The Veterinary clinics of North America. Small animal practice
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The goal of treatment for all types of shock is the improvement of tissue perfusion and oxygenation. The mainstay of therapy for hypovolemic and septic shock is the expansion of the intravascular volume by fluid administration, including crystalloids, colloids, and blood products. Frequent physical examinations and monitoring enable the clinician to determine the adequacy of tissue oxygenation and thus the success of the fluid therapy.
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The occurrence of hypocalcemia is well documented in clinical veterinary medicine. In this article, we have attempted to provide an overview of the established causes as well as information on more recently recognized etiologies such as the ionized hypocalcemia seen in cats with urethral obstruction and the presence of the disorder in critically ill patient populations. Hypomagnesemia has been identified as the most common electrolyte abnormality in canine and feline critically ill patients. ⋯ Dhupa, BVM, MRCVS, unpublished observations, 1997). Although cardiac arrythmias are associated with hypomagnesemia in human patients, documentation of this association in veterinary patients is lacking. Because hypomagnesemia has been associated with other electrolyte abnormalities in human and veterinary populations, the detection of hypokalemia (particularly if refractory to therapy), hyponatremia, hypophosphatemia, or hypocalcemia should indicate the possibility of coexisting hypomagnesemia.
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Vet. Clin. North Am. Small Anim. Pract. · May 1998
ReviewClinical disorders of potassium homeostasis. Hyperkalemia and hypokalemia.
Potassium plays an important role in cell metabolism and membrane excitability. Disorders of potassium balance can have profound clinical effects, particularly on the cardiovascular and neuromuscular systems. Chronic hyperkalemia invariably results from impaired renal potassium excretion. ⋯ Treatment is usually directed at correcting the defect in potassium excretion. Hypokalemia has become closely linked with in cats. Clinical signs include muscle weakness and renal dysfunction, which usually respond well to oral potassium supplementation.
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Vet. Clin. North Am. Small Anim. Pract. · Mar 1998
ReviewTreatment of endotoxic shock: glucocorticoids, lazaroids, nonsteroidals, others.
Review of the literature would indicate that a therapy inhibiting a single step in the inflammatory mediator cascade, although potentially beneficial, cannot serve as the "magic bullet" in endotoxic shock. Thus, combination therapy using drugs that target multiple steps in the mediator cascade may prove useful in the future. Until controlled clinical studies have been performed in veterinary medicine using the agents discussed in this manuscript (or others), many questions will remain regarding the best possible pharmacologic therapies to use in supplementing traditional supportive care (e.g., fluids, broad-spectrum antimicrobials) measures. ⋯ Therapies that may hold promise for the patient with established endotoxic shock possibly include the lazaroids, certain NSAIDs, pentoxifylline, and selective inhibitors of iNOS activity. Although still controversial, methylprednisolone and other glucocorticoids are probably best reserved for the patient at risk for endotoxic shock, or those identified very early in the course of endotoxemia and endotoxic shock, and should never be used in conjunction with NSAIDs. Since no one therapy is likely to provide the "magic bullet" for the patient in endotoxic shock, treatment may ultimately involve combination therapy using some of these drugs that target different pathways and mediators and may also include antibodies against endotoxin or its mediators.
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Appropriate fluid therapy requires an understanding of fluid dynamics and pathologic alterations during various disease states. In addition, it requires an understanding of the pharmacologic differences of available fluids. ⋯ Blood products are used to replace blood components and coagulation proteins. Frequent monitoring and reassessment are required to prevent volume overload and life-threatening edema.