Page 477 - Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice

Fluid, Electrolyte, and Acid-Base Disturbances in Liver Disease 465

160 135 6.0 8.0
155 130 5.5
7.0
150 125
5.0
145 120 6.0
4.5
140 115 5.0
4.0
135 110
4.0
130 105 3.5
125 100 3.0 3.0
120 95 2.5 2.0

Sodium mEq/L Chloride mEq/L Potassium mEq/L Phosphate mg/dL

1.045 60 3.5 4.0 6.0 ≥500
1.040 50 250
3.0 3.5 5.5
1.035 40 200
5.0
2.5 3.0 175
1.030 30
4.5 150
1.025 25 2.0 2.5
4.0 125
1.020 20
1.5 2.0 100
1.015 15 3.5
75
1.0 1.5
1.010 10 3.0
50
1.005 5 0.5 1.0 2.5 25
Urine specific BUN mg/dL Creatinine Albumin g/dL Globulins g/dL Fibrinogen
gravity mg/dL mg/dL
Figure 19-7 Scattergram showing the serum electrolytes, blood urea nitrogen (BUN), creatinine, proteins,
and urine specific gravity in cats with hepatic lipidosis; n ¼ 73. (Data from SA Center: College of Veterinary
Medicine, Cornell University, 1998).

(e.g., vomiting, diarrhea, nutrient malassimilation), treat- concentrations. Although the prognosis is worse for cats
ment with loop diuretics, and secondary hyperaldos- with HL and hypokalemia, the prognostic significance of
teronism. 30,213,221 Magnesium deficiency also can hypokalemia has not been evaluated in the other
complicate hypokalemia by potentiating kaliuresis disorders. 39
through its effects on aldosterone. 84 Hypokalemia may Itisimportanttorecognizeandcorrecthypokalemiafor
go unrecognized because of the transcellular shift that severalreasons.Mostimportantly,areciprocalrelationship
occurs between potassium and hydrogen ions. Serum exists between intracellular and extracellular potassium
potassium concentrations of dogs with cirrhosis, dogs concentrations and renal ammoniagenesis. 93,212,213 Infu-
with PSVA, and cats with HL are shown in sion of potassium chloride in hypokalemic patients signifi-
Figures 19-5, 19-6, and 19-7. Frank hypokalemia was cantly improved central nervous system (CNS) function in
present in 11 of 48 cirrhotic dogs with ascites, in 10 of earlyhepaticencephalopathy(HE)andprolonged survival
42 of cirrhotic dogs without ascites, in 6 of 113 dogs with in cirrhotic humans. 242 Patients given potassium chloride
PSVA, and in 32 of 116 cats with HL. A total of 34 of 90 to establish normokalemia experienced decreased arterial
þ
cirrhotic dogs (19 of 48 with ascites and 15 of 42 without NH 3 concentration and pH, increased arterial NH 4 /
ascites), 24 of 104 dogs with PSVA, and 44 of 116 cats NH 3 ratio, decreased urine pH, and slightly increased
with HL had subnormal or low normal serum potassium 24-hour urinary ammonia excretion with a significantly