UT-VMC emergency room tails: saving Teenie

UTVMC COLUMN HEADER  2By Dr. Amanda Rainey

We weren’t expecting any emergency cases that we were aware of when the overhead page suddenly erupted with a stat call to the reception area. Our ER students, trained to jump into action with such a beckoning, immediately sprinted for the front desk. They quickly returned holding a small, lifeless bundle in their arms and breathlessly relayed some brief information about the patient.

“This is Teenie. He was fine earlier today and then the owners found him unresponsive at home just a little while ago,” the student explained. As we unwrapped the black and white Chihuahua mix from the blankets surrounding him, my heart lurched as I saw his limp form delivered onto the exam table. I was concerned he may have already passed away.

Thankfully, when I placed my stethoscope on his thin chest, I detected a heartbeat. Although, it was dangerously low. Teenie was also very cold with a markedly decreased temperature and blood pressure was almost nonexistent. He was in a serious state of cardiovascular shock and I knew we needed to act fast.

Our technician expertly placed an intravenous catheter in one of the veins on Teenie’s right front leg while we lifted him onto a heating mat and cocooned him in warm blankets. I began silently going through a list of differentials in my head regarding what could be causing Teenie’s clinical signs while one of the students helping with the case checked some basic blood parameters in the small lab area adjacent to the ICU. I didn’t have to think too long however, as the student called out his blood glucose level.

“His BG is 21,” she shouted with panic in her voice. Normal is somewhere between 80 and 120 for a dog. I now knew why he was so lifeless and within moments we were supplementing Teenie with intravenous dextrose, followed up with warm fluids. We all began to breathe a little easier when only minutes after receiving the dextrose solution Teenie lifted his head and gazed around with a confused look in his chocolate brown eyes. I spoke with his owners about admitting him to the ICU for monitoring and continued dextrose supplementation to which they eagerly agreed. He rapidly stabilized over the course of the next few hours and even ate hungrily when offered some of the boiled chicken stash we keep sick patients.

I was relieved that my patient had improved, but was now left with the task of discerning why this had happened in the first place. As veterinarians we keep a go-to list of diseases for some problems in our minds and low blood sugar is one of them. I performed screening blood work and radiographs to look for any signs of organ dysfunction or cancer, both of which can cause decreased blood sugar. Fortunately, everything looked good on Teenie’s results. I then decided to perform a test for something called Addison’s Disease, which is an endocrine condition involving the body’s lack of production of natural steroids by the adrenal glands. It can cause problems with blood glucose and electrolyte concentrations, but is relatively easy to treat.

After obtaining our samples for this test we started Teenie on oral steroids and he continued to thrive in the hospital, becoming one of our favorite patients due to his love of being cuddled close. His test results came back definitive for Addison’s Disease. As long as his owners are diligent with his medication and monitoring plan, his prognosis is excellent.

(Dr. Amanda Rainey, DVM, is a clinical assistant professor in the small animal clinical sciences department at the University of Tennessee Veterinary Medical Center in Knoxville.)

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