Low ratios of sodium to potassium in the serum of 238 dogs

Nielsen, Lise Nikolic; Bell, R.; Zoia, Andrea; Mellor, D. J.; Neiger, R.; Ramsey, Ian

doi:10.1136/vr.162.14.431

Cited by 25 publications

(29 citation statements)

References 22 publications

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“…Compared to a recent study16 that showed a sensitivity of 92% and a specificity of 91% with a best calculated cut‐off of ≤22, our sensitivity is markedly lower. Several earlier studies have evaluated SPR as a diagnostic test in dogs in which HA is suspected 1, 17, 18. In none of them was there convincing evidence that SPR could be a reliable test, either to confirm or exclude the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of the Cortisol‐to‐ACTHRatio in Dogs with Hypoadrenocorticism, Dogs with Diseases Mimicking Hypoadrenocorticism and in Healthy Dogs

Boretti

Meyer

Burkhardt

et al. 2015

Veterinary Internal Medicne

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BackgroundThe adrenocorticotropic hormone (ACTH) stimulation test is the gold standard for diagnosing hypoadrenocorticism (HA) in dogs. However, problems with the availability of synthetic ACTH (tetracosactrin/cosyntropin) and increased costs have prompted the need for alternative methods.ObjectivesTo prospectively evaluate the cortisol‐to‐ACTH ratio (CAR) as a screening test for diagnosing canine HA.AnimalsTwenty three dogs with newly diagnosed HA; 79 dogs with diseases mimicking HA; 30 healthy dogs.MethodsPlasma ACTH and baseline cortisol concentrations were measured before IV administration of 5 μg/kg ACTH in all dogs. CAR was calculated and the diagnostic performance of ACTH, baseline cortisol, CAR and sodium‐to‐potassium ratios (SPRs) was assessed based on receiver operating characteristics (ROC) curves calculating the area under the ROC curve.ResultsThe CAR was significantly lower in dogs with HA compared to that in healthy dogs and in those with diseases mimicking HA (P < .0001). There was an overlap between HA dogs and those with HA mimicking diseases, but CAR still was the best parameter for diagnosing HA (ROC AUC 0.998), followed by the ACTH concentration (ROC AUC 0.97), baseline cortisol concentration (ROC AUC 0.96), and SPR (ROC AUC 0.86). With a CAR of >0.01 the diagnostic sensitivity and specificity were 100% and 99%, respectively.Conclusion and Clinical ImportanceCalculation of the CAR is a useful screening test for diagnosing primary HA. As a consequence of the observed overlap between the groups, however, misdiagnosis cannot be completely excluded. Moreover, additional studies are needed to evaluate the diagnostic reliability of CAR in more dogs with secondary HA.

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Section: Discussionmentioning

confidence: 99%

“…In none of them was there convincing evidence that SPR could be a reliable test, either to confirm or exclude the diagnosis. Not all dogs with HA have electrolyte abnormalities and only a minority of dogs with decreased SPR do indeed have HA 1, 17…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Cortisol‐to‐ACTHRatio in Dogs with Hypoadrenocorticism, Dogs with Diseases Mimicking Hypoadrenocorticism and in Healthy Dogs

Boretti

Meyer

Burkhardt

et al. 2015

Veterinary Internal Medicne

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“…The low sodium:potassium ratio observed in this case was determinant for the suspicion of HA, once the usual ratio ranges from 27:1 to 40:1 (SCOTT-MONCRIEFF, 2015),and values lower than 24:1 (ADLER et al, 2007) the diagnosis of HA. However, other studies have identified that the proportion of dogs with sodium:potassium ratio lower than 24:1 that suffered from HA varied from 17% to 24% of the animals, suggesting that other diseases may also cause changes in sodium:potassium ratio (ROTH; TYLER, 1999;NIELSEN et al, 2008). In a retrospective study of 225 dogs with HA, 96% of them had hyperkalemia and 81% hyponatremia (PETER-SON et al, 1996).…”

Section: Discussionmentioning

confidence: 99%

Primary Hypoadrenocorticism in a Dog

Anjos

Babo-Terra²,

Palumbo³

2016

ArqVet

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This report describes the clinical and laboratorial findings as well as the therapeutic protocol performed in a three-year-old mongrel female intact dog, referred to the Veterinary Hospital of FAMEZ/UFMS. The animal had a previous history of recurrent gastrointestinal signs (such as lethargy, vomiting, loss of appetite, melena and abdominal pain), acute crisis episodes, bradycardia, hypotension, hypothermia and increase of capillary refill time, recognized as addisonian crisis due to primary hypoadrenocorticism. Laboratorial findings included anemia, eosinophilia, neutrophilia, lymphocytosis, sodiumpotassium ratio of 14,02 mEq/L and prerenal azotemia. Based on that, it was confirmed the diagnosis of primary hypoadrenocorcitism. Thus, it was recommended supplementation therapy with mineralocorticoid (aldosterone) and glucocorticoid (cortisol) corresponding respectively, fludrocortisone acetate of 0.2 mg per kg of BW, by mouth, once daily and prednisone 0.2 mg per kg of BW, by mouth, twice daily until further recommendations. The prognostic was excellent, since the animal significantly improved body condition, andclinical signs disappeared after therapy which lead the sodium-potassium ratio to 35.11 mEq/L. Thus, the clinician must always suspect of primary hypoadrenocorticism in dogs with intermittent nonspecific signs that get better with support therapy. Presumably, hypoarenocorticism must be under diagnosed in veterinary medicine, reinforcing the need to require specific exams in patients that show this wax and wane feature of clinical signs. KEYWORDS: Addison's disease. Dogs. Endocrinopathies. Glucocorticoid. Mineralocorticoid. Sodium-potassium ratio. HIPOADRENOCORTICISMO PRIMÁRIO EM UM CÃORESUMO: O presente relato descreve os achados clínicos, laboratoriais e conduta terapêutica de um animal da espécie canina, fêmea, com três anos de idade, inteiro, sem raça definida, diagnosticado com hipoadrenocorticismo primário atendido no Hospital Veterinário da FAMEZ/UFMS. O animal apresentou histórico de recidivas de sinais gastrintestinais (letargia, vômi-tos, perda de apetite, melena e dor abdominal), crise adrenal aguda, bradicardia, hipotensão, hipotermia e aumento do tempo de preenchimento capilar. As alterações laboratoriais compreenderam linfocitose, anemia, eosinofilia, neutrofilia, densidade urinária < 1.030, relação sódio: potássio 14,02 mEq/L e azotemia pré-renal. Baseado nos achados clínicos-laboratoriais confirmou-se o hipoadrenocorticismo primário. Em seguida, foi instituído terapia de suplementação de mineralocorticoide (aldosterona) e glicocorticoide (cortisol), correspondendo respectivamente ao acetato de fludrocortisona na dose de 0,2 mg/ kg por via oral uma vez ao dia e prednisona 0,2 mg/kg por via oral duas vezes por dia até novas recomendações. O prognóstico foi excelente para este caso, já que houve melhora significativa do animal, com o desaparecimento dos sinais clínicos e com nova relação sódio: potássio de 35,11 mEq/L. Assim, deve-se sempre suspeitar de hipoadrenocorticismo primário ...

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“…However, the measurement of endogenous ACTH in plasma and, perhaps, pituitary and adrenal imaging would make the differentiation from the secondary form more solid (Feldman and Nelson 2004). In previous studies, renal and urinary tract disorders, gastrointestinal disease, pancreatitis, pleural effusions and liver failure were more often associated with a lower than 27 Na:K ratio than hypoadrenocorticism itself (Roth and Tyler 1999, Son-Il-Park 2000, Nielsen et al 2008. However, the fact of the lower than 24 Na:K ratio in all 5 dogs may facilitate the differentiation from the aforementioned diseases, since the specificity of this cut-off value is approaching 100% (Adler et al 2007).…”

Section: Discussionmentioning

confidence: 99%

Οξύς Υποφλοιοεπινεφριδισμος (Αδισσώνια Κρίση) Στο Σκύλο: Αναφορά Σε Έξι Περιστατικά

Kasabalis

Soubasis

Pardali

et al. 2017

J Hellenic Vet Med Soc

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Medical records of six dogs admitted with acute hypoadrenocorticism were reviewed. All 6 animals were bradycardic and had prolonged capillary refilling time. Hypothermia was detected in 5/6 animals. Clinicopathological evaluation on admission revealed anemia (3/6 dogs), increased (2/6) and normal (2/6) lymphocyte and eosinophil counts, azotemia and hyperkalemia (6/6), hyponatremia, in 5/6 dogs in which sodium was measured with a sodium (Na) : potassium (K) ratio lower than 24, hypoglycemia (2/6) and hypercalcemia, hypocholosterolemia, increased serum alkaline phosphatase and alaninoaminotransferase activities, one dog each. Urine specific gravity was lower than 1025 in 4 dogs. Thoracic radiographs and abdominal ultrasonography disclosed microcardia (2/6), pleural effusion (2/6) and ascites (1/6). Two dogs (2/6), also, presented atrial standstill or atrioventricular block, detected on electrocardiograms. In all 6 animals emergency treatment included the use of intravenous normal saline and glucocorticoids (dexamethasone) immediately after the completion of an ACTH stimulation test with tetracosactide. Two dogs died, one during the 1st day and the other on the 4th day of hospitalization, the latter after the sudden appearance of severe hemorrhagic gastroenteritis. Hospitalization time in the remaining 4 dogs ranged from 3 to 10 days. Prolongation of hospitalization was associated with worsening of anemia, hypoalbuminemia, neurologic complications and non-responsive azotemia. Four dogs (4/6) were discharged on oral prednisolone and fluodrocortisone, but one died after a week for unknown reasons. Acute hypoadrenocorticism is a life threatening condition requiring emergency treatment for a successful outcome. Its inclusion in the differential diagnosis of canine emergencies, presented with acute weakness and gastrointestinal signs, is mandatory, but for its confirmation a complete laboratory and, most importantly, an ACTH stimulation test are always required.

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Low ratios of sodium to potassium in the serum of 238 dogs

Cited by 25 publications

References 22 publications

Evaluation of the Cortisol‐to‐ACTHRatio in Dogs with Hypoadrenocorticism, Dogs with Diseases Mimicking Hypoadrenocorticism and in Healthy Dogs

Evaluation of the Cortisol‐to‐ACTHRatio in Dogs with Hypoadrenocorticism, Dogs with Diseases Mimicking Hypoadrenocorticism and in Healthy Dogs

Primary Hypoadrenocorticism in a Dog

Οξύς Υποφλοιοεπινεφριδισμος (Αδισσώνια Κρίση) Στο Σκύλο: Αναφορά Σε Έξι Περιστατικά

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