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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 26200
Experience:  University of California at Davis graduate veterinarian with 44 years of experience
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Yesterday my 11 yr old Jack Russel started vomiting. Today he has bloody loose stools. He

Customer Question

Yesterday my 11 yr old Jack Russel started vomiting. Today he has bloody loose stools. He won't eat or drink or walk anymore, and just lays there. He is at the vet and blood test shows kidney failure, but she says we should test him for Addison Disease. They gave him steroids, IV, pain medicine and he is still not moving, etc. He also has pancreatitis.
Submitted: 1 year ago.
Category: Dog Veterinary
Expert:  Dr. Michael Salkin replied 1 year ago.
I'm sorry to hear of this with Roscoe. Both renal failure and pancreatitis can cause his symptoms and are far more commonly found than Addison's disease. Ask Roscoe's vet if the tell-tale hyperkalemia (increased serum potassium level) and hyponatremia (decreased serum sodium level) of Addison's disease are present in Roscoe's blood work. If the ratio of serum sodium to serum potassium is less than 27 (often less than 23 in Addison's disease), it would be worth testing him for that disease. I might also find hypercalcemia (increased serum calcium level) and hypoglycemia (decreased serum glucose rather than "high sugar") in an Addisonian. In fact, can you upload a copy of Roscoe's test results to our conversation? I understand that you might not have a copy at home but Roscoe's vet can give you one which you can scan into your computer and then give me file link or you can photograph the pages and upload them by using the paperclip icon above your message box (if you can see the icon) or by using an external app such as dropbox.com/
Customer: replied 1 year ago.

Dr. Salkin,

I have his blood work and downloaded drop box, but I am still trying to figure out how to send it to you.

Expert:  Dr. Michael Salkin replied 1 year ago.
I understand. If you need asistance,***@******.*** can help you. They'll forward information to me. It can take up to 24 hours, however, and I know that time is of the essence with Roscoe.
Customer: replied 1 year ago.

Dr. Salkin,

Did you receive this?

GLUCOSE 66, BUN 64, CREATININE 2.9, PHOSPHORUS, >16.1, CALCIUM 11, SODIUM 135, POTASSIUM 5.0, NA K RATIO 27, CHLORIDE 96, TOTAL PROTEIN 9.7, ALBUMIN 4.1, GLOBULIN 5.6, ALB GLOB RATIO .7, ALT 197, ALP 478, GGT < 0, BILIRUBIN TOTAL 1.1, CHOLESTEROL 280, AMYLASE >2,500, OSMOLALITY 287

Thank you,

Laura

Expert:  Dr. Michael Salkin replied 1 year ago.
No, that's the first I've seen of the results, Laura. I need to see a complete urinalysis to make sense out of the elevated BUN and creatinine; in particular, I need to see the specific gravity of the urine and degree of proteinuria (loss of protein through the urine). The potassium isn't elevated to the point that I would consider Addison's likely and a normal glucose and calcium doesn't support Addison's either. I admit that there are less common cases of Addison's in which his results could be found. Most important, however, is his greatly elevated phosphorus which indicates renal secondary hyperparathyroidism which takes some time to develop secondary to chronic renal failure. It can, however, also be seen with pre-renal causes of kidney failure such as Addison's. His liver enzymes are significantly elevated which is consistent with pancreatitis but also primary hepatic disorders.See if you can track down his urinalysis which would be very helpful to me. Concentrated urine (a specific gravity over 1.030) would suggest pre-renal uremia/azotemia (elevated BUN/creatinine). Dilute urine ( specific gravity often lower than 1.020) would suggest chronic renal insufficiency.
Customer: replied 1 year ago.

Dr. Salkin,

Thank you for your response. Unfortunately, I had to put my poor Roscoe to sleep. The vet he was at did not have overnight supervision, and they felt it was best for me to bring him home for the night or take him to a clinic with 24 hour care. Roscoe was on an IV all day, but hasn't urinated, so a urinalysis was not possible. He also was on hydromorphone, and still in significant pain.

Although she didn't rule it out, the vet at the emergency hospital did not think it was likely to be Addison's either. She said he had kidney disease and chronic pancreatitis (which he was diagnosed with when he was a puppy). Even if he had Addison's his prognosis was poor when combined with the other conditions. It was a very sad & difficult decision to make, but he was suffering and I believe we did the right thing.

Thank you again for your assistance.

Laura

Expert:  Dr. Michael Salkin replied 1 year ago.
My condolences for your loss of Roscoe. I appreciate your taking the time to let me know. You may receive an inappropriate follow-up from the site ostensibly sent by me. It wasn't and I apologize in advance should you receive it.

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