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)
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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.
Continue reading “Approach to Hyperkalemia: Diagnosis and Treatment”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).
Continue reading “Wide complex tachycardia – More complex than first thought?”Dysnatremias: The role of urine sodium and osmolality
All living organisms originated in the sea. A constant salt concentration was important to maintain their vital functions. To overcome their dependency on the sea environment, a sophisticated renal system has developed in modern mammals that allows them to maintain a steady concentration of various electrolytes and water balance.
Understanding sodium and water balance is important for clinicians who treat animals with renal disorders, sodium derangements and other critical conditions. Not surprisingly, this topic may appear complex and daunting to the majority of veterinary practitioners.
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