Effect of Intravenous Small‐Volume Hypertonic Sodium Bicarbonate, Sodium Chloride, and Glucose Solutions in Decreasing Plasma Potassium Concentration in Hyperkalemic Neonatal Calves with Diarrhea

Abstract

BackgroundHyperkalemia is a frequently observed electrolyte imbalance in dehydrated neonatal diarrheic calves that can result in skeletal muscle weakness and life‐threatening cardiac conduction abnormalities and arrhythmias.HypothesisIntravenous administration of a small‐volume hypertonic NaHCO3 solution is clinically more effective in decreasing the plasma potassium concentration (cK) in hyperkalemic diarrheic calves than hypertonic NaCl or glucose solutions.AnimalsTwenty‐two neonatal diarrheic calves with cK >5.8 mmol/L.MethodsProspective randomized clinical trial. Calves randomly received either 8.4% NaHCO3 (6.4 mL/kg BW; n = 7), 7.5% NaCl (5 mL/kg BW; n = 8), or 46.2% glucose (5 mL/kg BW; n = 7) IV over 5 minutes and were subsequently allowed to suckle 2 L of an electrolyte solution. Infusions with NaHCO3 and NaCl provided an identical sodium load of 6.4 mmol/kg BW.ResultsHypertonic NaHCO3 infusions produced an immediate and sustained decrease in plasma cK. Hypertonic glucose infusions resulted in marked hyperglycemia and hyperinsulinemia, but cK remained unchanged for 20 minutes. Between 30 and 120 minutes after initiation of treatment, the most marked decrements in cK from baseline occurred in group NaHCO3, which were significantly (P < .05) larger during this period of time than in calves in group NaCl, but not group glucose. After 120 minutes, the mean decrease in cK from baseline was −26 ± 10%, −9 ± 8%, and −22 ± 6% in groups NaHCO3, NaCl, and glucose, respectively.Conclusions/Clinical ImportanceSmall‐volume hypertonic NaHCO3 infusions appear to have clinical advantages for the rapid resuscitation of hyperkalemic diarrheic calves, compared to hypertonic NaCl or glucose solutions.

Electrocardiographic findings in 130 hospitalized neonatal calves with diarrhea and associated potassium balance disorders

“…Between January 2015 and March 2017 a prospective study was conducted involving a convenience sample of 130 calves up to an age of 21 days that were admitted to the Clinic for Ruminants with Ambulatory and Herd Health Services, LMU Munich, with a clinical diagnosis of diarrhea. A subset of included hyperkalemic calves was also used in a recent study focusing on the potassium‐lowering effect of different hypertonic infusion solutions . According to previous publications, diarrhea was defined as fecal consistency that permitted feces to run through slightly open fingers.…”

“…Within 15 minutes after recording the ECG, a lithium‐heparinized blood sample was anaerobically collected from the jugular vein and blood pH, partial pressure of carbon dioxide (pCO 2 ) and oxygen (pO 2 ), sodium ( c Na + ), chloride ( c Cl – ), potassium ( c K + ), and ionized calcium concentrations ( c Ca 2+ ) determined using a blood pH, gas, and electrolyte analyzer with ion‐selective electrodes (Rapidpoint 405, Siemens Healthcare Diagnostics, Tarrytown). Further detailed information concerning the determination of acid‐base variables can be found elsewhere …”

“…A subset of included hyperkalemic calves was also used in a recent study focusing on the potassium-lowering effect of different hypertonic infusion solutions. 26 According to previous publications, 2,27 diarrhea was defined as fecal consistency that permitted feces to run through slightly open fingers. The presence of concurrent problems was not an exclusion criteria for study enrollment; however, calves were not included if diarrhea was not considered to be the main problem on admission.…”

“…Further detailed information concerning the determination of acid-base variables can be found elsewhere. 26 An…”

Diagnosis and Treatment of Infectious Enteritis in Neonatal and Juvenile Ruminants

“…Correction of hyperkalemia can be accomplished by administering small volumes of hypertonic (8.4%) sodium bicarbonate, followed by oral electrolytes. 21 Hypertonic sodium bicarbonate can safely be administered at a rate of 6.4 mL/kg body weight (equivalent to 6.4 mEq HCO 3 -/kg body weight) as a bolus over 5 minutes in calves with diarrhea and evidence of metabolic acidosis. A recent issue (March, 2009) covered fluid therapy in calves extensively.…”