Background

Hypoadrenocorticism resulting in Addisonian crisis is a rare but life-threatening disease. Dogs presenting in hypovolemic shock require immediate treatment.

Case Presentation

A three-year-old female Rhodesian ridgeback was presented to emergency service due to weakness of the hind limbs. The dog was able to walk into the hospital but arrested immediately after arrival and cardio-pulmonary resuscitation (CPR) according to the RECOVER guidelines was initiated. During basic CPR monitoring was initiated with end-tidal CO₂ of 1,2 vol-% and vascular access was obtained, but blood sampling was unsuccessful. Hypoglycaemia was detected using a veterinary glucometer and treated immediately. The dog underwent four cycles of chest compressions and low-dose epinephrine or atropine every other cycle when ECG revealed ventricular fibrillation and the dog underwent four further cycles of CPR including defibrillation before return of spontaneous circulation (ROSC) after a total CPR time of approximately 20 minutes. Basic history was obtained during CPR. An Addisonian crisis was included as one of the differential diagnoses based on clinical signs and hypoglycaemia. Therefore, hypertonic saline was administered during CPR. After ROSC blood sampling was possible and revealed hyperkalaemia. Sodium and glucose were slightly elevated at this point but possibly due to the administered fluids. Aggressive fluid therapy was continued and the dog regained spontaneous breathing and consciousness within 30 minutes. After an initial phase of hypertension post resuscitation blood pressure normalized and no further vasopressor therapy was needed. The dog was conscious and alert but in lateral recumbency for 10 hours after CPR and then regained normal behaviour including walking, drinking and urinating. Due to the fast cardio-vascular stabilisation of the patient, an ACTH-stimulation test could be performed on the same day, which was diagnostic for hypoadrenocorticism. The dog was treated accordingly and was discharged after three days of hospitalization.

New/Unique Information

Cardiopulmonary arrest is one of the most stressful situations encountered in veterinary emergency clinics. If out of hospital, or just on arrival as in our case, obtaining the necessary history from the owner can be challenging but might be detrimental for treatment success and adapting guidelines on the individual case.

Disclosures

No disclosures to report.