Page 523 - Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice

Fluid Therapy in Endocrine and Metabolic Disorders 511

Isotonic fluids (0.9% NaCl or lactated Ringer’s solu- 3. Adler JA, Drobatz KJ, Hess RS. Abnormalities of serum
tion) should be administered initially at a rapid rate electrolyte concentrations in dogs with hypoadreno-
corticism. J Vet Intern Med 2007;21:1168–73.
(up to 90 mL/kg/hr) to restore intravascular volume 4. Androgue JC, Wilson H, Boyd AE, et al. Plasma acid-base
and reduce core body temperature. 31 The volume and
patterns in diabetic ketoacidosis. N Engl J Med
rateof fluidadministrationshouldbedeterminedbysever- 1982;301:1603–10.
ity of signs and response to the therapy. Hypokalemia can 5. Aroch I, Segev G, Loeb E, Burchim Y. Peripheral nucleated
occur in some animals with heatstroke, and it may be red blood cells as a prognostic indicator in heatstroke in
dogs. J Vet Intern Med 2009;23:544–51.
necessary to add potassium chloride to intravenous fluids
6. Atkinson K, Aubert I. Myxedema coma leading to respira-
after initial resuscitation. If hypoalbuminemia is present, a
tory depression in a dog. Can Vet J 2004;45:318–20.
colloid (hetastarch at 10 mL/kg) may be combined with 7. Bouchama A, Knochel JP. Heat stroke. N Engl J Med
the crystalloid treatment. 31 Monitoring should be 2002;346:1978–88.
performed frequently during initial treatment, consisting 8. Bouchama A, Dehbi M, Chaves-Carballo E. Cooling and
hemodynamic management in heatstroke: practical
of pulse rate and quality, capillary refill time, blood pres-
recommendations. Crit Care 2007;11:R54.
sure, respiratory rate, urine output, and central venous 9. Bouchama A, Kwaasi A, Dehbi M, et al. Glucocorticoids do
pressure when necessary. A coagulopathy usually is pres- not protect against the lethal effects of experimental heat-
ent, most often consistent with DIC. 5,13,22 Therefore stroke in baboons. Shock 2007;27:578–83.
plasma transfusion and, if indicated, treatment for DIC 10. Brady CA, Vite CH, Drobatz KJ. Severe neurologic
should be considered early in therapy. 13 Gastrointestinal sequelae in a dog after treatment of hypoadrenal crisis.
J Am Vet Med Assoc 1999;215:222–5.
hemorrhage is common and may be of sufficient severity 11. Brothers RM, Bhella PS, Shibata S, et al. Cardiac systolic
to result in anemia, necessitating transfusion with packed and diastolic function during whole body heat stress. Am
red blood cells or whole blood. Because of compromise of J Physiol Heart Circ Physiol 2009;296:H1150–H1156.
the gastrointestinal tract and bacterial translocation, intra- 12. Broussard JD, Wallace MS. Insulin treatment of diabetes
venous administration of a broad-spectrum antibacterial mellitus in the dog and cat. In: Bonagura JD, editor. Kirks
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drug is indicated. Gastroprotective treatment can be 1995. p. 393–8.
administered but is likely to be of limited efficacy. Acid- 13. Bruchim Y, Klement E, Saragusty J, et al. Heat stroke in
base disturbances should be managed when present, but dogs: a retrospective study of 54 cases (1999-2004) and
the acidosis associated with heatstroke often responds to analysis of risk factors for death. J Vet Intern Med
2006;20:38–46.
intravenous fluid therapy alone. If cerebral edema is
14. Bruchim Y, Loeb E, Saragusty J, Aroch I. Pathologic
suspected, administration of mannitol, furosemide, and
findings in dogs with fatal heatstroke. J Comp Path
dexamethasone should be considered. The efficacy of 2009;140:97–104.
corticosteroids in treatment of heatstroke has not been 15. Bruskiewicz KA, Nelson RW, Feldman ED, et al. Diabetic
established and should be avoided unless indicated for a ketosis and ketoacidosis in cats: 42 cases (1980-1995).
9
specific complication. Hypoglycemia is common and J Am Vet Med Assoc 1997;211:188–92.
16. Chastain CB, Graham CL, Riley MG. Myxedema coma in
may be severe, so periodic monitoring and intravenous two dogs. Canine Pract 1982;9:20–34.
dextrose administration when indicated is recommended. 17. Chastain CB, Nichols CE. Low-dose intramuscular insulin
After an adequate response to initial fluid therapy, therapy for diabetic ketoacidosis in dogs. J Am Vet Med
subsequent rates of administration and composition of Assoc 1981;178:561–4.
18. Chiasson JL, Aris-Jilwan N, Belanger R, et al. Diagnosis
fluids should be determined by estimating fluid deficits,
and treatment of diabetic ketoacidosis and the hyperglyce-
noting urine output, and monitoring serum electrolyte mic hyperosmolar state. CMAJ 2003;168:859–66.
concentrations. Recognition of complications including 19. Christopher MM, Broussard JD, Peterson ME. Heinz body
DIC, coagulation factor deficiency, severe thrombocytope- formation associated with ketoacidosis in diabetic cats. J Vet
nia, hepatic failure, renal failure, pulmonary edema, cardiac Intern Med 1995;9:24–31.
20. Crenshaw KL, Peterson ME. Pretreatment clinical and lab-
arrhythmias, seizures, hypoglycemia, acidosis, and sepsis
oratory evaluation of cats with diabetes mellitus: 104 cases
requires careful monitoring. Many of these complications (1992-1994). J Am Vet Med Assoc 1996;209:943–9.
may not develop until 48 to 72 hours after presentation, 21. Della Manna T, Steinmetz L, Campos PR, et al. Subcutane-
so frequent adjustments to treatment are often necessary. ous use of a fast-acting insulin analog. Diabetes Care
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