Page 1010 - Cote clinical veterinary advisor dogs and cats 4th

496 Hyperlipidemia

enteritis, renal disease, pregnancy, pleural
effusion, diabetes mellitus. QRS
VetBooks.ir with prerenal (e.g., hypoadrenocorticism), T
○ Blood urea nitrogen, creatinine: elevated
renal, or postrenal (e.g., urethral obstruc-
tion, urinary bladder rupture) azotemia.
−
○ Total CO 2 /HCO 3 decreased with meta-
bolic acidosis
○ Glucose may be decreased in hypoadreno-
corticism, sepsis or increased in diabetes HYPERKALEMIA ECG for a cat with urethral obstruction and hyperkalemia (serum K = 7.1 mEq/L) shows
+
mellitus. atrial standstill. No P waves are seen, but the R-R rhythm is regular, typical of atrial standstill. The heart rate is
• Urinalysis: isosthenuria concurrent with 210 beats/min, demonstrating that in cats, unlike dogs, a rapid heart rate is consistent with hyperkalemia. There
azotemia in renal failure or in hypoadreno- is mild ST-segment elevation, suggesting myocardial hypoxia. Lead V 2 , 25 mm/sec, 1 cm = 1 mV.
corticism.
−
• Blood gas: pH, HCO 3 or total CO 2 typically
decreased ○ Terbutaline or albuterol 0.01 mg/kg IV • Calcium gluconate IV works within a few
• Abdominal imaging: small adrenal glands slowly over 3-5 minutes minutes, sodium bicarbonate IV works
with ultrasonography (Addison’s disease); ○ Hemodialysis within 15 minutes, regular insulin and
abdominal effusion; small or large bladder ○ Potassium-binding resins orally dextrose work within 30 minutes, and
(urinary rupture or obstruction) • Treat the underlying cause (e.g., relieve beta-agonists (albuterol and terbutaline)
• ECG: depending on severity, tented T urethral obstruction, DOCP for hypoadre- work within minutes.
waves, widened QRS complexes, accelerated nocorticism). • Blood samples put in ethylenediaminetet-
idioventricular rhythm, bradycardia, atrial raacetic acid (EDTA) tubes cause pseudo-
+
standstill, ventricular fibrillation Chronic Treatment hyperkalemia because of the K EDTA.
Treat any underlying disease • In cats, hyperkalemia does not always cause
Advanced or Confirmatory Testing bradycardia; hyperkalemic cats may be
+
• Measure plasma K if pseudohyperkalemia Drug Interactions tachycardic even with severe hyperkalemia.
is suspected. Avoid ACE inhibitors and aldosterone antago- • On an ECG, peaked T waves are often
• ACTH stimulation test for hypoadrenocorti- nists as they can cause hyperkalemia. normal; the transition from normal T wave
cism to peaked T wave, however, is very suggestive
• Assess effusions, if present. Possible Complications of evolving hyperkalemia.
• Urinary fractional excretion tests for renal Cardiac arrest, death. Insulin administration • When present, hyponatremia exaggerates the
tubular acidosis can cause hypoglycemia. effects of hyperkalemia on cardiac myocytes.
• Other tests as necessitated by suspected cause
Recommended Monitoring Prevention
TREATMENT • Monitor electrolytes until normalized or as Monitor electrolytes when using parenteral
+
dictated by underlying disease fluids with large amounts of K .
Treatment Overview • Monitor ECG until severe hyperkalemia is
• Antagonize myocardiotoxicity. resolved. Technician Tips
• Treat the underlying cause. • Recognize ECG changes of hyperkalemia.
+
• Stop drugs known to increase serum K PROGNOSIS & OUTCOME • Shut off outlet port of IV fluid line while
+
concentration. adding K to the bottle; mix well before
Prognosis depends on cause administration.
Acute General Treatment • Guarded for AKI
• Calcium gluconate 10% solution 0.5-1.5 mL/ • Good for hypoadrenocorticism, urethral Client Education
kg IV immediately antagonizes myocardio- obstruction Straining to urinate or failure to urinate should
+
toxicity without actually lowering serum K prompt emergent visit.
concentration. PEARLS & CONSIDERATIONS
• Emergent reduction of serum K + SUGGESTED READING
○ Sodium bicarbonate 1-2 mEq/kg IV bolus Comments Kogika MM, et al: A quick reference on hyperkalemia.
(minimally effective) • Do a lead II ECG on all patients suspected Vet Clin Small Anim Pract 47:223-228, 2017. DOI:
○ Regular insulin and glucose, give 0.25-0.5 of having hyperkalemia. https://doi.org/10.1016/j.cvsm.2016.10.009.
units of insulin/kg IV, covering each unit • Bradycardia in a dehydrated patient is inap- AUTHOR: Michael Schaer, DVM, DACVIM, DACVECC
of insulin administered with 2 g dextrose propriate; hyperkalemia should be considered EDITOR: Leah A. Cohn, DVM, PhD, DACVIM
(2 g = 4 mL 50% dextrose) as one of the causes.

Hyperlipidemia Client Education
Sheet

Epidemiology
BASIC INFORMATION (dogs) to rare (cats) disorder in small
animals SPECIES, AGE, SEX
Definition • Postprandial: any animal for up to 12 hours
Increased fasting blood cholesterol and/or Synonyms after a meal
triglyceride (TG) concentrations; a common Hyperlipoproteinemia, lipemia

www.ExpertConsult.com