Bloodwork Retesting on some parameters High ALT, Low Na:K ratio and low cortisol

[LilF]

Blossom was retested for her Na:K ratio and indeed it came out low again so what does it mean we are looking at -- possible Addisons? 2 weeks ago her Na:K ratio was 25 (sodium 150 and potassium 5.9). On June 29th her Na:K ratio is also 25 with sodium at 146 and potassium at 5.9. So what is the next step--ACTH? Xray of chest? I do not know I can get her 1 hr away for USound right now. This is also a lot of stress for her. She resisted going into the vet clinic for this recent draw and had to be pulled. When she saw I was behind her she went in more willingly to do the blood but I was not in the room when it was being drawn. She was very hyper as usual because she had to ride in the car to get there (take that in context with her cortisol score please) So her cortisol was a 2.0... does that mean she is not pumping out enough for her level of excitement. She has been rather low energy since thursday. I would expect with that level of stimulation her cortisol would be HIGH. Does this support a possible Addison's DX? Finally, her ALT was high now at 133. Two weeks ago it was normal at 66. I read this could be liver injury but do not know what would cause liver cells to die. I read it could be heart failure but her ProBNP was normal in April. I have been giving taurine with her meals but probably nothing else new. It is quite a departure from the first draw. GGT changed from a 7 in mid June to a 4 now at the end of June. Can you weigh in and also about possible next steps? I have not talked to the vet who did the draw yet as he is out for the holiday but my other vet has yet to see these. I want to know what you all think before I ask further questions.I also asked them to repeat the SPEC cPL but I do not see it on the results. I will have to ask about that I think I was charged for it. Oh, also, at what point would I be concerned about irregular heartbeat if her electrolytes are off and what does not drinking water have to do with this even if she is getting fluids from juices/goat milk.

 

[Dr. Jeff]

So what is the next step--ACTH?

Yup. It's a 2 hour test.

Does this support a possible Addison's DX?

Not IMHO.

about possible next steps? I

For her liver, perhaps they can also draw a bile acid test when she gets her ACTH stim. The elevated ALT and decreased GGT may not be significant.

All of her parameters should improve along with her curative energetic treatment.

at what point would I be concerned about irregular heartbeat if her electrolytes are off

Bradycardia (slow heartbeat) and hyperkalemia (high potassium) typically are seen with much higher potassiums (above 8 in my experience):

Laboratory abnormalities Hyperkalemia, hyponatremia, and hypochloremia represent the most consistent serum chemistry abnormalities among dogs with hypoadrenocorticism, particularly primary hypoadrenocorticism (1,2,10,11,28,29). These changes may occur independently or together. Hyperkalemia occurs in up to 95% of dogs with primary hypoadrenocorticism, and none of the dogs with secondary hypoadrenococorticism (1). Hyponatremia occurs in up to 86% of dogs with primary hypoadrenocorticism, and up to 34% of dogs with secondary hypoadrenocorticism (1,10). In 506 dogs with hypoadrenocorticism, serum sodium levels ranged from normal (142–155 mmol/L) to severely decreased at 106 mmol/L; the mean serum sodium was 128 mmol/L (1). Serum potassium in these dogs ranged from normal (4.1–5.5 mmol/L) to severely increased at 10.8 mmol/L; the mean measured 7.0 mmol/L (1). In the same group of dogs, neither hypokalemia nor hypernatremia was reported (1). Hypochloremia occurs frequently (40%) as serum chloride levels often parallel serum sodium levels. Chloride losses occur via renal and gastrointestinal routes (1).

From:

Canine hypoadrenocorticism: Part I

Hypoadrenocorticism (Addison’s disease) has been referred to as “the great pretender,” due to its ability to mimic other common diseases in the dog and thereby represent a diagnostic challenge. Naturally occurring hypoadrenocorticism ...

www.ncbi.nlm.nih.gov

what does not drinking water have to do with this

I'm glad you asked! Physiologically/conventionally, this is just the opposite of what is typically seen.

Homeopathically however, this may be a significant symptom tho. Has Blossom had any Pulsatilla dosing?

 

[LilF]

So in April, her sodium, potassium and Na:K ratio were normal. So since then I put her on homeopathy, first aconite and now arsenicum and in June all values are out of whack. I am supposed to give her the Arsenicum when she is bad in the car. That's it. I don't see any improvement in her medical and the blood tests are worse. You mention Pulsatilla. I put JJ on that and his nocturia stopped! Nobody ever mentioned Pulsatilla for Blossom. So if I never took her in the car again, what homeopathy would she be on because arsenicum would not be needed since she is not going in the car. Just presenting a scenario to show that she is then getting nothing to help with this. I did not know Addisons is the big pretender. When I read the symptoms she did not have them. She loves to eat, no vomit or diarrhea. She only has exercise induced tiredness. VEEEERy intereresting. I am thinking of the stress involved tracking this down, bile acids and ACTH more blood pokes. She REALLY could develop an aversion to the car if this is what is in store. I do not want to put her through all this and I do not want to go through this. She resisted going into the vets thursday and had to be pulled. I don't think I want to do this, put her through this medical trauma at all. Her cortisol was low also. I don't know what other conditions could cause low cortisol. I am not encouraged that her energy is being corrected and I just had a phone conf friday. I keep wanting something for her medical stuff and I am only supposed to give her stuff when she is bad in the car. I am so confused even though I just talked to her. When something gets worse like the blood values did, I see what happened to JJ all over again. He had a benign irregular heartbeat in March, he goes on homeopathy and then dies of a major heart failure 2 months later. I gave last dose of arsenicum June 23rd. So not only did her blood get worse, her behavior going into the vets is worse. Before she sauntered in cooperatively and now she has to be dragged. I am not going to drag my dog in for poking and prodding like this because I feel it is suffering. So the homeopathy is not helping and she is worse as I descrbed. I do think she needs something for her medical--I do appreciate the suggestion and going to research pulsatilla and see if I think it fits. I won't give anything on my own though but oddly, with JJ, I was the one who found that remedy for him and it worked, later the homeopath agreed it should be tried. I wonder if she has some heart issue. One vet is pushing an xray, others are pushing ultrasound Thank you so much on behalf of Blossom. I hope to find a remedy that would indeed reverse this concerning medical problem which i feel is primary or maybe even causes the car problem.