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Segev G, Cortellini S, Foster JD, Francey T, Langston C, Londoño L, Schweighauser A, Jepson RE. International Renal Interest Society best practice consensus guidelines for the diagnosis and management of acute kidney injury in cats and dogs. Vet J 2024; 305:106068. [PMID: 38325516 DOI: 10.1016/j.tvjl.2024.106068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 12/10/2023] [Accepted: 01/19/2024] [Indexed: 02/09/2024]
Abstract
Acute kidney injury (AKI) is defined as an injury to the renal parenchyma, with or without a decrease in kidney function, as reflected by accumulation of uremic toxins or altered urine production (i.e., increased or decreased). AKI might result from any of several factors, including ischemia, inflammation, nephrotoxins, and infectious diseases. AKI can be community- or hospital-acquired. The latter was not previously considered a common cause for AKI in animals; however, recent evidence suggests that the prevalence of hospital-acquired AKI is increasing in veterinary medicine. This is likely due to a combination of increased recognition and awareness of AKI, as well as increased treatment intensity (e.g., ventilation and prolonged hospitalization) in some veterinary patients and increased management of geriatric veterinary patients with multiple comorbidities. Advancements in the management of AKI, including the increased availability of renal replacement therapies, have been made; however, the overall mortality of animals with AKI remains high. Despite the high prevalence of AKI and the high mortality rate, the body of evidence regarding the diagnosis and the management of AKI in veterinary medicine is very limited. Consequently, the International Renal Interest Society (IRIS) constructed a working group to provide guidelines for animals with AKI. Recommendations are based on the available literature and the clinical experience of the members of the working group and reflect consensus of opinion. Fifty statements were generated and were voted on in all aspects of AKI and explanatory text can be found either before or after each statement.
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Affiliation(s)
- Gilad Segev
- Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, Hebrew University of Jerusalem, Israel.
| | - Stefano Cortellini
- Department of Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hertfordshire, UK
| | - Jonathan D Foster
- Department of Nephrology and Urology, Friendship Hospital for Animals, Washington DC, USA
| | - Thierry Francey
- Department of Clinical Veterinary Medicine, Vetsuisse Faculty University of Bern, Bern, Switzerland
| | - Catherine Langston
- Veterinary Clinical Science, The Ohio State University, Columbus, OH, USA
| | - Leonel Londoño
- Department of Critical Care, Capital Veterinary Specialists, Jacksonville, FL, USA
| | - Ariane Schweighauser
- Department of Clinical Veterinary Medicine, Vetsuisse Faculty University of Bern, Bern, Switzerland
| | - Rosanne E Jepson
- Department of Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hertfordshire, UK
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Margeti C, Kazakos G, Galatos AD, Skampardonis V, Zacharopoulou T, Tsioli V, Tyrnenopoulou P, Loukopoulos E, Papatsiros VG, Flouraki E. The Effect of a Subsequent Dose of Dexmedetomidine or Other Sedatives following an Initial Dose of Dexmedetomidine on Electrolytes, Acid-Base Balance, Creatinine, Glucose, and Cardiac Troponin I in Cats: Part II. Vet Sci 2024; 11:143. [PMID: 38668411 PMCID: PMC11053990 DOI: 10.3390/vetsci11040143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/13/2024] [Accepted: 03/16/2024] [Indexed: 04/29/2024] Open
Abstract
The administered dose of dexmedetomidine may occasionally fail to produce the anticipated sedative effects. Therefore, a subsequent dose or administration of another sedative may enhance sedation; however, patient safety may be affected. The safety of seven different drugs administered at the following time point after an insufficient dose of dexmedetomidine was evaluated in a crossover, blind, experimental study that included six healthy adult cats. All cats received an initial dose of dexmedetomidine and a subsequent dose of either dexmedetomidine (Group DD), NS 0.9% (DC), tramadol (DT), butorphanol (DBT), buprenorphine (DBP), ketamine (DK), or midazolam (DM). Animal safety was assessed using repeated blood gas analysis and measurement of electrolytes, glucose, cardiac troponin I, and creatinine to evaluate cardiac, respiratory, and renal function. The median values of creatinine, cardiac troponin I, pH, partial pressure of carbon dioxide, potassium, and sodium did not change significantly throughout the study. Heart rate was significantly decreased in all groups after administration of the drug combinations, except for in the DK group. Respiratory rate decreased significantly after administration of the initial dose of dexmedetomidine and in the DBP and DM groups. The partial pressure of oxygen, although normal, decreased significantly after the administration of dexmedetomidine, whereas the median concentration of glucose increased significantly following the administration of dexmedetomidine. The results of our study suggest that the drug combinations used did not alter the blood parameters above normal limits, while cardiac and renal function were not compromised. Therefore, a safe level of sedation was achieved. However, the administration of dexmedetomidine reduced the partial pressure of oxygen; thus, oxygen supplementation during sedation may be advantageous. Additionally, the increase in glucose concentration indicates that dexmedetomidine should not be used in cats with hyperglycaemia, whereas the decrease in haematocrit suggests that dexmedetomidine is not recommended in anaemic cats.
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Affiliation(s)
- Chrysoula Margeti
- Clinic of Surgery, Faculty of Veterinary Medicine, School of Health Sciences, University of Thessaly, Trikalon 224, 43100 Karditsa, Greece; (C.M.); (A.D.G.); (T.Z.); (V.T.); (P.T.); (E.L.)
| | - Georgios Kazakos
- Companion Animal Clinic, School of Veterinary Medicine, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece;
| | - Apostolos D. Galatos
- Clinic of Surgery, Faculty of Veterinary Medicine, School of Health Sciences, University of Thessaly, Trikalon 224, 43100 Karditsa, Greece; (C.M.); (A.D.G.); (T.Z.); (V.T.); (P.T.); (E.L.)
| | - Vassilis Skampardonis
- Department of Epidemiology, Biostatistics and Animal Health Economics, Faculty of Veterinary Medicine, School of Health Sciences, University of Thessaly, Trikalon 224, 43100 Karditsa, Greece;
| | - Theodora Zacharopoulou
- Clinic of Surgery, Faculty of Veterinary Medicine, School of Health Sciences, University of Thessaly, Trikalon 224, 43100 Karditsa, Greece; (C.M.); (A.D.G.); (T.Z.); (V.T.); (P.T.); (E.L.)
| | - Vassiliki Tsioli
- Clinic of Surgery, Faculty of Veterinary Medicine, School of Health Sciences, University of Thessaly, Trikalon 224, 43100 Karditsa, Greece; (C.M.); (A.D.G.); (T.Z.); (V.T.); (P.T.); (E.L.)
| | - Panagiota Tyrnenopoulou
- Clinic of Surgery, Faculty of Veterinary Medicine, School of Health Sciences, University of Thessaly, Trikalon 224, 43100 Karditsa, Greece; (C.M.); (A.D.G.); (T.Z.); (V.T.); (P.T.); (E.L.)
| | - Epameinondas Loukopoulos
- Clinic of Surgery, Faculty of Veterinary Medicine, School of Health Sciences, University of Thessaly, Trikalon 224, 43100 Karditsa, Greece; (C.M.); (A.D.G.); (T.Z.); (V.T.); (P.T.); (E.L.)
| | - Vasileios G. Papatsiros
- Clinic of Medicine, Faculty of Veterinary Medicine, School of Health Sciences, University of Thessaly, Trikalon 224, 43100 Karditsa, Greece
| | - Eugenia Flouraki
- Clinic of Surgery, Faculty of Veterinary Medicine, School of Health Sciences, University of Thessaly, Trikalon 224, 43100 Karditsa, Greece; (C.M.); (A.D.G.); (T.Z.); (V.T.); (P.T.); (E.L.)
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Comparison of Clinical and Laboratory Findings at Different Clinical Stages in Cats Naturally Infected with Feline Coronavirus. ACTA VET-BEOGRAD 2023. [DOI: 10.2478/acve-2023-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Abstract
Feline coronavirus (FCoV) infections occur commonly in cats, with entrocyte and monocyte-macrophage tropism. Most FCoV-infected cats remain asymp tomatic, but up to 10% develop fatal feline infectious peritonitis (FIP). This study aims to investigate the diagnostic utility of clinical and laboratory examinations including serum and effusion AGP levels in cats either with symptomatic effusive FIP or asymptomatic feline enteric coronavirus (FECV). The study included 40 cats with effusive FIP and 10 cats with FECV infection. The FIP group was divided into two subgroups: abdominal (AE; n=30) and thoracic effusion (TE; n=10). Clinical and laboratory examinations, including serum or effusion AGP measurement, were performed. Among all the groups, TE group had higher body temperature, heart and respiratory rates (P<0.000). Compared with the FECV group, the FIP group had lower pH and HCO3 levels and higher base excess and lactate levels (P<0.05). The leukocyte and lymphocyte counts were higher and the hematocrit was lower in the AE group among all the groups (P<0.023). MCV was lower in the FIP group compared to the FECV group (P<0.002). In the AE group, total protein level was the lowest and the AST, GGT, total bilirubin and cholesterol levels were the highest (P<0.032) among all the groups. Magnesium level was lower in the FIP group compared to the FECV group (P<0.044). Although the serum AGP level was highest in the TE group among all groups (P<0.004), the AGP levels of cats with FECV were similar to the AE group (P>0.05). Since FECV-positive cats will likely develop FIP, differences in clinical and laboratory findings in FECV-positive cats were identified. Among them, pH, HCO3, base excess, lactate, MCV and magnesium were found to be important in the course of the disease, and AGP in the evaluation of the presence of an inflammatory state. It was concluded that clinical, laboratory and serum AGP evaluation could be used in the index of suspicion of development of FIP and FECV.
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Quintavalla F, Spindler KP, Aldigeri R, Fidanzio F. The Effect of Different Opioids on Acid-Base Balance and Blood Gas Analysis in Hospitalized Dogs. Front Vet Sci 2022; 9:802186. [PMID: 35372538 PMCID: PMC8968933 DOI: 10.3389/fvets.2022.802186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/17/2022] [Indexed: 11/17/2022] Open
Abstract
Pain management is central to veterinary practice, contributing to successful case outcomes and enhancement of the veterinarian-client-patient relationship. Analgesic drugs represent one of the pillars of the multimodal approach to acute and chronic pain management. In dogs, the most used opioids are methadone, buprenorphine and tramadol. Several episodes of hypoglycemia in people treated with tramadol and methadone have recently been described. The aim of this work is to evaluate the changes in the glycemic and acid-base balance induced by tramadol, methadone and buprenorphine in hospitalized dogs. A retrospective review of the medical records of dogs hospitalized for both medical and surgical reasons was performed. During 2018-2020, a total of 876 canine patients were treated with opioids, including 228 with tramadol, 273 with methadone and 375 with buprenorphine. Of all these dogs, only a small percentage met the inclusion criteria presented in the initial design. All the hospitalized animals were monitored daily through clinical examination and blood sampling. Blood samples were obtained before opioid administration (T0), and 24 h (T1) and 48 h (T2) after °pioid administration. The following parameters were evaluated: blood gas value (pH, pCO2), acid-base state (cHCO3), oxymetric values (ctHb, haematocrit), electrolyte values (K+, Na+, iCa, Cl-) and metabolic values (glucose, lactate, anion GAP K+c). The glycemic value in enrolled dogs showed a decrease over time, regardless of the type of opioid used, but remained within the physiological range. The highest average glycemic drop was recorded for methadone, between T0 and T1, followed by tramadol between T1 and T2, while buprenorphine recorded the highest overall glycemic drop between T0-T2 when compared to the other two opioids. Female dogs showed the greatest drop in glycemic value. Lactate concentration always presented values beyond the physiological range at an early stage, which then normalized quickly. Measurement of electrolyte concentrations showed a consistent increase in the values of iCa, Na and Cl. In hospitalized dogs treated with opioids monitoring of gas analytic parameters is important and more attention should be paid to patients hospitalized with certain metabolic and endocrine diseases.
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Affiliation(s)
- Fausto Quintavalla
- Department of Veterinary Sciences, University of Parma, Parma, Italy
- *Correspondence: Fausto Quintavalla
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Tosuwan J, Hunprasit V, Surachetpong SD. Usefulness of peripheral venous blood gas analyses in cats with arterial thromboembolism. Int J Vet Sci Med 2021; 9:44-51. [PMID: 34754877 PMCID: PMC8555553 DOI: 10.1080/23144599.2021.1982335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Feline arterial thromboembolism (ATE) is a condition with a high mortality rate. Acid-base abnormalities may be beneficial to the prognosis of cats with ATE. Venous blood gas and electrolytes data on the first day of ATE presentation of 47 cats with ATE were retrospectively reviewed and analysed. The Cox and logistic regression were analysed to evaluate the relationship between acid-base parameters and death. The most common venous acid-base disorder was simple metabolic acidosis. Age, body weight, and partial venous pressure of carbon dioxide (PvCO2) differed between the dead and alive groups within 7 days of the onset of ATE presentation (p < 0.05). Cox-regression showed that increasing age (HR=1.175 [95% CI: 1.027-1.343], p = 0.019), increasing PvCO2 (HR=1.066 [95% CI: 1.010-1.125], p = 0.021) and PvCO2 more than 34 mmHg (HR=7.878 [95% CI: 1.036- 59.915], p = 0.046) were associated with increased hazard of death. Multivariable logistic regression showed that age > 5 years (OR=9.030, 95% CI: 1.258- 64.823; p=0.029), and PvCO2 > 34 mmHg (OR=21.764, 95% CI: 1.747-271.141; p=0.017) were associated with an increased risk of death, while concomitant administration of enoxaparin with clopidogrel (OR=0.111, 95% CI: 0.015-0.795; p=0.029) were associated with a decreased risk of death within 7 days of the onset of ATE presentation. This study demonstrated the power of venous blood gas analysis which may be used as prognostic indicators for cats with ATE.
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Affiliation(s)
- Jidapa Tosuwan
- Department of Veterinary Medicine, Faculty of Veterinary Science, Chulalongkorn University, Bangkok Thailand
| | - Vachira Hunprasit
- Department of Veterinary Medicine, Faculty of Veterinary Science, Chulalongkorn University, Bangkok Thailand
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Zeiler GE, Fuller A, Kamerman P, Buck RK, Pohlin F, Dzikiti BT. Describing acid-base balance using three different methods of analysis in a feline acute haemorrhage-resuscitation model. Vet Anaesth Analg 2021; 49:65-75. [PMID: 34865969 DOI: 10.1016/j.vaa.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 05/26/2021] [Accepted: 07/21/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe acid-base status using the Henderson-Hasselbalch, Stewart and semi-quantitative methods of analysis in a feline haemorrhage-resuscitation model. STUDY DESIGN Randomized crossover study. ANIMALS A total of six domestic cats (mean age, 21 months; weight, 4.9 kg). METHODS Venous blood samples were taken before haemorrhage, after haemorrhage at 30 minute intervals during fluid resuscitation and at 24 hours. The cats were anaesthetized and underwent following treatments: no purposeful haemorrhage and resuscitation (NoPHR), purposeful haemorrhage followed by either lactated Ringer's solution (LRS) or 6% tetrastarch 130/0.4 (Voluven) for resuscitation. LRS and Voluven were administered at 60 and 20 mL kg-1 hour-1, respectively, for 120 minutes. Variables used for the analysis methods were measured or calculated from the blood samples and then compared among treatments over time using a general linear mixed model (p < 0.05; data reported as mean and standard deviation). RESULTS The total blood loss at 120 minutes was 10.2 ± 2.3, 29.3 ± 9.0 and 29.1 ± 6.3 mL kg-1 for NoPHR, LRS and Voluven, respectively. Total volumes of LRS and Voluven administered were 120 and 40 mL kg-1, respectively. All cats became acidaemic during anaesthesia regardless of treatment. The Henderson-Hasselbalch method indicated that anaesthetized cats undergoing severe haemorrhage and resuscitation manifest a mixed acidosis. The Stewart method indicated two counter metabolic processes that contributed to the overall pH-decrease in apparent strong ion difference (acidosis) and decrease in total weak acids (alkalosis). The semi-quantitative method identified the free water and chloride effects as variables causing acidosis and the albumin effect causing alkalosis. CONCLUSIONS AND CLINICAL RELEVANCE In an experimental haemorrhage and resuscitation model in cats, blood pH was similar among treatments over time regardless of severe haemorrhage and resuscitation with LRS or Voluven or mild haemorrhage and no resuscitation.
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Affiliation(s)
- Gareth E Zeiler
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa; Anaesthesia and Critical Care Services, Valley Farm Animal Hospital, Pretoria, South Africa; Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa.
| | - Andrea Fuller
- Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Peter Kamerman
- Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Roxanne K Buck
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Friederike Pohlin
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Brighton T Dzikiti
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa; Clinical Sciences Department, Ross University School of Veterinary Medicine, Basseterre, St. Kitts, South Africa
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Cameron S, Weltman JG, Fletcher DJ. The prognostic value of admission point-of-care testing and modified Glasgow Coma Scale score in dogs and cats with traumatic brain injuries (2007-2010): 212 cases. J Vet Emerg Crit Care (San Antonio) 2021; 32:75-82. [PMID: 34432934 DOI: 10.1111/vec.13108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the association between admission point-of-care parameters and survival to discharge in dogs and cats with traumatic brain injury (TBI). DESIGN Retrospective study 2007-2010. SETTING A rural university teaching hospital and an urban private practice teaching hospital. ANIMALS One hundred thirty-one dogs and 81 cats admitted to the emergency service with evidence of head injury based on history from the owner or physical exam. MEASUREMENTS AND MAIN RESULTS In dogs, nonsurvivors had significantly higher glucose concentrations at admission than survivors (median = 8.49 mmol/L [153 mg/dl] vs 6.83 mmol/L [123 mg/dl], p = 0.039). In cats, there was no significant difference in admission glucose between survivors and nonsurvivors (median = 10.21 mmol/L [184 mg/dl] vs 10.93 mmol/L [197 mg/dl], p = 0.17). Modified Glasgow Coma Scale (MGCS) score was available for 105 of the 131 dogs (80%) and was significantly higher in survivors than in nonsurvivors (median = 16 vs 11, p < 0.0001). MGCS was available for 45 of the 81 cats (56%) and was significantly higher in survivors than in nonsurvivors (median = 17 vs 14, p = 0.0005). The relative prognostic value of the admission point-of-care testing parameters and MGCS were assessed using a stepwise linear regression model, which included admission glucose, pH, base excess, sodium, and MGCS. In dogs, only admission glucose was an independent predictor of survival (odds ratio = 1.027, 95% confidence interval, 1.0042-1.05, p = 0.019). CONCLUSIONS These results suggest that, as in people with TBI, increased blood glucose concentrations may have prognostic significance in dogs with TBI but not in cats. In addition, MGCS score may be predictive of survival in both dogs and cats with TBI.
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Affiliation(s)
- Starr Cameron
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Joel G Weltman
- Emergency and Critical Care Department, Animal Medical Center, New York, New York, USA
| | - Daniel J Fletcher
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, New York, USA
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Donati PA, Londoño L, Benavides G, Mouly J, González S, Otero PE. Clinicopathological factors associated with the presence of hypercapnia at admission in hospitalised cats with decompensated chronic kidney disease. N Z Vet J 2021; 69:343-348. [PMID: 34085906 DOI: 10.1080/00480169.2021.1939188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIMS To evaluate associations between clinicopathological variables and hypercapnia measured in cats with decompensated chronic kidney disease (CKD) on admission to a veterinary hospital. METHODS This is a retrospective, cross-sectional study of cats (n = 39) that presented to a tertiary veterinary hospital in Argentina between June 2015 and December 2017 with blood creatinine concentrations >140 μmol/L, and abdominal ultrasound results consistent with CKD. Data recorded included venous partial pressure of CO2 (PvCO2), blood pH, haematocrit and concentrations of glucose, potassium, sodium, corrected sodium (Na+c), and ionised calcium in blood. A logistic regression model was used to assess associations between the presence of hypercapnia (PvCO2 ≥ 44.7 mmHg) and the other clinicopathologic variables. The duration of hospitalisation was compared in cats with and without hypercapnia using the Wilcoxon Rank Sum test. RESULTS The final study population comprised 39 cats. Eleven cats (28.2%) had hypercapnia. In the logistic regression model, two independent variables were associated with the presence of hypercapnia at admission in cats with CKD: the concentration of creatinine in blood (OR = 1.06 (95% CI = 1.016-1.108); p = 0.007) and Na+c (OR = 1.33 (95% CI = 1.08-1.63); p = 0.005). There were no statistically significant differences in the length of hospital stay between the two groups. CONCLUSIONS AND CLINICAL RELEVANCE There appears to be an association between elevated concentrations of creatinine and Na+c in blood, and hypercapnia in cats with CKD, suggesting careful assessment of blood gas and electrolyte parameters during hospitalisation is required. Further prospective studies are needed to evaluate the mechanisms behind this association and the association of hypercapnia with disease outcome including mortality.
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Affiliation(s)
- P A Donati
- UCICOOP, Ciudad Autónoma de Buenos Aires, Argentina.,Cátedra de Anestesiología y Algiología, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - L Londoño
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - G Benavides
- UCICOOP, Ciudad Autónoma de Buenos Aires, Argentina
| | - J Mouly
- Veterinaria del Sol, La Plata, Provincia de Buenos Aires, Argentina
| | - S González
- Cátedra de Patología Clínica y Enfermedades Médicas, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - P E Otero
- Cátedra de Anestesiología y Algiología, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
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Johnston L, Leister E, Singer L. Severe metabolic acidosis due to acetazolamide intoxication in a dog. Aust Vet J 2020; 99:11-14. [PMID: 33025586 DOI: 10.1111/avj.13027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 12/01/2022]
Abstract
CASE REPORT This case report describes the clinical signs and case management of a 1-year-old neutered male Siberian Husky that accidentally ingested 635 mg/kg of oral acetazolamide (a carbonic anhydrase inhibitor). The dog presented with severe tachypnoea due to the development of hyperchloraemic metabolic acidosis and associated hypokalaemia that persisted for 7 days. Clinical and biochemical changes resolved with intravenous and subsequent oral supplementation of sodium bicarbonate and potassium. Complete recovery occurred within 9 days of presentation. CONCLUSION To the authors' knowledge, this is the first case that reports overdosage of an oral carbonic anhydrase inhibitor in a dog and subsequent recovery with adequate supplementation and supportive care.
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Affiliation(s)
- L Johnston
- Internal Medicine, Veterinary Specialist Services, Eastlake Street, Carrara, Queensland, 4211, Australia
| | - E Leister
- Emergency and Critical care, Pet ICU, Lexington Road, Underwood, Queensland, 4119, Australia
| | - L Singer
- Internal Medicine, Veterinary Specialist Services, Eastlake Street, Carrara, Queensland, 4211, Australia
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Sławuta P, Sikorska-Kopyłowicz A, Sapikowski G. Diagnostic utility of different models used to assess the acid-base balance in cats with chronic kidney disease. Acta Vet Hung 2020; 68:169-176. [PMID: 32857709 DOI: 10.1556/004.2020.00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 05/06/2020] [Indexed: 11/19/2022]
Abstract
Metabolic acidosis is diagnosed based on the concentration of bicarbonate ions and partial pressure of carbon dioxide in arterial blood, although acid-base balance (ABB) disorders may also be diagnosed based on the serum ion concentrations in order to determine the values of strong ion difference (SID), anion gap (AG), corrected anion gap (AGcorr) and chloride/sodium ratio (Cl-/Na+). The aim of this study was to assess and compare the classic model, the value of the AG, AGcorr, and Cl-/Na+ in the diagnosis of ABB disorders in cats with chronic kidney disease (CKD). The study group consisted of 80 cats with CKD, divided into four groups based on the guidelines of the International Renal Interest Society (IRIS). The control group (C) included 20 healthy cats. Metabolic acidosis - diagnosed based on the classic model (Hendersson-Hasselbalch equation) - was found in IRIS group IV. AG, AGcorr, SID calculated for IRIS groups II, III and IV were lower than in group C, while the value of AGdiff and Cl-/Na+ in those groups was higher than in group C. We can conclude that ABB analysis using the classic model enabled the detection of ABB disorders in cats in stage IV CKD. However, the analysis of the AG, AGcorr and Cl-/Na+ values enabled the diagnosis of acid-base balance disorders in cats with IRIS stage II, III and IV CKD.
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Affiliation(s)
- Piotr Sławuta
- Department of Internal Medicine and Clinic of Diseases of Horses, Dogs and Cats, The Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Science, Norwida 32, 50-375, Wrocław, Poland
| | - Agnieszka Sikorska-Kopyłowicz
- Department of Internal Medicine and Clinic of Diseases of Horses, Dogs and Cats, The Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Science, Norwida 32, 50-375, Wrocław, Poland
| | - Grzegorz Sapikowski
- Department of Internal Medicine and Clinic of Diseases of Horses, Dogs and Cats, The Faculty of Veterinary Medicine, Wrocław University of Environmental and Life Science, Norwida 32, 50-375, Wrocław, Poland
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Lawson CA, Spangler EA. The effect of adding lactic acid to canine whole blood on platelet aggregation as measured by impedance aggregometry. Vet Clin Pathol 2020; 49:217-221. [PMID: 32535936 DOI: 10.1111/vcp.12862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/22/2019] [Accepted: 10/25/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acidemia in sick dogs often results from the accumulation of lactic acid. The resulting decrease in blood pH can have many physiologic effects, including alteration of platelet function. OBJECTIVES We aimed to evaluate the effect of hyperlactatemia and subsequent acidemia on platelet aggregation in canine blood using impedance aggregometry. METHODS Platelet aggregation was measured in blood from 27 healthy dogs using the Multiplate analyzer at baseline and after in vitro addition of two different volumes of lactic acid to adjust the pH. The area under the curve (AUC), reported by the Multiplate analyzer, was used to assess the extent of platelet aggregation in each sample. A linear mixed effects model was used to test for the association between platelet aggregation and pH. The association of baseline platelet aggregation with HCTs, platelet counts, and WBC counts was assessed using Pearson's correlations. RESULTS Acidemia was associated with a significant decrease in platelet aggregation. No significant correlations were detected between platelet aggregation and HCT, platelet count, or WBC count. Platelet aggregation measured using the Multiplate analyzer showed substantial individual variation. CONCLUSIONS Worsening acidemia due to the addition of lactic acid caused a mild but significant decrease in platelet aggregation in canine blood. The clinical significance of this change is uncertain but could be important when combined with other abnormalities of hemostasis associated with illness.
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Affiliation(s)
- Cheryl A Lawson
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
| | - Elizabeth A Spangler
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
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Rauserova-Lexmaulova L, Vanova-Uhrikova I, Rehakova K. Acid-Base, Electrolyte and Lactate Abnormalities as Well as Gastric Necrosis and Survival in Dogs With Gastric Dilation-Volvulus Syndrome. A Retrospective Study in 75 Dogs. Top Companion Anim Med 2020; 39:100403. [PMID: 32482282 DOI: 10.1016/j.tcam.2020.100403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 01/02/2020] [Accepted: 01/08/2020] [Indexed: 11/29/2022]
Abstract
Gastric dilation-volvulus (GDV) syndrome in dogs is associated with complex metabolic, acid-base, and electrolyte abnormalities. The aim of this study was to evaluate previously analyzed factors (lactate and BE) in combination with other acid-base parameters (pH, pCO2, bicarbonate, base excess [BE], anion gap [AG], and strong ion difference) and electrolyte concentrations and to evaluate their association with the incidence of gastric necrosis and outcome in dogs with GDV. A retrospective study in 75 dogs with gastric dilation-volvulus syndrome, University veterinary teaching hospital. Medical records were reviewed including signalment, history, initial plasma lactate, acid-base parameters, and electrolyte concentrations, surgical findings and outcome. The overall mortality was 18.7%. In dogs with gastric necrosis, higher initial plasma lactate (median 5.84 vs. 3.36 mmol/L) and AG (20.7 vs. 16.55 mmol/L) and lower pH (7.29 vs. 7.36), bicarbonate (18.7 vs. 22.9 mmol/L), and BE concentration (-8.1 vs. -1.85 mmol/L) were found compared to dogs without gastric necrosis. Anorganic phosphorus was the only electrolyte investigated for which a significant difference was noted between dogs with and without gastric necrosis (1.93 vs. 1.39 mmol/L). The initial plasma lactate concentration (3.36 mmol/L vs. 9.68 mmol/L) and AG (16.8 vs. 20.95 mmol/L) were lower in survivors than nonsurvivors. Survivors had higher pH (7.35 vs. 7.27), bicarbonate concentrations (22.9 vs. 17.35 mmol/L), and BE (-1.9 vs. -9.55 mmol/L) compared to nonsurvivors. Anorganic phosphorus was ultimately the only electrolyte with a significant difference between survivors and nonsurvivors (1.4 vs. 1.84 mmol/L). A multivariate logistic regression model of combination lactate, pH, bicarbonate, BE, AG, and anorganic phosphorus identified pH ≤7.331 and bicarbonate as factors independently associated with gastric necrosis. Similarly, pH ˃7.331, bicarbonate and anorganic phosphorus were independently associated with outcome. Higher initial plasma lactate, AG and anorganic phosphorus levels, and lower pH, BE and bicarbonate concentrations were found in GDV dogs with gastric necrosis. Similarly, initially higher plasma lactate, AG and anorganic phosphorus concentrations, and lower pH, BE and bicarbonate were found in GDV dogs who required euthanasia or who died after surgery. Of these parameters, pH and bicarbonate were strongly and independently associated with gastric necrosis, and pH, bicarbonate and phosphorus were independently associated with outcome.
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Affiliation(s)
- Leona Rauserova-Lexmaulova
- Department of Surgery and Orthopedics, Small Animal Clinic, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic.
| | - Ivana Vanova-Uhrikova
- Small Animal Clinical Laboratory, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic
| | - Kristina Rehakova
- Small Animal Clinical Laboratory, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences Brno, Brno, Czech Republic
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Hasuda A, Flaiban K, Lisbôa J, Gomes L, Polizelli I, Santana L. Identifying hydric, electrolytic and acid-base imbalances through traditional and quantitative approaches in dogs with hemorrhagic gastroenteritis. ARQ BRAS MED VET ZOO 2020. [DOI: 10.1590/1678-4162-11017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Vomiting and diarrhea are two important clinical signs that can cause significant electrolytic and acid-base imbalances. The purposes of this study were to characterize hydric, electrolytic and acid-base disorders presented by puppies with hemorrhagic gastroenteritis and to compare the traditional and quantitative approaches to acid-base status interpretation. Sixty-one animals with a history of vomiting and/or diarrhea were used in this study and the following tests were performed: complete blood count, total plasma protein concentration and hemogasometry. Mean, standard deviation and Kappa values were calculated. The imbalances characterized by both approaches were: 42 (69%) animals without imbalance, 17 (28%) with metabolic alkalosis and 2 (3%) with metabolic acidosis by the traditional approach and 17 (28%) dogs without imbalance, 26 (43%) with metabolic alkalosis and 18 (29%) with metabolic acidosis by the quantitative approach. The agreement calculated between two approaches coincide in 28 cases, with a moderate Kappa value equivalent to 0.459. The most found imbalances were metabolic alkalosis, hypokalemia, and mild dehydration. Most of acid-base disturbances were not identified by the traditional approach, whereas by the quantitative approach, they were easily determined. Thus quantitative approach proved to be superior in identification of possible acid-base imbalances.
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Affiliation(s)
- A.L. Hasuda
- Universidade Estadual de Londrina, Brazil; Universidade Estadual de Londrina, Brazil
| | | | | | - L.A. Gomes
- Universidade Estadual de Londrina, Brazil
| | - I.G. Polizelli
- Universidade Estadual de Londrina, Brazil; Universidade Estadual de Londrina, Brazil
| | - L.S. Santana
- Universidade Estadual de Londrina, Brazil; Universidade Estadual de Londrina, Brazil
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14
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Rosenstein PG, Tennent-Brown BS, Hughes D. Clinical use of plasma lactate concentration. Part 1: Physiology, pathophysiology, and measurement. J Vet Emerg Crit Care (San Antonio) 2018. [PMID: 29533512 DOI: 10.1111/vec.12708] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To review the current literature with respect to the physiology, pathophysiology, and measurement of lactate. DATA SOURCES Data were sourced from veterinary and human clinical trials, retrospective studies, experimental studies, and review articles. Articles were retrieved without date restrictions and were sourced primarily via PubMed, Scopus, and CAB Abstracts as well as by manual selection. HUMAN AND VETERINARY DATA SYNTHESIS Lactate is an important energy storage molecule, the production of which preserves cellular energy production and mitigates the acidosis from ATP hydrolysis. Although the most common cause of hyperlactatemia is inadequate tissue oxygen delivery, hyperlactatemia can, and does occur in the face of apparently adequate oxygen supply. At a cellular level, the pathogenesis of hyperlactatemia varies widely depending on the underlying cause. Microcirculatory dysfunction, mitochondrial dysfunction, and epinephrine-mediated stimulation of Na+ -K+ -ATPase pumps are likely important contributors to hyperlactatemia in critically ill patients. Ultimately, hyperlactatemia is a marker of altered cellular bioenergetics. CONCLUSION The etiology of hyperlactatemia is complex and multifactorial. Understanding the relevant pathophysiology is helpful when characterizing hyperlactatemia in clinical patients.
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Affiliation(s)
- Patricia G Rosenstein
- Department of Veterinary Clinical Sciences, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Victoria, Australia
| | - Brett S Tennent-Brown
- Department of Veterinary Clinical Sciences, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Victoria, Australia
| | - Dez Hughes
- Department of Veterinary Clinical Sciences, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Victoria, Australia
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15
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Goggs R, De Rosa S, Fletcher DJ. Multivariable analysis of the association between electrolyte disturbances and mortality in cats. J Feline Med Surg 2017; 20:1072-1081. [PMID: 29206071 PMCID: PMC6259255 DOI: 10.1177/1098612x17743564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Electrolyte disorders have been individually associated with mortality in small populations of cats with specific conditions, but the associations and interactions between electrolyte disturbances and outcome have not been evaluated in a large, heterogeneous population. It was hypothesized that abnormalities of sodium, chloride, potassium and calcium concentrations would be independently and proportionately associated with death from natural causes and with all-cause mortality in cats. METHODS An electronic database containing 7064 electrolyte profiles was constructed to assess the association between disorders of sodium, potassium, corrected-chloride and ionized calcium concentrations with non-survival by multivariable modelling. A second database containing 2388 records was used to validate the models constructed from the first database. RESULTS All four electrolytes assessed had non-linear U-shaped associations with case fatality rates, wherein concentrations clustered around the reference interval had the lowest case fatality rates, while progressively abnormal concentrations were associated with proportionately increased risk of non-survival (area under the receiver operator characteristic curve [AUROC] 0.689) or death (AUROC 0.750). CONCLUSIONS AND RELEVANCE Multivariable modelling suggested that these electrolyte disturbances were associated with non-survival and with death from natural causes independent of each other. The present study suggests that measurement of electrolyte concentrations is an important component of the assessment of cats in emergency rooms or intensive care units. Future studies should focus on confirming these associations in a prospective manner accounting for disease severity.
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Affiliation(s)
- Robert Goggs
- 1 Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
| | - Sage De Rosa
- 2 Department of Clinical Studies, University of Pennsylvania School of Veterinary Medicine, Philadelphia, PA, USA
| | - Daniel J Fletcher
- 1 Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
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16
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Muir W. Effect of Intravenously Administered Crystalloid Solutions on Acid-Base Balance in Domestic Animals. J Vet Intern Med 2017; 31:1371-1381. [PMID: 28833697 PMCID: PMC5598900 DOI: 10.1111/jvim.14803] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/30/2017] [Accepted: 07/13/2017] [Indexed: 12/28/2022] Open
Abstract
Intravenous fluid therapy can alter plasma acid-base balance. The Stewart approach to acid-base balance is uniquely suited to identify and quantify the effects of the cationic and anionic constituents of crystalloid solutions on plasma pH. The plasma strong ion difference (SID) and weak acid concentrations are similar to those of the administered fluid, more so at higher administration rates and with larger volumes. A crystalloid's in vivo effects on plasma pH are described by 3 general rules: SID > [HCO3-] increases plasma pH (alkalosis); SID < [HCO3-] decreases plasma pH (alkalosis); and SID = [HCO3-] yields no change in plasma pH. The in vitro pH of commercially prepared crystalloid solutions has little to no effect on plasma pH because of their low titratable acidity. Appreciation of IV fluid composition and an understanding of basic physicochemical principles provide therapeutically valuable insights about how and why fluid therapy can produce and correct alterations of plasma acid-base equilibrium. The ideal balanced crystalloid should (1) contain species-specific concentrations of key electrolytes (Na+ , Cl- , K+ , Ca++ , Mg++ ), particularly Na+ and Cl- ; (2) maintain or normalize acid-base balance (provide an appropriate SID); and (3) be isosmotic and isotonic (not induce inappropriate fluid shifts) with normal plasma.
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Affiliation(s)
- W. Muir
- College of Veterinary MedicineLincoln Memorial UniversityHarrogateTN
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17
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Goggs R, De Rosa S, Fletcher DJ. Electrolyte Disturbances Are Associated with Non-Survival in Dogs-A Multivariable Analysis. Front Vet Sci 2017; 4:135. [PMID: 28868302 PMCID: PMC5563317 DOI: 10.3389/fvets.2017.00135] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 08/04/2017] [Indexed: 11/13/2022] Open
Abstract
Electrolyte disorders have been individually associated with mortality in small populations of dogs and cats with specific conditions, but the associations and interactions between electrolyte disturbances and outcome have not been evaluated in a large, heterogeneous population. It was hypothesized that abnormalities of sodium, chloride, potassium, and calcium concentrations would be independently and proportionately associated with death from natural causes and with all-cause mortality in dogs. An electronic database containing 33,117 electrolyte profiles was constructed to retrospectively assess the association between disorders of sodium, potassium, corrected chloride, and ionized calcium concentrations with non-survival and with death excluding euthanasia by multivariable modeling. A second database containing 11,249 records was used to validate the models constructed from the first database. All four electrolytes assessed had non-linear U-shaped associations with case fatality rates, wherein concentrations clustered around the reference interval had the lowest case fatality rates, while progressively abnormal concentrations were associated with proportionately increased risk of non-survival (AUROC 0.624) or death (AUROC 0.678). Multivariable modeling suggested that these electrolyte disturbances were associated with non-survival and with death from natural causes independent of each other. This study suggests that measurement of electrolyte concentrations is an important component of the assessment of dogs in emergency rooms or intensive care units. Future studies should focus on confirming these associations in a prospective manner accounting for disease severity.
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Affiliation(s)
- Robert Goggs
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Sage De Rosa
- Department of Clinical Studies, University of Pennsylvania School of Veterinary Medicine, Philadelphia, PA, United States
| | - Daniel J Fletcher
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
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18
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Abstract
Hydrogen concentration is a critical determinant of many physiologic functions and is tightly regulated. Any alteration in acid-base equilibrium sets into motion a compensatory response by either the lungs or the kidneys. The compensatory response attempts to return the ratio between Pco2 and [HCO3-] to normal and thereby minimize the pH change. A primary increase or decrease in one component is associated with a predictable compensatory change in the same direction in the other component, and the expected compensation can be estimated clinically in dogs and cats.
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Abstract
Lactate is a product of anaerobic metabolism. Lactate concentration in blood is used clinically as an indicator of tissue hypoperfusion and hypoxia to determine disease severity, assess response to therapy, and predict outcome. This article reviews lactate physiology, sample collection and processing, and interpretation of lactate concentration in clinical practice.
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Affiliation(s)
- Leslie C Sharkey
- Veterinary Clinical Sciences Department, University of Minnesota College of Veterinary Medicine, 1352 Boyd Avenue, St Paul, MN 55108, USA.
| | - Maxey L Wellman
- Department of Veterinary Biosciences, The Ohio State University, 1925 Coffey Road, Columbus, OH 43210, USA
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20
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Zeugswetter FK, Pagitz M, Friedrich MS. Hypochloremia in cats - prevalence and associated diseases. TIERAERZTLICHE PRAXIS AUSGABE KLEINTIERE HEIMTIERE 2016; 44:237-44. [PMID: 27074163 DOI: 10.15654/tpk-150647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 01/07/2016] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To describe the prevalence and possible causes of hypochloremia in the local hospital cat population. MATERIAL AND METHODS Retrospective study consisting of two parts. Data were collected from the local electronic medical records database using the search terms "chloride" and "cats" (part A), and "blood gas analysis" and "cats" (part B). The medical records of the hypochloremic cats were then reviewed to determine prior treatment or infusions and to identify major underlying disease processes. Part A included an age and gender matched non-hypochloremic control group, whereas in part B acid-base status was assessed. RESULTS Hypochloremia was detected in 367 (27%) of 1363 blood samples. The application of a correction formula to adjust for free water changes decreased the number of hypochloremic cats to 253 (19%). Only a minority had received glucocorticoids or loop diuretics and the prevalence of vomiting was 44%. Common associated disorders were gastrointestinal and respiratory diseases, as well as azotemia and diabetes mellitus. Polyuria/polydipsia, dehydration, prednisolone or furosemide pretreatment, azotemia and diabetes mellitus increased, whereas fluid therapy and the diagnosis of neoplasia decreased the prevalence of hypochloremia. An inverse correlation was found between corrected chloride and standardized base excess (rs = -0.597, p = 0.001) as well as anion gap (rs = -0.4, p = 0.026). 99% of the hypochloremic cats had derangements of acid-base balance. CONCLUSION Hypochloremia is a common electrolyte disorder in the local cat population. The correction formula is necessary to adjust for changes in plasma osmolality. Although associated with metabolic alkalosis, most of the hypochloremic cats have a normal or decreased pH. The inverse correlation of chloride and anion gap als well as the high proportion of azotemic or diabetic animals support the concept of compensatory acidosis induced hypochloremia. CLINICAL RELEVANCE Hypochloremia should prompt the clinician to performe blood-gas analysis. Diabetes mellitus (especially ketoacidosis) and renal disease should be included in current algorithms for the evaluation of hypochloremic patients.
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Affiliation(s)
- Florian K Zeugswetter
- Florian K. Zeugswetter, University of Veterinary Medicine Vienna, University Clinic for Small Animals, Internal Medicine, Veterinärplatz 1, 1210 Vienna, Austria,
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21
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Wagner J, Rieker T, Siegling-Vlitakis C. [Blood gas analysis in dogs in veterinary practice. A review]. TIERARZTLICHE PRAXIS. AUSGABE K, KLEINTIERE/HEIMTIERE 2015; 43:260-273. [PMID: 26235495 DOI: 10.15654/tpk-141021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 06/17/2015] [Indexed: 06/04/2023]
Abstract
Blood gas analysis is useful to obtain information about acid-base state and gas exchange of the lung. Interpretation is based on the Henderson-Hasselbalch equation. This approach has its limitations especially in interpretation of complex disturbances of acid-base status and has been complemented by base excess and anion gap. Peter Stewart described a model of quantitative approach to the acid-base disturbances which has been further developed and is known as the strong ion approach. This model differs from the traditional approach in the assessment of metabolic disorders of acid base status. Both models complement each other but also have their advantages and disadvantages. For simple disorders of the acid-base state the Henderson-Hasselbalch approach can be used, however in complex disturbances of acid-base balance, especially with abnormalities of serum albumin and phosphate concentrations, the strong ion approach is recommended. With the understanding of both models and of the clinical presentation of blood gas abnormalities, optimal case management and therapy can be provided.
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Affiliation(s)
- J Wagner
- Dr. med. vet. Judith Wagner, Kleintierklinik am Hochberg, Zuppingerstraße 10/1, 88213 Ravensburg, E-Mail:
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22
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Hopper K, Epstein SE, Kass PH, Mellema MS. Evaluation of acid-base disorders in dogs and cats presenting to an emergency room. Part 1: Comparison of three methods of acid-base analysis. J Vet Emerg Crit Care (San Antonio) 2014; 24:493-501. [DOI: 10.1111/vec.12215] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Accepted: 07/04/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Kate Hopper
- Departments of Veterinary Surgical and Radiological Sciences; School of Veterinary Medicine; University of California at Davis; Davis CA 95616
| | - Steven E. Epstein
- Departments of Veterinary Surgical and Radiological Sciences; School of Veterinary Medicine; University of California at Davis; Davis CA 95616
| | - Philip H. Kass
- Population, Health and Reproduction; School of Veterinary Medicine; University of California at Davis; Davis CA 95616
| | - Matthew S. Mellema
- Departments of Veterinary Surgical and Radiological Sciences; School of Veterinary Medicine; University of California at Davis; Davis CA 95616
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23
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Hopper K, Epstein SE, Kass PH, Mellema MS. Evaluation of acid-base disorders in dogs and cats presenting to an emergency room. Part 2: Comparison of anion gap, strong ion gap, and semiquantitative analysis. J Vet Emerg Crit Care (San Antonio) 2014; 24:502-8. [DOI: 10.1111/vec.12214] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Accepted: 07/04/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Kate Hopper
- Departments of Veterinary Surgical and Radiological Sciences; School of Veterinary Medicine; University of California at Davis; Davis CA 95616
| | - Steven E. Epstein
- Departments of Veterinary Surgical and Radiological Sciences; School of Veterinary Medicine; University of California at Davis; Davis CA 95616
| | - Philip H. Kass
- Population, Health and Reproduction; School of Veterinary Medicine; University of California at Davis; Davis CA 95616
| | - Matthew S. Mellema
- Departments of Veterinary Surgical and Radiological Sciences; School of Veterinary Medicine; University of California at Davis; Davis CA 95616
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24
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Torrente C, Manzanilla EG, de Gopegui RR. A comparison of traditional and quantitative analysis of acid-base imbalances in hypoalbuminemic dogs. J Vet Emerg Crit Care (San Antonio) 2014; 24:509-18. [PMID: 25142816 DOI: 10.1111/vec.12218] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 07/13/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare the traditional (HH) and quantitative approaches used for the evaluation of the acid-base balance in hypoalbuminemic dogs. DESIGN Prospective observational study. SETTING ICU of a veterinary teaching hospital. ANIMALS One hundred and five client-owned dogs. MEASUREMENTS AND MAIN RESULTS Jugular venous blood samples were collected from each patient on admission to determine: total plasma protein (TP), albumin (Alb), blood urea nitrogen (BUN), glucose (Glu), hematocrit (HCT), Na(+) , Cl(-) , K(+) , phosphate (Pi ), pH, PvCO2, bicarbonate (HCO3 (-) ), anion gap (AG), adjusted anion gap for albumin (AGalb ) or phosphate (AGalb-phos ), standardized base excess (SBE), strong ion difference (SID), concentration of nonvolatile weak buffers (Atot ), and strong ion gap (SIG). Patients were divided in 2 groups according to the severity of the hypoalbuminemia: mild (Alb = 21-25 g/L) and severe (Alb ≤20 g/L). All parameters were compared among groups. Patients with severe hypoalbuminemia showed significant decrease in TP (P = 0.011), Atot (P = 0.050), and a significant increase in adjusted AG (P = 0.048) and the magnitude of SIG (P = 0.011) compared to animals with mild hypoalbuminemia. According to the HH approach, the most frequent imbalances were simple disorders (51.4%), primarily metabolic acidosis (84.7%) associated with a high AG acidosis. However, when using the quantitative method, 58.1% of patients had complex disorders, with SIG acidosis (74.3%) and Atot alkalosis (33.3%) as the most frequent acid-base imbalances. Agreement between methods only matched in 32 cases (kappa < 0.20). CONCLUSIONS The agreement between the HH and quantitative methods for interpretation of acid-base balance was poor and many imbalances detected using the quantitative approach were missed using the HH approach. Further studies are necessary to confirm the clinical utility of using the quantitative approach in the decision-making process of the severely ill hypoalbuminemic patients.
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Affiliation(s)
- Carlos Torrente
- Servei d'Emergències i Cures Intensives de la Fundació Hospital Clínic Veterinari-UAB, Departament de Medicina i Cirurgia Animal, and Departament de Ciència Animal i dels Aliments, Facultat de Veterinària, Universitat Autònoma de Barcelona (UAB), Bellaterra, Barcelona, Spain
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25
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Burchell RK, Schoeman JP, Leisewitz AL. The central role of chloride in the metabolic acid-base changes in canine parvoviral enteritis. Vet J 2014; 200:152-6. [PMID: 24613416 PMCID: PMC7128572 DOI: 10.1016/j.tvjl.2014.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 01/19/2014] [Accepted: 01/24/2014] [Indexed: 11/24/2022]
Abstract
The acid–base disturbances in canine parvoviral (CPV) enteritis are not well described. In addition, the mechanisms causing these perturbations have not been fully elucidated. The purpose of the present study was to assess acid–base changes in puppies suffering from CPV enteritis, using a modified strong ion model (SIM). The hypothesis of the study was that severe acid–base disturbances would be present and that the SIM would provide insights into pathological mechanisms, which have not been fully appreciated by the Henderson–Hasselbalch model. The study analysed retrospective data, obtained from 42 puppies with confirmed CPV enteritis and 10 healthy control dogs. The CPV-enteritis group had been allocated a clinical score, to allow classification of the data according to clinical severity. The effects of changes in free water, chloride, l-lactate, albumin and phosphate were calculated, using a modification of the base excess algorithm. When the data were summated for each patient, and correlated to each individual component, the most important contributor to the metabolic acid–base changes, according to the SIM, was chloride (P < 0.001). Severely-affected animals tended to demonstrate hypochloraemic alkalosis, whereas mildly-affected puppies had a hyperchloraemic acidosis (P = 0.007). In conclusion, the acid–base disturbances in CPV enteritis are multifactorial and complex, with the SIM providing information in terms of the origin of these changes.
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Affiliation(s)
- Richard K Burchell
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Onderstepoort 0110, South Africa.
| | - Johan P Schoeman
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Onderstepoort 0110, South Africa
| | - Andrew L Leisewitz
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Onderstepoort 0110, South Africa
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26
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Sharkey LC, Wellman ML. Use of Lactate in Small Animal Clinical Practice. Vet Clin North Am Small Anim Pract 2013; 43:1287-97, vi. [DOI: 10.1016/j.cvsm.2013.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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27
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Abstract
Acid-base abnormalities are common in critically ill veterinary patients. Rapid recognition of disturbances can be helpful in identifying the underlying cause of the patient's clinical signs, directing diagnostics, and monitoring response to therapy. If acid-base disturbances are left unidentified and untreated, severe physiologic consequences can result, including cardiovascular and neurologic dysfunction, protein and enzyme dysfunction, and electrolyte derangements. Treatment of acid-base disorders is aimed at correcting the underlying disease process.
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Affiliation(s)
- Andrea A Monnig
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, 601 Vernon L. Tharp Street, Columbus, OH 43210, USA.
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Ha YS, Hopper K, Epstein S. Incidence, Nature, and Etiology of Metabolic Alkalosis in Dogs and Cats. J Vet Intern Med 2013; 27:847-53. [DOI: 10.1111/jvim.12122] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 03/26/2013] [Accepted: 05/01/2013] [Indexed: 11/29/2022] Open
Affiliation(s)
- Y.-S. Ha
- William R. Pritchard Veterinary Medical Teaching Hospital; University of California; Davis CA
| | - K. Hopper
- Department of Veterinary Surgical and Radiological Sciences; University of California; Davis CA
| | - S.E. Epstein
- Department of Veterinary Surgical and Radiological Sciences; University of California; Davis CA
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