Page 323 - Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice
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314        ACID-BASE DISORDERS



              BOX 12-8        Examples of Potential              mind that mixed disturbances that cause additive effects
                                                                 on pH (e.g., respiratory and metabolic acidosis) require
                              Causes of Triple                   more aggressive therapy than those with neutralizing
                              Disorders                          effects (e.g., respiratory alkalosis and metabolic acidosis).


               Metabolic Acidosis, Metabolic Alkalosis,
               and Respiratory Acidosis                          REFERENCES
               Low-output heart failure with pulmonary edema and
                                                                  1. Aberman A, Fulop M. The metabolic and respiratory acido-
                 diuretics
                                                                    sis of acute pulmonary edema. Ann Intern Med
               Gastric dilatation-volvulus
                                                                    1972;76:173–8.
               Metabolic Acidosis, Metabolic Alkalosis, and       2. Adams LG, Polzin DJ. Mixed acid-base disorders. Vet Clin
               Respiratory Alkalosis                                North Am Small Anim Pract 1989;19:307–26.
                                                                  3. Alfaro V, Torras R, Iba ´n ˜ez J, et al. A physical-chemical anal-
               Low-output heart failure with pulmonary edema and
                                                                    ysis of the acid-base response to chronic obstructive pulmo-
                 diuretics                                          nary disease. Can J Physiol Pharmacol 1996;74:1229–35.
               Gastric dilatation-volvulus                        4. Barnard P, Andronikou S, Pokorski N, et al. Time-depen-
               Parvovirus gastroenteritis (vomiting, diarrhea, and sepsis)  dent effect of hypoxia on carotid body chemosensory
               Severe canine babesiosis caused by Babesia canis rossi  function. J Appl Physiol 1987;63:685–91.
                                                                  5. Better O, Goldschmid Z, Chaimowitz C, et al. Defect in
                                                                    urinary acidification in cirrhosis. Arch Intern Med
                                                                    1972;130:77–82.
                                                                  6. Bia M, Thier SO. Mixed acid-base disturbances: a clinical
            1. Treat the most life-threatening disorder that the body  approach. Med Clin North Am 1981;65:347–61.
                                                                  7. Brown SA, Spyridakis LK, Crowell WA. Distal renal tubular
               cannot address itself first (e.g., decompress the dilated
                                                                    acidosis and hepatic lipidosis in a cat. J Am Vet Med Assoc
               stomach of a patient with gastric dilatation-volvulus
                                                                    1986;189:1350–2.
               while aggressively supporting intravascular volume  8. Center SA. Pathophysiology and laboratory diagnosis of
               before trying to manipulate ventilatory volume or rate  liver disease. In: Ettinger SJ, editor. Textbook of veterinary
               or correct electrolyte disturbances; manage the meta-  internal medicine: diseases of dog and cat. 3rd ed
                                                                    Philadelphia: WB Saunders; 1989. p. 1421–78.
               bolic  components   [carbohydrate  and   fluid
                                                                  9. Ching SV, Fettman MJ, Hamar DW, et al. The effect of
               abnormalities] of the acid-base abnormalities in the  chronic dietary acidification using ammonium chloride
               patient with diabetic ketoacidosis before concerning  on acid-base and mineral metabolism in the adult cat.
               yourself  with  the  respiratory  abnormalities).    J Nutr 1989;119:902–15.
               Correcting these priority disorders will allow the body  10. Christopher M, Pereira J, Brigmon R, et al. Automated
               the opportunity to address the lesser abnormalities  determination of b-hydroxybutyrate for the assessment of
                                                                    ketoacidosis, In: Proc Am Coll Vet Intern Med. New
               itself.                                              Orleans, La; 1991. p. 903.
            2. Treat the most treatable disorder next.           11. Constable PD, Hinchcliff KW, Muir WW. Comparison of
            3. Direct manipulation of blood pH is rarely required   anion gap and strong ion gap as predictors of unmeasured
               and more often than not may be contraindicated.      strong ion concentration in plasma and serum from horses.
            4. Take into consideration the systemic pH of the       Am J Vet Res 1998;59:881–7.
                                                                 12. Constable PD, Sta ¨mpfli HR. Experimental determination
               patient. For example, if a dog has a pH of 7.35 and
                                                                    of net protein charge and A tot and K a of nonvolatile buffers

               [HCO 3 ] of 12 mEq/L, no attempts should be made     in canine plasma. J Vet Intern Med 2005;19:507–14.
               to correct this relatively normal pH. The exception to  13. Cornelius LM, Rawlings CA. Arterial blood gas and acid-
               the rule is the patient with [HCO 3 ] of 5 mEq/L or  base values in dogs with various diseases and signs of dis-

                                                                    ease. J Am Vet Med Assoc 1981;178:992–5.
               less. In these patients, a small decrease in [HCO 3 ]is

                                                                 14. de Morais HSA. A nontraditional approach to acid-base
               associated with a large decrease in pH.
                                                                    disorders. In: DiBartola SP, editor. Fluid therapy in small
            5. Do not overlook the second disorder. The effect that  animal practice. Philadelphia: WB Saunders; 1992.
               treating one disorder has on the second disorder must  p. 297–320.
               be anticipated, and both processes should be assessed  15. de  Morais  HSA.  Mixed  acid-base  disorders.  In:
                                                                    DiBartola SP, editor. Fluid therapy in small animal practice.
               simultaneously.
                                                                    2nd ed Philadelphia: WB Saunders; 2000. p. 251–61.
               The potential complications of treatment also should  16. de Morais HSA, DiBartola SP. Ventilatory and metabolic
            be anticipated (e.g., overshoot metabolic alkalosis after  compensation in dogs with acid-base disturbances. J Vet
            NaHCO 3 treatment), and iatrogenic mixed acid-base      Emerg Crit Care 1991;1:39–49.
            disorders should be avoided (e.g., administration of  17. DiBartola SP, de Morais HSA. Appendix: clinical cases. In:
                                                                    DiBartola SP, editor. Fluid therapy in small animal practice.
            drugs that suppress ventilation in patients with metabolic
                                                                    Philadelphia: WB Saunders; 1992. p. 599–688.
            acidosis). The reader is referred to chapters on the  18. Durward A, Skellett S, Mayer S, et al. The value of the
            individual acid-base disorders for further discussion of  chloride:sodium ratio in differentiating the aetiology of
            treatment (see Chapters 10 and 11). However, bear in    metabolic acidosis. Intensive Care Med 2001;27:828–35.
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