Blog - Page 9 of 11

Approach to Hypernatremia in Dogs and Cats

Hypernatremia is defined as a serum sodium level above the reference range. It is a relatively infrequently encountered electrolyte disturbance in dogs and cats. In one retrospective study (Ueda et al. 2015), 5.7% dogs and 8.0% cats were diagnosed with hypernatremia. It was associated with increased case fatality rates in this population of patients. Understanding hypernatremia requires a comprehension of body fluid compartments, as well as concepts of the preservation of normal body water balance. The animal body maintains a normal osmolality between 280 and 310 mOsm/kg via Arginine Vasopressin (AVP), thirst, and the renal response to AVP; dysfunction of all three of these factors can cause hypernatremia (Mushin et al. 2016). In this post, I present a step-by-step approach to the hypernatremia in canine and feline patients. Further reading is recommended to deepen understanding of the physiology and pathophysiology of sodium and water balance.

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Trauma, acute kidney injury and mannitol

Traumatic injury is a risk factor for acute kidney injury (AKI). The cause of AKI is likely multifactorial and may include renal hypoperfusion and renal hypoxia secondary to hypovolemic shock and/or increased abdominal pressure, rhabdomyolysis and direct nephrotoxic effects of therapy including general anesthesia (Harris et al., 2017). The osmotic diuretic, mannitol, has been used both in the prevention, and the treatment of AKI. It has been used peri-operatively to prevent the development of AKI and in the management of AKI secondary to traumatic rhabdomyolysis (Sharman et al., 2013; Yang et al., 2014). However, mannitol itself has nephrotoxic potential and therefore the benefits of its use should be considered in light of its potential to cause adverse effects (Perez-Perez et al., 2002; Fang et al., 2010)

Approach to Hypokalemia: Diagnosis and Treatment

All causes of hypokalemia can be divided into 3 big groups:

Decreased intake (unlikely to be a sole cause)
Intracellular shift
External loss (GI or renal)

A step-by-step approach to diagnosis of hypokalemia

Step 1: Review current medication history. Drugs that can promote hypokalemia (via intracellular shifting or increased losses/decreased intake):

K-deficient fluids
loop/thiazide diuretics
insulin, dextrose
albuterol, terbutaline and other beta agonists
catecholamines

Approach to Hyperkalemia: Diagnosis and Treatment

This blog post commences a series of articles on diagnostic and therapeutic approaches to potassium and sodium derangements. This is meant to be a quick reference/guideline for emergency veterinarians, students and technicians. All readers are welcome to leave feedback and comments below.

Wide complex tachycardia – More complex than first thought?

A 7 year-old male neutered domestic shorthaired 5 kg cat is currently hospitalized for management of an aortic thromboembolism. The cat was diagnosed with hypertrophic cardiomyopathy, left sided congestive heart failure and aortic thromboembolism causing complete lack of motor function in the pelvic limbs. It is being managed with oxygen therapy provided by commercial oxygen kennel, 2 μg/kg/hr fentanyl infusion, furosemide 2 mg/kg q12 hours and 18.75 mg clopidogrel. The cat is being monitored with regular respiratory rate checks and continuous electrocardiogram (ECG). The cat began to show some improvement in pelvic limb motor function. However, 48 hours post initiation of therapy there was a dramatic change in the ECG (Figure 1).