Page 131 - Cote clinical veterinary advisor dogs and cats 4th

Alkalosis 44.e3

nonprimates because of differences in Prevention SUGGESTED READING
methanol metabolism. Keep alcoholic beverages and alcohol-containing Wismer T. Ethanol toxicosis: a review. Todays Vet
VetBooks.ir from the gastrointestinal (GI) tract (within Supervise pets or confine in other areas during ADDITIONAL SUGGESTED Diseases and Disorders
household products out of reach of pets.
• Alcohols are rapidly and completely absorbed
Pract July/August, 2017.
30 minutes to 2 hours).
parties where adult beverages are served.
• Isopropanol and methanol persist in circula-
tion longer than ethanol. Methanol and Technician Tips READING
Means C: Bread dough toxicosis in dogs. J Vet Emerg
isopropanol generally produce greater CNS • Careful airway management is essential with Crit Care 13(1):39-41, 2003.
depression than ethanol. these patients if CNS depression/uncon- Thrall MA, et al: Alcohols and glycols. In Gupta
• Uncooked bread dough, when ingested by sciousness have occurred. Appropriate RC, editor: Veterinary toxicology: basic and clinical
dogs, ferments in the GI tract and produces endotracheal intubation and cuff inflation principles, ed 2, New York, 2007, Academic Press,
ethanol, causing signs of drunkenness and are necessary to avoid aspiration. p 735-744.
bloat. • Rising bread dough ingestion in dogs can
• Windshield washer fluids contain 20%-100% lead to drunkenness, bloat, and potentially AUTHOR: Charlotte Means, DVM, MLIS, DABVT, DABT
EDITOR: Tina Wismer, DVM, MS, DABVT, DABT
ethanol. Windshield washer fluid is generally gastric volvulus quickly.
translucent blue and nonviscous (like water);
antifreeze (ethylene glycol, not methanol) is Client Education
generally fluorescent green and viscous (like Warn clients about dangers of alcohol exposures
light syrup). by pets around holidays.

Alkalosis

BASIC INFORMATION ○ Eclampsia (alkalosis also worsens the in veterinary medicine. In the case of
2+
availability of Ca ) hyperaldosteronism, excessive renal excretion
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Definition ○ Mechanical ventilation with inappropriate of K results in increased blood pH due to
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A systemic acid-base disturbance of metabolic settings H /K exchange as the body attempts to
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or respiratory origin, alkalosis is a consequence ○ Pain or anxiety maintain plasma [K ]
of another disease or disorder. Clinical Presentation • Persistent metabolic alkalosis results in hypo-
• Metabolic alkalosis is characterized by a kalemia because in most cases of metabolic
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primary increase in plasma [HCO 3 ], result- DISEASE FORMS/SUBTYPES alkalosis, there is renal Na retention, and
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ing in decreased plasma [H ], increased • Metabolic alkalosis hypokalemia develops as the kidneys increase
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plasma pH, and a potentially compensatory ○ Hypochloremic: result of chloride (Cl ) Na /K exchange. The K loss is not the
increase in PCO 2 . loss (e.g., vomiting, diuretics) cause of alkalosis, but it can result. Potassium
• Respiratory alkalosis results from a primary ○ Non-hypochloremic: other abnormalities supplementation alone does not correct alka-
decrease in PCO 2 (hypocapnia, hyperven- (e.g., hypokalemia, refeeding syndrome) losis, but KCl supplementation can correct
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tilation), increasing pH, and eliciting a • Respiratory alkalosis has no subclassification. alkalosis because of the Cl supplementation.
compensatory partial decrease in blood • Respiratory alkalosis develops when the
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[HCO 3 ]. HISTORY, CHIEF COMPLAINT degree of alveolar ventilation exceeds that
Reflects an underlying disorder because alkalosis required to eliminate the metabolic load of
Epidemiology produces no specific signs. CO 2 produced. Endogenous compensation
SPECIES, AGE, SEX for respiratory alkalosis usually results in a
Any ill or injured animal may develop acid-base PHYSICAL EXAM FINDINGS normal or very near normal blood pH.
disturbances. Signs caused by the underlying disorder pre-
dominate. Weakness, cardiac arrhythmias, signs DIAGNOSIS
RISK FACTORS of altered renal function, and GI ileus are
• Metabolic alkalosis possible if metabolic alkalosis is associated with Diagnostic Overview
○ Upper gastrointestinal (GI) obstruction, hypokalemia. Severe alkalosis may cause Alkalosis is always the consequence of another
vomiting of stomach contents hypocalcemia, and this may cause muscle disease; initial database that includes CBC,
○ Diuretic drugs twitching and irritability. serum biochemistry profile, urinalysis, and
○ Hyperadrenocorticism (rare) blood gas analysis is vital in identifying the
○ Hyperaldosteronism (rare) Etiology and Pathophysiology acid-base disturbance, assessing the degree of
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○ Alkali administration (e.g., oral or IV • Metabolic alkalosis associated with Cl loss severity, and identifying an underlying cause.
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NaHCO 3) occurs when Cl -rich fluid is lost from the
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○ Refeeding after fasting body, such as in vomiting, when Cl -rich Differential Diagnosis
○ Excessive suctioning of nasogastric tube gastric fluid and extracellular fluid volume Each possible cause of alkalosis as previously
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○ Severe K or Mg deficiency are lost. Cl loss is followed by renal reabsorp- listed has its own differential diagnosis list.
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• Respiratory alkalosis tion of Na and excretion of H , leading to
○ Hyperventilation caused by hypoxemia or a metabolic alkalosis. Initial Database
pulmonary disease • With decreases in circulating blood volume, • CBC, serum biochemistry panel (includ-
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○ Central nervous system (CNS)–mediated renal HCO 3 excretion is limited. ing electrolytes), urinalysis: evaluate for
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hyperventilation • Cl -unresponsive alkalosis (i.e., does not underlying systemic disorder resulting in
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○ Heat stroke resolve by supplementation of Cl ) is rare alkalosis
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