Page 183 - Basic Monitoring in Canine and Feline Emergency Patients

small punctate lesions on her lenses bilaterally that Plunkett, S.J. (2013) Emergency Procedures for the Small
were consistent with chronic hypocalcemia. Animal Practitioner, 3rd edn. Saunders Elsevier,
VetBooks.ir 9.7–12.3 mg/dL). An ionized calcium (iCa) on a
Philadelphia, Pennsylvania, USA.
Her total calcium was low (5.8 mg/dL, normal
bedside monitor revealed 0.48 mmol/L (normal
1.2–1.3 mmol/L) with all other electrolytes normal Bibliography
or near normal including the sodium reported by
her primary care veterinarian (Na= 131 mEq/L; Bleul, U., Gotz, E. (2014) Evaluation of the i-STAT port-
able point-of-care analyzer for determination of blood
normal 139-150 mEq/L). An electrocardiogram gases and acid-base status in newborn calves. Journal
(ECG) placed at the time of presentation revealed a of Veterinary Emergency and Critical Care 24,
variety of heart rates and rhythms ranging from 519–528.
sinus bradycardia (heart rate 50–60 bpm) to an Burnett, R.W., Covington, A.K., Fogh-Andersen, N., et al.
idioventricular rhythm (heart rate 90–100 bpm) (2000) Use of ion-selective electrodes for blood-
and then an escape rhythm (heart rate <40 bpm). electrolyte analysis. Recommendations for nomen-
During the period when she was displaying various clature, definitions, and conventions. International
bradyarrhythmias, her measured blood pressure Federation of Clinical Chemistry and Laboratory
was 240 mmHg. She was given 1 mL/kg of 10% Medicine (IFCC). Scientific Division Working Group
calcium gluconate IV slowly over 30 minutes to on Selective Electrodes. Clinical Chemistry and
Laboratory Medicine 38, 363–70.
address her hypocalcemia while observing the ECG Dalal, B.I., Brigden, M.L. (2009) Factitious biochemical
for worsening bradycardia. She was also given man- measurements resulting from hematologic condi-
nitol (1 g/kg IV over 30 minutes) to treat a possible tions. American Journal of Clinical Pathology 131,
Cushing’s reflex (obtunded mentation with brady- 195–204.
cardia and hypertension). These signs seemed to DiBartola, S.P. (2012) Disorders of sodium and water:
resolve with treatment but it was unclear if the cal- hypernatremia and hyponatremia. In: Dibartola, S.P.
cium gluconate or the mannitol had a greater effect. (ed.) Fluid, Electrolyte and Acid-Base Disorders in
Table 8.8 shows Queenie’s serial iCa measure- Small Animal Practice, 4th edn. Elsevier, St. Louis,
ments and the intervention taken in response to Missouri, USA, pp. 45–79.
each one. This table is not meant as a guide to DiBartola, S.P., de Morais, H.A. (2012) Disorders
of potassium: hypokalemia and hyperkalemia.
treatment but simply to illustrate alterations in In: Dibartola, S.P. (ed.) Fluid, Electrolyte and
calcium in response to various interventions in a Acid-Base Disorders in Small Animal Practice,
real clinical case. 4th edn. Elsevier, St. Louis, Missouri, USA, pp.
Queenie was worked up for her hypocalcemia 92–119.
and diagnosed with primary hypoparathyroidism DiBartola, S.P., Willard, M.D. (2012) Disorders of
on the basis of an inappropriately low parathy- phosphorus: hypophosphatemia and hyperphos-
roid hormone level (0.6 pmol/L; normal 0.5– phatemia. In: Dibartola, S.P. (ed.) Fluid, Electrolyte
5.8 pmol/L) in the face of a low iCa (0.86 mmol/L; and Acid-Base Disorders in Small Animal Practice,
normal 1.25–1.45 mmol/L). She was discharged 4th edn. Elsevier, St. Louis, Missouri, USA, pp.
195–211.
3 days after presentation on oral calcium carbon- Estridge, B.H., Reynolds, A.P. (2012) Principles of chem-
ate tablets and vitamin D to manage her hypopar- istry instrumentation. In: Estridge, B.H., Reynolds,
athyroidism. Follow-up 4 months after discharge A.P. (eds) Basic Clinical Laboratory Techniques, 6th
revealed that Queenie was doing well aside from edn. Delmar Cengage Learning, Clifton Park, New
intermittent episodes once or twice a week York, USA, pp. 622–629.
wherein she would run in circles chasing her tail Higgins, C. (2007) Pseudohyponatremia. Available at:
and then freeze, but was responsive to her name https://acutecaretesting.org/en/articles/pseudohy-
during those events. Her mentation was back to ponatremia (accessed 1 March, 2019).
normal and she was otherwise doing well. Learn more about flame photometry (2019) Available
at: www.sciencedirect.com/topics/medicine-and-
dentistry/flame-photometry (accessed 15 February
Further Reading 2019).
Liamis, G., Liberopoulos, E., Barkasa, F., et al. (2013)
Matthews, K.M. (2017) Veterinary Emergency and Spurious electrolyte disorders: a diagnostic challenge
Critical Care Manual, 3rd edn. Lifelearn, Guelph, for clinicians. American Journal of Nephrology 38,
Ontario, Canada. 50–57.

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