Fancy is a very cute little Yorkie.  She is about 8 years old and well-cared for (spayed, current on vaccines, etc.)  She came in one Sunday a few weeks ago.  Her owners reported she was feeling off since about Friday, and hadn’t eaten at all.   Sunday morning, she started having little head bobbles and then would just collapse to the floor.  She just seemed very weak. 

My techs brought Fancy to the treatment room immediately as she definitely was weak and dull.  And sure enough, her head would wobble sort of like a bobble-head, and then she was just sink to the treatment table.  We quickly ran some bloodwork on her.  Her blood glucose was dangerously low – an unusual finding in an 8 year old dog.  And given her state, her heart rate seemed too low.

But as always in the ER, first things first – stabilization.  I went to put an intravenous catheter into her front leg.  This turned out to be a challenge – not only is Fancy a small dog with small veins, her veins were collapsed from low blood pressure.  I had to resort to something called an IV cutdown.  This is where I put some lidocaine in the skin (to numb it), and then I make a small incision in the skin over the vein with a scalpel blade.  Then I take a small pair of hemostats (‘clamps’) and spread the tissue under the skin until I can actually see the vein.  Then I can feed an IV catheter directly into the vein.  We don’t normally have to resort to this – we often put IV catheters in puppies and kittens weighing less than 1 lb without cutting them down.  But when a dog is not stable, we don’t have time to waste poking and prodding, and a cutdown is quick, easy, and most importantly, effective.  The IV catheter was in.  It’s always a relief to have that intravenous access in a critical animal. 

We started giving Fancy some fluids, and I drew some more blood for more specialized testing.  Then we gave her some intravenous dextrose (sugar solution).  We gave her some additional fluids to try to get her blood pressure up.

But as always when we are stabilizing an animal, my mind is racing ahead and waiting for the rest of the diagnostics.  What was wrong with Fancy?  She had no history of trauma, and only vague signs of illness (lethargy, weakness and inappetance). 

The next bloodwork results gave me a big clue.  Her serum potassium level was high, and her serum sodium level was low, along with her glucose and serum calcium.  I began to strongly suspect she had something called Addison’s Disease (hypoadrenocorticism), and that she was having an ‘Addisonian crisis.’  (Diagnostic testing completed the next day confirmed this.)

Addison’s disease is caused by inadequate production of vital hormones by the adrenal glands.  These hormones allow the body to respond to normal stresses and regulate electrolyte concentrations in the blood.  It can also cause the low blood glucose Fancy had, and a variety of other signs.  These dogs may have have vomiting and diarrhea, heart arrhythmias caused by the electrolyte abnormalities in the blood, poor appetite, lethargy, weight loss, dehydration, kidney value elevations, or the vague ‘ADR’ (Ain’t Doing Right), .  Because it can cause so many different symptoms, it is sometimes called ‘the great pretender.’

The breeds most commonly affected are Standard Poodles and West Highland White Terriers, but any breed can be affected.  The typical age of diagnosis young adult to middle-age.  It is rare in cats.  People can get it too – President Kennedy suffered from Addison’s.

The most common cause is destruction of part of the adrenal gland by the animal’s immune system.  Other causes include abrupt withdrawal of steroid administration (this is why if your pet is treated with steroids for any reason, the dose must be tapered down).

The classic presentation of Addison’s Disease is shock and collapse, and this is what Fancy had.  This is actually not that common, but they really emphasize it in vet school, so it’s actually sort of fun to see the Addisonian crisis.   The other reason it’s fun is because most of these dogs respond well to IV fluids and supportive care.  And Fancy did just that – she was up and barking and eating by the next morning.    And the last reason we like it is because although it cannot be cured, it can be treated with good success.  These dogs need life-long medication (this can be expensive in large dogs).