Meet The Author
March 2025
Lara Brunori, DVM, CertAVP(ECC), DipECVECC, MRCVS
I am from northern Italy, graduating from Bologna University in 2009. I started as an equine vet, practicing in various locations before moving to the UK in 2014, where I transitioned to small animal practice. After several years in general practice, I focused on emergency and critical care. In 2019, I moved to Glasgow to complete internships and a residency at Vets Now, where I now work as an ECC clinician. Outside of work, I am passionate about fitness and strength training. I also love traveling, especially to warm destinations.
Lara Brunori, Olivia X Walesby, Daniel H Lewis, Alisdair M Boag
The Study Background
Adrenal crisis in dogs with hypoadrenocorticism is a life-threatening condition requiring prompt medical intervention. While dexamethasone boluses are the most commonly used hormonal replacement therapy, hydrocortisone continuous rate infusion (CRI) has been proposed as a viable alternative due to its combined glucocorticoid and mineralocorticoid effects. This retrospective study assesses the effectiveness of hydrocortisone CRI versus dexamethasone boluses in stabilising dogs with adrenal crisis.
What is the primary knowledge gap your study aims to address?
Most veterinary practices use dexamethasone due to its availability, ease of administration and lack of direct interference with ACTH stimulation tests. However, human medical guidelines prefer hydrocortisone CRI, leading to the question of whether this approach could offer benefits in dogs. The study explored whether hydrocortisone CRI led to quicker stabilisation of electrolyte and acid-base imbalances, shorter hospitalisation times, or improved survival outcomes compared to dexamethasone boluses.
The Study Design
This is a retrospective analysis of 39 dogs diagnosed with adrenal crisis across three referral centres. Dogs were divided into two treatment groups: those receiving hydrocortisone CRI and those treated with dexamethasone boluses. Hospitalisation time, frequency of electrolyte monitoring, time to normalisation of sodium and potassium levels, and overall survival rates were recorded.
What are the main study results?
- There was no significant difference in hospitalisation duration and survival rates.
- Both treatments were equally effective in correcting electrolyte imbalances (Na, K, and Na/K ratio)
- The choice of intravenous fluids did not significantly impact outcomes.
Were there any unexpected results or challenges during your research?
Contrary to expectations, hydrocortisone CRI did not show a clear advantage over dexamethasone boluses in stabilising electrolyte imbalances. However, an interesting observation was that some dexamethasone-treated dogs experienced sodium overcorrection, suggesting that hydrocortisone’s mineralocorticoid activity may help prevent hypernatremia by promoting balanced sodium and water retention.
Takeaways from this study
The findings suggest that both hydrocortisone CRI and dexamethasone boluses are safe and effective for treating adrenal crises in dogs. While the hydrocortisone group showed a tendency toward shorter hospitalisation (not statistically significant) and potentially a lower risk of sodium fluctuations—without an increased need for intensive monitoring—there is no clear advantage of one treatment over the other. Therefore, currently, the choice of therapy should be guided by clinician preference, hospital protocols, and drug availability.
What future directions would you like to explore based on this study?
This study's conclusions are limited by its retrospective design and small sample size. Prospective, controlled studies are needed to determine whether hydrocortisone CRI offers clear advantages in dogs with adrenal crises. Additionally, assessing the cost-effectiveness and logistical feasibility of hydrocortisone CRI versus dexamethasone across various clinical settings and severity levels could further refine treatment recommendations.
