Page 179 - Basic Monitoring in Canine and Feline Emergency Patients

presentation, Norah had been receiving meloxi- mentation improved during the initial overnight
cam orally once daily and she had also been period with fluid therapy.
VetBooks.ir receiving triple antibiotic eye lubricant three times likely chronic, the goal was to reduce her sodium
Since her renal failure and hypernatremia were
daily in both eyes for 2 weeks to treat ocular
discharge.
cerebral edema formation. Please see Table 8.6 for
At presentation, she was hypothermic (98.4°F; levels by no more than 0.5–1.0 mEq/L/h to prevent
36.9°C), mildly tachycardic (heart rate 212 beats the serial BUN, creatinine, and Na levels in Norah.
per minute) and was very thin (2.0 kg; body condi- Her fluid rates and fluid types are included on the
tion score 2/9). She had mucopurulent ocular chart for reference as well as the frequency at
discharge and blepharospasm in both eyes with a which her sodium levels were checked. Footnotes
fractured right maxillary canine tooth. There was to the table provide rationale for the various fluid
evidence of dehydration on examination (pro- rates selected. The chart is not meant as a guide for
longed skin tenting, tacky mucous membranes). treatment but simply to illustrate the fluctuations
She appeared to be weak and was obtunded. She in Na levels in a real clinical case.
also had a grade I–II/VI left-sided systolic heart Norah was discharged on the day 6 of hospitali-
murmur with normal lung sounds and was esti- zation and was reportedly doing well at home.
mated to be approximately 8% dehydrated.
Bloodwork was performed which revealed
evidence of hemoconcentration: total protein 10.8 g/ Case study 2:
dL (normal 6.0–8.0 g/dL) and hematocrit 62% (nor- The hyperkalemic cat
mal 30–45%). She also had azotemia characterized A 6-year-old male neutered domestic shorthaired
by a blood urea nitrogen (BUN) of 294 mg/dL (nor- cat named Stormy was presented to the hospital for
mal 15–25 mg/dL) and creatinine 12.60 mg/dL evaluation of vocalizing and vomiting. The owners
(normal 0.9–2.3 mg/dL). She was severely hyperna- also felt that he had been more lethargic than usual
tremic with a sodium concentration of 207 mEq/L overnight. He had a history of a prior urethral
(normal 148–157 mEq/L). Her urine specific gravity obstruction, was indoor–outdoor, and had no other
was 1.024 suggesting an inappropriate concentrat- pre-existing health problems.
ing ability given her clinical dehydration. On presentation, Stormy was quiet, alert and
Norah was diagnosed with renal failure and responsive with normal heart and lung sounds. His
dehydration with concurrent chronic hypernatremia heart rate was 180 beats per minute. He was hypo-
(based on the duration of her clinical signs). During thermic (temperature 96.5°F; 35.8°C). A large firm
the first night of hospitalization, the initial goal was bladder was palpated in the abdomen that could not
to correct her dehydration and observe for changes be expressed. He was diagnosed with a urethral
in her sodium during that correction period. She obstruction.
was given an isotonic crystalloid that was compara- Bloodwork was performed which revealed a
tively high in total sodium content to slow the BUN >140 mg/dL, creatinine 14.6 mg/dL, and
overall decrease in sodium as she was rehydrated potassium of >9.0 mEq/L. Stormy was given a
and attempt to keep her rate of sodium decrease no bolus of intravenous crystalloids (plasmalyte,
more than 1 mEq/L/h. 20 mL/kg), calcium gluconate (100 mg/kg of 10%
Therefore, she was initially placed on 0.9% saline calcium gluconate), and insulin/dextrose (0.5 U/kg
fluids to correct an estimated 8% dehydration over regular insulin + 2 g of 25% dextrose/unit of insu-
12 hours plus administer maintenance fluids. Her lin) to treat his hyperkalemia. General anesthesia
estimated dehydration deficit was 160 mL (13.3 mL/h was induced with hydromorphone and propofol to
given over 12 hours) and her maintenance fluid rate allow placement of a urinary catheter to relieve the
was calculated at 3.3 mL/h (40 mL/kg/day). The obstruction. After the fluid bolus and relief of the
total fluid rate was 17 mL/h or 215 mL/kg/day. She obstruction, his potassium was 7.9 mEq/L, creati-
was also given famotidine and maropitant to treat nine was 12.2 mg/dL, and BUN was >140 mg/dL.
uremia-associated gastrointestinal disease from her Please see Table 8.7 for the subsequent interven-
renal failure and started on ofloxacin and cidofovir tions and values for Stormy’s potassium over the
topically to treat the corneal ulcer. She almost next few days of his hospitalization. Each time
immediately started eating in the hospital and her Stormy received a fluid bolus as indicated below, it

Electrolyte Monitoring 171