CS: Renal/ endocrine disease Flashcards Preview

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Flashcards in CS: Renal/ endocrine disease Deck (11):
1

What is USG dependent on?

dehydration and azotaemia

2

How does addison's cause azotaemia?

Addison's --> hyponatraemia --> hypovolaemia --> azotaemia

3

ECK signs - hyperkalaemia

- flat P wave
- bradycardia (increased PR interval)
- tall T waves

4

When is a USG of 1.020 adequate when a patient has severe azotaemia?

if hyponatraemia also present (as this makes it hard for kidneeys to concentrate urine appropriately)

5

Indicators on biochemistry of renal damage

- high K
- low Na
- low Cl

6

2 broad causes of azotaemia

= reduced GFR:
1. underperfusion (low USG)
2. not enough glomeruli (v concentrated urine/ high USG)
> differentiate via USG

7

T/F: proteinuria doesn't stop you concentrating urine

True

8

Management - acute addisonian crisis

- Rapid infusion 0.9% saline (NaCl) for 2 hours at 8ml/kg/hr then reduce infusion rate
- IV glucocorticoids
o Hydrocortisone sodium succinate (hydrocortisone)
o 0.5mg/kg/hr at 1-2mg/ml IV
o Start on oral tx once eating and drinking (usually within 36 hours)
o Reduce infusion rate to 0.25mg/kg/ IV
o Stop after further 24-48 hours
o PERFORM ACTH STIM TEST BEFORE GIVING GLUCOCORTICOIDS
- IV glucose with saline if hypoglycaemic
- IVFT until electrolytes stabilised and animal eating
- Treat hyperkalaemia (overall not necessary)

9

Chronic tx - Addison's

- MC replacement: either fludrocortisone acetate OR desoxycorticosterone pivalate (DOCP)
- GC replacement (50% cases need this): prednisolone or cortisone acetate
o Correct dose is 0.2mg/kg/24 hours (prednisolone has 5x activity of cortisol)
o Use the least potent GC possible (= cortisone acetate) at 0.5mg/kg/12 h for 5 days and then 0.5mg/kg/24 hours
- Table salt to food daily until Na normal (no evidence)
- Prednisolone at times of stress
- Water ad lib

10

How to monitor response to tx for an addisonian crisis?

- Should show rapid response to therapy (1-2 hours)
- ECG changes should resolve
- Na and K concentrations normalising
- Uraemia resolving
- Rehydration may unmask severe anaemia

11

Px - addisonian crisis treated successfully

long-term outlook excellent as most dogs can be controlled with oral or injectable medications to replace the deficient hormones.