Hypertonic Saline Treatment of Severe Hyperkalemia in Nonnephrectomized Dogs

Kaplan, Justin L.; Eynon, C. Andrew; Dalsey, William C.; Braitman, Leonard E.; Clas, Dawn; Garavilla, Lawrence de

doi:10.1111/j.1553-2712.2000.tb02085.x

Cited by 10 publications

(7 citation statements)

References 29 publications

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“…Low sodium concentrations also decrease the amplitude and the rate of rise of phase 0 of the cardiac action potential and therefore probably exaggerate the cardiotoxic effect of hyperkalemia . This interrelation between increased c K + and low c Na + is of some therapeutic usefulness because the cardiotoxic effects of hyperkalemia can be rapidly reversed by increasing plasma c Na + , which has been demonstrated for hypertonic saline in hyperkalemic humans, dogs, and a diarrheic calf …”

Section: Discussionmentioning

confidence: 99%

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

Trefz

Lorenz

Constable

2018

Veterinary Internal Medicne

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BackgroundHyperkalemia in neonatal diarrheic calves can potentially result in serious cardiac conduction abnormalities and arrhythmias.ObjectivesTo document electrocardiographic (ECG) findings and the sequence of ECG changes that are associated with increasing plasma potassium concentrations (cK+) in a large population of neonatal diarrheic calves.AnimalsOne hundred and thirty neonatal diarrheic calves (age ≤21 days).MethodsProspective observational study involving calves admitted to a veterinary teaching hospital.ResultsHyperkalemic calves (cK+: 5.8‐10.2, blood pH: 6.55‐7.47) had significantly (P < .05) longer QRS durations as well as deeper S wave, higher T wave, and higher ST segment amplitudes in lead II than calves, which had both venous blood pH and cK+ within the reference range. The first ECG changes in response to an increase in cK+ were an increase in voltages of P, Ta, S, and T wave amplitudes. Segmented linear regression indicated that P wave amplitude decreased when cK+ >6.5 mmol/L, S wave amplitude voltage decreased when cK+ >7.4 mmol/L, QRS duration increased when cK+ >7.8 mmol/L, J point amplitude increased when cK+ >7.9 mmol/L, and ST segment angle increased when cK+ >9.1 mmol/L. P wave amplitude was characterized by a second common break point at cK+ = 8.2 mmol/L, above which value the amplitude was 0.Conclusions and Clinical ImportanceHyperkalemia in neonatal diarrheic calves is associated with serious cardiac conduction abnormalities. In addition to increased S and T wave amplitude voltages, alterations of P and Ta wave amplitudes are early signs of hyperkalemia, which is consistent with the known sensitivity of atrial myocytes to increased cK+.

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Section: Discussionmentioning

confidence: 99%

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

Trefz

Lorenz

Constable

2018

Veterinary Internal Medicne

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“…In general, hypertonic sodium‐containing infusion solutions such as 8.4% sodium bicarbonate or 7.2% sodium chloride (saline) have a sound physiologic basis in the initial treatment of affected calves as these solutions not only induce rapid plasma volume expansion and correct hyperkalemia, but they also enhance the redistribution of potassium ions into cells. Consequently, hypertonic sodium solutions can rapidly reverse the electrocardiographic manifestations of hyperkalemia,20 which has been demonstrated for hypertonic saline in hyperkalemic humans, dogs, and a calf 14, 21, 22. However, hypertonic saline might be inferior to hypertonic sodium bicarbonate as hypertonic saline does not correct the concomitant acidemia, which is usually present in affected calves.…”

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confidence: 99%

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

Trefz

Constable

Lorenz

2017

Veterinary Internal Medicne

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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.

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“…This was a secondary analysis of data collected during a study of induced hyperkalemia in a canine model. 4 Electrocardiographic parameters were used to predict serum potassium levels using an artificial neural network. The Animal Care Committee of the Albert Einstein Medical Center approved the protocol.…”

Section: Methodsmentioning

confidence: 99%

“…The animal protocol was described in detail in previous work. 4 Ten conditioned colony-bred dogs (14 to 20 kg, HRP, Inc., Denver, PA) underwent the same protocol in three separate experiments at least one week apart. On the day of the experiments, the animals were premedicated with thiopental (16 mg/kg IV).…”

Section: Methodsmentioning

confidence: 99%

Prediction of Hyperkalemia in Dogs from Electrocardiographic Parameters Using an Artificial Neural Network

Porter¹,

Kaplan²,

Zhao³

et al. 2001

Academic Emergency Medicine

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Abstract. Objective: To predict severe hyperkalemia from single electrocardiogram (ECG) tracings. Methods: Ten conditioned dogs each underwent this protocol three times: Under isoflurane anesthesia, 2 mEq/kg/hr of potassium chloride was given intravenously until P-waves were absent from the ECG and ventricular rates decreased Ն20% in Յ5 minutes. Serum potassium levels (K ϩ ) were measured at regular intervals with concurrent digital storage of lead II of the surface ECG. A three-layer artificial neural network with four hidden nodes was trained to predict K ϩ from 15 separate elements of corresponding ECG data. Data were divided into a training set and a test set. Sensitivity, specificity, and diagnostic accuracy for recognizing hyperkalemia were calculated for the test set based on a prospectively defined K ϩ = 7.5. Results: The model produced data for 189 events; 139 were placed in the training set and 50 in the test set. The test set had 37 potassium levels at or above 7.5 mmol/L. The neural network had a sensitivity of 89% (95% CI = 75% to 97%) and a specificity of 77% (95% CI = 46% to 95%) in recognizing these. The positive likelihood ratio was 3.87. Overall accuracy of this model was 86% (95% CI = 73% to 94%). Mean (ϮSD) difference between predicted and actual K ϩ values was 0.4 Ϯ 2.0 (95% CI = Ϫ0.2 to 1.0). Conclusions: An artificial neural network can accurately diagnose experimental hyperkalemia using ECG parameters.Further work could potentially demonstrate its usefulness in bedside diagnosis of human subjects. Key words: hyperkalemia; neural network; diagnosis; ECG. ACADEMIC EMERGENCY MEDICINE 2001; 8:599-603 H YPERKALEMIA is commonly seen in emergency department (ED) patients and may be associated with lethal dysrhythmias. While hyperkalemia is easily diagnosed by laboratory testing, the result may be unavailable for 45 to 120 minutes or more, unless the ED has the capability of bedside measurement of electrolytes, a practice that is still not widespread. During this time, the undiagnosed hyperkalemic patient may decompensate suddenly and without warning. Unanticipated decompensation of the clinically occult hyperka- Because of its key role in cardiac electrophysiology, hyperkalemia often results in surface electrocardiogram (ECG) changes such as peaked Twaves, low-amplitude P-waves, and increases in PR or QRS intervals. Since the ECG may be obtained at the bedside much more quickly than the results of blood testing, ECG findings have been used for rapid bedside diagnosis of hyperkalemia, 1 but there are limitations. Since hyperkalemic ECG abnormalities are nonspecific, diagnostic accuracy may be decreased by many false-positive results. Additionally, sensitivity acceptable for screening for a life-threatening condition has not been demonstrated. Wrenn et al.2 tested two experienced ED clinicians in evaluating 220 ECGs for the diagnosis of hyperkalemia. In this group there were 87 subjects (40%) with hyperkalemia, defined as K ϩ > 5.0 mmol/L. Twenty-nine of those 87 subjects had K ϩ > 6.5 mmol/L....

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Hypertonic Saline Treatment of Severe Hyperkalemia in Nonnephrectomized Dogs

Cited by 10 publications

References 29 publications

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

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

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

Prediction of Hyperkalemia in Dogs from Electrocardiographic Parameters Using an Artificial Neural Network

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