- If your pet collapses, is unable to walk or get up, or experiences severe trauma, these are considered “RED” – or true emergencies – on our Fast Track Triage system. We advise you to seek immediate veterinary care. Please call ahead of your arrival so the veterinary team knows to expect you!
Basel the three-year-old Bernese Mountain Dog just wasn’t feeling like himself. He’d pooped in the kitchen – a definite no-no. The stool was loose and became looser as the day wore on, and oddly, Basel began to favor his hindlimbs. Then Basel’s back legs began to give out on him, so Monday morning, straight to his veterinarian he went. Inexplicably, Basel had lost 4 pounds, but his examination was normal, as were x-rays of his hindlimbs and belly. Basel was put on pain medications and an antibiotic, in the event that he was suffering from a tick-borne illness.
Arriving at The ER
As Monday evening arrived, Basel stopped walking entirely and seemed uncomfortable. He’d also vomited several times. His owner decided it was time to visit the ER.
During the exam, Dr. Tabor noted that Basel’s belly was tender, and he was somewhat dehydrated, unable to walk, and his heartrate was slower than normal. She ordered bloodwork to try to get to the bottom of Basel’s mysterious illness.
Putting Together the Puzzle
Basel had low blood pressure, and his baseline blood work confirmed mild dehydration, low-normal glucose, elevated kidney values, elevated phosphorus, low cortisol, low cholesterol, low sodium and significantly elevated potassium. His potassium was so high, in fact, that it was having a negative effect on Basel’s heart and cardiovascular system in the form of a cardiac arrhythmia. Basel’s potassium would need to be addressed, or it could lead to life-threatening cardiovascular problems.
Basel was also positive for anaplasma and Lyme, but the test looks for antibodies to these two tickborne illnesses, and antibodies can indicate either a previous exposure or current infection.
Dr. Tabor did not believe that Basel’s current state was caused by a tickborne disease. But what was going on? She reviewed the bloodwork’s major findings: low sodium, high potassium, azotemia (a buildup of waste products in the blood, including urea and creatinine) and low cortisol. Additionally, Basel’s bloodwork showed that he lacked a stress leukogram, a specific pattern of changes in white blood cell counts that occur in response to stress. Basel’s low cortisol was likely responsible for this.
Dr. Tabor was suspicious that Basel might have Addison’s Disease. Addison’s Disease, also known as hypoadrenocorticism, is a condition where the adrenal glands fail to produce sufficient corticosteroid hormones, primarily cortisol and aldosterone. This deficiency affects various bodily functions, including stress response, electrolyte balance, and metabolism. Basel’s low cortisol, lack of a stress response as shown in his bloodwork, high potassium, and loss of four pounds in body weight could all be signs of Addison’s. A special test called an ACTH Stim test was performed to see if Basel had Addison’s Disease.
Treatment
In the meantime, Basel’s electrolyte and hormone imbalances needed to be treated. A dose of calcium gluconate was given to protect Basel’s heart from his high potassium level, and it resolved his arrhythmia. Fluids and insulin were given to help bring down his potassium level, and Basel was given an anti-inflammatory dose of steroids to supplement the steroids not being produced in his own body. He was also given a drug called Zycortal which helps replace mineralocorticoids, a class of corticosteroids including aldosterone.
Basel Begins to Feel Better
Over the next day and a half, Basel’s potassium, sodium and kidney values returned to normal. He also began eating and was able to walk again. And guess what? The ACTH Stim test confirmed that the source of Basel’s illness was Addison’s disease.
Basel was sent home on oral steroids which were tapered down to a maintenance dose over time. Basel will be on steroids daily and Zycortal monthly for the rest of his life.
Addison’s Disease and Addisonian Crisis
Addison’s disease (hypoadrenocorticism) is a hormonal disease characterized by a deficiency of cortisol and aldosterone which is produced by the adrenal glands. The hormones are crucial for regulating stress response, blood pressure and fluid balance. Addison’s disease is fairly rare and can be tricky to diagnose. In fact, it is known as “The Great Pretender” because its clinical signs can mimic those of many other diseases. Breeds like Standard Poodles, Portuguese Water Dogs, Bearded Collies, West Highland White Terriers, Great Danes, and Nova Scotia Duck Tolling Retrievers are believed to show a genetic predisposition to Addison’s Disease.
Unfortunately for Basel, he experienced what is called an Addisonian Crisis. Fortunately, however, his family acted quickly and got him help when they noticed things going south. Addisonian Crisis is characterized by a sudden and drastic drop in hormone levels, leading to a range of symptoms – all of which Basel experienced – including lethargy, vomiting, diarrhea, weakness, and even collapse. Without prompt veterinary treatment, an Addisonian crisis can be fatal.
As long as Basel’s disease is properly managed, he has a great chance at a healthy and long future!
Our “Fur-tunately: Stories of Animal Survival” series features real pets treated by our team at Animal Emergency & Referral Center of Minnesota. All images and information have been shared with the owner’s permission.
Case content provided by Kylie Tabor, DVM.
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