From Novice to Expert: How to Master Small Animal Electrolyte and Acid-Base Disorders?

For emergency veterinarians, interns and residents, ECC and anesthesia technicians seeking to truly master emergency and critical care topics, traditional continuing education (CE) courses, webinars, and lectures may prove to be inadequate. These conventional methods often fall short in several key aspects, hindering effective learning and retention. Over the last 15 years, I have attended dozens of CE events and watched hundreds of hours of webinars, only to realize a week later that I can recall 5-10% of this information. Have you ever felt that way?

Continue reading “From Novice to Expert: How to Master Small Animal Electrolyte and Acid-Base Disorders?”

Avoiding Overcorrection: Rebound Hyperkalemia Awareness

Potassium functions as the primary cation inside cells. More than 95% of the total body potassium resides within the cells. Abnormal serum potassium levels may arise due to disturbances in potassium intake, imbalances in internal potassium distribution, or issues with external potassium excretion.

Changes in how potassium is distributed within cells, such as when ß-adrenergic stimulation (as seen in albuterol toxicosis) prompts the movement of potassium in the liver and muscle cells, are usually temporary. On the other hand, a prolonged lack of potassium intake or excessive potassium loss can lead to sustained hypokalemia.

Even though hypokalemia caused by the shift of potassium within cells is temporary, potassium supplementation may be necessary when hypokalemia is moderate to severe, especially if there are observable symptoms like arrhythmia and/or muscle weakness. However, the rate at which potassium is supplemented may need adjustment to prevent a condition called ‘rebound hyperkalemia,’ which can occur after the cause of the potassium shift is resolved. 

Continue reading “Avoiding Overcorrection: Rebound Hyperkalemia Awareness”

Unveiling the Mysteries of Ketone Detection in Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus that requires prompt diagnosis and treatment. One of the hallmarks of DKA is the presence of ketone bodies in the blood and urine. In this blog post, we’ll dive into the fascinating world of ketone detection and explore the various methods used to identify ketonemia and ketonuria in dogs and cats.

Continue reading “Unveiling the Mysteries of Ketone Detection in Diabetic Ketoacidosis”

Deep dive into insulin infusion protocols for management of diabetic ketoacidosis in dogs and cats

Diabetic ketoacidosis (DKA) is a relatively common complication of diabetes mellitus in dogs and cats. In the face of insulin deficiency or resistance, the liver produces ketones to provide an alternative energy source from glucose. However, excessive ketone production can lead to high anion gap metabolic acidosis and other negative effects. Besides restoration of intravascular and interstitial fluid deficits as well as electrolyte derangements such as hypokalemia, insulin administration is necessary to stop production of ketones, reduce lipolysis and enhance cellular uptake of glucose. 

Several insulin protocols have been described in veterinary medicine to treat DKA patients during the first 24-72 hours of hospitalization until the patient becomes stable and regains appetite. One of the most commonly utilized protocols in clinical practice is an intravenous variable-rate insulin infusion protocol when a short-acting insulin is infused IV and the rate is altered based on blood glucose concentration (Figure 1). 

Continue reading “Deep dive into insulin infusion protocols for management of diabetic ketoacidosis in dogs and cats”

Hyperkalemia Associated with General Anesthesia in Dogs and Cats

Hyperkalemia has been reported as a complication of general anesthesia in systemically healthy animals with normal renal function. Several case reports and case series are summarized in Table 1. Upon reviewing the literature, several distinct patterns and interesting observations are worth discussing. Some of these observations may be relevant to veterinary practitioners and technicians dealing with anesthetized animals or managing their post-anesthetic recovery.

Continue reading “Hyperkalemia Associated with General Anesthesia in Dogs and Cats”

Intravenous phosphate supplementation in dogs and cats

In animals and humans, phosphorus plays a crucial role in the synthesis of several compounds that are vital for maintaining cellular membrane integrity, energy stores, metabolic processes, and biochemical messenger systems. These compounds include ATP, guanosine triphosphate, cyclic adenosine monophosphate, and phosphocreatine (Yanagawa et al. 1994; DiBartola et al. 2012). Phosphate is a molecular anion that contains phosphorus. Approximately 80-85% of phosphate resides in the bone and teeth as inorganic hydroxyapatite, 14-15% in soft tissues, and less than 1% in the extracellular space (Yanagawa et al. 1994; DiBartola et al. 2012). The body and plasma contain both organic and inorganic phosphates, though blood chemistry analyzers measure only inorganic phosphates.

Continue reading “Intravenous phosphate supplementation in dogs and cats”