Page 182 - Basic Monitoring in Canine and Feline Emergency Patients

was to improve kidney perfusion and increase renal not have an appetite. Her water consumption was
excretion of potassium. Stormy was discharged on unchanged. She received no medications other than
VetBooks.ir the day 4 of hospitalization and did not return with monthly heartworm preventative. There was no
history of toxin exposure.
an additional urethral obstruction. Table 8.7 is not
While at her primary care veterinarian’s office
meant as a guide to treatment but simply to illus-
trate the changes in potassium in response to vari- being examined prior to presentation at the hospi-
ous interventions in a real clinical case. tal, she became laterally recumbent with worsening
muscle tremors and blood was noted in her mouth.
Bloodwork at her primary veterinarian’s office
Case study 3: The chronically revealed hypocalcemia and hypernatremia (exact
hypocalcemic dog
values unknown).
Queenie, an 8-year-old female spayed Pit Bull On presentation to our hospital, Queenie was
Terrier was presented to the hospital for evaluation ambulatory but severely obtunded. Her tempera-
of abnormal behavior. For at least 24 hours prior ture was 100.6°F (38.1°C), heart rate 90 beats per
to presentation, the owners reported that she was minute, and respiratory rate 44 breaths/min. Her
squinting her eyes, shaking her head and pawing at level of awareness waxed and waned, ranging from
her face. She seemed to be restless and they also being almost stuporous to mild obtundation. She
noted muscle tremors as well as rhythmic teeth had multiple erythematous regions on her skin with
clicking. The owners felt that she was becoming scattered crusts and superficial abrasions. There
progressively weaker and having more and more was a scab on her tail and a 3 cm rounded pedun-
trouble getting up on the couch. She had been eat- culated mass on the right lateral phalanx of her
ing well until the day of presentation when she did front leg. Ophthalmologic examination revealed

Table 8.8. Serial ionized calcium levels in a dog with hypoparathyroidism presenting for neurologic signs and cardiac
arrhythmias.

iCa levels
Time (hours) (normal 1.2–1.3 mmol/L) Intervention
Presentation 0.48 1 mL/kg 10% calcium gluconate IV over 30 minutes
(time 0) 1.0 g/kg IV mannitol over 30 minutes
1 1.22 a 120 mL/kg/day plasmalyte
8 0.72 90 mL/kg/day plasmalyte
21 0.69 60 mL/kg/day plasmalyte
27 0.66 b 60 mL/kg/day lactated Ringer’s solution
1 mL/kg 10% calcium gluconate IV over 30 minutes
Calcium carbonate tablets started at 50 mg/kg by mouth every 12 hours
Calcitriol started at 0.02 mg/kg by mouth every 12 hours
33 0.79 60 mL/kg/day lactated Ringer’s solution
41 0.79 60 mL/kg/day lactated Ringer’s solution
65 0.53 c 60 mL/kg/day lactated Ringer’s solution
Sent home later that day
iCa, ionized calcium; plasmalyte is an isotonic crystalloid with 5 mEq/L of calcium; lactated Ringer’s solution is an isotonic crystalloid
with 3 mEq/L of calcium.
a Due to the initial improvement in iCa values (and clinical condition) with calcium gluconate treatment and the fact that Queenie had
not been worked up at all for her clinical signs, the iCa levels were initially just observed and not treated again.
b After about 24 hours of hospitalization when hypoparathyroidism became the top differential, Queenie was started on oral vitamin D
(calcitriol) and oral calcium carbonate. She was given one more bolus of calcium gluconate since any increase in iCa due to calcitriol
can take hours to days to become apparent.
c Even though Queenie’s iCa levels had actually dropped while in the hospital when she was receiving calcium carbonate and calcitriol
orally, she was not displaying any cardiac signs and her mentation had improved from presentation. The owners requested that she be
discharged for continued care at home.

174 E.J. Thomovsky