Addisons in adult dog post suspected rat bait poisoning.

Re: Addisons in adult dog post suspected rat bait poisoning.

Eleanor Raffan — Fri, 05 Aug 2011 19:07:31 GMT

Thanks for the message to me, Rachael. It sounds like you have heaps of evidence for the bleed. Great case! In your 'spare time' (since when do vets have that?!) it would make a great case to write up.

Will reply separately with more. E

Re: Addisons in adult dog post suspected rat bait poisoning.

Eleanor Raffan — Thu, 04 Aug 2011 14:10:50 GMT

Hi Rachael,

I'm late in on this one (just cruising the website and saw your posts) but though I'd add my ha'pennyworth.

Unless I've missed something in the history (can see no sign that you actually had evidence of a bleed somewhere, such as melaena/clinical signs of cavity bleed), my suspicion is that you are dealing with Addison's alone. In particular, 'atypical' (cortisol deficient only) addisonions can cope quite well for a long time until they reach crisis point (becoming very severely anaemic along the way) when they will crash in fine style when an additional stress of some sort tips them over the brink. Sometimes that crisis point is reached when they become 'properly' addisonion with electrolyte abnormalities etc too.

I had one of these with a PCV of 14 that came in fitting with hypoglycaemia having not seen a vet but had gone downhill slowly over years without owner noticing.

It's important to think about whether you could be dealing with a very rare coagulopathy causing adrenal crisis, though. First, what evidence was there for coagulopathy (signs, smear evidence regeneration)? Then, is there evidence for long-term disease that might have been unnoticed for a while (my case had had intermittent d+ for years, was thin and had been 'slowing down with old age' according to the owners).

The hypothesis that the Addison's could be secondary to the presumed coagulopathy doesn't really survive much scrutiny unless you can demonstrate bleeding into the adrenals and that would be the first ever case in a dog. By rights, a stressed dog (and a PCV of 8 certainly would count as a physiological stress) should have high cortisol. It's also worth thinking about whether the PCV of 8 perhaps a low estimate - it sounds like it was a nightmare to get blood and so you could have had a teeny clot in the sample, falsely lowering it. That would explain the miraculous 8->normal change over a couple of days with a single transfusion!

I suspect you are in for the long haul with Addison's tx here. Bear in mind that if he was mild enough to take ages to show signs the last time, he might be the same again if you've taken him off meds and he's not showing signs yet.

Interesting case! How's the little dog doing now? What treatment did you opt for? Good luck. Eleanor.

Re: Addisons in adult dog post suspected rat bait poisoning.

Rach — Sun, 17 Jul 2011 18:36:38 GMT

Hi Andy,

Could well be, but my main reason for thinking the other way round (other than it being more interesting!) is that even with the slightly less than observant/quick acting owners is it not quite surprising that this dog would have got to 10years old with primary addisons and not have at least required veterinary attention with signs that could be attributed to addisons, and we have rarely seen this dog.

I guess we may never know, unless the addisons resolves with time...

The only reference in the BSAVA manual was a human paper, the title was something along the lines of bilateral adrenal haemorrhage associated with coagulopathy.

Rachael

Re: Addisons in adult dog post suspected rat bait poisoning.

Andrew Kent — Sun, 17 Jul 2011 18:11:01 GMT

I think it is probably difficult to know which came first

Could it be that when the dog initially presented it was in an addisonian crisis with the low PCV a result of gastrointestinal haemorrhage or DIC secondary to the addisons? But that there was a good response to fluids etc?

I suppose in theory haemorrhage into the adrenals could cause addisons but I haven't found any reports of this in an quick search.

Andy

Re: Addisons in adult dog post suspected rat bait poisoning.

Rach — Sun, 17 Jul 2011 17:48:46 GMT

No unfortunately the dog was in such severe circulatory shock that we were only able to obtain enough blood for PCV and a smear, and were to concerned about damaging the catheterised vein to use that for a pre-transfusion sample, so the coagulopathy diagnosis is only presumptive, based on clinical signs, subcut bruising, rebleeding wounds, JRT on farm... and response to treatment.

Unfortuatley not, despite best efforts, the owners are keen to 'see how it goes' over the weekend, as I said in my original post it had been bleeding for 48hrs before presentation....

Re: Addisons in adult dog post suspected rat bait poisoning.

Christopher Saul — Sun, 17 Jul 2011 17:11:48 GMT

I have never encountered a case of addison's secondary to a coagulopathy, and would be interested to hear if anyone else has.

One quick question; how sure are you that the inital cause of the anaemia was a coagulopathy? Did you do clotting times etc?

I take it that you now have the dog hospitalised for fluid recussitation.....

Chris