The Veterinary clinics of North America. Small animal practice
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Vet. Clin. North Am. Small Anim. Pract. · May 1998
ReviewFluid therapy in the hypoproteinemic patient.
Hypoproteinemia can result in many adverse consequences, including hypovolemia and the formation of edema. An understanding of the normal forces governing plasma will help the clinician tailor appropriate fluid therapy in these patients. Various fluids that can be used including crystalloids, colloids, and blood products will be discussed.
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Correcting fluid deficits and preventing fluid overload in patients with cardiac disease can be challenging. The purpose of the fluid therapy, the projected duration of the therapy, and the type of heart disease affecting the patient play important roles in the decision-making process. In addition, the distinction between patients who are not symptomatic (NYHA Class I) and those who are symptomatic (NYHA Classes II to IV) for their cardiac disease should be made early in fluid therapy planning.
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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.