674
edits
Changes
Jump to navigation
Jump to search
no edit summary
Also known as: '''''Addison's disease
Also known as: '''''Addison's disease
==Treatment==
==Treatment==
===Stabilisation===
===Stabilisation===
It is important to get as much information during initial triage of a collapsed animal as possible. Some differentials include anaphylaxis, HGE, Parvo, arrythmias, pericardial effusion, any cause of hyperkalemia, hemoabdomen. A FAST ultrasound exam can be used to investigate anaphylaxis (gall bladder edema), pericardial effusion, and hemoabdomen. ECG can evaluate for heart block and bradycardias as well as typical hyperkalemia induced changes (prolonged S-T interval, enlarged T waves). Electrolytes, PCV, blood gas, lactate can all help with initial work up and diagnosis.
The classic Addisonian is ~ 3 years old and as such anaphylaxis and HGE are the most common differentials. Differentiating anaphylaxis from Addison's early on is critical to saving these patients.
Since collapsed, bradycardic animals are unlikely to survive for long, urgent intervention is required to stabilise these patients. '''Intra-venous 0.9% sodium chloride (saline) solution''' should be provided at shock rates to restore normovolaemia and begin to correct the electrolyte imbalances. Additional '''glucose''' can be added to fluids in hypoglycaemic animals but blood glucose levels should be monitored closely if this is undertaken.
Since collapsed, bradycardic animals are unlikely to survive for long, urgent intervention is required to stabilise these patients. '''Intra-venous 0.9% sodium chloride (saline) solution''' should be provided at shock rates to restore normovolaemia and begin to correct the electrolyte imbalances. Additional '''glucose''' can be added to fluids in hypoglycaemic animals but blood glucose levels should be monitored closely if this is undertaken.
When the diagnosis has been made with some certainty, '''intra-venous glucocorticoid replacement therapy''' can be initiated together with a '''mineralocorticoid'''. Dexamethasone is the corticosteroid of choice as it has greater mineralocorticoid activity than other products. Although there is an intra-muscular injectable mineralocorticoid (desoxycorticosterone acetate) available in the USA, this is not usually required for stabilisation.
Hypothermia must be corrected slowly so as not to cause cell shrinkage in the brain. Hyperkalemia will improve with [[Fluid therapy|IV fluid therapy]], but in the case of life threatening arrhythmias 10% CaGluconate can be given to protect the heart (1ml/kg @ 1ml/minute to effect). Insulin and Dextrose can be used to drive potassium into the cells and sodium bicarbonate can be used to correct acidosis.
When the diagnosis has been made with some certainty, '''intra-venous glucocorticoid replacement therapy''' can be initiated together with a '''mineralocorticoid'''. Hydrocortisone sodium succinate is the steroid of choice as it is short acting and provides equal glucocorticoid and mineralocorticoid activity. Although there is an intra-muscular injectable mineralocorticoid (desoxycorticosterone acetate) available in the USA, this is not usually required for stabilisation.
Avoid giving prednisone or prednisolone as it will alter the results of ACTH stim test. Dexamethasone or Dex-SP are accetable pre-test steroids.
[[Gastroprotective Drugs|'''Gastro-protectant drugs''']] (such as sucralfate, ranitidine or omeprazole) may be administered to vomiting animals and '''antibiotics''' should be provided to any animals that develop pyrexia.
[[Gastroprotective Drugs|'''Gastro-protectant drugs''']] (such as sucralfate, ranitidine or omeprazole) may be administered to vomiting animals and '''antibiotics''' should be provided to any animals that develop pyrexia.
{{review}}
{{review}}
==Webinars==
<rss max="10" highlight="none">https://www.thewebinarvet.com/endocrinology/webinars/feed</rss>
[[Category:Cell Mediated Autoimmune Diseases]][[Category:Endocrine Diseases - Dog]][[Category:Expert Review]]
[[Category:Cell Mediated Autoimmune Diseases]][[Category:Endocrine Diseases - Dog]][[Category:Expert Review]]
[[Category:Neurological Diseases - Dog]][[Category:Immunological Diseases - Dog]]
[[Category:Neurological Diseases - Dog]][[Category:Immunological Diseases - Dog]]
[[Category:Adrenal Glands - Pathology]]
[[Category:Adrenal Glands - Pathology]]