Page 566 - Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice

554 FLUID THERAPY

concentration in mild to moderate cases, diet alone is PO q12h) simultaneously addresses metabolic acidosis
generally not sufficient as the renal disease worsens. and hypokalemia. Oral sodium bicarbonate (8 to
Phosphate binders prevent absorption of phosphorus 12 mg/kg PO q12h) is more palatable in tablet form
in ingested food in the gastrointestinal tract. Aluminum compared with powder. Doses should be adjusted based
containing phosphate binders are commonly used in vet- on the individual patient response.
erinary medicine. They are rarely used in people because
of the potential for complications from long-term expo- CONCLUSIONS
sure to aluminum, including anemia and neurologic
disorders. These effects are rarely noted in animals unless Careful fluid therapy is the most important aspect of
receiving chronic hemodialysis. Aluminum hydroxide or treating a uremic crisis, and involves astute assessment
aluminum carbonate are administered at 30 to 90 mg/ of hydration status with frequent reassessment, appropri-
kg/day divided with meals. Calcium acetate and calcium ate fluid type and rate, and flexibility to respond to
carbonate are alternatives to aluminum containing changes in the patient’s clinical status. Electrolyte and
binders. They may cause hypercalcemia, and should be acid-base disturbances are common with renal failure,
avoided in patients with an elevated calcium concentra- and frequently require specific therapy.
tion. Calcium carbonate combined with chitosan is a vet-
erinary specific product for binding phosphorus. Several
newer phosphate binders such as sevelamer hydrochlo- REFERENCES
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