Today's Veterinary Practice

SEP-OCT 2016

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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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 93 Lucky, a 6-year-old, 20-kg, female spayed, mixed- breed dog was presented due to a 1-week history of progressive " adr " (ain't doing right). HISTORY Lucky was presented to the emergency referral veterinary clinic because her primary care veterinarian was closed for the evening. The owner reported that Lucky vomited in the car a week earlier when coming home from the groomer. Over the past week, Lucky's appetite diminished but she seemed thirstier. Lucky had become progressively more lethargic and anorectic over the past 2 days. Lucky was up-to-date on vaccines, receiving seasonal flea and tick medication and heartworm preventative, and healthy until a week ago. PHYSICAL EXAMINATION The physical examination findings for Lucky upon presentation to the referral facility are listed in Table 1. d oppler blood pressure measurement revealed that Lucky's systolic blood pressure was 80 mm h g. INITIAL DIAGNOSTICS d ue to the combination of Lucky's dehydration and hypovolemia (based on poor pulse quality), a peripheral 18-gauge, 6-cm cephalic i V catheter was placed. a small amount of blood from the catheter hub was obtained for analysis of packed cell volume, total solids, blood urea nitrogen ( a zostix, usa.healthcare.siemens.com), blood glucose, and venous blood gas/electrolytes. Laboratory results are listed in Table 2, page 94. d ue to the severe hyperkalemia (see INITIAL DIAGNOSIS, Electrolyte Abnormalities, page 94), an electrocardiogram ( ec G) was obtained immediately. a sinoventricular rhythm was observed, with absent P waves and widened Q r S complexes (Figure 1, page 94). Typical ec G findings in hyperkalemic patients include The adr ( a in't d oing r ight) d og Endocrin E Em E rg E nci E s Justine A. Lee, DVM, Diplomate ACVECC & ABT Garret Pachtinger, VMD, Diplomate ACVECC VETgirl, St. Paul, Minnesota The first annual Today's Veterinary Practice symposium— i nsights from Experts—took place at the NAVC Conference 2016 in Orlando, Florida. This article reviews the information provided by Dr. Justine Lee and Dr. Garret Pachtinger in the session, Emergency m anagement of Hypoadrenocorticism. Stay tuned for more information on the 2017 NAVC Conference TVP symposium at tvpjournal.com and navc.com. Table 1. Physical Examination Findings B EH avior Ambulatory but weak Responsive but quiet c ardiac/ rE s P iratory Mild bradycardia (heart rate, 70 beats/min) Pink tacky mucous membranes Fair femoral pulse quality but poor metatarsal pulse quality Eupneic with normal lung sounds Body c ondition Mildly prolonged skin turgor Body condition score 5/9; no weight loss noted Hypothermia (98.1°F [36.7°C]) 5% dehydration Pal P ation No obvious abnormalities, effusion, or masses palpated Severe hyperkalemia is a potentially life-threatening complication in a variety of conditions and, thus, emphasizes the importance of rapid evaluation and treatment.

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