Clinical signs, diagnosis, and treatment of alkalemia in dogs: 20 cases (1982-1984)

Alkalemia (pH greater than 7.50) was measured in 20 dogs admitted over a 3-year period for various clinical disorders. Alkalemia was detected in only 2.08% of all dogs in which blood pH and blood-gas estimations were made. Thirteen dogs had metabolic alkalosis (HCO3- greater than 24 mEq/L, PCO2 greater than 30 mm of Hg), of which 8 had uncompensated metabolic alkalosis, and of which 5 had partially compensated metabolic alkalosis. Seven dogs had respiratory alkalosis (PCO2 less than 30 mm of Hg, HCO3- less than 24 mEq/L); 4 of these had uncompensated respiratory alkalosis and 3 had partially compensated respiratory alkalosis. Ten dogs had double or triple acid-base abnormalities. Dogs with metabolic alkalosis had a preponderance of clinical signs associated with gastrointestinal disorders (10 dogs). Overzealous administration of sodium bicarbonate or diuretics, in addition to anorexia, polyuria, or hyperbilirubinemia may have contributed to metabolic alkalosis in 8 of the dogs. Most of the dogs in this group had low serum K+ and Cl- values. Two dogs with metabolic alkalosis had PCO2 values greater than 60 mm of Hg, and 1 of these had arterial hypoxemia (PaO2 less than 80 mm of Hg). Treatments included replacement of fluid and electrolytes (Na+, K+, and Cl-), and surgery as indicated (8 dogs). Six dogs with respiratory alkalosis had a variety of airway, pulmonary, or cardiac disorders, and 3 of these had arterial hypoxemia. Two other dogs were excessively ventilated during surgery, and 1 dog had apparent postoperative pain that may have contributed to the respiratory alkalosis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Ventilatory and Metabolic Compensation in Dogs With Acid-Base Disturbances

Ventilatory and metabolic compensation to acid-base disturbances is reviewed. The mechanisms for compensation as well as the values obtained from several studies using normal dogs and dogs with experimentally induced diseases are provided. Compensation is not the same in dogs and human beings. Dogs have a better ability to adapt to most respiratory disorders, and human beings adapt better to metabolic acidosis. In metabolic alkalosis and chronic respiratory acidosis there is no difference in compensation between these species. Ventilatory compensation for metabolic disorders in dogs is the same whether they have metabolic acidosis or metabolic alkalosis, whereas metabolic compensation in respiratory disturbances is less effective in acidosis. Values for the expected changes in PCO₂ in dogs with metabolic acidosis and metabolic alkalosis, and for bicarbonate concentration (HCO₃-) in dogs with acute and chronic respiratory alkalosis and acidosis are presented.     

Simple acid-base disorders

The body regulates pH closely to maintain homeostasis. The pH of blood can be represented by the Henderson-Hasselbalch equation: pH = pK + log [HCO3-]/PCO2 Thus, pH is a function of the ratio between bicarbonate ion concentration [HCO3-] and carbon dioxide tension (PCO2). There are four simple acid base disorders: (1) Metabolic acidosis, (2) respiratory acidosis, (3) metabolic alkalosis, and (4) respiratory alkalosis. Metabolic acidosis is the most common disorder encountered in clinical practice. The respiratory contribution to a change in pH can be determined by measuring PCO2 and the metabolic component by measuring the base excess. Unless it is desirable to know the oxygenation status of a patient, venous blood samples will usually be sufficient. Metabolic acidosis can result from an increase of acid in the body or by excess loss of bicarbonate. Measurement of the "anion-gap" [(Na+ + K+) - (Cl- + HCO3-)], may help to diagnose the cause of the metabolic acidosis. Treatment of all acid-base disorders must be aimed at diagnosis and correction of the underlying disease process. Specific treatment may be required when changes in pH are severe (pH less than 7.2 or pH greater than 7.6). Treatment of severe metabolic acidosis requires the use of sodium bicarbonate, but blood pH and gases should be monitored closely to avoid an "overshoot" alkalosis. Changes in pH may be accompanied by alterations in plasma potassium concentrations, and it is recommended that plasma potassium be monitored closely during treatment of acid-base disturbances.     

Respiratory alkalosis: a quick reference.

This article serves as a quick reference for respiratory alkalosis. Guidelines for analysis and causes, signs, and a stepwise approach are presented.     

Contemporary approach to acid-base balance and its disorders in dogs and cats

The issue of the acid-base balance (ABB) parameters and their disorders in pets is rarely raised and analysed, though it affects almost 30% of veterinary clinics patients. Traditionally, ABB is described by the Henderson-Hasselbach equation, where blood pH is the resultant of HCO3- and pCO2 concentrations. Changes in blood pH caused by an original increase or decrease in pCO2 are called respiratory acidosis or alkalosis, respectively. Metabolic acidosis or alkalosis are characterized by an original increase or decrease in HCO3- concentration in the blood. When comparing concentration of main cations with this of main anions in the blood serum, the apparent absence of anions, i.e., anion gap (AG), is observed. The AG value is used in the diagnostics of metabolic acidosis. In 1980s Stewart noted, that the analysis of: pCO2, difference between concentrations of strong cations and anions in serum (SID) and total concentration of nonvolatile weak acids (Atot), provides a reliable insight into the body ABB. The Stewart model analyses relationships between pH change and movement of ions across membranes. Six basic types of ABB disorders are distinguished. Respiratory acidosis and alkalosis, strong ion acidosis, strong ion alkalosis, nonvolatile buffer ion acidosis and nonvolatile buffer ion alkalosis. The Stewart model provides the concept of strong ions gap (SIG), which is an apparent difference between concentrations of all strong cations and all strong anions. Its diagnostic value is greater than AG, because it includes concentration of albumin and phosphate. The therapy of ABB disorders consists, first of all, of diagnosis and treatment of the main disease. However, it is sometimes necessary to administer sodium bicarbonate (NaHCO3) or tromethamine (THAM).     

The use of the standard exercise test to establish the clinical significance of mild echocardiographic changes in a Thoroughbred poor performer

A 4-year-old Thoroughbred gelding racehorse was referred to the Onderstepoort Veterinary Academic Hospital (OVAH) with a history of post-race distress and collapse. In the absence of any obvious abnormalities in the preceding diagnostic work-up, a standard exercise test was performed to determine an underlying cause for the post-race distress reported. In this particular case oxygen desaturation became evident at speeds as slow as 6 m/s, where PO2 was measured at 82.3 mm Hg. Similarly at a blood pH of 7.28, PCO2 had dropped to 30.0 mm Hg indicating a combined metabolic acidosis and respiratory alkalosis. The cause of the distress was attributed to a severe hypoxia, with an associated hypocapnoea, confirmed on blood gas analyses, where PO2 levels obtained were as low as 56.6 mm Hg with a mean PCO2 level of 25.4 mm Hg during strenuous exercise. Arterial oxygenation returned to normal immediately after cessation of exercise to 106.44 mm Hg, while the hypocapnoeic alkalosis, PCO2 25.67 mm Hg, persisted until the animal's breathing normalized. The results obtained were indicative of a dynamic cardiac insufficiency present during exercise. The combination of an aortic stenosis and a mitral valve insufficiency may have resulted in a condition similar to that described as high-altitude pulmonary oedema, with respiratory changes and compensation as for acute altitude disease. The results obtained were indicative of a dynamic cardiac insufficiency present during exercise and substantiate the fact that an extensive diagnostic regime may be required to establish a cause for poor performance and that the standard exercise test remains an integral part of this work-up.     

Cardiopulmonary effects of controlled versus spontaneous ventilation in pigeons anesthetized for coelioscopy

OBJECTIVE: To evaluate the cardiorespiratory effects of controlled versus spontaneous ventilation in pigeons anesthetized for coelioscopy. DESIGN: Prospective study. ANIMALS: 30 healthy adult pigeons (Columbia livia). PROCEDURE: During isoflurane anesthesia, 15 pigeons were allowed to breathe spontaneously (SP group) and 15 were mechanically ventilated (MV group) by use of a pressure-limited ventilator. In each group, cardiopulmonary variables (including end-tidal CO2 concentration [ETCO2]) were measured before (baseline), during, and after coelioscopy. An arterial blood sample was collected for blood gas analyses from each pigeon before coelioscopy and after the procedure, when the caudal thoracic air sac was still open. RESULTS: At baseline, hypoventilation was greater in the SP group than the MV group. Compared with the SP group values, ETCO2 overestimated PaCO2 to a greater degree in the MV group. Cardiovascular variables were not different between groups. After coelioscopy (when the air sac was open), PaCO2 had decreased significantly from baseline in the MV group. In the SP group, hypoventilation worsened despite an increase in respiratory rate. After coelioscopy, PaO2 in the SP group had decreased from baseline and was lower than PaO2 in the MV group; arterial blood pressure and heart rate in the MV group had decreased from baseline and were lower than values in the SP group. CONCLUSIONS AND CLINICAL RELEVANCE: In adult pigeons, controlled ventilation delivered by a pressure-limited device was not associated with clinically important adverse cardiopulmonary changes but may be associated with respiratory alkalosis and cardiovascular depression when air sac integrity has been disrupted.     

Respiratory acid-base disorders.

Respiratory acid-base disorders, although infrequently diagnosed in veterinary medicine, can cause or contribute to adverse clinical outcomes. Recognition of the mechanisms and causes of respiratory acidosis and alkalosis can prompt clinical detection of the acid-base derangement, allowing for appropriate intervention.     

A comparison of the sedative and analgesic effects of buprenorphine in combination with acepromazine, midazolam or medetomidine in dogs

The effects of buprenorphine in combination with acepromazine, midazolam or medetomidine were compared in dogs. Induction and recovery times, heart rate, respiratory rate and body temperature were measured. Posture, reaction to noise, analgesia and muscle relaxation were assessed and a global score of "sedation-analgesia" was calculated. There were 3 groups of 4 animals: group 1 received 0.1 mg.kg-¹ acepromazine IM and 20 minutes later, 10 g.kg-¹ buprenorphine IV; group 2 received 1 mg.kg-¹ midazolam IV simultaneously with 10 ig.kg-¹ buprenorphine IV and group 3 received 1 mg/m² body surface area medetomidine IM and 20 minutes later, 10 Hg.kg-¹ buprenorphine IV. Only one dog given acepromazine and buprenorphine reached a "sedation-analgesia" stage, denned as the inability to stand together with the absence of reaction to stimulation, including pain. Animals in this group showed a decrease in respiratory rate and in body temperature. None of the dogs given midazolam and buprenorphine became sedated or showed signs of analgesia. Following this combination, the dogs were excited and showed dysphoric reactions which disappeared within 20 minutes.
All of the dogs given medetomidine and buprenorphine showed good sedation and analgesia lasting more than 20 minutes. This drug combination produced a decrease in heart and respiratory rates and body temperature.     

Responses of serum electrolytes of goats to twelve hours of road transportation during the hot-dry season in Nigeria, and the effect of pretreatment with ascorbic acid

Twenty goats which served as the experimental group were administered ascorbic acid (AA) per os at a dosage rate of 100 mg/kg body mass, while 20 others served as controls and were given 10 ml each of sterile water. Forty minutes after the administration and loading, the goats were transported for 12 h. Handling and loading of the experimental and control groups of goats decreased (P < 0.05) the potassium and sodium serum concentrations. The concentration of serum chloride, sodium and calcium increased significantly (P < 0.05) immediately post-transportation, while potassium and magnesium decreased (P < 0.05) in the control goats. In AA-treated goats sodium and magnesium concentrations decreased abruptly (P < 0.05), while calcium increased significantly (P < 0.05) after transportation. Handling, loading and transportation adversely affected the electrolyte balance of the goats which suggested respiratory alkalosis, dehydration and muscular damage in the transported goats, and the administration of AA alleviated the adverse effects of road transportation stress on serum electrolytes.     

Thermal panting and respiratory alkalosis in the laying hen

1. Changes in respiratory rate (f), rectal temperature (T_r ) and blood acid‐base values were measured in laying hens exposed to ambient temperatures (T_a) of 32, 35, 38 or 41 °G.

2. At T_a 32 °G there was no panting. At T_a 35 °G panting occurred without any increase in T_r but there was a slight alkalosis (pH 7.55).

3. At T_a 38 °G T_r increased and panting was accompanied by moderate alkalosis (pH 7.58).

4. At T_a 41 °G T_r increased considerably and severe alkalosis developed (pH 7.65).

5. From the relation between T_r , f and pH it is concluded that some degree of alkalosis is a normal response to panting in the laying hen.     

Treatment of heartwater: potential adverse effects of furosemide administration on certain homeostatic parameters in normal sheep

Diuretics, in particular furosemide, are generally recommended as a supportive treatment in the advanced stages of heartwater in ruminants. However, after what appeared to be possible adverse effects accompanying its use in field cases of heartwater, the effects of this drug on certain blood and urine parameters were investigated in normal sheep at the same dose rates. Diuresis with concomitant natriuresis was significant after furosemide administration, as was the expected plasma volume decrease. Other significant changes included metabolic alkalosis, hypokalaemia and reduced blood ionised calcium. The difference in duration of the diuretic effect and the duration of the changes in blood parameters from c. 3 h and c. 6 h respectively make it difficult to determine a time interval between successive treatments with furosemide. It appears that the probable cause of death of sheep with heartwater is a drastic reduction in blood volume and decreased cardiac output that leads to general circulatory failure. A therapeutic approach that involves further loss of plasma volume due to diuresis appears contradictory. The added effects of potentiating respiratory alkalosis and the terminal drop in blood ionised calcium seen in heartwater-affected animals indicate that the use of furosemide in supportive treatment of this disease is not warranted.     

Furosemide and sodium bicarbonate-induced alkalosis in the horse and response to oral KCl or NaCl therapy

Metabolic alkalosis was induced in 10 clinically normal horses by administration of furosemide (1 mg/kg of body weight, IM) followed 4.5 hours later by sodium bicarbonate (NaHCO3; 500 g in 8 L water) via nasogastric tube. Furosemide diuresis resulted in a mean weight loss of 21.1 kg, which was associated with small, but significant, increases in venous blood pH, bicarbonate, and plasma protein concentrations (P less than 0.001), while plasma potassium, chloride, and calcium concentrations declined significantly (P less than 0.001). Oral administration of the hypertonic NaHCO3 solution resulted in clinical evidence of hypovolemia, which was accompanied by a marked increase (P less than 0.001) in plasma protein concentration. Seven of the 10 horses developed signs of neuromuscular excitability, as evidenced by muscle fasciculations, and 5 of the horses developed diaphragmatic flutter. Hypernatremia was transiently induced, but it resolved as the horses were allowed access to water. The alkalosis induced by furosemide and NaHCO3 was profound and persisted for a 24-hour period and was associated with marked hypochloremia and hypokalemia. Partial replacement of the electrolyte deficits and correction of the metabolic alkalosis was attempted, using 1,000 mEq of NaCl or KCl given as an isotonic solution via nasogastric tube. In the KCl-treated group, there was a prompt and significant decline in venous blood pH and bicarbonate concentration (P less than 0.001) accompanied by a significant increase in plasma potassium concentration (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Paradoxic aciduria in bovine metabolic alkalosis.

Cows with metabolic alkalosis secondary to abomasal displacement and other abomasal disorders were often found to excrete acidic urine. This paradoxic aciduria contradictsthe classical view that the pH of the urine may be used to estimate the acid-base status of the body. Data from bovine clinical patients with metabolic alkalosis, serum electrolyte changes, and paradoxic aciduria suggested that the balance of sodium potassium, and chloride in the body places limits on the kidneys' ability to regulate the acid-basebalance.     

A proposal of clinical breakpoints for amoxicillin applicable to porcine respiratory tract pathogens

In the present position paper, an attempt was made to establish clinical breakpoints of amoxicillin to classify porcine respiratory tract pathogens as susceptible, intermediate or resistant based on their minimum inhibitory concentrations of amoxicillin. For this, a thorough review of the published literature with regard to swine-specific pharmacological data (including dosages of amoxicillin applied and routes of administration used), clinical efficacy, and in vitro susceptibility of the target pathogens was performed. Based on the comparative analysis of the results, the working group "Antibiotic Resistance" of the German Veterinary Medical Society (DVG) proposed to classify porcine respiratory tract pathogens that show MIC values of amoxicillin of < or =0.5microg/ml as "susceptible", those with MICs of 1microg/ml as "intermediate", and those with MICs of > or =2microg/ml as "resistant".     

Effect of a quadrivalent vaccine against respiratory virus on the incidence of respiratory disease in weaned beef calves

We investigated the effect of vaccination of male beef calves (mean age+/-S.D.: 158+/-31 days) against bovine herpes virus (BHV-1 or IBR virus), bovine respiratory syncitial virus (BRSV), bovine viral diarrhea (BVD) virus and para-influenza (PI(3)) virus on the incidence of respiratory disease during the first forty days after weaning and entering a feed-lot in Portugal. In May 2003, Mertolenga, Preta and mixed-breed calves from 10 different beef herds, were systematically assigned (by order of entrance in a chute) to two treatment groups, before moving to a common feed-lot. One hundred and twenty five male calves were vaccinated with a quadrivalent vaccine (Rispoval 4) and revaccinated after 21-27 days while 148 herdmates were injected with saline (0.9% NaCl) on the same occasions. The incidence and severity of clinical cases of "bovine respiratory disease" (BRD) were evaluated every day during the first 40 days after entering the feed-lot. Morbidity (3% vs. 14%) and mortality (0% vs. 4%) due to BRD were significantly lower in the vaccinated group. Ten days after revaccination, the calves were treated with an antimicrobial - ending the study - after an outbreak of BRD caused a high incidence of disease in the non-vaccinated group. In conclusion, our results showed that Rispoval 4, a quadrivalent vaccine against respiratory viruses, under field conditions, reduces morbidity and mortality due to BRD in beef calves after weaning.     

NH_4Cl和NaHCO_3对肉用仔鸡慢性热应激的影响

３２０ 羽１ 周龄健康肉用雏鸡被随机分成４ 组, 经１ 周的适应后进行试验。组Ⅰ、组Ⅱ、组Ⅲ和组Ⅳ的日粮处理分别为： 基础日粮（Ｂ, 对照组） , Ｂ＋ ０－５ ％ ＮａＨＣＯ３ , Ｂ＋ ０－５ ％ ＮａＨＣＯ３ ＋ １ ％ ＮＨ４Ｃｌ 和Ｂ＋ １ ％ ＮＨ４Ｃｌ。试验为期５ 周。研究日粮中添加ＮａＨＣＯ３ 和ＮＨ４Ｃｌ 对慢性热应激肉用仔鸡的血液ｐＨ、ＣＯ２ 分压（ＰＣＯ２） 及生产性能的影响。结果表明： 在慢性热应激（２３ ～３５ ℃） 条件下, 肉用仔鸡未发生呼吸性碱中毒, 组Ⅱ的血液ＰＣＯ２高于对照组（ Ｐ＜ ０－０１） , 增重比对照组多９－４９ ％ ; 组Ⅲ血液ｐＨ 低于组Ⅰ和组Ⅱ（ Ｐ ＜ ０－０１） , 血液的ＰＣＯ２ 高于组Ⅰ和组Ⅳ（ Ｐ ＜ ０－０１） , 增重比对照组多８－１９％ 。组Ⅳ的血液ｐＨ 值极显著低于对照组（ Ｐ ＜ ０－０１） , 比对照组少增重２－５ ％     

Changes in blood gas, acid-base and metabolic parameters in horses during three-day event competition

Sixteen horses competing in a three-day event had venous blood samples collected during the speed and endurance test (day 2) to examine changes in blood gas ands acid-base balance, and the concentrations of lactate, pyruvate, beta-hydroxybutyrate, acetoacetate, alpha-ketoglutarate and cortisol. Following the roads and tracks and steeplechase phases there was a significant metabolic and respiratory alkalosis despite a rise in lactate. After completion of the cross country section, although there was a significant decrease in total base, there was no significant change in pH from pre-event values. This was because the decrease in total base was accompanied by a concomitant fall in carbon dioxide levels.