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Too Thirsty?

Hannah, an eight-year old female spayed Schaunzer; Chloe, a 12-year old female spayed Shih Tzu; Barney, a 5-year old male neutered Doberman; Molly, a 14-year old miniature poodle; and Ollie, a 2-year old male neutered Labrador, each presented to an Internal Medicine Specialist at CARE for drinking more than normal. While their presenting symptom was the same, the diagnostic plan, diagnosis, treatment plan and prognosis were different.

Increased thirst is a common concern for dog parents. Change in water consumption is often easy to notice when the water bowl needs filled more often or the dog start begging for more water. Needing to urinate more frequently or in larger volume often accompanies the increase in water intake.

While there are many potential causes of this symptom the most common causes are diabetes mellitus, hyperadrenocorticism (Cushings disease), liver disease, and kidney disease. Less common causes include hypoadrenocorticism, hypercalcemia, hypokalemia, infections, diabetes insipidus, paraneoplastic disorders, toxins,  polycythemia and psychogenic disorders.

The “history” is very important to the veterinarian and will help narrow down the possible causes as well as provide important information to guide the treatment plan. Pet parents are asked how long the symptom has been present, is it getting worse, is appetite normal, has weight changed, has there been any vomiting or diarrhea, have there been any changes in diet or new medications started, is there a change in urination as well? An assessment of how severe the change will also be important.

Physical examination will also provide some helpful information including body condition, muscle condition, skin/coat condition and organ size.

The initial diagnostic plan is straightforward and includes testing to look for the most common conditions. Typically this includes a complete blood count, chemistry panel with electrolytes, screening radiographs and urinalysis with culture. A second diagnostic step is often needed to reach a diagnosis. Additional testing is sometime necessary, especially if there is more than one condition or a less common condition.

Hannah was found to have an elevated blood glucose and glucose in her urine. Urine culture was positive. She was diagnosed with diabetes mellitus and a urinary tract infection. Treatment of a diet change, insulin and antibiotics was started. Most dogs with diabetes are well controlled with medications and have a good prognosis.

Chloe was found to have elevated liver values and protein in her urine. She has a “pot belly”, large liver and skin infection. Second step diagnostics were recommended. Additional blood testing revealed cortisol levels that were higher than normal. Ultrasound revealed that both adrenal glands were enlarged. She was diagnosed with pituitary dependent hyperadrenocorticism (Cushings disease). She was started on Trilostane. Most dogs with this condition are well treated and have a fair to good prognosis.

Barney was found to have elevated liver values. Second step diagnostics were recommended. Ultrasound revealed a small liver with coarse texture, normal biliary system and normal adrenal glands. Liver biopsy revealed a copper hepatopathy. He was started on a combination of oral medications. Prognosis is fair.

Molly was found to have elevated kidney values mild anemia and dilute urine. Additional diagnostics revealed elevated blood pressure and small irregular kidneys. She was diagnosed with chronic renal failure. After a short hospital stay, medications were started to help slow the progression and manage her symptoms. The owners are able to provide nursing care at home including fluid support at home. Prognosis is fair.

Ollie was found to have a low sodium and high potassium. An ACTH stimulation test confirmed hypoadrenocorticism (Addisons disease). Injectable percorten and oral prednisone were started. Prognosis is good.

Increased thirst is a common condition that can have many different causes. The most common of these can be identified quickly and treatment often results in a good outcome.