Page 476 - Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice

464 FLUID THERAPY

135
160 6.0
130
155 5.5
125
150
5.0
145 120
4.5 115
140
4.0 110
135
3.5 105
130
100
125 3.0
95
120 2.5
Sodium mEq/L Potassium mEq/L Chloride mEq/L

60 3.5 1.045 4.0 4.5 ≥500
50 1.040 4.0 250
3.0 3.5
40 1.035 200
2.5 3.5
30 1.030 3.0 175
3.0
25 2.0 1.025 150
2.5
20 1.020 2.5 125
1.5 2.0 100
15 1.015 2.0
1.0 75
10 1.010 1.5 1.5
50
5 0.5 1.005
1.0 1.0 25
BUN mg/dL Creatinine mg/dL Urine specific Albumin g/dL Globulins Fibrinogen
gravity g/dL mg/dL
Figure 19-6 Scattergram showing the serum electrolytes, blood urea nitrogen (BUN), creatinine, and
proteins, and urine specific gravity in dogs with portosystemic vascular anomalies. (Data from SA Center:
College of Veterinary Medicine, Cornell University, 1998).

protein intake as tolerated and observing the response can further deplete fibrinogen, antithrombin III, and
98,112
over weeks, the role of dietary protein restriction in protein C.
hypoalbuminemia can be evaluated. The wide range of serum albumin concentrations in
Hypoalbuminemia in liver disease generally is not normally hydrated cirrhotic dogs with and without ascites
accompanied by decreased globulin concentration (see demonstrates that hypoalbuminemia is only one factor
Figures 19-5, 19-6, and 19-7). Rather, globulin concen- influencing ascites formation (see Figure 19-5). In dogs
tration is normal or increased because of a disproportion- with ascites (n ¼ 52), median serum albumin concentra-
ate increase in a-globulins and acute-phase proteins. tion was 2.0 g/dL (range, 1.2 to 3.2 g/dL), and in dogs
a-Globulin concentrations increase as a result of without ascites (n ¼ 50), median serum albumin concen-
increased systemic exposure to gut-derived antigens, tration was 2.4 g/dL (range, 0.7 to 4.2 g/dL). Median
microorganisms, and debris normally removed by the serum globulin concentrations in these dogs were similar,
hepatic mononuclear phagocytes (Kupffer cells) and pres- whereas median plasma fibrinogen concentration
ence of inflammatory and immune-mediated processes was significantly decreased in ascitic dogs (median,
associated with the underlying disease. a-Globulins (par- 105 mg/dL; range, 30 to 780 mg/dL) compared with
ticularly haptoglobin), fibrinogen, and antithrombin III dogs without ascites (median, 165 mg/dL; range, 64
are abnormally low in dogs with end-stage cirrhosis and to 550 mg/dL).
hepatic synthetic failure. 190 Portosystemic shunting and
severe hepatic insufficiency also decrease plasma concen- SERUM ELECTROLYTES
tration of protein C, an important anticoagulant also
involved in the inflammatory response. 222,223 The diag- Hypokalemia in Liver Disease
nostic utility of the serum total protein concentration is Hypokalemia is a serious electrolyte disturbance
complicated by the induction of haptoglobin by associated with hepatic insufficiency. 37 Contributing
glucocorticoids and development of coagulopathies that factors include insufficient energy intake, enteric losses