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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 99 appropriately hydrated, her electrolytes were corrected, and she was eating and drinking voluntarily. Lucky's owner was instructed on the long-term management of hypoadrenocorticism, taught how to administer medications (including extra dosing during stressful events), and counseled to follow up with the veterinarian for long-term mineralocorticoid management (eg, d O c P). The primary care veterinarian performed a recheck examination 3 days after discharge and noted that the physical examination and electrolyte findings were normal; follow-up was scheduled for 3 weeks later to recheck electrolytes and administer d O c P (Table 6 ). The owner was pleased with the outcome and rapid improvement in Lucky's condition. IN SUMMARY c linicians should be able to rapidly recognize hypoadrenocorticism on the basis of history, sig - nalment, clinical signs, and classic clinicopatho- logic testing. r apid and appropriate diagnostic workup should be performed (eg, baseline cortisol, ac T h cortisol evaluation) to rule out other "look-alike" diseases, such as metabolic disorders (eg, renal disease, pancreatitis), toxicosis (eg, from ingestion of grapes, cholecalciferol), and infectious disease (eg, Leptospira infection, urinary tract infection, pyelonephritis). While long-term management may be cumulatively expensive (eg, prednisone, periodic electrolyte monitoring, and mineralocorticoid supplementation), with medical management, the prognosis for hypoadrenocorticism is good to excellent. ac T h = adrenocorticotropic hormone; a K i = acute kidney injury; c B c = complete blood count; ec G = electrocardiogram Table 5. d rugs c ommonly Used for the t reatment of Hypoadrenocorticism 10 t HE ra P y dosag E not E s act H s timulation t est c osyntropin 5 mcg/kg or 250 mcg IV/IM 1. Draw pre-ACTH stimulation serum level 2. Administer cosyntropin 3. Draw post-ACTH stimulation serum level 1 H later g lucocorticoid t herapy d examethasone or d examethasone sodium phosphate 0.1 mg/kg IV Q 12–24 H For treatment of glucocorticoid deficiency; can be used before or after ACTH stimulation test because it does not interfere with testing Prednisone 0.03–0.05 mg/kg per day PO Q 12–24 H • For use after ACTH stimulation test • Additional dosing necessary in stressful situations m ineralocorticoid t herapy d esoxycorticosterone pivalate 1.1–2.2 mg/kg IM Q 25–30 days Fludrocortisone acetate 0.02 mg/kg per day g astroprotectant Famotidine 1 mg/kg IV Q 12 or 24 H Pantoprazole 1 mg/kg IV Q 24 H o meprazole 1 mg/kg PO Q 24 H a ntiemetic m aropitant 1 mg/kg SC or IV Q 24 H Table 6. l ong- t erm Follow-Up m onitoring for Hypoadrenocorticism Patients monitoring F r EQUE ncy (dependent on severity of clinical signs) Electrolytes 3–7 days after discharge; then every 21–25 days for 3–6 months, depending on stability of electrolytes Complete blood count Serum biochemical profile Urinalysis Every 6 months Are you a busy veterinary professional that is constantly on the run and experiencing "time poverty"? Join VETgirl, a subscription- based podcast and webinar service offering RACE- approved, online veterinary CE. Founded by Dr. Justine Lee and Dr. Garret Pachtinger, VETgirl offers clinically relevant, practical online veterinary CE for just $199/year. With a VETgirl ELITE subscription, you receive 40+ hours of CE, all provided by board-certified veterinary specialists and experts. Learn more at Join v E t girl.com and use the discount code tv P2016 for a 10% discount.