Electrolyte Disturbances Are Associated with Non-Survival in Dogs—A Multivariable Analysis

Goggs, Robert; Rosa, Sage De; Fletcher, Daniel J.

doi:10.3389/fvets.2017.00135

Cited by 21 publications

(23 citation statements)

References 52 publications

(49 reference statements)

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“…It should be noted that much of the calcium disorder literature discusses only total calcium concentrations that are known to be unreliable indicators of the concentrations of biologically active ionized calcium (10, 11). The severity of the calcium disorder is associated with mortality in both dogs and cats (12, 13). Ionized calcium concentrations have non-linear U-shaped associations with case fatality rates in dogs and cats, wherein concentrations clustered around the RI midpoint had the lowest case fatality rates, while progressively abnormal concentrations were associated with proportionately increased risk of non-survival (12, 13).…”

Section: Introductionmentioning

confidence: 99%

Severity of Ionized Hypercalcemia and Hypocalcemia Is Associated With Etiology in Dogs and Cats

2019

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Background: Calcium disorders are common in small animals, but few studies have investigated the etiology of ionized hypercalcemia and hypocalcemia in large populations. This study aimed to determine the incidence of ionized calcium disorders in dogs and cats treated at a tertiary referral clinic and to describe the associated diseases. Methods: An electronic database of electrolyte analyses conducted at the Cornell University Hospital for Animals from 2007 to 2017 was searched. Dogs and cats with ionized hypercalcemia or hypocalcemia were identified based on institution reference intervals. Duplicate case entries were removed. Medical records were reviewed to identify the cause of the calcium abnormality. Chi-squared analysis with Bonferroni adjustment was performed to compare frequencies of disease processes between mild and moderate-severe disturbances. Results: The database included 15,277 dogs and 3,715 cats. Hypercalcemia was identified in 1,641 dogs and 119 cats. The incidence of canine and feline hypercalcemia was 10.7 and 3.2%, respectively. Hypocalcemia was identified in 1,467 dogs and 450 cats. The incidence of canine and feline hypocalcemia was 9.6% and 12.1%, respectively. The most common pathologic causes of hypercalcemia in dogs were malignancy-associated (12.9%), parathyroid-dependent (4.6%) and hypoadrenocorticism (1.7%). In cats, malignancy-associated hypercalcemia (22.7%), kidney injury (13.4%) and idiopathic hypercalcemia (12.6%) were most common. Dogs presenting with moderate-severe hypercalcemia vs. mild hypercalcemia were significantly more likely to have hyperparathyroidism, malignancy-associated hypercalcemia or hypervitaminosis D, whereas cats were significantly more likely to have malignancy-associated hypercalcemia or idiopathic hypercalcemia. The most common pathologic causes of hypocalcemia in dogs were critical illness (17.4%), kidney injury (10.4%) and toxicity (7.5%). In cats, kidney injury (21.6%), urethral obstruction (15.1%), and critical illness (14.7%) were most frequent. Dogs presenting with moderate-severe hypocalcemia were significantly more likely to have hypoparathyroidism, kidney injury, eclampsia or critical illness, whereas cats were significantly more likely to have kidney injury, soft tissue trauma or urethral obstruction. Conclusions: Mild calcium disturbances are most commonly associated with non-pathologic or transient conditions. Malignancy-associated hypercalcemia is the most common cause of ionized hypercalcemia in dogs and cats. Critical illness and kidney injury are frequent causes of ionized hypocalcemia in both species.

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Section: Introductionmentioning

confidence: 99%

Severity of Ionized Hypercalcemia and Hypocalcemia Is Associated With Etiology in Dogs and Cats

2019

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“…A variety of human and animal disorders are associated with changes in serum tonicity [4, 5, 6, 7, 8]. Serum hypertonicity may serve as an early marker for several human disease states, including diabetes [9, 10, 11].…”

Section: Introductionmentioning

confidence: 99%

The mean cell volume difference (dMCV) reflects serum hypertonicity in diabetic dogs

Norris

Schermerhorn

2019

PLoS ONE

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Serum hypertonicity may develop during diabetes mellitus due to hyperglycemia and other biochemical changes. Hypertonicity may produce detrimental cellular and systemic effects and has been identified as a serum marker for some clinical disorders. In non-diabetic dogs, the mean cell volume difference, a novel erythrocyte measure, is increased by serum hypertonicity. However, it is not known whether hyperglycemic hypertonicity produces a similar change. The hypothesis that the mean cell volume difference could detect serum hypertonicity in diabetes was investigated in a group of thirty-two dogs with naturally-occurring diabetes mellitus that were prospectively recruited over a 1-year period from the outpatient population of a veterinary teaching hospital. The effect of hyperglycemia on the mean cell volume difference and the ability of the mean cell volume difference to predict serum hypertonicity were examined. Serum hyperosmolality and hypertonicity due to hyperglycemia was present in 91% and 94% of dogs, respectively. Hyperglycemia was the principal cause identified for serum hypertonicity and hyperosmolality. Using a cut-off value of ≥ 3 μm 3 for the mean cell volume difference, serum hypertonicity ≥ 320 mmol/kg was identified with 79% sensitivity and 61% specificity. The dMCV correlated with changes in serum glucose, tonicity, and measured osmolality. Dogs with a mean cell volume difference ≥ 3 μm 3 were at risk for serum tonicity ≥ 320 mmol/kg (risk ratio = 2.2) and serum glucose ≥ 13.9 mmol/L (risk ratio = 2.3). In conclusion, the mean cell volume difference is a useful surrogate marker for detecting serum hypertonicity in diabetic dogs and elevated mean cell volume difference is associated with increased risks for clinically relevant serum hypertonicity and hyperglycemia.

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“…Serum chloride disturbances are commonly observed in critically ill dogs with diverse disease etiologies. 1 , 2 While increased mortality has been related to serum chloride disturbances in dogs, 3 , 4 it remains unclear if this is reflective of the severity of primary underlying disease processes or if chloride plays an inherent role in disease progression. A recent abstract presented at the 2016 International Veterinary Emergency and Critical Care symposium found that the presence and severity of hospital-acquired hyperchloremia and hypochloremia in dogs and cats were associated with higher fatality rates than community-acquired chloride disturbances, 4 suggesting that in-hospital interventions may play a role in the morbidity and mortality related to dyschloremia in these species.…”

Section: Introductionmentioning

confidence: 99%

“…1 , 2 While increased mortality has been related to serum chloride disturbances in dogs, 3 , 4 it remains unclear if this is reflective of the severity of primary underlying disease processes or if chloride plays an inherent role in disease progression. A recent abstract presented at the 2016 International Veterinary Emergency and Critical Care symposium found that the presence and severity of hospital-acquired hyperchloremia and hypochloremia in dogs and cats were associated with higher fatality rates than community-acquired chloride disturbances, 4 suggesting that in-hospital interventions may play a role in the morbidity and mortality related to dyschloremia in these species. In human studies, it has been suggested the use of supraphysiologic intravenous chloride solutions, such as 0.9% saline (normal saline; NS), carries an increased risk of acute kidney injury (AKI), mortality, prolonged ICU stay, and hyperchloremic metabolic acidosis as compared to balanced crystalloid solutions.…”

Section: Introductionmentioning

confidence: 99%

<p>A Preliminary Investigation into the Association of Chloride Concentration on Morbidity and Mortality in Hospitalized Canine Patients</p>

Libin¹,

Weltman²,

Prittie³

2020

VMRR

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Purpose: To evaluate whole blood chloride concentration and hospital-acquired AKI in hospitalized canine patients. Secondary outcome measures included the volume-adjusted chloride load, in-hospital mortality and length of ICU stay. Patients and Methods: This is a prospective, observational study. Sixty dogs admitted to the ICU and receiving IV fluid therapy for >24 hours from February 2018 to July 2019. Corrected chloride and creatinine concentrations were obtained twice daily. Total volume of IV fluid and total chloride load were recorded. Volume-adjusted chloride load (VACL) was calculated by dividing the chloride administered by the volume of fluid administered. Hospital-acquired AKI was defined as an increase in creatinine of ≥26.5 μmol/L (0.3 mg/dL) or 150% from baseline to maximum. Survival to hospital discharge or non-survival and ICU length of stay were also recorded. Results: Fifteen out of 60 patients developed hospital-acquired AKI. Maximum corrected chloride was significantly different in AKI group (median 122.3 mmol/L) vs non-AKI group (median 118.1 mmol/L; p=0.0002). Six out of 60 patients developed hyperchloremia. Hyperchloremic patients were significantly more likely to develop in-hospital AKI (p=0.03). Patients hospitalized ≥2 days had a significantly higher [Cl − ] max compared to those with shorter ICU stay (121.8 ± 5.9 mmol/L vs 117.5 ± 4.3 mmol/L; p=0.002). Eight out of 60 patients were non-survivors. Maximum corrected chloride and creatinine concentrations were not significantly different between survivors and non-survivors. VACL was not significantly different between AKI or mortality groups. Conclusion: Maximum corrected chloride concentration was significantly higher in dogs with hospital-acquired AKI, even amongst dogs without hyperchloremia. Additionally, maximum corrected chloride concentrations were significantly higher in dogs hospitalized in the ICU longer compared to those hospitalized for fewer than two days. There was no significant difference in VACL in any of the outcome groups. Results from this study suggest alterations in chloride may be observed alongside the development of acute kidney injuries. Future studies in critically ill dogs are warranted.

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Electrolyte Disturbances Are Associated with Non-Survival in Dogs—A Multivariable Analysis

Cited by 21 publications

References 52 publications

Severity of Ionized Hypercalcemia and Hypocalcemia Is Associated With Etiology in Dogs and Cats

Severity of Ionized Hypercalcemia and Hypocalcemia Is Associated With Etiology in Dogs and Cats

The mean cell volume difference (dMCV) reflects serum hypertonicity in diabetic dogs

<p>A Preliminary Investigation into the Association of Chloride Concentration on Morbidity and Mortality in Hospitalized Canine Patients</p>

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