• Journal of Veterinary Clinics
• /
• v.38 no.6
• /
• pp.299-304
• /
• 2021

A 3-year-old female Connemara pony was referred to Jeju National University Equine Hospital because of weight loss and prolonged anorexia. On admission, heart and respiratory rates were slightly elevated while body temperature was within the normal range. The color of the conjunctival and oral mucosa was yellowish pink. The blood chemistry results showed that total bilirubin, aspartate aminotransferase, and gamma-glutamyl transferase levels were remarkably elevated while blood urea nitrogen was within the reference range. Transcutaneous abdominal ultrasound revealed an enlarged right lobe of the liver with prominently increased parenchymal echogenicity, reduced hepatic vessels, and rounded caudal border. The pony was tentatively diagnosed with chronic hepatitis and icterus; rest and supportive treatments were provided. Clinical signs aggravated on day 2 with hind quarter paresis and cranial nerve signs such as circling, drooping, jerking, and head pressing against walls. Recumbency and generalized ataxia (grade 5/5) were shown on day 3. Plasma ammonia concentration on day 3 was as high as 656 µmol/L. Necropsy and histopathologic examinations strongly supported a diagnosis of hepatic encephalopathy. This case of hepatic encephalopathy exhibited rapid progress from low to terminal grade within 4 days in a Connemara pony. The results provide well-established clinical and pathological data for future application.

• Neonatal Medicine
• /
• v.17 no.2
• /
• pp.224-231
• /
• 2010

Purpose: Hospital readmissions have recently increased due to early hospital discharge and increased trends in breast-feeding. Neonatal hyperbilirubinemia can lead to fatal permanent neurological sequelae without appropriate management. Early detection and intervention are critical. We evaluated the clinical features, risk factors, and brain MRI findings of Korean newborns with idiopathic nonhemolytic hyperbilirubinemia to determine the optimal management policy. Methods: A retrospective review of the medical records of 79 newborns with idiopathic nonhemolytic hyperbilirubinemia was performed at the NICU of the Kyungpook National University Hospital from January 2006 to September 2009. All patients were 35 or more weeks of gestation, and their peak level of serum total bilirubin was more than 20 mg/dL. Results: The mean gestational age was $38^{+3}{\pm}1^{+4}$ weeks, and the mean age on admission was 8.8$\pm$4.0 days. The mean body weight (3,105$\pm$479 g) was decreased by 2.8$\pm$6.4 percent compared to the mean birth weight (3,174$\pm$406 g). There were no statistically significant differences for the peak serum bilirubin level or the duration and effects of phototherapy between the patients with and without risk factors, which included: breastfeeding, cephalohematoma, subdural hemorrhage, and/or ABO incompatibility. Patients were grouped according to change of body weight. Group I consisted of patients that gained weight compared to birth weight, and group II of patients that lost weight compared to birth weight. There were significant differences in the peak serum total bilirubin level between the two groups. Thirty nine patients had brain MRI evaluation; 21 patients had bilateral symmetric signal intensity increases in the globus pallidus compared to adjacent corticospinal tract and putamen on T1-weighted images. Conclusion: Bilirubin encephalopathy is preventable with early screening and proper management. Parents require instruction on feeding practices and follow-up to prevent complications from idiopathic nonhemolytic hyperbilirubinemia.