Page 479 - Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice

Fluid, Electrolyte, and Acid-Base Disturbances in Liver Disease 467

5.0 18
4.7 100 2.6
4.4 50 2.4
4.1 30 2.2
2.0
3.8 27
3.5 24 1.8
Albumin g/dL 3.2 BUN mg/dL 21 Creatinine mg/dL 1.4
1.6
2.9
18
1.2
2.6
2.3 15 1.0
12
2.0 9 0.8
0.6
1.7 6
0.4
1.4 3
0.2
1.1 0
0
Albumin BUN Creatinine

160 6.4
155 6.0
150 5.6
145 5.2
140 4.8
135 4.4
4.0
Electrolyte mEq/L 125 Electrolyte mEq/L 3.6
130
3.2
120
2.8
115
110
2.0
105 2.4
100 1.6
95 1.4
90 1.2
0.8
Sodium Chloride Potassium Magnesium Phosphate
Figure 19-9 Scattergram showing the serum potassium, magnesium, phosphate, sodium, chloride,
albumin, blood urea nitrogen (BUN), and creatinine from a survey of 157 cats with severe hepatic lipidosis.
Normal range indicated by slashed boxes. (Data from SA Center: College of Veterinary Medicine, Cornell
University, 2004).

refeeding. Hypophosphatemia in patients with liver dis- GSH in erythrocytes. Muscle weakness in
ease is thought to reflect intracellular shifts of phos- hypophosphatemia may be severe enough to impair ven-
phate. 81,206 Although less common on presentation tilation, leading to ventilatory failure and respiratory aci-
than hypokalemia, severe hypophosphatemia can produce dosis. Hypophosphatemia induced by refeeding in cats
many clinical signs including weakness (e.g., ventilatory with HL typically appears within the first 48 hours of ali-
failure severe enough to cause respiratory acidosis, neck mentation, and overt clinical effects are observed with
ventroflexion in cats), vomiting, gastric atony, hemolysis, serum phosphorus concentrations less than 1.5 mg/dL.
bleeding tendencies (i.e., platelet dysfunction), hemolytic
anemia, and neurologic signs that can be confused with Hypomagnesemia in Liver Disease
HE. 59,81 Mechanisms of hemolysis involve depletion of Symptomatic hypomagnesemia is observed infrequently
red cell energy related to impaired glycolysis and ATP in patients with liver disease. Recognition of low serum
production and diminished ability to maintain reduced magnesium concentration is important because of the