Endo Treatment Flashcards
Ketosis (cattle)
- Oral glucose precursors: propylene glycol; glycerol
- Glucocorticoids - stimulate appetite + promote gluconeogenesis
- B vitamins - appetite stimulation
- Nutrition + nursing
Pregnancy toxaemia (sheep)
- Oral glucose precursors
- IV dextrose
- NSAIDs
- Hypocalcium Tx - prolonged IV calcium
- Induction of parturition: glucocorticoids + PGF / caesarean section
- Euthanasia
Hypocalcaemia (cattle + sheep)
- IV calcium borogluconate (40%) (Don’t give sub-cut, not as effective, IV = better perfusion) bolus
- Oral calcium (e.g. calcium chloride / propionate)
- Nursing + nutrition - e.g. manipulate PTH system w/ low Ca^2+ diet prior to parturition, dilute grass w/ straw; Mg^2+ supplementation - MgCl2 in TMR/drinking water
- Management of 2^y conditions
Hypomagnesaemia (ruminants)
- Slow IV: 100 mL MgSO4 in 300 mL CaBG 20%
- SC: 400 mL MgSO4
- Warm infusions first, IV important for perfusion (sub-cut = poorer Px, only perfusion of peripheral tissues)
Primary hyperparathyroidism - hypercalcaemia (companion animal, equine)
- IVFT - NaCl - extra Na+ competes w/ Ca2+ to reduce tubular uptake in kidney
- Loop diuretic when adequately hydrated e.g. furosemide to reduce serum Ca2+ w/o causing hypokalemia
- Glucocorticoids - only when clear Dx (may hide malignancy/paraneoplastic syndrome)
- Bisphosphonates - inhibit osteoclastic action
- Surgical parathyroidectomy - glands v hard to find, scintigraphy to localise tissue
- Percutaneous ultrasound-guided ethanol/heat ablation (leave unaffected gland in-situ if want maintain own ability to control calcium homeostasis, often only one affected) - ethanol - induces coagulation, necrosis + thrombosis in parathyroid gland, can stop production of PTH
Hypoparathyroidism (companion animal)
- Acute: intravenous calcium gluconate
- Chronic: oral elemental calcium supplementation; vitamin D supplementation; calcitriol
Feline hyperaldosteronism (Conn syndrome)
- Sx - only if unilateral tumour, removal of adrenal gland
- Potassium supplementation - kaminox
- Spironolactone - aldosterone blocker
- Amlodipine - Ca2+ channel blocker -> smooth muscle relaxant for hypertension
Diabetes insipidus (companion animal)
- Desmopressin
- Intranasal spray/conjunctival drop
- Provide water
Hypothyroidism (dog)
- Sodium levothyroxine (0.02mg/kg q12 h) - T4 tablet supplement
- Repeat T4, TSH 6-8 weeks following treatment - Test 4-6 hours post tablet administration (peak of total T4)
- Want to be within normal range or T4 just above normal
Thyroid carcinoma (dog)
- Surgical excision - palliative - mets
- Radiotherapy - remove hyperactive tissue
- Radioiodine^131 - high dose compared to cats
Feline hyperthyroidism (cat)
(Non-curative)
- 1). MEDICAL - anti-thyroid hormone drugs: carbimazole, methimazole, thiamazole; monitor T4 levels, haematological side effects, renal disease, blood pressure
- 2). DIET - ultra-low iodine diet
(Curative)
- 3). Sx - unilateral/bilateral thyroidectomy
- 4). Radioiodine (I^131) - locally destructive, but preserves thyroid tissue + parathyroid glands
Feline hyperthyroidism renal disease - hyperthyroidism
- Diet: Hyperthyroid diets often high in protein
- Balance T4 levels with azotaemia
- Avoid iatrogenic hypothyroidism
- Consider medical trial before definitive treatment if worried about renal function
Feline hypothyroidism
- Levothyroxine supplementation
- Monitor TSH + renal parameters
Canine hyperadrenocorticism (Cushing’s disease) (+ feline)
Sx:
- Transphenoidal hypophysectomy - surgical removal of pit gland + long-term management: glucocorticoids, thyroxine, desmopressin
- Unilateral adrenalectomy - curative, glucocorticoids 6 w post-op
Medical:
- Trilostane (vetoryl) - dec cortisol production, risk of iatrogenic hypercortisolaemia (Addison’s)
- Monitor pre-pill for dose; ACTH stim test - if over-suppressed/can up dose
Canine hypoadrenocorticism (Addison’s) - acute collapsed
- IVFT - 0.9% NaCl, crystalloid (K+ in Hartmann’s negligible) dextrose/glucose if hypocalcaemia
- ECG - to monitor for life-threatening bradycardia, insulin + glucose = co-transporter of K+
- Hydrocortisone sodium succinate (Solu-Cortef) = balanced glucocorticoid + weak mineralocorticoid action, IVFT
- Once stable - long-term Tx: zycortal + oral perdnisolone
Canine hypoadrenocorticism (Addison’s) - sub-acute
- Oral prednisolone - 0.2 - 0.4 mg/kg cortisol required q24 h (normal adrenal production), so aim for 0.05 - 0.1 mg/kg prednisolone q24 h
- Zycortal (desoxycortone pivalate (DOCP)) - for mineralocorticoid deficiency, sub-cut injection q4 w
Canine diabetes
- Insulin - Canisulin - starting dose 0.25 – 0.5 IU/kg /12 h, BID; hospitalise for 12 hours to do initial BG curve; discharge appointment (use of diary/home monitoring); initial BG curve: 1 week after starting insulin - glucose measurement q 2hr
- Diet
- Control co-morbidities
- Discontinue glucocorticoids
- Spay intact bitches
- Regular moderate exercise
Canine diabetes - hypoglycaemia, insulin resistance
- Glucose admin
- Reduce insulin dose
Somogyi response to insulin therapy (hypoglycaemia-induced hyperglycaemia)
- Reduce insulin dose
Feline diabetes mellitus
- 1). DIET
- 2). WEIGHT CONTROL
- 3). EXOGENOUS INSULIN THERAPY - ProZinc
- 4). ORAL HYPOGLYCAEMIC AGENTS
Acromegaly - due to diabetes (cats)
- Glycaemic control
- Radiotherapy
- Hypophysectomy - Sx removal of pit gland, dec GH
Insulinoma (companion animal)
- Emergency: IV dextrose, glucose infusion
- Surgical resection
- Small freq meals, q4 - 6 per day to avoid spikes in insulin
- Diazoxide - inhibits insulin secretion
- Chemotherapy - streptozocin
Insulinoma (ferret)
- Constant access to food but avoidance of sugary snacks
- Prednisolone - 2 mg/kg q12 h
- Sx
Calcium tetany (poultry, layers)
- Soluble Ca (e.g. Ca pidolate) in water
- 5 g oyster shell in feed per hen (>1 mm particle size, stays in intestinal tract longer for inc absorption - must be available in afternoon for when shell is laid down
- Vit D3 (25(OH)D3) = HyD in water, 3d on, 3d off until resolution, up to 3w
- Hospitalise individuals w/ ready access to feed + water supplements
Hypocalcaemia prevention (layers)
- Feed recommended levels of Ca, large particle size calcium, controlled light stimulation, adequate ventilation
- Control bullying (BCS monitoring)
Metabolic syndrome / spiking mortality syndrome (poultry)
- Glucose supplement in drinking water
- Resolve underlying issue
- Inc day length so spend longer eating
Pituitary pars intermedia dysfunction (PPID) (equine)
- Dopamine agonists - pergolide mesylate (only licensed form), bromocriptine mesylate, cabergoline (Parkinson disease drug)
- Cyproheptadine hydrochloride -> dec ACTH secretion from pars distalis, not fully established in equids
- Monitor ACTH + CS + adjust dose (after 4 - 8 w)
Diabetes mellitus (equine) (type II)
- Diet - high energy, low NSC (good hay, beet pulp, copra, alfalfa)
- Dopamine agonists (PPID cases only)
- Exogenous insulin - too expensive + doesn’t stabilise cases
- Insulin secretagogues (glibenclamide), less helpful if pancreas failing
Diabetic ketoacidosis (companion animal)
- Medical emergency
- Short-acting (human insulin - Humulin), intermittent injections until BG 11 - 14mmol for 4-10 hours
- Intravenous fluids (isotonic saline) /
management of electrolytes (K +) - In-patient care
- Transition to long-acting insulin once
stable and eating
