Effect of Intravenous Small-Volume Hypertonic Sodium Bicarbonate, Sodium Chloride, and Glucose Solutions in Decreasing Plasma Potassium Concentration in Hyperkalemic Neonatal Calves with Diarrhea

Intravenous and Oral Fluid Therapy in Neonatal Calves With Diarrhea or Sepsis and in Adult Cattle

Optimal fluid therapy protocols in neonatal calves and adult cattle are based on consideration of signalment, history, and physical examination findings, and individually tailored whenever laboratory analysis is available. Measurement of the magnitude of eye recession, duration of skin tenting in the lateral neck region, and urine specific gravity by refractometry provide the best estimates of hydration status in calves and cattle. Intravenous and oral electrolyte solutions (OES) are frequently administered to critically ill calves and adult cattle. Application of physicochemical principles indicates that 0.9% NaCl, Ringer's solution, and 5% dextrose are equally acidifying, lactated Ringer's and acetated Ringer's solution are neutral to mildly acidifying, and 1.3-1.4% sodium bicarbonate solutions are strongly alkalinizing in cattle. Four different crystalloid solutions are recommended for intravenous fluid therapy in dehydrated or septic calves and dehydrated adult cattle: (1) lactated Ringer's solution and acetated Ringer's solution for dehydrated calves, although neither solution is optimized for administration to neonatal calves or adult cattle; (2) isotonic (1.3%) or hypertonic (5.0 or 8.4%) solutions of sodium bicarbonate for the treatment of calves with diarrhea and severe strong ion (metabolic) acidosis and hyponatremia, and adult cattle with acute ruminal acidosis; (3) Ringer's solution for the treatment of metabolic alkalosis in dehydrated adult cattle, particularly lactating dairy cattle; and (4) hypertonic NaCl solutions (7.2%) and an oral electrolyte solution or water load for the rapid resuscitation of dehydrated neonatal calves and adult cattle. Much progress has been made since the 1970's in identifying important attributes of an OES for diarrheic calves. Important components of an OES for neonatal calves are osmolality, sodium concentration, the effective SID that reflects the concentration of alkalinizing agents, and the energy content. The last three factors are intimately tied to the OES osmolality and the abomasal emptying rate, and therefore the rate of sodium delivery to the small intestine and ultimately the rate of resuscitation. An important need in fluid and electrolyte therapy for adult ruminants is formulation of a practical, effective, and inexpensive OES.

Dependence of the apparent bicarbonate space on initial plasma bicarbonate concentration and carbon dioxide tension in neonatal calves with diarrhea, acidemia, and metabolic acidosis

BACKGROUND

Marked strong ion (metabolic) acidosis in neonatal diarrheic calves usually is corrected by IV administration of NaHCO₃ . The distribution space for IV-administered bicarbonate, called the apparent bicarbonate space (ABS), appears to depend on initial plasma bicarbonate concentration (cHCO₃ ) and varies considerably in calves.

OBJECTIVE

To determine whether ABS was associated with initial plasma cHCO₃ and other acid-base variables.

ANIMALS

Twenty-five neonatal diarrheic calves with acidemia and metabolic acidosis.

METHODS

Prospective observational study using a convenience sample. Calves received NaHCO₃ (10 mmol/kg) and glucose (1.4 mmol/kg) IV in a crystalloid solution at 25 mL/kg over 60 minutes. The ABS (L/kg) was calculated at 4 time points over 2 hours after the end of the infusion. The relationship between ABS and initial acid-base variables was characterized using nonlinear, linear, and stepwise regression.

RESULTS

The median value for ABS calculated from the initial plasma cHCO₃ increased from 0.53 L/kg (range, 0.40-0.79) at the end of IV infusion to 0.96 L/kg (range, 0.54-1.23) 120 minutes later. Data obtained at the end of infusion provided the best fit to initial plasma cHCO₃ and jugular venous blood Pco₂ , such that: ABS = 0.41 + 1.06/cHCO₃ and ABS = 0.87-0.0082 × Pco₂ .

CONCLUSIONS AND CLINICAL IMPORTANCE

The observed median value for ABS of 0.53 L/kg in our study was similar to the empirically used value of 0.6. However, ABS values varied widely and were increased in calves with severe metabolic acidosis. We therefore recommend calculating ABS using the initial plasma cHCO₃ or venous blood Pco₂ , if respective measurements are available.

D-Lactic Acid as a Metabolite: Toxicology, Diagnosis, and Detection

Two enantiomers of lactic acid exist. While L-lactic acid is a common compound of human metabolism, D-lactic acid is produced by some strains of microorganism or by some less relevant metabolic pathways. While L-lactic acid is an endogenous compound, D-lactic acid is a harmful enantiomer. Exposure to D-lactic acid can happen by various ways including contaminated food and beverages and by microbiota during some pathological states like short bowel syndrome. The exposure to D-lactic acid cannot be diagnosed because the common analytical methods are not suitable for distinguishing between the two enantiomers. In this review, pathways for D-lactic acid, pathological processes, and diagnostical and analytical methods are introduced followed by figures and tables. The current literature is summarized and discussed.

Tailoring treatment of hyperkalemia

Hyperkalemia is a common electrolyte disorder that may be rapidly life-threatening because of its cardiac toxicity. Hyperkalemia risk factors are numerous and often combined in the same patient. Most of the strategies to control serum potassium level in the short term have been used for decades. However, evidence for their efficacy and safety remains low. Treatment of hyperkalemia remains challenging, poorly codified, with a risk of overtreatment, including short-term side effects, and with the priority of avoiding unnecessary hospital stays or chronic medication changes. Recently, new oral treatments have been proposed for non-life-threatening hyperkalemia, with encouraging results. Their role in the therapeutic arsenal remains uncertain. Finally, a growing body of evidence suggests that hyperkalemia might negatively impact outcomes in the long term in patients with chronic heart failure or kidney failure through underdosing or withholding of cardiovascular medication (e.g. renin-angiotensin-aldosterone system inhibitors). Recognition of efficacy and potential side effects of treatment may help in tailoring treatments to the patient's status and conditions. In this review we discuss how treatment of hyperkalemia could be tailored to the patient's conditions and status, both on the short and mid term.

Treatment of acute rumen lactic acidosis with intravenous hypertonic sodium chloride or bicarbonate solutions followed by intraruminal water

The effectiveness of 7% hypertonic saline solution (HSS) and 6% hypertonic bicarbonate solution (HBS) followed by intraruminal water administration for the treatment of acute rumen lactic acidosis (ARLA) has not been evaluated yet. The hypothesis of the study is that treatment with HBS causes a faster correction of imbalances and clinical recovery than treatment with HSS. ARLA was induced in six healthy mature female sheep with sucrose twice. The sheep received both treatment regimens in a cross over design. After 18 h of induction, rumen lavage was performed and IV infusion of 7% HSS (4 mL/kg BW) or 6% HBS (6.7 mL/kg BW) was done over 5 min, followed by intraruminal administration of water (8% BW). The solutions provided 4.8 mmol/kg BW of sodium. Physical and laboratory tests were performed for 168 h. Both treatments increased plasma volume. After HSS treatment, pH and HCO₃^- returned to baseline values at 144 h and BE at 168 h. With HBS treatment, pH returned to baseline at 24 h, and HCO₃^- and BE at 48 h. In both treatments, the ruminal motility and the maximum hay intake were restored at 96 and 120 h, respectively. In conclusion, administration of HSS or HBS followed by intraruminal water corrects dehydration and mild-to-moderate metabolic acidosis in sheep with ARLA. Treatment with HBS promoted a faster correction of metabolic acidosis and could be indicated for the most severe cases.

Nebulized salbutamol diminish the blood glucose fluctuation in the treatment of non-oliguric hyperkalemia of premature infants

BACKGROUND

Hyperkalemia is a risky and potentially life-threatening condition in pre-term infants. Glucose-insulin infusion has been considered a major therapeutic way for non-oligouric hyperkalemia but affects the stability of blood sugar level. We aimed to evaluate the effectiveness of salbutamol nebulization compared to glucose-insulin infusion for the treatment of non-oliguric hyperkalemia in premature infants.

METHODS

Forty premature infants (gestation age ≤36 weeks) with non-oliguric hyperkalemia (central serum potassium level greater than 6.0 mmol/L) within 72 h of birth were enrolled in this study. These infants were randomly assigned into two groups. One group received a regular insulin bolus with glucose infusion (Group A; n = 20), and the other received salbutamol (Ventolin) by nebulization (Group B; n = 20). Potassium level, blood sugar, heart rate, and blood pressure were recorded for each group before treatment and at 3, 12, 24, 48, and 72 h post-treatment.

RESULTS

The serum potassium levels were reduced after treatment in both groups. No significant changes in heart rate or blood pressure were observed in either group. The fluctuation in glucose levels was gentler in the salbutamol-treated group than in the glucose-insulin infusion group.

CONCLUSION

Salbutamol nebulization is not only as effective as glucose-insulin infusion for treating non-oliguric hyperkalemia in premature infants but can avoid potential side effects such as vigorous blood glucose fluctuations.

Drinking water intake of newborn dairy calves and its effects on feed intake, growth performance, health status, and nutrient digestibility

Although it is recommended to offer free drinking water (called drinking water hereafter) immediately after birth, producers wait, on average, 17 d to first offer drinking water to newborn dairy calves. The objective of this study was to examine water and feed intake, growth performance, health status, and nutrient digestibility of Holstein heifer calves offered drinking water from birth (W0) as compared with those offered it at 17 d of age (W17), when fed an ad libitum volume of milk. Thirty Holstein heifer calves, balanced for parity of the dam, birth weight, and birth week, were randomly assigned (n = 15) to W0 or W17. Calves had free access to drinking water and a starter ration, offered in 2 separate buckets, until they were 70 d of age. Calves were bottle-fed with pasteurized whole milk 3× per day (2.0 kg/feeding until d 14, and 3.2 kg/feeding thereafter). Calves were partially weaned (33% of the milk allowance 1 × per day) at 42 d of age and completely weaned at 49 d of age. Drinking water intake, starter intake, milk intake, ambient temperature, and the fecal consistency were recorded daily. Body weight, hip height, hip width, heart girth, and body length were measured weekly. Blood (drawn from a jugular vein) was analyzed for hematocrit and haptoglobin concentrations at 14 d of age. On d 69 and 70, total fecal output of individual calves was measured and analyzed for chemical composition to determine apparent total-tract digestibility of nutrients. When offered from birth, newborn calves consumed 0.75 ± 0.05 kg/d water aside from the water they received from ad libitum milk allowance during the first 16 d. Once offered, W17 calves drank more water (59%) than W0 calves during the preweaning period. Starter intake of W0 and W17 calves was similar, but W0 calves consumed 0.285 kg/d more milk and tended to achieve greater body weight and heart girth compared with W17 calves during the preweaning period. Offering water from birth versus offering it later did not affect the number of days with diarrhea, intensity of diarrhea, or blood hematocrit and haptoglobin concentrations of preweaned calves. Despite a similar starter intake, W0 calves had greater hip height, body length, apparent total-tract digestibility of acid detergent fiber and neutral detergent fiber, and feed efficiency than W17 calves postweaning (50 to 70 d of age). When followed up to 5 mo of age, W0 calves had greater body weight than W17 calves. Provision of drinking water immediately after birth could improve growth and development of calves pre- and postweaning, potentially by stimulating rumen development, thus increasing nutrient availability.

Effect of dehydration and acidemia on the potassium content of muscle tissue and erythrocytes in calves with neonatal diarrhea

Disturbances of extracellular potassium (K) homeostasis in calves with severe neonatal diarrhea have been studied extensively. Although total body depletion of this predominantly intracellular electrolyte is generally thought to occur in diarrheic calves, the mechanisms through which K depletion occurs are poorly understood. The aim of this study was to investigate how intracellular K homeostasis is affected by dehydration and acidemia, the 2 most important metabolic disturbances in calves with naturally occurring diarrhea. Twenty-seven calves with naturally occurring neonatal diarrhea, pronounced dehydration, and acidemia, and 2 groups of 10 healthy control calves were included in this study. Blood samples and muscle biopsies were obtained immediately before initiation of treatment (T₀) and after complete rehydration and correction of acidemia (T₁) from diarrheic calves. Blood samples were used to perform blood gas, blood biochemical, and hematological analyses and to determine K content in erythrocytes. Muscle biopsies were used to determine muscle tissue K content and tissue dry matter. Controls were used to determine values for erythrocyte and muscle tissue K content in healthy neonatal calves for comparison with diarrheic calves. As defined by the inclusion criteria, diarrheic calves showed pronounced acidemia and dehydration at T₀. Mean muscle tissue K content and tissue dry matter remained unchanged between sampling times and did not differ from values measured in healthy control calves. Erythrocyte K content increased from 73.63 ± 13.73 to 77.64 ± 15.97 mmol/L (±standard deviation) but was associated with a concomitant decline in erythrocyte volume. Values measured at both sampling times in diarrheic calves did not differ from erythrocyte K measured in healthy control calves. The plasma K concentration (median [interquartile range]) decreased from 5.44 [4.76-6.17] to 4.16 [3.99-4.31] mmol/L between T₀ and T₁. Although changes in plasma [K] were associated with the degree of dehydration, neither dehydration nor acidemia was associated with changes of K content in muscle tissue or erythrocytes. In conclusion, severe dehydration and acidemia in diarrheic calves were not associated with notable changes in K content of muscle tissue or erythrocytes. These results do not support the concept of pronounced K depletion occurring in calves with neonatal diarrhea. Erythrocytes are a poor surrogate tissue in which to measure changes of intracellular K content in diarrheic calves because of concomitant changes in erythrocyte volume that complicate the interpretation of results.

Electrocardiographic findings in 130 hospitalized neonatal calves with diarrhea and associated potassium balance disorders

Background

Hyperkalemia in neonatal diarrheic calves can potentially result in serious cardiac conduction abnormalities and arrhythmias.

Objectives

To document electrocardiographic (ECG) findings and the sequence of ECG changes that are associated with increasing plasma potassium concentrations (cK⁺) in a large population of neonatal diarrheic calves.

Animals

One hundred and thirty neonatal diarrheic calves (age ≤21 days).

Methods

Prospective observational study involving calves admitted to a veterinary teaching hospital.

Results

Hyperkalemic calves (cK⁺: 5.8‐10.2, blood pH: 6.55‐7.47) had significantly (P < .05) longer QRS durations as well as deeper S wave, higher T wave, and higher ST segment amplitudes in lead II than calves, which had both venous blood pH and cK⁺ within the reference range. The first ECG changes in response to an increase in cK⁺ were an increase in voltages of P, Ta, S, and T wave amplitudes. Segmented linear regression indicated that P wave amplitude decreased when cK⁺ >6.5 mmol/L, S wave amplitude voltage decreased when cK⁺ >7.4 mmol/L, QRS duration increased when cK⁺ >7.8 mmol/L, J point amplitude increased when cK⁺ >7.9 mmol/L, and ST segment angle increased when cK⁺ >9.1 mmol/L. P wave amplitude was characterized by a second common break point at cK⁺ = 8.2 mmol/L, above which value the amplitude was 0.

Conclusions and Clinical Importance

Hyperkalemia in neonatal diarrheic calves is associated with serious cardiac conduction abnormalities. In addition to increased S and T wave amplitude voltages, alterations of P and Ta wave amplitudes are early signs of hyperkalemia, which is consistent with the known sensitivity of atrial myocytes to increased cK⁺.

Diagnosis and Treatment of Infectious Enteritis in Neonatal and Juvenile Ruminants

Common causes of infectious enteritis in neonate and juvenile ruminants include viral, bacterial, and protozoal pathogens. The most common presenting sign in ruminants with infectious enteritis is diarrhea. Diagnosis of the cause of enteritis has important zoonotic and herd health implications. Severity of clinical signs with similar pathogens may differ between calves and small ruminants. Treatment of enteritis involves supportive care to correct fluid and electrolyte imbalances, provision of nutritional support for neonates, prevention and treatment of endotoxemia or sepsis, and pathogen-specific treatments when relevant and available.