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T O day' S Ve T erinary Prac T ice | September/October 2016 | tvpjournal.com cO n S ider Thi S c a S e Peer r eviewed 96 insulinoma, iatrogenic insulin administration, hunting dog hypoglycemia, neoplasia, or sepsis • e lectrolyte abnormalities, with a sodium:potassium ratio of 16:1 • a zotemia: May be due to prerenal or primary a K i • h ypercalcemia: May be due to underlying metabolic disease (eg, hypoadrenocorticism, hyperparathyroidism), toxicosis (eg, cholecalciferol, calcipotriene), or neoplasia • i sosthenuria: May be due to medullary washout secondary to excessive sodium loss into the urine or underlying renal disease. Lucky's baseline cortisol (< 2 mcg/dL) was consistent with hypoadrenocorticism. d ue to concern regarding the low baseline cortisol, a complete adrenocorticotropic hormone ( ac T h ) stimulation test was submitted. Both pre- ac T h (< 2 mcg/dL) and post- ac T h (< 2 mcg/dL) stimulation test results were consistent with hypoadrenocorticism. DEFINITIVE DIAGNOSIS Based on the baseline cortisol and ac T h stimulation tests, all the clinicopathologic tests were consistent with a diagnosis of hypoadrenocorticism. a dditional diagnostics may include fecal testing (to rule out whipworms) and advanced diagnostic imaging, such as ultrasound (to rule out signs and disease, such as gastrointestinal bleeding, ascites, and neoplasia). THERAPY FOR HYPOADRENOCORTICISM Typical supportive therapies for the patient with hypoadrenocorticism include: 8,9 • Crystalloid fluids, along with dextrose supplementation as needed • Steroids, such as Table 4. Serum Biochemical Profile & Urinalysis Results val UE r E s U lt r EFE r E nc E rang E Serum Biochemical Profile White blood cells (10 3 cells/mcL) 8 4–17.6 r ed blood cells (10 6 cells/mcL) 4 4.48–8.53 Hemoglobin (g/dL) 11.6 10.5–20.1 Hematocrit (%) 35 33.6–58.7 m ean corpuscular value (fL) 65 63–78.3 m ean corpuscular hemoglobin (pg) 22.9 15.3–39.2 m ean corpuscular hemoglobin concentration (g/dL) 34.9 30.8–35.9 Platelet count (10 3 cells/mcL) 245 110–460 Platelet (estimate) Adequate Adequate d ifferential n eutrophils Absolute (cells/mcL) 5135 2.5–14.3 Percentage 64 Bands Absolute (cells/mcL) 0 0.0–0.2 Percentage 0 l ymphocytes Absolute (cells/mcL) 1334 0.3–3.9 Percentage 16 m onocytes Absolute (cells/mcL) 231 0–1.4 Percentage 2.9 Eosinophils Absolute (cells/mcL) 1332 0–1.3 Percentage 16.6 Basophils Absolute (cells/mcL) 0 0–0.1 Percentage 0 t otal protein (g/dL) 6.1 5–8.3 a lbumin (g/dL) 2.7 2.6–4 g lobulin (g/dL) 3.4 2.2–4.1 a lbumin/globulin ratio 1.3 0.8–2 a spartate aminotransferase (U/L) 30 18–86 a lanine aminotransferase (U/L) 89 14–151 a lkaline phosphatase (U/L) 130 13–289 t otal bilirubin (mg/dL) 0.1 0.1–0.5