Hypochloremia in cats – prevalence and associated diseases

Background: Hypochloremia associated with congestive heart failure (CHF) in dogs is likely multifactorial. Loop diuretics cause 1:2 sodium [Na + ]:chloride [Cl − ] loss, whereas water retention causes a 1:1 [Na + ]:[Cl − ] dilution. Mathematical [Cl − ] correction separates these effects on [Cl − ]. Hypothesis: We hypothesized that corrected [Cl − ] (c[Cl − ]) would not differ from measured [Cl − ] (m[Cl − ]) in dogs with controlled CHF because of loop diuretics, and dogs with refractory CHF would have higher c[Cl − ] than m[Cl − ], indicating relative water excess. Animals: Seventy-one client-owned dogs with acquired heart disease, without CHF (NO-CHF), 76 with Stage C CHF and 24 with Stage D CHF. Methods: Clinicopathological data from a previous study were retrospectively analyzed. Corrected [Cl − ], m[Cl − ], and differences were compared among NO-CHF, Stage C CHF, and Stage D CHF, using the formula: c[Cl − ] = (mid-reference range [Na + ]/ measured [Na + ]) × m[Cl − ]. Results: Corrected [Cl − ] and m[Cl − ] were lower in Stage D vs Stage C and NO-CHF (all P < .0001). The c[Cl − ] was higher than m[Cl − ] in Stage D (P < .0001) but not Stage C or NO-CHF. Median difference between c[Cl − ] and m[Cl − ] was higher for Stage D vs Stage C (P = .0003). No hypochloremic Stage D dogs had normal c[Cl − ], but 11/24 had [Cl − ] that was increased by >2 mmol/L. Conclusions and Clinical Importance: Serum [Cl − ] increased after mathematical correction in Stage D CHF dogs but not in Stage C and NO-CHF dogs. Although c[Cl − ] was higher than m[Cl − ] in Stage D dogs supportive of relative water excess, hypochloremia persisted, consistent with concurrent loop diuretic effects on electrolytes. Future study correlating c[Cl − ] to antidiuretic hormone concentrations is warranted. Abbreviations: [Na + ], sodium concentration; ACVIM, American College of Veterinary Medicine; ADH, antidiuretic hormone; c[Cl − ], corrected chloride concentration; CHF, congestive heart failure; m[Cl − ], measured chloride concentration.

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Glargine versus regular insulin protocol in feline diabetic ketoacidosis

Zeugswetter

Luckschander-Zeller

Karlovits

et al. 2021

J Vet Emergen Crit Care

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Objectives: To determine whether basal-bolus administration of glargine insulin is a safe and effective alternative treatment compared to the standard continuous rate infusion (CRI) protocol. Design: Prospective randomized clinical trial.Setting: University teaching hospital. Animals: Twenty cats diagnosed with diabetic ketoacidosis (DKA).Interventions: The cats were block-randomized to either a CRI protocol using regular insulin (CRI-group; n = 10) or a basal-bolus SC and IM glargine protocol (glarginegroup, n = 10). Baseline blood gases, electrolytes, glucose, and β-hydroxybutyrate (β-OHB) concentrations were measured at the time of admission and later at predefined intervals until reaching the primary endpoint of the study, defined as a βhydroxybutyrate concentration < 2.55 mmol/L. Measurements and main results:The main outcome measure was time (h) to resolution of ketonemia. Secondary outcome measures were time until first improvement of hyperglycemia and ketonemia, decrease of glucose to ≤13.9 mmol/L (250 mg/dL), resolution of acidosis, consumption of first meal, and discharge from hospital. Additionally, occurrence of treatment-associated adverse events and death were compared. Seventeen cats (85%) survived to discharge, with no difference in survival between groups (P = 1.0). Median times to β-OHB < 2.55 mmol/L were 42 (CRI-group) and 30 (glarginegroup) hours, respectively (P = 0.114). Median times to first improvement of hyperglycemia (glargine-group: 2 h; CRI-group: 6 h; P = 0.018) and until discharge from hospital (glargine-group: 140 h; CRI-group: 174 h; P = 0.033) were significantly shorter in the glargine-group. No significant differences were observed in any other parameter under investigation (P > 0.05).

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Hypochloremia in cats – prevalence and associated diseases

Abstract: Hypochloremia should prompt the clinician to performe blood-gas analysis. Diabetes mellitus (especially ketoacidosis) and renal disease should be included in current algorithms for the evaluation of hypochloremic patients.

Cited by 3 publications

References 35 publications

Electrolyte Evaluation

Electrolyte Evaluation

Correction of serum chloride concentration in dogs with congestive heart failure

Glargine versus regular insulin protocol in feline diabetic ketoacidosis

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