Page 289 - Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice

280 ACID-BASE DISORDERS

responsive metabolic alkalosis. It is best to use solutions 4. Adrogue HJ, Brensilver J, Madias NE. Changes in the
containing NaCl and KCl because affected animals typi- plasma anion gap during chronic metabolic acid-base
cally have been sick long enough to develop clinically rel- disturbances. Am J Physiol 1978;235:F291.
5. Adrogue HJ, Eknoyan G, Suki WK. Diabetic ketoacidosis:
evant potassium deficits. Administering 0.9% NaCl
role of the kidney in the acid-base homeostasis re-
without KCl can cause diuresis and increased urinary evaluated. Kidney Int 1984;25:591.
excretion of potassium, thus worsening any potassium 6. Adrogue HJ, Madias NE. Changes in plasma potassium
deficit. As shown in Figure 10-12, provision of NaCl concentration during acute acid base disturbances. J Clin
Invest 1981;71:456.
corrects metabolic alkalosis induced in dogs by gastric
7. Adrogue HJ, Madias NE. Management of life-threatening
drainage, but the potassium deficit persists unless potas-
acid-base disorders. N Engl J Med 1998;338:26.
sium is provided. A few days may be required to restore 8. Adrogue HJ, Rashad MN, Gorin AB, et al. Arteriovenous
normal electrolyte and acid-base balance, but in nearly acid-base disparity in circulatory failure: studies on mech-
all instances, these measures are sufficient to resolve the anism. Am J Physiol 1989;257:F1087.
9. Adrogue HJ, Wilson H, Boyd AE, et al. Plasma acid-base
alkalosis. In human patients with severe metabolic alkalo-
patterns in diabetic ketoacidosis. N Engl J Med
sis or in those with severely impaired renal function, HCl 1982;307:1603.
or arginine HCl has been used for rapid correction of 10. Appleman EH, Cianciolo R, Mosenco AS, et al. Transient
metabolic alkalosis, but there is no report of the use of acquired Fanconi syndrome associated with copper storage
these compounds in animals with metabolic alkalosis, hepatopathy in 3 dogs. J Vet Intern Med 2008;22:1038.
11. Arieff AI, Graf H. Pathophysiology of type A hypoxic lac-
and their use is not recommended.
tic acidosis in dogs. Am J Physiol 1987;253:E271.
H2-blocking drugs such as cimetidine, ranitidine, or 12. Arruda JAL, Carrasquillo T, Cubria A, et al. Bicarbonate
famotidine may be considered as adjunctive therapy if reabsorption in chronic renal failure. Kidney Int
gastric losses are ongoing because this approach reduces 1976;9:481.
gastric acid secretion. For the patient with heart failure 13. Atkins CE, Tyler R, Greenlee P. Clinical, biochemical,
receiving loop diuretics, oral KCl administration is the acid-base, and electrolyte abnormalities in cats after hyper-
tonic sodium phosphate enema administration. Am J Vet
best way to provide chloride without sodium and prevent Res 1985;46:980.
further retention of fluid and aggravation of edema. Even 14. Atkins EL, Schwartz WB. Factors governing correction of
in the presence of sodium avidity, provision of chloride the alkalosis associated with potassium deficiency: the crit-
þ
þ
þ
lessens Na -H and Na -K exchange at distal nephron ical role of chloride in the recovery process. J Clin Invest
þ
1962;41:218.
sites and prevents development of alkalosis when loop
15. Barbee RW, Kline JA, Watts JA. Depletion of lactate by
diuretics are used. Simultaneous use of distal blocking
dichloroacetate reduces cardiac efficiency after hemor-
agents such as spironolactone, triamterene, or amiloride rhagic shock. Shock 2000;14:208–14.
may also be considered. These drugs work in the principal 16. Bark H, Perk R. Fanconi syndrome associated with amox-
þ
cells of the cortical collecting tubule and impair Na -H þ icillin therapy in the dog. Canine Pract 1995;20:19.
17. Beckett SD, Shields RP. Treatment of acute ethylene gly-
þ
þ
and Na -K exchange by inhibiting aldosterone-sensitive
col (antifreeze) poisoning in the dog. J Am Vet Med Assoc
sodium channels. In metabolic alkalosis caused by chronic 1971;158:472.
administration of alkali, discontinuation of the source of 18. Bellingham AJ, Detter JC, Lenfant C. Regulatory
alkali results in correction of the alkalosis over a few days, mechanisms of hemoglobin oxygen affinity in acidosis
provided that renal function is normal. and alkalosis. J Clin Invest 1971;50:700.
19. Benjamin J, Oropello JM, Abalos AM, et al. Effects of
Chloride-resistant metabolic alkalosis is uncommon in
acid-base correction on hemodynamics, oxygen dynamics,
comparison with chloride-responsive metabolic alkalosis. and resuscitability in severe canine hemorrhagic shock.
When present, its successful treatment requires that the Crit Care Med 1994;22:1616.
underlying disease be diagnosed and treated before 20. Bergman KS, Harris BH. Arteriovenous pH difference:
alkalosis can be resolved. a new index of perfusion. J Pediatr Surg 1988;23:1190.
21. Bersin RM, Arieff AL. Improved hemodynamic function
during hypoxia with Carbicarb, a new agent for the man-
agement of acidosis. Circulation 1988;77:227.
REFERENCES 22. Boag AK, Coe RJ, Martinez TA, et al. Acid-base and elec-
trolyte abnormalities in dogs with gastrointestinal foreign
1. Abraham LA, Tyrrell D, Charles JA. Transient renal bodies. J Vet Intern Med 2005;19:816.
tubulopathy in a racing Greyhound. Aust Vet J 23. Borkan S, Northrup TE, Cohen JJ, et al. Renal response to
2006;84:398. metabolic alkalosis induced by isovolemic hemofiltration
2. Adams WH, Toal RL, Walker MA, et al. Early renal ultra- in the dog. Kidney Int 1987;32:322.
sonographic findings in dogs with experimentally induced 24. Bovee KC. Characterization and treatment of isolated renal
ethylene glycol nephrosis. Am J Vet Res 1989;50:1370. tubular acidosis in a dog. Washington, DC: American
3. Adrogue HJ, Brensilver J, Cohen J, et al. Influence of College of Veterinary Internal Medicine; 1984. p. 48.
steady-state alterations in acid-base equilibrium on the fate 25. Bovee KC, Joyce T, Reynolds R, et al. The Fanconi syn-
of administered bicarbonate in the dog. J Clin Invest drome in basenji dogs: a new model for renal transport
1983;71:867. defects. Science 1978;201:1129.