Why Does My Dog Need Injectable Medication?
Certain medications, such as insulin, can only be administered by injection. Depending on the formulation and the type of medication, injectable medications can be given by several routes. They can be given through direct injection into a vein (known as intravenous, or IV injection), injection into a muscle (known as intramuscular, or IM injection), or injection directly under the skin – a procedure known as subcutaneous (SC or SQ) injection. It is very important that you understand how your pet’s injectable medication needs to be given; for example, if you accidentally give a medication intravenously instead of subcutaneously, complications can result. Most injectable medications given at home are intended to be given subcutaneously.
Before you start, ask your veterinary health care team for training and advice to make sure you know how to give injectable medication without injuring yourself or your dog. If you aren’t comfortable or need additional training sessions, don’t be afraid to ask!
Here are a few things to consider:
The “syringe” is the clear (usually plastic) cylinder that holds the medication to be injected. The “needle” is the sharp, metal tip that is injected into the skin. The “plunger” is a stem that moves inside the syringe. Pull the plunger backward to fill the syringe and push it forward to empty the syringe. A new needle/plunger and syringe are sterile until they are opened.
The bottle of injectable medication is also sterile. It is important to handle these items properly to avoid contaminating them. Your veterinary care team will show you how to properly open a syringe and draw up injectable medication without breaking sterility. Be sure to use a new syringe, plunger, and needle for each injection. Reusing syringes and needles can cause infection. Additionally, a used needle is dull and therefore more painful than a new needle.
A small dog may be happy lying or sitting on your lap while you administer an injection. For a larger dog, you may need to sit in a chair next to the dog or sit on the floor with the dog. Some small dogs may do better on a smooth surface, such as a table; the surface of a washing machine can simulate the smooth metal table at your veterinarian’s office and encourage your dog to remain still during the procedure. Additionally, some dogs do better with two people administering the injection – one person to hold the pet and the other one to give the injection.
Giving a Subcutaneous Injection
Your veterinary care team will show you how to administer an injection before you have to try it alone at home:
Giving an Intramuscular Injection
There are a few precise areas on the body that are commonly used for giving intramuscular injections. You will need to find “landmarks” on your dog so that you know where to give the injection. Your veterinary care team will show you how to find an appropriate injection site and administer an intramuscular injection before you have to try it alone at home:
Ask your veterinary team to teach you how to administer medication injections safely. If you aren’t comfortable giving injections, ask about scheduling outpatient visits for the injections to be given.
What Is Addison’s Disease?
Glucocorticoids (primarily cortisol) and mineralocorticoids are two important types of hormones produced by the body’s adrenal glands. Under normal conditions, the brain releases a hormone called adrenocorticotropic hormone (ACTH) that stimulates the adrenal glands to release their hormones. Addison’s disease occurs when the brain doesn’t release adequate amounts of ACTH, or the adrenal glands fail to release their hormones in response to ACTH. The medical term for Addison’s disease is hypoadrenocorticism.
Glucocorticoids and mineralocorticoids help regulate numerous complex processes in the body and participate in critical functions such as the following:
The body has highly developed systems called feedback mechanisms that control how much of these hormones the adrenal glands produce and release, based on the body’s needs. During times of physical or emotional stress, the body tends to increase the production and release of glucocorticoids (cortisol) to help it deal with the stressful episode. In contrast, when the body is receiving cortisol from an outside source (like a cortisone pill or injection), it reduces the amount of cortisol that the adrenal glands produce.
In most cases, the cause of Addison’s disease is not determined. Sometimes, the body’s immune system can damage the adrenal glands’ cells so extensively that they can’t release hormones when they need to. In other cases, such as a brain tumor, the part of the brain that should release ACTH is unable to. However, Addison’s disease can also occur if a pet that is receiving cortisol medication suddenly stops getting it. In this case, the body has reduced its own cortisol production and can’t increase it quickly enough to compensate when the medication is discontinued. This is why steroid medications (such as prednisone) should not be discontinued suddenly, but must instead be gradually reduced and then discontinued.
Addison’s disease is most commonly diagnosed in dogs, although it does occur rarely in cats. Young to middle-aged dogs are generally affected, and females are more commonly affected than males.
What Are the Clinical Signs of Addison’s Disease?
The clinical signs associated with Addison’s disease can vary greatly and can resemble those of other diseases. They include the following:
These clinical signs can vary in severity, and many owners report that the problems seem to “wax and wane”—sometimes seeming to resolve on their own and sometimes responding temporarily to very nonspecific treatment. Because dogs with Addison’s disease have a reduced ability to handle stress, the emotional stress of visiting a boarding kennel or the excitement of a family gathering can cause clinical signs to resurface.
How Is Addison’s Disease Diagnosed?
Diagnosis of Addison’s disease may require several steps. Your veterinarian will likely begin by reviewing your pet’s medical history. A complete physical examination may be followed by recommendations to perform diagnostic tests. Results of these tests can support a diagnosis of Addison’s disease:
If your veterinarian suspects Addison’s disease, an additional test called an ACTH stimulation test may be recommended. As described above, ACTH is the hormone the brain produces that stimulates the adrenal glands to release glucocorticoids and mineralocorticoids. In a dog with Addison’s disease, ACTH may be absent or the adrenal glands may be unable to respond adequately to it. The ACTH stimulation test involves administering a small amount of ACTH by injection and then measuring the levels of cortisol produced over a period of a few hours. In dogs with Addison’s disease, the injection of ACTH does not result in a significant increase in cortisol levels. This response can be used to confirm a diagnosis.
The ACTH stimulation test requires a few hours of hospitalization so that blood can be drawn to check the body’s response to the injection.
What Are the Treatment and Outcome for Addison’s Disease?
Some dogs with Addison’s disease arrive at the veterinary office in a state of life-threatening crisis. Low blood pressure, shock, dehydration, impaired heart function, and other complications of the disease can be fatal if not treated immediately and aggressively. In such a case, hospitalization for emergency intravenous fluid therapy and other stabilization is necessary. In other cases, the clinical signs of Addison’s disease are more subtle. As long as the dog is stable, treatment can begin on an outpatient basis.
The primary treatment for Addison’s disease consists of giving the body the adrenal gland hormones it is unable to produce on its own. Glucocorticoid supplementation commonly involves administering prednisone or hydrocortisone pills. Most dogs also need mineralocorticoid supplementation; these are available in pill and injectable formulations. A popular mineralocorticoid formulation is injectable deoxycorticosterone pivalate (DOCP); this medication can be given as an injection every 21 to 30 days.
Medications for Addison’s disease only replace missing hormones; they don’t cure the disease. Therefore, dogs with Addison’s disease need to receive medications for the rest of their lives. Periodic veterinary examinations and repeat blood testing are required for the life of the pet, and sometimes medication dosages need to be adjusted. Your veterinarian may also want to discuss modifying your pet’s medication during times of stress, when the body’s need for these hormones may increase. Fortunately, dogs that receive proper treatment for Addison’s disease can have a normal lifespan and enjoy a good quality of life.
What Is Acetaminophen Toxicity?
Acetaminophen is the active ingredient in Tylenol and some other related medications that are used to treat pain and fever in people. Unfortunately, this drug can be extremely toxic (poisonous) to cats and dogs. Acetaminophen toxicity occurs when a cat or dog swallows enough of the drug to cause damaging effects in the body.
Acetaminophen is mostly metabolized (broken down and eliminated from the body) by the liver. Some of the substances that are created during this process can have harmful effects on cats and dogs. Cats are at much greater risk of toxicity than dogs because they lack certain proteins necessary for the liver to safely metabolize acetaminophen.
How Does Acetaminophen Toxicity Occur?
Many cases of acetaminophen toxicity in dogs and cats are accidental. A pet may find and chew on a bottle of pills or eat a pill that has fallen on the floor. Sadly, some cases occur because pet owners give medication intended for people to their pets without being instructed to do so by a veterinarian.
Acetaminophen is a drug meant for people. However, there are situations in which your veterinarian may prescribe a specific dosage of acetaminophen for your dog. Be sure to follow your veterinarian’s dosage directions very carefully and report any vomiting or other problems right away. Cats are 7 to 10 times more susceptible to acetaminophen toxicity than dogs are. Because cats are extremely sensitive to the drug’s toxic effects, acetaminophen is not given to cats.
What Are the Clinical Signs of Acetaminophen Toxicity?
Once swallowed, acetaminophen is rapidly absorbed from the stomach and intestines and can achieve significant levels in the blood within 30 minutes. The main toxic effects take two forms:
Cats and dogs can develop both forms of acetaminophen toxicity. However, cats are more likely to suffer hemoglobin damage while dogs are more likely to suffer liver damage. The main clinical signs associated with acetaminophen toxicity that result from liver injury and an inability of the blood to carry oxygen include:
How Is Acetaminophen Toxicity Diagnosed?
Diagnosis of acetaminophen toxicity is commonly based on a history of recently chewing or swallowing pills. Your veterinarian may recommend diagnostic testing, such as a chemistry panel and complete blood cell count (CBC), to assess the extent of the damage.
What Are the Treatment and Outcome for Pets Suffering From Acetaminophen Toxicity?
Acetaminophen is absorbed and metabolized very quickly. If you realize right away that your pet has swallowed acetaminophen, vomiting can be induced to remove the drug from your pet’s stomach before the body can absorb it. Another option may be to anesthetize your pet in order to flush out the contents of the stomach. Your veterinarian may also administer a special preparation of liquid-activated charcoal to slow absorption of toxic material from the stomach and intestines.
There is a specific antidote for acetaminophen toxicity. This medication, N-acetylcysteine, limits formation of the toxic substance that damages the liver and red blood cells. Additional treatments may include blood transfusions, intravenous fluid therapy, and other medications to help support and stabilize the patient.
Acetaminophen toxicity can be fatal. However, pets can survive if the condition is recognized, diagnosed, and treated quickly.
Most cases of acetaminophen toxicity are preventable. Never give medications meant for people to your pet unless instructed to do so by your veterinarian, and keep all medications in the home secured to help prevent accidental swallowing.
What Is a Radiograph?
A radiograph (sometimes called an x-ray) is a type of photograph that reveals the body’s internal organs. The procedure for obtaining a radiograph is called radiography. Radiography is a very useful diagnostic tool for veterinarians because it can help obtain information about almost any organ in the body, including the heart, lungs, and abdominal organs, as well as the bones.
How Does Radiography Work?
Traditional radiography machines use very low doses of radiation delivered in a focused beam (an x-ray) that is aimed at a photographic plate containing specialized photographic film. The patient is positioned between the x-ray beam and the photographic plate. When the x-ray beam passes through the patient, an image is created on the specialized film. Structures that are very thick or dense, such as bone, do not allow much of the beam to penetrate and expose the film. These structures look very bright or white on a radiograph (see the x-ray image). In contrast, structures that are not dense (such as gas in the intestines) allow the beam to penetrate more completely and expose the film. As a result, these structures appear relatively dark when the radiograph is viewed. Structures that are of medium density, such as fluid, appear in various shades of gray on the film.
Digital radiograph machines use a very similar principle, but the final image can be much sharper and can show greater detail than images obtained from traditional radiography machines.
How Is Abdominal Radiography Performed?
Abdominal radiography is painless, safe, and completely noninvasive. Your pet will be positioned on the x-ray table, and the width of the abdomen will be measured. This is necessary for precisely adjusting the intensity of the x-ray beam to capture the most accurate information. Once the measurements are complete, the x-ray tube (which will generate a beam of low-level radiation) is aligned over the abdomen, and a button is pushed on the radiograph machine to take the “photograph.” This part of the procedure is very much like taking a photograph with a camera. In most cases, at least two “pictures” are taken from different angles to create a three-dimensional image of the abdominal organs.
Your veterinarian may recommend that your pet receives sedation before undergoing radiography. When an animal is sedated, positioning is much easier because the patient is completely relaxed. Sedation may also be recommended if the patient is in pain.
What Are Abdominal Radiographs Used For?
Abdominal radiography may be recommended to investigate a variety of clinical signs, including the following:
Radiographs are used to examine the size, shape, and position of the abdominal organs. The size of organs is important because some medical conditions can cause enlargement of the kidneys, liver, spleen, or other abdominal organs. Some chronic conditions, such as chronic kidney disease or chronic liver disease, can cause these organs to appear smaller than normal on a radiograph. The shape and position of organs can be altered or distorted by certain medical conditions, including intestinal blockages or cancer. Radiography is sometimes used to detect pregnancy and determine the number and position of the fetuses. Tumors, depending on their size and position, can be detected using radiography. Fluid or gas in the abdomen can also be detected through radiography. Conditions such as internal bleeding or intestinal perforation (holes) can cause fluid or gas to collect in the abdomen.
Radiography can be used to diagnose many other conditions involving abdominal organs, including bladder stones, kidney stones, and intestinal foreign bodies.
What Are the Benefits and Risks of Abdominal Radiography?
Radiography has many benefits and very minimal risks. It is very safe, completely painless, and non-invasive. It is available in most veterinary practices and can sometimes be performed during an outpatient visit while you wait. Depending on the type of radiographic study being performed, the procedure may take only a few minutes.
The risks of radiography are minimal. Because the level of radiation exposure needed to perform radiography is very low, even pregnant females and very young pets can undergo radiography. If a pet is very unstable, such as a pet with severe breathing difficulties, the stress of performing radiography may be a concern. In these cases, it may be necessary to stabilize the pet (with oxygen or other therapy) before attempting to perform radiography. In the vast majority of cases, the benefits of performing radiography far outweigh the possible risks. Radiography is a valuable tool for your veterinarian because it can provide critical information about many different illnesses and medical conditions.
This abdominal radiograph shows several organs that your veterinarian will examine: the stomach (A), intestines (B), bladder (C), and colon (D). Gas in the colon and stomach appears very dark on the radiograph; however, fluid in the bladder is gray, and the bones of the spine (E) appear closer to white.
ACTH STIMULATION TEST
What Is ACTH?
Glucocorticoids (primarily cortisol) and mineralocorticoids are two important types of hormones produced by the body’s adrenal glands. Glucocorticoids and mineralocorticoids help regulate numerous complex processes in the body and participate in critically important functions, including the following:
Under normal conditions, the brain releases a hormone called adrenocorticotropic hormone (ACTH) that stimulates the adrenal glands to release their hormones. The body has highly developed systems called feedback mechanisms that control, based on the body’s needs, how much of these hormones the adrenal glands produce and release. For example, during times of physical or emotional stress, the body tends to increase the production and release of glucocorticoids (cortisol) to help it deal with the stressful episode. In contrast, when the body is receiving cortisol from an outside source (like a cortisone pill or injection), it reduces the amount of cortisol that the adrenal glands produce.
Two medical conditions, Cushing’s disease and Addison’s disease, occur when the body’s regulation of these hormones is altered; such alterations can cause significant illness in affected pets. Cushing’s disease occurs when the body produces and releases excessive amounts of cortisol. The clinical term for Cushing’s disease is hyperadrenocorticism. Addison’s disease occurs when the brain doesn’t release adequate amounts of ACTH, or the adrenal glands fail to release their hormones in response to ACTH. The medical term for Addison’s disease is hypoadrenocorticism.
Cushing’s disease occurs when a change in the body causes the adrenal glands to ignore the normal feedback mechanisms that regulate cortisol, leading to excessive production and release of the hormone. Sometimes Cushing’s disease is caused by a tumor on one of the adrenal glands, which continues to make cortisol despite signals from the body telling it to stop. Sometimes, the adrenal glands are “tricked” by the pituitary gland in the brain into continuing to produce too much cortisol. Either way, the sustained overproduction and release of cortisol eventually results in negative effects on the body.
In most cases, the cause of Addison’s disease is not determined. Sometimes, the body’s immune system can damage the adrenal glands’ cells so extensively that they can’t release hormones when necessary. In other cases, such as a brain tumor, the part of the brain that should release ACTH is unable to. However, Addison’s disease can also occur if a pet that is receiving cortisol medication suddenly stops getting it. In this case, the body has reduced its own cortisol production and can’t increase it quickly enough to compensate when the medication is discontinued. This is why steroid medications, such as prednisone, should not be discontinued suddenly, but must instead be gradually reduced and then discontinued.
Cushing’s disease and Addison’s disease are most commonly diagnosed in dogs, although they occur rarely in cats.
What Is an ACTH Stimulation Test?
If your veterinarian suspects your pet may have Cushing’s disease or Addison’s disease, an ACTH stimulation test may be recommended. The ACTH stimulation test involves administering a small amount of ACTH by injection and then measuring the levels of cortisol produced over a period of a few hours. In dogs with Cushing’s disease, the injection of ACTH causes the adrenal glands to release unusually high amounts of cortisol. In a dog with Addison’s disease, the adrenal glands may be unable to respond adequately to ACTH, so the injection of ACTH does not result in a significant increase in cortisol levels. These responses can help your veterinarian diagnose Addison’s disease or Cushing’s disease in your pet. However, additional tests are recommended in many cases to confirm a diagnosis.
How Is an ACTH Stimulation Test Performed?
Your veterinarian will begin the test by drawing a small amount of blood from your pet to check the baseline (“starting”) cortisol level. Afterward, a very small amount of ACTH is given by injection. A repeat blood sample is taken 1 to 2 hours after the injection to measure the cortisol level and determine if the body’s response is appropriate. The blood samples are submitted to a diagnostic laboratory, and results are generally available within a few days.
Your veterinarian will likely recommend that your pet remain in the hospital for the few hours that are needed to complete the ACTH stimulation test. This is to avoid stress or excitement (for example, from a car ride), which can affect your pet’s cortisol level and reduce the accuracy of the final test result. Generally, pets undergoing an ACTH stimulation test are temporarily kept in a very quiet area of the hospital to reduce stress and excitement as the test is being performed. Your veterinarian may ask you to withhold food on the day of the test. You should mention any medications or supplements that your pet may be receiving, as some chemicals can affect the accuracy of the test. Be sure to address any questions or concerns with your veterinarian.
What Is an ACTH Stimulation Test Used For?
Cushing’s disease and Addison’s disease are complicated medical conditions, and confirming a diagnosis can be challenging. Your pet’s response on this test can provide valuable information to help your veterinarian reach a diagnosis. In many cases, additional tests (including blood tests, x-rays, abdominal ultrasound examinations, and urine tests) are recommended to confirm a diagnosis.
Once a pet has been diagnosed with Cushing’s disease and is undergoing treatment, many veterinarians periodically perform ACTH stimulation tests to assess how well the pet is responding to treatment.
Are There Risks Associated with Performing an ACTH Stimulation Test?
There are very few risks associated with ACTH stimulation testing. The ACTH injection is very safe and side effects are exceptionally rare. Drawing blood takes only a few seconds, and your veterinary team will take precautions to ensure that your pet is not injured during this procedure. Your veterinarian will also take steps to ensure that your pet is safe and comfortable while being hospitalized for the test. Once blood is obtained, all further processing is performed at your veterinarian’s office or at a diagnostic laboratory, so there is no risk of harm to your pet.
Diagnosing Cushing’s disease and Addison’s disease can be complicated, but an early diagnosis can mean early treatment and a better chance at a normal life for your pet.
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