C09988776 / invoice 10000

Reason: Admit for ACTH stim test History: Trilostane 20mg/ml 0.6ml given this morning @ 6am (also gets 0.6mls in the pm) All OK - perhaps slightly less urination. Plan: Aim to pick her up by 11.45 am please. ACTH stim testProtocol - ideally fasted dog (If on trilostane - Perform the test 4-6 hours after administration of trilostane)1. Collect blood - plain tube, t=02. Inject 0.2ml synacthen IV RF @ 10.35am 3. Collect blood in plain tube (red top) at EXACTLY 1 hr after step 2, label t=1To run cortisol test;Need serumAssessment - Interpretation;* diagnosising cushings - resting cortsiol, t=0 should be normal or high (2-6ug/dl = 55-165nmol/L), t=1 should be much higher (18-22ug/dl - equivocal; > 22ug/dl = >607nmol/L => failure to suppress  * if assessing effectivness of treatment => want resting and post acth stim cortisol to be <75nmol charges reflect inclusion of rt consult fee For Monitoring: Key pearls to put into practice:Trilostane therapy that starts with 0.5 to 1 mg/kg PO every 12 hours and gradually increases in dose is recommended for treatment of pituitary-dependent hyperadrenocorticism in dogs to minimize signs of hypoadrenocorticism.Periodic (ie, every 4-6 weeks) ACTH stimulation testing is recommended to monitor trilostane therapy. cpACTH >7 micrograms/dL, particularly when noted concurrently with unresolved clinical signs, indicates a dose increase is warranted. Dose escalation is common, possibly due in part to adrenal hyperplasia during therapy.Pet owners should be informed that cpACTH =27 micrograms/dL at the time of diagnosis indicates the trilostane dose will likely need to be gradually increased to achieve disease control. As basal (ie, pre-ACTH) cortisol had no predictive value in this study, basal cortisol measurement may be eliminated as a cost-savings measure, especially in patients without signs of hypoadrenocorticism.Most studies have evaluated dosage and efficacy of commercially available trilostane. Greater variability should be expected from compounded trilostane.    Vital Signs