Page 2096 - Cote clinical veterinary advisor dogs and cats 4th

1047.e2 Water Intoxication, Acute

○ Clinical signs of myelinolysis (weakness, • Respiratory rate and character • Include AWI in the differential diagnosis list
ataxia, hypermetria, quadriparesis) occur • Urinalysis, particularly urinary specific gravity if dog has CNS signs and had been around
VetBooks.ir ○ Sodium deficit = 0.6 × body weight • Airway monitoring (comatose patients) Client Education
3-4 days after overly rapid correction of
fresh water for several hours.
• Urine output
chronic hyponatremia.
(kg) × (normal Na [mEq/L] − patient
Na [mEq/L]) PROGNOSIS & OUTCOME Do not allow dogs to consume excessive amounts
of water without electrolyte replenishment.
○ Administer isotonic crystalloid saline solu- • Guarded to poor if severe acute hyponatremia
tion IV. Aim to increase serum sodium with CNS signs SUGGESTED READING
no more rapidly than 0.5 mEq/L/h (i.e., • Good if mild hyponatremia, polydipsia, Fleming M. Hyponatremia. In Tilley LP, et al, editors:
10-12 mEq/L/day). and polyuria are present but no CNS signs Blackwell’s five minute veterinary consult: canine
○ Monitor sodium frequently to avoid too develop and feline, ed 6, Hoboken, NJ, 2016, Wiley
rapid correction, and adjust fluids as Blackwell, pp 717-718.
needed. Keep in mind that crystalloids PEARLS & CONSIDERATIONS
with less sodium than normal saline (e.g., ADDITIONAL SUGGESTED
lactated Ringer’s solution) may be required Comments READINGS
to avoid overly rapid correction. • A serious, potentially life-threatening DiBartola SP: Disorders of sodium and water:
condition hypernatremia and hyponatremia. In DiBartola
Nutrition/Diet • Excessive consumption of seawater (not fresh SP, editor: Fluid therapy in small animals, ed 4,
Limit water intake at admission in suspect cases. water) can result in hypernatremia in dogs, St. Louis, 2012, Saunders, pp 45-79.
not AWI. Toll J: Acute water intoxication in a dog. J Vet Emerg
Possible Complications Crit Care 9:19-24, 1999.
Cerebral edema, temporary blindness, demy- Prevention AUTHOR: Safdar A. Khan, DVM, MS, PhD, DABVT
elination, brain herniation Limit dog exposure to fresh water during exer- EDITOR: Tina Wismer, DVM, MS, DABVT, DABT
cise (supplement water with oral electrolytes).
Recommended Monitoring
• Serum electrolyte concentrations Technician Tips
• Serum osmolality • Overly rapid normalization of hyponatremia
• Heart rate, blood pressure with hypertonic saline can be more detri-
• Body temperature mental and lead to severe CNS sequela.

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