           A few of the common uses of the laser:

  Feline Declaws                    Perianal adenomas
  Soft palate surgery               Entropion & eye growths
  Stenotic nares surgery            Anal glad removal
  Lick Granuloma                    Perianal Fistulas and other
                                            vascular growths

                  Avondale Veterinary Healthcare Complex, 4318 E Army Post Rd., Des Moines, IA 50320
                               Phone: 515-262-6111 or 800-339-4873 Fax: (515) 262-6017