Veterinary Medicine - March 2009 - (Page 126)

PEER-REVIEWED A challenging case: Severe hypercalcemia in a puppy with hypoadrenocorticism The point of interest in this case was not the disease, but the degree to which it caused an elevated calcium concentration. Teresa L. Goodson, DVM, DACVIM, and Susan C. Randell, BVSc, DACVIM A Vital Stats Signalment • 5-month-old 14.9-lb female English springer spaniel History and presenting complaints • Lethargy, decreased appetite, and weight loss of two weeks’ duration • Treatment with lactated Ringer’s solution, aminopentamide hydrogen sulfate, enroﬂoxacin, and penicillin G one week before referral Initial examination ﬁndings • Lateral recumbency, rectal temperature 99.7 F, poor body condition with a dry, unkempt coat and 8% dehydration • Bilateral mucopurulent ocular discharge • Waxy debris in both ears 5-month-old intact female English springer spaniel had been evaluated by the referring veterinarian for lethargy, decreased appetite, vomiting, and weight loss of one week’s duration. A complete blood count (CBC) had revealed no abnormalities. Abnormal serum chemistry pro le results were elevated blood urea nitrogen and creatinine concentrations, hypercalcemia, hyperphosphatemia, hyponatremia, and hyperkalemia (Table 1). Treatment had included intravenous lactated Ringer’s solution (26 ml/kg every 12 hours as a bolus) and injections of aminopentamide hydrogen sulfate (0.03 mg/kg every 12 hours), enro oxacin (0.59 mg/kg every 12 hours—note that enro oxacin is contraindicated in small- and medium-breed dogs between 2 and 8 months of age), and penicillin G (19,480 U/kg every 12 hours). The puppy’s clinical signs had improved slightly after 24 hours of hospitalization, at which time it had been discharged to the owner. The referring veterinarian had tentatively diagnosed renal failure due to a genetic or congenital problem. A therapeutic renal diet had been the only treatment prescribed. had a poor body condition, a dry and unkempt coat, bilateral mucopurulent ocular discharge, and waxy debris in both ears. The puppy’s rectal temperature was 99.7 F (37.6 C), its heart rate was 150 beats/min, and its respiratory rate was 32 breaths/min. Its mucous membranes were pale-pink. We suspected hypoadrenocorticism and performed a CBC, a urinalysis, a serum chemistry pro le, and an ACTH stimulation test. The CBC results revealed no abnormalities. The lack of a stress leukogram in this critically ill animal supported our suspicion of hypoadrenocorticism. The urinalysis results were normal, including a urine speci c gravity of 1.020 (adult dog reference range = 1.015 to 1.050). Puppies older than 4 weeks of age have urine speci c gravity measurements similar to those of healthy adult dogs.1 However, urine speci c gravity is expected to be increased in the face of hypovolemic shock, even in a puppy. Serum chemistry pro le results revealed mild azotemia and hyponatremia and severe hyperkalemia, hypercalcemia, and hyperphosphatemia (Table 1, day 7). The sodium:potassium PHYSICAL EXAMINATION AND DIAGNOSTIC TESTING Six days later (day 7), the puppy was referred to our hospital because of progression of clinical signs and for evaluation of possible renal failure. On presentation, the patient weighed 14.9 lb (6.8 kg) and was laterally recumbent and about 8% dehydrated. The puppy Initial suspicions • Hypoadrenocorticism Teresa L. Goodson, DVM, DACVIM Susan C. Randell, BVSc, DACVIM Afﬁliated Veterinary Specialists 9905 S. U.S. Highway 17-92 Maitland, FL 32751 126 March 2009 VETERINARY MEDICINE

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Veterinary Medicine - March 2009 Contents Letters Correction Author Guidelines Hot Literature Idea Exchange A Challenging Case Local and Regional Anesthesia Techniques The Latest Scoop on Litter Product Preview CE Form/Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - March 2009

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