SAM - Addisons

Addison's disease is most commonly primary secondary or tertiary

Primary

Addison has what effects on the body

Decreased vascular tone (hypertension, hypoperfusion, shock)

Loss of G.I. mucosal integrity (G.I. signs and anorexia)

Decreased gluconeogenesis

Decreased metabolism of glucose (weight loss and hypocholesterolaemia)

Decreased erythropoiesis (non-regenerative anaemia

Hypercalcaemia due to decrease calcium loss in urine

Signalment for Addison dog

Medium giant breed dogs

4.5 years old

75% are females

Clinical signs in the Addison's dog

Lethargy and weakness

G.I. - anorexia vomiting, diarrhoea

Weight loss

PUPD

Shivering

Abdominal pain

Clinical signs often, waxing and waning

What would you find on a CBC with Addison's?

No stress Leukogram

Possible anaemia (EPO)

Biochem common findings

Hi, potassium low sodium (less than 27)

Azotemia, hypoglycemia, hypercalcemia, hypo cholesterol metabolic acid dosis (no gluconeogenesis no lipolysis)

Dilute urine

Note: atypical will have no electrolyte changes (only sign maybe no response to stress)

What G.I. disease can mimic the electrolyte changes you see with Addison

Whipworm (pseudo Addison's)

Normally, you don't need diagnostic imaging for Addison's

But in the early stages due to such vague signs, it may be ordered and what would you see?

Micro cardia

Decreased caudal vena cava

Rare: megaesophagus

First two are due to hypovolaemia

What would you see on ultrasound?

Small adrenal glands

Thin G.I. mucosa

When do you see heart changes with excess potassium level levels?

When they are over 7.5 MEQ/L

Tented T waves, wide QRS, absent P waves = arrhythmias, and death

Initial treatment for Addison crisis dog

0.9% NACL

Give shock dose (1/4) over 20/30 minutes (repeat as necessary)

Once they are out of shock 90 - 120 for 1-2 days

Best treatment for hyperkalaemia in Addison dog

Fluids

What can you give to protect the heart from arrhythmias

Calcium gluconate 1ml/kg

Stabilize, sodium gated channels, making them harder to open, causing less depolarization

Hyperkalaemia increases depolarization via decreasing the threshold and will eventually shut down the sodium channels, which will cause the Bradycardia

What can you give to drive potassium in the cells in cases of hyperkalaemia and would be your third step in treating hyperkalaemia in this situation

Insulin plus dextrose

Fourth step but is rarely needed in treating hyperkalaemia

Bicarbonate

Can Addison dogs become septic?

Possibly due to bacterial translocation because of their thin GIS system

Can give ampicillin

Yes, animal comes in Addison crisis what can you give that does not react with cortisol assay

Dexamethasone

Seven times as potent as prednisone

What can you give during crisis after you've done the cortisol essay that has both glucocorticoid and mineralocorticoid activity

Hydrocortisone

Immunosuppressive, anti-inflammatory and physiological dose of prednisone

Immunosuppressive = 2 MG

Anti-inflammatory = .5-1

Physiologic = 0.2

Mineralocorticoid you can give to the dog

Desoxycorticosterone pivalate

Fludcortisone (both a little glucocorticoid and more mineralocorticoid)

How long does DOCP last?

25-30 days

2.2 MG/KG (max dose of 50 MG)

Check electrolytes after two weeks starting therapy and then every 4-6 months

What is a good option to save money with DOCP

Decrease dose by 10% each month

Recheck electrolytes and treat at lowest effective dose

What is a another option that you can also do to save money (second choice)

You checked your electrolytes at two weeks after starting therapy

You then check monthly and then every 3 to 4 days until it becomes abnormal and then you treat with DOCP

(some can go up till two months without showing clinical signs without DOCP injection) - average 40 days

If you were only giving fludcortisone When should you do your recheck?

Recheck weekly for first month, then monthly for three months

May need to add prednisone