Emergency Medicine Case of the Week -- Addisonian Crisis

Emergency Medicine Case of the Week

Case #7 -- Addisonian Crisis

**Learning Objectives**
After reviewing this case you will be able to:
Recognize a dog in an Addisonian crisis Provide emergency treatment for this condition Review the pathophysiology behind the clinical condition

Case Presentation by: Eleanor Jenson and Melissa Etheridge

Patient Profile: "Grisby", a 9-year old, intact male, Great Pyrenese, CSU #170390

170390-1.jpg (60417 bytes)

History: "Grisby" had a relatively acute onset of weakness, vague history of vomiting and diarrhea for the past week, and a decreased appetite. Referring veterinarian thought the dog had a weak pulse and muffled heart sounds. Also noted were cool extremities and a prolonged capillary refill time. Grisby is normally quite "growlly" and sometimes aggressive. Today Grisby is very calm and seems depressed.

Physical Examination: Heart and pulse rate = 120/minute. Respiratory rate = 32 breaths/minute. Body weight = 46 kg. "Grisby" was recumbent, reluctant to move, had a normal capillary refill time, and was assessed to be at least 7% dehydrated. Auscultation of the heart revealed no apparent abnormalities but the heart was difficult to auscult and sounds were muffled. Grisby was depressed but no abnormal neurological findings were noted. The musculoskeletal system was apparently normal.

Laboratory Findings: A peripheral blood smear was examined and showed the following:

rbc2.jpg (192861 bytes) rbc1.jpg (206964 bytes)

Abnormalites from the Small Animal Biochemical Profile were as follows:

	Patient Results	VTH Reference Range
BUN	65	7 - 28 mg/dl
Creatinine	2.5	0.6 - 1.5 mg/dl
Cholesterol	99	130 - 300 mg/dl
Sodium	122	145 - 158 mEq/L
Potassium	6.4	4.1 - 5.5 mEq/L
Chloride	95	106 - 127 mEq/L
Bicarbonate	13.8	14 - 27 mEq/L
Osmolality	266	280 - 310 mOsm/Kg

Thoracic Radiographs:

170390-3.jpg (34361 bytes) 170390-4.jpg (34774 bytes)

Click here to see an enlargement of the radiograph

Electrocardiogram: Lead II, 25 mm/second paper speed, 1 mV = 10 mm

Click on the electrocardiogram to see an enlargement

Questions:

After examining the blood smear, what makes you think of an Addisonian crisis?
Describe the abnormalites on the small animal biochemical profile which suggest an Addisonian?
Describe the radiographic abnormalites you would expect to see with an Addisonian crisis.
Interpret the electrocardiogram in light of the physical examination and clinical pathological results.
Describe the intravenous fluid you would use in the initial resuscitation of Grisby.
Select the corticosteroid you would use in the emergency treatment of Grisby.
Select the test you would use for confirmation of a diagnosis of hypoadrenocorticism (Addison's disease).

Answers and Discussion:

Return to Introduction:

Emergency Medicine Case of the Week

Copyright Wayne E. Wingfield, DVM, Colorado State University, 1999. All rights reserved. This page was last edited: 04/08/99

Copyright Wayne E. Wingfield, DVM, Colorado State University, 1999. All rights reserved.
This page was last edited: 04/08/99