Evaluation of Low Sodium: Potassium Ratios in Dogs

Roth, Lois; Tyler, Ronald D.

doi:10.1177/104063879901100110

Cited by 34 publications

(33 citation statements)

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“…Although a low SPR is highly suspicious for HA, there are several other conditions such as Trichuris vulpis infection, other gastrointestinal problems, renal, or cardiorespiratory problems and ascites that also are associated with hyperkalemia and concurrent hyponatremia 4, 5, 6, 7, 8. In our study, using the best calculated cut‐off ratio of ≤24 resulted in a specificity of 99% and a sensitivity of only 56% for diagnosing HA.…”

Section: Discussionmentioning

confidence: 57%

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Evaluation of the Cortisol‐to‐ACTHRatio in Dogs with Hypoadrenocorticism, Dogs with Diseases Mimicking Hypoadrenocorticism and in Healthy Dogs

Boretti

Meyer

Burkhardt

et al. 2015

Veterinary Internal Medicne

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BackgroundThe adrenocorticotropic hormone (ACTH) stimulation test is the gold standard for diagnosing hypoadrenocorticism (HA) in dogs. However, problems with the availability of synthetic ACTH (tetracosactrin/cosyntropin) and increased costs have prompted the need for alternative methods.ObjectivesTo prospectively evaluate the cortisol‐to‐ACTH ratio (CAR) as a screening test for diagnosing canine HA.AnimalsTwenty three dogs with newly diagnosed HA; 79 dogs with diseases mimicking HA; 30 healthy dogs.MethodsPlasma ACTH and baseline cortisol concentrations were measured before IV administration of 5 μg/kg ACTH in all dogs. CAR was calculated and the diagnostic performance of ACTH, baseline cortisol, CAR and sodium‐to‐potassium ratios (SPRs) was assessed based on receiver operating characteristics (ROC) curves calculating the area under the ROC curve.ResultsThe CAR was significantly lower in dogs with HA compared to that in healthy dogs and in those with diseases mimicking HA (P < .0001). There was an overlap between HA dogs and those with HA mimicking diseases, but CAR still was the best parameter for diagnosing HA (ROC AUC 0.998), followed by the ACTH concentration (ROC AUC 0.97), baseline cortisol concentration (ROC AUC 0.96), and SPR (ROC AUC 0.86). With a CAR of >0.01 the diagnostic sensitivity and specificity were 100% and 99%, respectively.Conclusion and Clinical ImportanceCalculation of the CAR is a useful screening test for diagnosing primary HA. As a consequence of the observed overlap between the groups, however, misdiagnosis cannot be completely excluded. Moreover, additional studies are needed to evaluate the diagnostic reliability of CAR in more dogs with secondary HA.

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Section: Discussionmentioning

confidence: 57%

“…The most consistent biochemical abnormalities include azotemia and electrolyte disturbances such as hyponatremia, hyperkalemia, and a low sodium‐to‐potassium ratio (SPR). Hyponatremia and hyperkalemia, although highly suspicious for HA, are neither always present nor pathognomonic for the condition 4, 5, 6, 7, 8…”

mentioning

confidence: 99%

Evaluation of the Cortisol‐to‐ACTHRatio in Dogs with Hypoadrenocorticism, Dogs with Diseases Mimicking Hypoadrenocorticism and in Healthy Dogs

Boretti

Meyer

Burkhardt

et al. 2015

Veterinary Internal Medicne

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“…[1][2][3][7][8][9][17][18][19]22 Although Na:K ratios of 27 or 28 identify the same percentage of dogs correctly, these Na:K cutoff ratios differ in their sensitivity and specificity. The sensitivity of a Na:K ratio cutoff of 28 is 93%, while the sensitivity of a Na:K ratio cutoff of 27 is 89%.…”

Section: Discussionmentioning

confidence: 99%

Abnormalities of Serum Electrolyte Concentrations in Dogs with Hypoadrenocorticism

Adler¹,

Drobatz²,

Hess³

2007

J Vet Int Med

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Background: The sensitivity and specificity of the sodium to potassium ratio (Na:K ratio) as a cutoff for recommendation of an adrenocorticotropic hormone (ACTH) stimulation test in dogs suspected of having hypoadrenocorticism (HA) is unknown. Additionally, abnormalities in plasma ionized calcium (iCa 2+ ) and ionized magnesium (iMg 2+ ) concentrations and venous pH of dogs with HA are incompletely documented.Objectives: To define the sensitivity and specificity of the Na:K ratio as a diagnostic aid for HA in dogs and to examine for associations between venous pH and the Na:K ratio, iCa 2+ concentration, or iMg 2+ concentration in dogs with HA. Animals: Seventy-six dogs with HA and 200 dogs randomly selected from the general hospital population. Methods: Retrospective study. Dogs were included in the study if results of an ACTH stimulation test confirmed a diagnosis of HA, the dog had a serum sodium concentration below the reference range or a serum potassium concentration above the reference range, and the dog was treated with mineralocorticoids. Receiver operating curve analysis was used to determine optimal cutoffs of sensitivity and specificity for the Na:K ratio in diagnosing HA.Results: Use of Na:K ratios of 27 or 28 classified 95% of dogs correctly as diseased or not diseased. The sensitivity of a Na:K ratio of 28 was 93% (CI, 85-98%) and that of 27 was 89% (CI, 80-95%). The specificity of a Na:K ratio of 28 was 96% (CI, 92-98%) and that of 27 was 97% (CI, 93-99%). The sensitivity and specificity of a Na:K ratio of 24 were 79% (95% CI, 67-86%) and 100% (98% CI, 97%-100%), respectively.Conclusions and Clinical Importance: Na:K ratios of 27 or 28 identify the highest percentage of dogs with suspected mineralocorticoid and glucocorticoid deficiency correctly. In dogs with a Na:K ratio of 24 or less, the likelihood of confirming a diagnosis of HA with an ACTH stimulation test is high.

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“…However, the measurement of endogenous ACTH in plasma and, perhaps, pituitary and adrenal imaging would make the differentiation from the secondary form more solid (Feldman and Nelson 2004). In previous studies, renal and urinary tract disorders, gastrointestinal disease, pancreatitis, pleural effusions and liver failure were more often associated with a lower than 27 Na:K ratio than hypoadrenocorticism itself (Roth and Tyler 1999, Son-Il-Park 2000, Nielsen et al 2008. However, the fact of the lower than 24 Na:K ratio in all 5 dogs may facilitate the differentiation from the aforementioned diseases, since the specificity of this cut-off value is approaching 100% (Adler et al 2007).…”

Section: Discussionmentioning

confidence: 99%

Οξύς Υποφλοιοεπινεφριδισμος (Αδισσώνια Κρίση) Στο Σκύλο: Αναφορά Σε Έξι Περιστατικά

Kasabalis

Soubasis

Pardali

et al. 2017

J Hellenic Vet Med Soc

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Medical records of six dogs admitted with acute hypoadrenocorticism were reviewed. All 6 animals were bradycardic and had prolonged capillary refilling time. Hypothermia was detected in 5/6 animals. Clinicopathological evaluation on admission revealed anemia (3/6 dogs), increased (2/6) and normal (2/6) lymphocyte and eosinophil counts, azotemia and hyperkalemia (6/6), hyponatremia, in 5/6 dogs in which sodium was measured with a sodium (Na) : potassium (K) ratio lower than 24, hypoglycemia (2/6) and hypercalcemia, hypocholosterolemia, increased serum alkaline phosphatase and alaninoaminotransferase activities, one dog each. Urine specific gravity was lower than 1025 in 4 dogs. Thoracic radiographs and abdominal ultrasonography disclosed microcardia (2/6), pleural effusion (2/6) and ascites (1/6). Two dogs (2/6), also, presented atrial standstill or atrioventricular block, detected on electrocardiograms. In all 6 animals emergency treatment included the use of intravenous normal saline and glucocorticoids (dexamethasone) immediately after the completion of an ACTH stimulation test with tetracosactide. Two dogs died, one during the 1st day and the other on the 4th day of hospitalization, the latter after the sudden appearance of severe hemorrhagic gastroenteritis. Hospitalization time in the remaining 4 dogs ranged from 3 to 10 days. Prolongation of hospitalization was associated with worsening of anemia, hypoalbuminemia, neurologic complications and non-responsive azotemia. Four dogs (4/6) were discharged on oral prednisolone and fluodrocortisone, but one died after a week for unknown reasons. Acute hypoadrenocorticism is a life threatening condition requiring emergency treatment for a successful outcome. Its inclusion in the differential diagnosis of canine emergencies, presented with acute weakness and gastrointestinal signs, is mandatory, but for its confirmation a complete laboratory and, most importantly, an ACTH stimulation test are always required.

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Evaluation of Low Sodium: Potassium Ratios in Dogs

Cited by 34 publications

References 5 publications

Evaluation of the Cortisol‐to‐ACTHRatio in Dogs with Hypoadrenocorticism, Dogs with Diseases Mimicking Hypoadrenocorticism and in Healthy Dogs

Evaluation of the Cortisol‐to‐ACTHRatio in Dogs with Hypoadrenocorticism, Dogs with Diseases Mimicking Hypoadrenocorticism and in Healthy Dogs

Abnormalities of Serum Electrolyte Concentrations in Dogs with Hypoadrenocorticism

Οξύς Υποφλοιοεπινεφριδισμος (Αδισσώνια Κρίση) Στο Σκύλο: Αναφορά Σε Έξι Περιστατικά

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