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A-vin Night > Hypoadrenocorticism > Flashcards

Hypoadrenocorticism Flashcards

1
Q

Do cats have Addison’s disease?

A

Uncommon but possible

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2
Q

Main signalment for Addison’s disease in dogs?

A

Middle aged; Female dogs

Can be seen in as young as 4 m and as old as 14 yr

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3
Q

Most common breeds which can have Addison’s disease?

  • Large:
  • Small:
A
  • Large: Great dane, poodle, Retrievers, Rottweilers, Bearded collies
  • Small: West highland terrier
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4
Q

CS can wax and wane and mimic any other disease. T/F

A

T

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5
Q

In any patient who presents with CIRCULATORY SHOCK and ↓ HR, think Addison’s disease. T/F

A

T

Signs of circulatory shock are = Pale MM, Prolonged CRT, ↓ Temp, week pulses, mental depression/collapse

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6
Q 
Most common signs in Addison’s disease?
-
-
-
-
A
  • weakness and lethargy
  • V , D (Can see blood in both V and D)
  • PU/PD
  • Signs of circulatory shock
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7
Q

Main CBC abnormalities expected in Addison’s disease?

A
  • Absence of stress leukogram/ instead might see reverse leukogram
  • Anemia
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8
Q

What type of anemia due to expect in Addison’s disease?

A
  • N,N, NR anemia

Can be due to anemia of chronic disease or GI ulceration

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9
Q

Elaborate about leukogram findings in patients with Addison’s disease?

A
  • Absence of stress leukogram (i.e. normal neutrophils and lymphocytes)
  • Might show reverse leukogram (i.e. ↓neutropenia, ↑ lymphocytes)

Any MODERATELY ILL animal that presents with NORMAL or REVERSE LEUKOGRAM should raise suspicion of Addison’s disease

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10
Q

Chemistry findings in Addison’s disease:

  • Na:K Ratio
  • P
  • Creatinine, BUN
  • Glucose
  • albumin
  • cholesterol
A
  • Na:K Ratio <27:1
  • ↑ P
  • ↑ BUN and creatinine due to pre-renal azotemia
  • ↓ Glucose
  • ↓ albumin
  • ↓ cholesterol
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11
Q

A decreased Na:K ratio is not pathognomic for Addison’s disease and not all Addisonian patients will have low Na:K Ratio . T/F

A

T

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12
Q

Other causes of low Na:K Ratio?

A
  • Heart failure
  • GI disease(Trichuris, Salmonellosis)
  • Late term pregnancy
  • Pancreatitis
  • Neoplasia
  • Body cavity effusion, uroabdomen, renal failure
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13
Q

Urinalysis might reveal ISOSTHENURIA in face of pre-renal azotemia. T/F

A

T

Sodium loss → renal medullary washout → isosthenuria

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14
Q

With hyperkalemia, you might see marked ↓ HR i.e. < 70 . T/F

A

T

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15
Q

Unlike dogs, cats usually donot show ECG abnormalities with ↑ K. T/F

A

T

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16
Q

3 main ECG abnormalities with ↑ K ?

A
  • absence of P waves
  • Wide QRS
  • Tented T waves

Might see VF or asystole too

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17
Q

3 main findings which you will expect in XRAY in case of HOC?

A
  • microcardia
  • small caudal vena cava
  • microhepatica
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18
Q

Why is fecal analysis recommended in a suspected case of HOC?

A

To r/o pseudo-addison’s disease such as GI parasites (eg: whipworms)

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19
Q

What is the cut-off value of resting cortisol which tells you that HOC is highly unlikely.

A

If >2 ug/dl

If <2 ug/dl, then further testing such as ACTH stim test is needed

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20
Q

_______ is gold standard test for making definitive Dx of HOC

A

ACTH

Not LDDST

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21
Q

-

A
  • correct hypoperfusion/hypovolemia

- correct ACID BASE & Electrolyte abnormalities

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22
Q

Which fluid type to use?

A

Normosol R, LRS, Plasmalyte 1-48 or A

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23
Q

NaCl is not the fluid of choice in cases of HOC. T/F

A

T

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24
Q

Goal is to avoid increased of SODIUM by no more than _____ mEq/L per hour.

A

0.5-1

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25
Q

How much shock bolus in dog and what is limit?

A

20-40 mg/kg
Upto 90 ml/kg/hr

Easy way to calculate 1/4th bolus is Bw in LBS X 10

26
Q

How much shock bolus in cats and what is the limit?

A

10-15 ml/kg

Upto 60 ml/kg/hr

1/4th shock bolus is ~ BW in Kgs X 10

27
Q

Lower fluid rate be used for resuscitation in which 2 category of patients?

A
  • pet with HEART DISEASE

- HYPOTHERMIC CAT (go with bw in kg X 10 )

28
Q

Mnemonic for EOR ?

A

HCM PUB

H - HR
C - CRT
M - MM color & mentation
P - Pulse quality
U - UOP
B - BP
29
Q

So overall, first step in case of Rx for HOC is ________

A

Fluid resuscitation

Then constitute a fluid plan for dehydration + maintenance

30
Q

Usually, when do we worry about adding colloids based on albumin levels.

A

If < 1.5 g/dL

But AKI is a possibility , so be very careful

31
Q

How to Rx HYPERKALEMIA?

A
  • IV Fluid resuscitation will help

- Need MRx if > 7-8 mEq/L : options are Ca Gluconate +/- R insulin & Dextrose

32
Q

Elaborate Ca Gluconate dose for Rx of ↑ K?

A

0.5-1.5 mg/kg slow IV over 15 min

KEEP PET ATTACHED TO ECG

33
Q

What to look in ECG so that the Ca Gluconate infusion can be slowed or stopped?

A

↓ in HR or development of new arrhythmia

34
Q

Dose of R insulin & Dextrose as Rx for Hyperkalemia?

A
  • R insulin is 0.2 U/kg IV (BW in kg/4)
  • Dextrose 50% : 1 ml/kg IV

Give R insulin first, then give Dextrose

Pets might also need 2.5% dextrose CRI

35
Q

CHECK blood GLUCOSE prior to giving R INSULIN . T/F

A

T

36
Q

Rx for Hypoglycemia i.e. if < 60 mg/dL

A

Dextrose(50%) 1 ml/kg IV diluted 1:2 to 1:4 with 0.9% Saline

Repeat the bolus PRN or start 2.5% CRI if hypoglycemia persists

37
Q

PEARL: in cats with continued HYPOTENSION even after fluid resuscitation, consider checking _____ levels in blood

A

GLUCOSE

38
Q

So, Step 1 was resuscitation and Step 2 was IV fluids + correcting hyperkalemia and hypoglycemia.

What is step 3 ?

A

Glucocorticoid therapy

It should be withheld until after fluid resuscitation & Hypoperfusion is withheld

39
Q

Which corticosteroid does not mess with ACTH Test?

A

Dexamethasone

**Still to avoid any artifact, the test must be completed within 2-3 hr of giving Dexamethasone

40
Q

Do you start with IV steroids or PO Steroids in hospital?

A

IV until pet is eating and then can be transitioned to oral medications

41
Q

Main three options for IV steroids

A

Dex SP 0.1-0.4 mg/kg IV
Prednisolone SS 0.5 - 1 mg/kg IV
Hydrocortisone SS 5 mg/kg IV

42
Q

Outpatient therapy for HOC is lifelong . T/F

A

T

43
Q

2 options for outpatient therapy for HOC?

A
  • Fludrocortisone , or

- DOCP + Prednisolone

44
Q

Fludrocortisone has both glucocorticoid & mineralocorticoid activity. T/F

A

T

45
Q

DOCP only has mineralocorticoid activity. T/F

A

T

So we need to give Prednisone with it

46
Q

Dosage of Prednisone for outpatient therapy of HOC?

A

0.4-0.6 mg/kg PO Daily (for ~ 1 week)→ tapered to physiologic dose of 0.2 mg/kg daily

47
Q

How long can it take for dogs and cats to respond to initial therapy ?

A

Dogs: few hours to 1-2 days
Cats: may take upto 3-4 days

48
Q

-
-

A
  • Antibiotics
  • GI protectants & anti-emetics
  • Blood tranfusions
49
Q

What percentage of pets with HOC are ATYPICAL cases?

A

1/4th i.e. 25%

50
Q

Do pets with HOC have a hx of weight loss?

A

Yes, ~ 50%

51
Q

2 main points regarding Hx in ATYPICAL HOC?

A
  • VOMIT more common

- Longer course of disease

52
Q

-
-

A
  • ANEMIA
  • ↓ Albumin
  • ↓ Cholesterol
53
Q

What 2 CBC changes do you see in REVERSE LEUKOGRAM?

A

↓ Neutrophils

↑ Lymphocytes

54
Q

Sensitivity and specificity of ACTH Stim test.

A

Sensitivity is 100%

Specificity is ~ 80% (if positive = 20 false positives among 100 positives )

55
Q

We should avoid 0.9% NaCl, especially if Na is < ____ mEq/L in blood .

A

120

56
Q

Dose of HES is you need to give in case of ↓ albumin.

A

5-15 ml/kg

57
Q

Usually, we consider R insulin + Dextrose as an Rx for ↑ K if K levels are > ___

A

7

58
Q

Which medications to use if GI bleeding?

A

Omeprazole + Carafate +/- Antibiotics

59
Q

Its is best to DRAW BLOOD SAMPLE for ACTH STIM test BEFORE GIVING STEROIDS. T/F

A

T

60
Q

Florinef/Fludrocortisone dose

A

0.1-0.3 mg/kg/d

Remember: physiologic dose of predisone is ~ 0.2 mg/kg (so almost similar )

61
Q

DOCP Dose

A

2.2 mg/kg IM q21-25 d

check electrolytes within 7-12 days and then at day 25

A-vin Night (9 decks)

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