Efficacy of oral potassium chloride administration in treating lactating dairy cows with experimentally induced hypokalemia, hypochloremia, and alkalemia

Evaluation of a novel dipotassium phosphate bolus for treatment of metabolic disorders in dairy cattle

A dipotassium phosphate bolus (K Phos-Boost) has been developed to treat both hypophosphatemia and hypokalemia, as the clinical signs of both conditions are similar and occur in the early post-partum period. The objective of this research was to evaluate the efficacy and application of the bolus for prevention and treatment of metabolic diseases that are common in dairy production systems. Study 1 (Pharmacokinetic study): Healthy post-partum cows were either untreated or received two K Phos-Boost boluses at times 0, 24, and 48 h. Blood was taken at t = 0, 2-, 4-, 6-, 8-, 10-, 24-, and 52-h post-treatment for analysis of total serum minerals. There was an increase in serum phosphorous to normal levels within 2 h of treatment with the bolus, but control cows remained hypophosphatemic. Serum potassium was significantly elevated 2 h after bolus administration relative to control, while calcium, magnesium, sodium, and chloride levels were not affected by the K Phos-Boost bolus. Study 2 (Downer Cow Treatment): K Phos-Boost boluses were provided to cows that were unresponsive to intravenous calcium therapy and had been unable to stand for over 24 h ("downer cows"). Most cows (16 of 19) treated with two boluses were standing without assistance between 1 and 24 h after treatment and the serum phosphorous was increased to normal levels in five of five tested animals. Study 3 (Ketosis Treatment): cows with clinical ketosis were provided with propylene glycol and K Phos-Boost boluses (n = 29) or only propylene glycol (n = 23). Cows treated with the K Phos-Boost bolus showed a more rapid recovery by increased milk production (3.9 kg/day) and rumination rate (97 min/day). Study 4 (Health Promotion): cows in herds with >40% post-partum hypophosphatemia received K Phos-Boost boluses (n = 130) or no treatment (n = 146) following calving. There was a trend for treated 2nd-lactation animals to have higher milk production after 30 DIM (49.1 vs. 46.2 kg/day; P = 0.09). There were no significant differences between control and bolus treated animals in the incidence of subclinical ketosis, post-calving total health events, or culling rates. The K Phos-Boost bolus is a novel product and has the potential to treat and prevent several important metabolic diseases in dairy cattle. The studies described in this paper are early investigations and further research should be conducted to demonstrate the applications of a dipotassium phosphate bolus in dairy cows.

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.

Comparative study on 3 oral potassium formulations for treatment of hypokalemia in dairy cows

BACKGROUND

Hypokalemia is of clinical relevance in cattle. Different mostly empirical treatment options are suggested.

HYPOTHESIS/OBJECTIVES

To evaluate if oral administration of potassium influences the plasma concentration, the intracellular concentration in erythrocytes and in muscle, renal excretion of potassium, and to assess if there are differences in the efficacy of the potassium formulations.

ANIMALS

Thirty cows with hypokalemia (plasma concentration <3.5 mmol/L) were systematically allocated to 3 treatment groups (10 cows/group).

METHODS

The cows received 52 g of potassium in different formulations: group B-potassium chloride bolus (release over 12 hours); group G-potassium propionate gel (release over 2 hours); and group S-potassium chloride solution (immediately available). Potassium concentrations were repeatedly measured in plasma, erythrocytes, muscle, and urine using ICP-OES.

RESULTS

Plasma potassium concentrations for all preparations increased within 30 minutes and the increase lasted for 12 hours. The concentrations of potassium in the erythrocytes and in the muscle, renal potassium excretion, and total urine volume were not affected by administration of any product. There were no differences between the treatments groups. The feed intake increased in 50% of cows within 2 hours after potassium application, which may contribute to the increase of plasma potassium concentration.

CONCLUSIONS AND CLINICAL IMPORTANCE

All the studied potassium formulations are equally effective to treat hypokalemia in dairy cows for over 12 hours but do not influence intracellular concentration or renal excretion of potassium. The plasma potassium concentration should be reevaluated after 12 hours.

Evaluation of the analytical performance of a portable ion-selective electrode meter for measuring whole-blood, plasma, milk, abomasal-fluid, and urine sodium concentrations in cattle

A portable ion-selective electrode (ISE) meter (LAQUAtwin B-722; Horiba Instruments Inc., Irvine, CA) is available for measuring the sodium ion concentration ([Na]) in biological fluids. The objective of this study was to characterize the analytical performance of the ISE meter in measuring [Na] in whole-blood, plasma, milk, abomasal fluid, and urine samples from cattle. Method comparison studies were performed using whole-blood and plasma samples from 106 sick calves and 11 sick cows admitted to a veterinary teaching hospital, 80 milk and 206 urine samples from 16 lactating Holstein-Friesian cows with experimentally induced free water, electrolyte, and acid-base imbalances, and 67 abomasal fluid samples from 7 healthy male Holstein-Friesian calves fed fresh milk with or without an oral electrolyte solution. Deming regression and Bland-Altman plots were used to determine the accuracy of the meter against reference methods. The meter used in direct mode on undiluted samples measured whole-blood [Na] 9.7 mmol/L (7.3%) lower than a direct ISE reference method and plasma [Na] 16.7 mmol/L (12.7%) lower than an indirect ISE reference method. The meter run in direct mode measured milk [Na] 3.1 mmol/L lower and abomasal fluid [Na] 9.0% lower than indirect ISE reference methods. The meter run in indirect mode on diluted samples accurately measured urine [Na] compared with an indirect ISE reference method. We conclude that, after adjustment for the bias determined from Bland-Altman plots, the LAQUAtwin ISE meter provides a clinically useful and low-cost cow-side instrument for measuring [Na] in whole blood, plasma, milk, and abomasal fluid.

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.

Development of hypokalemia in patients with chronic hepatitis B: Causes and nursing care

AIM: To investigate the causes of hypokalemia in patients with chronic hepatitis B and summarize the methods of care.

METHODS: Clinical data for 60 chronic hepatitis B patients with hypokalemia treated from January 2012 to December 2013 at Yanchi County People's Hospital were analyzed retrospectively. The methods of care were discussed.

RESULTS: Main causes of hypokalemia in patients with chronic hepatitis B were drug-induced pseudo-aldosteronism (70.0%) and excessive chronic loss (30.0%). Potassium content was 3.1 mmol/L ± 0.5 mmol/L before nursing care and 4.3 mmol/L ± 1.1 mmol/L after nursing, and the difference was statistically significant (P < 0.05). Before nursing care, patients' chronic hepatitis B and hypokalemia-related knowledge scores were 63.6 points ± 4.8 points and 55.3 points ± 7.4 points, respectively; after nursing care, these scores were significantly elevated to 84.6 points ± 5.1 points and 80.4 points ± 5.5 points, respectively (P < 0.05). Nursing care also significantly improved SAS and SDS scores (55.3 points ± 6.3 points vs 23.3 points ± 2.7 points, 54.8 min ± 6.5 min vs 24.3 points ± 2.3 points, P < 0.05).

CONCLUSION: Hypokalemia in chronic hepatitis B occurs mainly due to drug-induced pseudo-aldosteronism and chronic loss. Nursing care and treatment should be strengthened to reduce the occurrence of hypokalemia in chronic hepatitis B.