Correction of serum chloride concentration in dogs with congestive heart failure

BackgroundPoor natriuresis is a potential marker of diuretic resistance in dogs with acute congestive heart failure (CHF) but little is known about the relationship between urine sodium concentration (uNa) and frequency of successful decongestion. Supplemental O2 is a common treatment in dogs with severe CHF. The time from start to discontinuation of supplemental O2 therapy (DCSO2) typically reflects the time course and ease of decongestion.Hypothesis/ObjectivesUrine Na concentration after IV administration of furosemide will be correlated with duration of treatment with supplemental O2 (timeO2) and the cumulative frequency of successful DCSO2 during hospitalization.AnimalsFifty‐one dogs with acute CHF.MethodsRetrospective observational single center study.ResultsDogs with low uNa had significantly longer mean timeO2 than dogs with high uNa (uNa <87 mmol/L, 24.2 ± 2.6 hours vs uNa ≥87 mmol/L, 16.6 ± 1.7 hours; P = .02). Low uNa was correlated with lower cumulative frequency of DCSO2 (12 hour, 28%; 24 hour, 42%; 36 hour, 73%) compared to high uNa (12 hour, 28%; 24 hour, 88%; 36 hour, 96%; P = .005). History of PO loop diuretics, low serum chloride concentration (sCl), and high PCV were associated with low uNa. Urine Na concentration outperformed other metrics of diuretic responsiveness including weight loss.Conclusions and Clinical ImportanceUrine Na concentration after IV furosemide predicted timeO2 and cumulative frequency of DCSO2 in dogs with acute CHF, which likely reflects important aspects of diuretic responsiveness. Urine Na can assess diuretic responsiveness and treatment efficacy in dogs with CHF.

Section: Discussionmentioning

confidence: 99%

Urine sodium concentration after intravenous furosemide in dogs with acute congestive heart failure and correlation with treatment efficacy

Convey,

Huh,

Achilles

et al. 2023

“…We found inverse relationships between both calOsm and dmOsm with the amount of Cl À correction, which was expected and supports that the amount that serum Cl À changes after mathematical correction reflects water in the body, as previously proposed. 4 Interestingly, osmolality by either method was not correlated with serum Cl À concentrations or cCl À . Although Cl À impacts osmolality, its reciprocal relationship with HCO 3 À means that net negative osmoles are maintained even with hypochloremia.…”

Section: Comparisons Between Acute and Chronicmentioning

confidence: 92%

Use of serum osmolality to identify heart disease stage in dogs and relationship to mathematical chloride correction

Daly,

Harris,

Adin

2023

Self Cite

BackgroundHeart failure‐associated hypochloremia can be depletional from diuretics or dilutional from water retention. Serum osmolality reflects water balance but has not been evaluated in dogs with heart disease.HypothesisTo determine if serum osmolality is related to heart disease stage and amount of mathematical correction of serum chloride (Cl−) concentrations in healthy dogs and dogs with myxomatous mitral valve degeneration (MMVD).AnimalsSeventy‐seven dogs (20 healthy, 25 Stage B MMVD, 32 Stage C/D MMVD).MethodsSerum Cl− concentrations were mathematically corrected. Osmolality was calculated (calOsm) and directly measured by freezing point depression (dmOsm) and compared by Bland‐Altman analysis. Biochemical variables and osmolality were compared among healthy, Stage B, and Stage C/D dogs. Correlations were explored between osmolality and biochemical variables. Median and range are presented. P < .05 was considered significant.ResultsThe calOsm was different among groups (P = .003), with Stage B (310 mOsm/kg; 306, 316) and C/D dogs (312 mOsm/kg; 308, 319) having higher calOsm than healthy dogs (305 mOsm/kg; 302, 308). Osmolality methods were moderately correlated (P < .0001, rs = .46) but with proportional bias and poor agreement. The amount of Cl− correction was negatively correlated with calOsm (P < .0001, rs = −.78) and dmOsm (P = .004, rs = −.33). Serum bicarbonate concentration was negatively correlated with Cl− (P < .0001, rs = −.67).Conclusions and Clinical ImportanceDogs with Stage B and Stage C/D heart disease had higher calOsm than healthy dogs. Osmolality was inversely related to the amount of Cl− correction, which supports its use in assessing relative body water content. Poor agreement between calOsm and dmOsm prevents methodological interchange.

“…Mechanisms of hypochloremia include loop diuretic chloride wasting and volume expansion causing dilution. 58 , 65 , 69 In dogs, hypochloremia is associated with advanced disease and correlates with other markers of diuretic resistance such as uNa : uK <1. 58 , 70 Some studies indicated that hypochloremia was a stronger predictor of poor outcomes than hyponatremia in people with CHF.…”

Section: Diuretic Resistancementioning

confidence: 99%

Toward quantification of loop diuretic responsiveness for congestive heart failure

Oyama

Adin

2022

Self Cite

Diuretics, such as furosemide, are routinely administered to dogs with congestive heart failure (CHF). Traditionally, dose and determination of efficacy primarily are based on clinical signs rather than quantitative measures of drug action. Treatment of human CHF patients increasingly is guided by quantification of urine sodium concentration (uNa) and urine volume after diuretic administration. Use of these and other measures of diuretic responsiveness is associated with decreased duration of hospitalization, complication rates, future rehospitalization, and mortality. At their core, loop diuretics act through natriuresis, and attention to body sodium (Na) stores and handling offers insight into the pathophysiology of CHF and pharmacology of diuretics beyond what is achievable from clinical signs alone. Human patients with low diuretic responsiveness or diuretic resistance are at risk for difficult or incomplete decongestion that requires diuretic intensification or other remedial strategies. Identification of the specific etiology of resistance in a patient can help tailor personalized interventions.In this review, we advance the concept of loop diuretic responsiveness by highlighting Na and natriuresis. Specifically, we review body water homeostasis and congestion in light of the increasingly recognized role of interstitial Na, propose definitions for diuretic responsiveness and resistance in veterinary subjects, review relevant findings of recent studies, explain how the particular cause of resistance can guide treatment, and identify current knowledge gaps. We believe that a quantitative approach to loop diuretic usage primarily involving natriuresis will advance our understanding and care of dogs with CHF.