Emergency management of hyperkalemia in dogs and cats - Part 2: Diagnosis and treatment.

PubMed · 2026-05-01

Objective: Hyperkalemia in dogs and cats can cause rapid cardiac and neuromuscular compromise. Fast recognition, ECG-guided stabilization, and cause-directed therapy improve survival. Animals and procedure: Part 2 of this 2-part review gives a patient-side approach for recognition, confirmation, and emergency treatment of hyperkalemia. It integrates current veterinary evidence and core physiology into step-by-step guidance for ECG interpretation, point-of-care testing, drug selection, and monitoring. It also maps 1st-hour priorities to common etiologies such as urethral obstruction and hypoadrenocorticism. Results: agonists serve as adjuncts, and bicarbonate is reserved for severe acidemia. Potassium elimination follows with balanced crystalloids and, when needed, renal replacement therapy. After initial stabilization, durable correction depends on identifying and treating the underlying cause and removing excess potassium from the body. Close glucose surveillance prevents late hypoglycemia after insulin. For urethral obstruction, prompt unblocking and fluids often normalize potassium with little need for repeat shifting drugs. For Addisonian crisis, fluids and glucocorticoids correct the driver while potassium decreases. Conclusion and clinical relevance: Use a consistent sequence: Verify true hyperkalemia, protect the heart, shift potassium, remove potassium, and fix the cause. Pair ECG findings with serum potassium concentrations to guide action, since ECG stages do not always match absolute potassium concentrations. This approach helps emergency clinicians stabilize patients quickly and avoid relapse. Part 1 of this review covered homeostasis and causes, whereas Part 2 delivers diagnostic and treatment approaches.

Emergency management of hyperkalemia in dogs and cats - Part 1: Pathophysiology and etiology.

PubMed · 2026-04-01

Objective: Hyperkalemia is a frequent, life-threatening emergency in dogs and cats. It disrupts neuromuscular function and cardiac conduction. Clinicians need a clear physiologic framework to recognize risk and act quickly. Animals and procedure: Part 1 of this 2-part review explains potassium homeostasis and the main causes of hyperkalemia in small animals. The article draws on peer-reviewed veterinary studies and core physiology, with direct patient-side relevance. Results: -adrenergic tone, and acid-base effects; and renal control through filtration, distal sodium delivery, tubular flow, and mineralocorticoid effect. Common clinical causes include decreased renal excretion (feline urethral obstruction, oligoanuric acute kidney injury, canine hypoadrenocorticism); transcellular shifts from intracellular to extracellular spaces (diabetic ketoacidosis, mineral metabolic acidosis, extensive tissue injury); increased intake or iatrogenic load when excretion is limited (potassium chloride in IV fluids, older stored blood, drugs that reduce aldosterone effect or distal sodium delivery); and pseudohyperkalemia due to sample factors (hemolysis, marked thrombocytosis or leukocytosis, anticoagulant contamination). Conclusion and clinical relevance: Evaluate hyperkalemia in the full clinical context. In dogs, common causes include hypoadrenocorticism, acute kidney injury, and urinary tract obstruction or rupture. In cats, urethral obstruction and advanced renal failure predominate, whereas iatrogenic potassium load and severe metabolic acidosis are additional concerns. A firm grasp of both pathophysiology and etiology improves differential diagnosis and early decisions. Part 2 of this review will build on this foundation and outline diagnosis and treatment.

Median blood lactate values are elevated in dogs presenting with acute seizure activity: 2014–2024

American Journal of Veterinary Research · 2025-06-20

Objective: To establish the expected presenting blood lactate values in dogs with acute seizure activity. The secondary goal was to compare lactate values between dogs presenting for a single seizure (SSG) or cluster seizures (CSG) or in status epilepticus (SEG). Methods: In this retrospective observational study, the electronic medical record at a university small animal hospital was queried for dogs with acute seizures (within 24 hours of presentation) with a blood lactate measurement within 2 hours of presentation between January 1, 2014, and October 31, 2024. Data related to seizure type, lactate values, patient vital parameters, and other blood parameters (if available) were extracted. Dogs with incomplete medical records were excluded. Results: 88 dogs were included in 95 presentation events. The median age was 6 years, 5 months; 52 events involved female dogs, and 43 events involved male dogs. Twenty-two dogs made up the SSG, 51 dogs made up the CSG, and 22 dogs made up the SEG. The majority (72.6%) of dogs had a high lactate value on presentation (median values: SSG, 2.7 mmol/L; CSG, 3.1 mmol/L; and SEG, 4.65 mmol/L). Status epilepticus dogs had a statistically significantly elevated body temperature (median, 39.4 °C) compared to the SSG (38.8 °C); there were no statistically significant differences in blood glucose, lactate, or blood pH between groups. Conclusions: Median lactate values were elevated in all groups at presentation, but there was no statistical difference between groups. The median temperature was elevated in the SEG. Clinical Relevance: This study provides expected lactate values in dogs with acute seizure activity.

Administration of high-dose intravenous vitamin C in healthy dogs transiently leads to a false increase in portable blood glucose monitor and interstitial glucose monitor readings

American Journal of Veterinary Research · 2025-06-16

Objective: To investigate the effects of high-dose IV vitamin C (HDIVC) on handheld portable blood glucose monitor (PBGM) and interstitial glucose monitor (IGM) readings in dogs. Methods: 6 client-owned Border Collies with normal physical examinations and baseline bloodwork were enrolled in this prospective experimental study from November through December 2024. Glucose was measured via an IGM, PBGM, and laboratory blood glucose analyzer (LG) at time (T)-0, T1, T2, T3, T6, T12, T18, and T24 hours after HDIVC (200 mg/kg; ascorbic acid 500 mg/mL diluted 1:10 with sterile water, given over 30 minutes, IV). Results: The median PBGM (T1, 189 mg/dL; T2, 138 mg/dL) and IGM (T1, high; T2, 321 mg/dL) readings were significantly higher than LG (T1, 76.5 mg/dL; T2, 93.5 mg/dL) at T1 and T2. The median IGM (183 mg/dL) readings were significantly higher than LG (99 mg/dL) at T3. There was no significant difference between modalities at T0 nor from T6 on. On consensus error grid analysis, all PBGM readings at T1 and 1 of 6 readings at T2 were clinically unacceptable. All IGM readings at T1 and T2 and 2 of 6 readings at T3 were clinically unacceptable. Conclusions: A 200-mg/kg, IV, bolus of vitamin C in healthy dogs causes clinically significant elevations in PBGM and IGM glucose readings that normalize within 3 and 6 hours, respectively. Clinical Relevance: Avoid the use of PBGM and IGM until 3 and 6 hours, respectively, after HDIVC in healthy dogs.

Ultrasonic Doppler as a guide for feline peripheral arterial catheterization

Journal of Feline Medicine and Surgery · 2024-08-01

Objectives The study aimed to determine if an ultrasonic Doppler-guided technique (UDGT) leads to improved placement efficacy (time, success) of feline dorsal pedal arterial catheters vs the traditional palpation-guided technique (TPT). Methods A total of 26 adult, client-owned cats requiring sedation or general anesthesia for any reason, aged >12 months and weighing >3.0 kg, and with Doppler blood pressure measurements of at least 80 mmHg were enrolled. Each hindlimb was randomly assigned for dorsal pedal arterial catheterization using either the UDGT or TPT. With the UDGT, the location of the artery was identified by an audible sound using the Doppler. Successful catheter placement was confirmed by visualization of an arterial pressure waveform using a transducer and monitor system attached to the catheter. The Kaplan–Meier method and log-rank test were used to compare the two techniques. Results The overall proportion of successful arterial catheterization was 17% (9/52): 19% (5/26) via UDGT and 15% (4/26) via TPT. Among successful arterial catheterizations (n = 9), the mean time to catheterization was 339 ± 198 s: 328 ± 237 s (n = 5) with UDGT and 353 ± 171 s (n = 4) with TPT. The log-rank test showed the two techniques were not significantly different in likelihood of successful arterial catheter placement or time to successful catheterization ( P = 0.698). An arterial flash occurred in 62% (32/52) of the limbs, 58% (15/26) with the UDGT and 65% (17/26) with the TPT. Complications (self-limiting bruising, hematoma formation) were observed equally between UDGT (3/26 limbs) and TPT (3/26 limbs) in six cats. Conclusions and relevance The UDGT did not improve the efficacy of catheter placement compared with the TPT. Few complications were associated with arterial catheterization.

Analgesia and sedation of emergency/intensive care unit patients

2024-09-27

Are you looking for a comprehensive guide to the anesthetic and analgesic protocols for emergency and intensive care unit (ICU) patients? This chapter provides an overview of the key topics, including monitoring techniques for triage and subsequent ICU monitoring, common ICU emergencies, analgesic and sedation protocols for ICU emergencies and pros and cons of short- and long-term use of opioids. By reading this chapter, you will understand the importance of monitoring for ICU patients. This chapter is essential reading for anyone who cares for ICU patients. It provides the information you need to safely and effectively manage the pain and sedation of these patients.

Emergency Approach to Acute Seizures in Dogs and Cats

Veterinary Sciences · 2024 · 19 citations

• Medicine
• Intensive care medicine
• Pediatrics

Seizures are a common presentation seen in small animal practices. Seizures require prompt management including initial interventions for triage, stabilization, and treatment with first-line anticonvulsant (AC) drugs like benzodiazepines. Concurrently, ruling out metabolic or extracranial causes with point-of-care diagnostics can help guide further diagnostics and treatments. Analysis of the history and a physical exam are also necessary to rule out common "look-alikes" that require specific diagnostic workup and treatments. Typically, causes of seizures can be grouped into intracranial and extracranial causes, with the latter being easier to diagnose with commonly available tests. This review presents a systematic approach to the diagnosis and treatment of single seizures, cluster seizures, and status epilepticus in dogs and cats.

Smoke Inhalation in Veterinary Patients: Pathophysiology, Diagnosis, and Management

Journal of the American Animal Hospital Association · 2024-09-01 · 1 citations

Smoke contains a mixture of harmful gases, chemicals, and superheated particles. Inhalation of smoke causes generalized hypoxia and airway inflammation due to impaired oxygen transport and utilization, as well as thermal and chemical injury in the airways. Generally, treatment is supportive with oxygen therapy and airway management, including chest physiotherapy, bronchodilators, and nebulization. Immediate oxygen therapy is mandatory for all suspected smoke inhalation patients and should not be delayed pending diagnostic test results or due to "normal" oxygen saturation readings that can be falsely elevated in carbon monoxide intoxication. Smoke inhalation patients with mild clinical signs who respond well to initial stabilization generally have a favorable prognosis. However, patients with severe signs or progression despite initial stabilization may require more advanced or intensive care.

Comparison of 4 point‐of‐care techniques to detect correct positioning of nasogastric tubes in dogs (2020–2021)

Journal of Veterinary Emergency and Critical Care · 2023-08-10 · 9 citations

OBJECTIVE: To compare 4 point-of-care (POC) techniques to assess nasogastric (NG) tube placement versus radiographs as a reference standard. POC methods included air inflation with auscultation, fluid aspiration with pH measurement, ultrasonography, and capnography. DESIGN: Prospective observational study in hospitalized dogs between 2020 and 2021. SETTING: University teaching hospital. ANIMALS: Fifty-one dogs requiring NG tube placement as part of their normal care. INTERVENTIONS: After standard blind NG tube placement, each POC method was performed following standardized instructions. All POC methods were scored as to whether the investigator believed the tube to be in the gastrointestinal tract (as indicated by positive auscultation of borborygmus during insufflation, positive fluid aspiration with pH ≤5, presence of hyperechoic shadow in the esophagus, or absence of capnographic waveform). Subsequently, radiographs were taken to determine NG tube position as a gold standard. The sensitivity, specificity, and accuracy of each test as compared to 2-view thoracic radiographs were determined. MEASUREMENTS AND MAIN RESULTS: Sensitivity, specificity, and accuracy for each POC technique were as follows: air auscultation (84.4%, 50.5%, and 80.4%, respectively), neck ultrasound (95.6%, 83.3%, and 94.1%, respectively), capnography (91.1%, 33.3%, and 84.3%, respectively), and fluid aspiration with pH measurement (22.2%, 100%, and 31.4%, respectively). CONCLUSIONS: Among the 4 techniques evaluated, neck ultrasound had the best overall performance for assessing NG tube placement. Fluid aspiration with pH measurement might also have potential due to perfect specificity, but its clinical utility may be limited by low sensitivity and accuracy. Nonetheless, 2-view thoracic radiography should still be considered the standard method for confirmation of NG tube placement as none of the 4 POC techniques investigated showed both high sensitivity and perfect specificity.

Clinical Assessment of Primary Hemostasis: A Review

Topics in companion animal medicine · 2023-09-01 · 2 citations