What are some causes of metabolic collapse?
1) diabetic ketoacidosis
3) hyper/hypo kalaemia
4) hyper/ hypo calcaemia
5) hyper/hypo natraemia
6) hepatic encephalopathy
7) phaeochronmocytoma- rare
8) hyperviscousity syndrome-rare
9) thyrotoxicosis- rare
10) myxoedema coma- rare
What are the initial tests done if collapse?
4) this is in addition to history and clinical exam
What should be normal on a clinical exam before moving onto laboratory tests?
Evidence of cardiac and other diseases e.g. pallor, cyanosis, dyspnoea, distended veins, resp noise/crackles, arrhythmias, muffled thoracic sounds.
Hypokalaemia is very common and often caused by?
1) intersitial loss: vomiting, diarrhoea
2) CRF cats
3) ch. diuresis (+ anorexia)
4) often a combination!
What are some complications of metabolic collapse?
2) acute renal failure
3) urinary tract infections
5) gastro intestinal haemorrhage
6) pulmonary thromboemboslim
7) disseminated intravascular coagulation
What do you add up for fluids in the first 24 hours?
1) % dehydration
2) continuing losses
What is the key to success in hypokalaemia?
Give a lot of fluids/ aggressive fluid therapy early on.
What is the main problem with hyperadrenocorticism?
The loss of aldosterone. it acts on the salt balance so that the urine salt balance causes loss of fluid and dehydration. There is therefore an increase of angiotensin II in the blood with Addison's because the body is trying to correct the dehydration, but its not working on the adrenals cos they are destroyed.
Hypoadrenocoticism immune mediated destruction occurs in what age and breed?
1) young to middle aged 1-5 year old, often females
2) Standard Poodles, Bearded Collies, Rottweiler's, West Highland White Terriers, German Shorthaired Pointers.
What are the 3 types of hypoadrenocoticism?
1) immune mediated destruction
2) mitotane/trilostane induced (adrenal necrosis/suppression)
3) other: haemorrhages, infarction, infection, tumour
There is variable presentation of hypoadrenocoticism, what CS would you see?
1) Chronic often respond to non specific therapy
2) neurological : depression, weakness
3) gastro-intestinal signs: iappetance, vomiting/ diarrhoea
4) metabolic: failure to thrive, weight loss, mild PU/PD
What are the clinical findings with severe hypoadrenocoticism?
1) severe dehydration
6) haemorrhagic gastroenteritis
What changes can be seen on an ECG with hypoadrenocoticism?
No P waves, and spiked T waves- if significantly dehydrates and hyperkalaemic.
What are some possible complications of hypoadrenocoticism?
1) acute renal failure
2) gastro intestinal haemorrhage
4) pulmonary thromboembolism
5) disseminated intravascular coagulation
What are some differential diagnosis to Addison's/ hypoadrenocoticism?
1) Inflammatory bowed disease - vomiting/diarrhoea
2) renal failure - PU/PD
3) Neoplasia - weight loss
4) pancreatitis- abdominal pain
5) H.G.E, Bradycardia, episodic collapse, lethargy
Haematology with hypoadrenocoticism might show what?
Anaemia: GI losses, Bone marrow suppression, IMHA, dehydration masks severity of this. 70% of cases are anaemic.
What does a reversed stress leucogram refer to?
Dogs that is ill will normally have a stressed leucogram= high neutrophils, eosinophils and lymphocytes low. But in Addison's it's the opposite- low neutrophils., and higher eosinophils and lymphocytes (most dogs are normal).
What kind of biochem results can you expect in Addison's?
Sodium decreased, Potassium increased, K:NA radio.
What are some causes of high potassium and low sodium?
1) Hyperkalaemia: RBC lysis, failure to excrete
2) Hyponatraemia (metabolic condition) over hydration and massive loss
What does hypoadrenocorticism and renal failure have in common?
1) acute episode after periodic illness
2) thin, dehydrated, may have collapsed
3) renal azotaemia (increased urea/creatinine) USG: 1.007-1.030.
4) high potassium
5) low sodium
What are the differences between renal failure and hypoadrenocoticism?
1) hAC: NA very decreased, K 90%, ca increased. USG: >1,008. no stress wbc, anaemia
2) CRF: USG: 1.008-1.002, Stress wbc, anaemia, no na or K
3) ARF: na decreased, k increased, USG: >1.030, stress wbc, no anaemia
What test can you use to diagnose Addison's?
1) ACTH stimulation test before starting therapy - no response its Addison's.
2) Could also use cortisol but cannot distinguish primary hAC from iatogenic HAC or recent steroid admin
3) aldosterone: same as cortisol
How do you tx Addison's?
1) initially aggressive fluid therapy
2) if acute: hypovolaemia, sodium deficit and hyperkalaemia.
3) if chronic: minaralocoricoid replacement, glucocorticoid replacement and dietary changes
Calculate this: total fluid replacement for a dog with 10% dehydration?
2kg = 2 litres +
20 kg x 50 ml /24h = 1000 ml =
3 litter in 24 hours + any additional losses
What fluids do you use to treat hyperkalaemia?
Saline. IV if possible. 20-60ml/kg/h for 2 hours then 4ml/kg/h.
What is a short term treatment for Addison's?
Hydrocortisone sodium succinate. Mineralocorticoid + glucocorticoid (if don't have use methylprednisolone/dexamethasone)
What do you have to monitor during acute phase Addison's?
6) urine output
What do you give for long term treatment of Addison's?
Fludrocortisone (UK) or DOCP (desoxycortisone puvilate -USA). If stressed: prednisolone. DOCP (always prednisolone).
Acromegaly in dogs are related to GH released from?
Progesterone induced secretion from mammary gland - into milk and info foetus.
What are some signs of acromegaly in cats?
Increased soft tissue mass: hepatomegaly, thickened skin, diates mellitus. Neurological signs: depression, gradual changes.
Congenital panhypopituitarism will show sings of?
1) proportionate dwarfism
2) juvenile mentality
3) coat changes
4) repro dysfunction