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tvpjournal.com | September/October 2016 | T O day' S Ve T erinary Prac T ice cO n S ider Thi S c a S e Peer r eviewed 97 dexamethasone, due to lack of adequate glucocorticoid levels; other types of steroids (eg, prednisone, prednisolone, hydrocortisone) should not be used before diagnostic testing (eg, ac T h stimulation, baseline cortisol) because they interfere with the radioimmunoassay for glucocorticoid measurement • Gastric protectants, such as famotidine or pantoprazole, if gastric ulceration is suspected • Antiemetics, such as maropi- tant, dolasetron, ondansetron, or metoclopramide, if vomiting is present • Mineralocorticoids, such as desoxycorticosterone pivalate ( d O c P) or fludrocortisone acetate (Florinef, bms.com), to help normalize electrolytes; they should be administered once the patient is stable, with life-threatening electrolyte abnormalities corrected, and can tolerate oral medication. Lucky's therapeutic approach included: 1. i nitial therapy for electrolyte abnormalities and arrhythmias (calcium gluconate), with continuous ec G monitoring 2. i nitial therapy for dehydration and hypovolemia (dextrose and fluid boluses, then fluid therapy) 3. r apid diagnosis of, and therapy for (Table 5, page 99), hypoadrenocorticism. Lucky's hydration and hypovolemic state improved with fluid therapy and her blood pressure returned to normal after 2 crystalloid boluses. Within 12 hours, Lucky was eating and drinking, and her electrolyte abnormalities had resolved. PROGNOSIS & FOLLOW- UP CARE Lucky was discharged the day after presentation—once she was Table 4. (Continued) Serum Biochemical Profile & Urinalysis Results val UE r E s U lt r EFE r E nc E rang E d ifferential (continued) Urea nitrogen (mg/dL) 72 (H) 8–30 c reatinine (mg/dL) 4.1 ( H ) 0.4–2 Blood urea nitrogen/creatinine ratio 17.6 4–27 Phosphorus (mg/dL) 13.3 ( H ) 2.5–7.9 g lucose (mg/dL) 42 ( l ) 74–145 c alcium (mg/dL) 14.4 ( H) 8.7–12 s odium (mEq/L) 136 ( l ) 141–159 Potassium (mEq/L) 8.2 (H) 3.4–5.6 s odium/potassium ratio 16:1 c hloride (mEq/L) 104 100–121 c holesterol (mg/dL) 324 98–300 c reatine phosphokinase (U/L) 292 50–554 Urinalysis c olor Yellow a ppearance Turbid Clear* Specific gravity 1.018 1.015–1.050 pH 6 5.5–7 Protein Negative Negative g lucose Negative Negative Ketone Negative Negative Bilirubin 1+ Negative to 1+ Blood 1+ ( H ) Negative White blood cells None 0–3 HPF r ed blood cells 0–1 0–3 HPF c asts None seen c rystals None seen Bacteria None seen Epithelial cells None seen Hemolysis 1+ No significant interference H = high; HPF = high power field; L = low * Collected after 20 mL/kg fluid bolus administered