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.

Use of artificial intelligence for veterinary triage: a promising tool but with limitations in the emergency setting

Veterinary Record · 2026-01-16

IN recent years, concepts once only spoken of in the context of science fiction have rapidly become a reality in our daily lives. For example, asking a computer to link ideas and draw conclusions from the data entered is something we used to see only on Star Trek. However, the use of artificial intelligence (AI) now forms part of many people's daily routines. With the increasing use of AI in everything from drafting emails to data searches and summarising research papers, AI has inevitably made its way into the veterinary medical field. Indeed, a quick search of the veterinary literature shows AI being used for a wide range of applications, including radiograph interpretation,1 development of diagnostic methods in oncology,2 screening for endocrine disease3 and medical record transcription.4 In each of these situations, the use of AI has strong potential to improve or augment existing human-based techniques, but it also has limitations and still requires human oversight. Research in the field of human medicine has demonstrated the potential of AI tools to support triage processes. However, the use of AI tools in veterinary triage has been little investigated. To this end, a recent study by Wong and colleagues, summarised on p 84 of this issue of Vet Record, evaluated the performance of AI models (specifically ChatGPT-3.5 and ChatGPT-4.0) for triaging canine emergency cases.5 The findings of this study raise several concerns, the primary of which is that if the AI model misses between 7 and 17 per cent of cases that require immediate evaluation and is no more accurate than a trained veterinary nurse, then there does not seem to be a strong reason to use it in place of standard triage techniques. In response to this, Wong and colleagues argue that AI's best place might be as a complementary tool to augment veterinary nurses' triage and improve detection of the most urgent cases.5 A further concern is that Wong and colleagues' findings5 would be very difficult to apply to a real-world emergency clinic. In contrast to a real-world setting, where rapid decision making is crucial, the individuals retrospectively performing triage in this investigation did not have a time limit; this immediately calls the findings into question. Would these individuals have triaged differently ‘in the moment’ than they did when retrospectively evaluating information from the medical records? Additionally, the veterinarians and veterinary nurses participating in this study were operating from a set of standard written findings.5 In a real-world setting, individuals may evaluate clinical findings differently (eg, a dog might be deemed obtunded by one operator and quiet-alert-responsive by another). Also, factors such as how the patient interacts with their environment and the history being given simultaneously by the owner during triage may influence clinical assessments. However, these factors could not be considered in this study due to its retrospective nature. Finally, it is unclear how AI triage would be applied in a real-world setting. Would a client enter data into the computer, followed by further data entry from a triage staff member? Would a veterinary nurse perform triage and then enter data to see whether the AI agreed with them? In cases that require immediate treatment, such as animals in respiratory distress, the time required to manually enter the information may potentially have severe consequences for the animal's welfare. In conclusion, the AI models used in Wong and colleagues' paper do not appear to significantly improve triage performance relative to triage by trained veterinary professionals.5 I also believe that the interface currently required to use the AI (ie, typing data into a questionnaire) is not practical within a busy emergency clinic; the time taken to enter the data could literally be the difference between life and death for a severely sick animal. Does this mean that AI will not continue to evolve and that a functional holographic doctor (straight out of Star Trek) who can assess a patient and apply an algorithm to not only triage but also treat a patient is not on the horizon? No. However, at this point in time, while AI has potential, it is not yet a tool that is ready for routine use in veterinary emergency medicine.

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.

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.

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.

Basic triage in dogs and cats: Part III.

PubMed · 2024-04-01

Background: Emergency cases can be presented at any time of the day or night. All small animal practitioners need to have the skills to triage and stabilize common emergency cases, even if the ultimate goal is to refer the animal to another facility. Objective and procedure: The third and final part of this 3-part review article series discusses arrhythmias typical in emergency cases and the approach to animals that are presented with an inability to stand up and walk normally. A stepwise method to categorize and stabilize these cases is outlined, along with helpful tips to optimize the referral experience, if indicated. Results: Recognizing and knowing how to treat tachy- and bradyarrhythmias is important in stabilizing a dog's or cat's condition. Understanding how to differentiate the various reasons that a dog or cat is unable to stand on its own allows a veterinarian to both treat and communicate outcome expectations for those animals. Conclusion and clinical relevance: Do not refer emergent cases before basic stabilization is completed. Many emergency cases can either be worked up by the primary veterinarian or sent to a referral clinic on an appointment basis after appropriate stabilization steps have occurred.

Basic triage in dogs and cats: Part I.

PubMed · 2024 · 3 citations

• Humanities
• Medicine
• Medical emergency

Background: Emergency cases can present at any time of the day or night. All small animal practitioners need to have the skills to triage and stabilize common emergency cases even if they ultimately aim to refer the patient to another facility. Objectives and procedures: The first part of this 3-part review article series covers respiratory distress and seizures. A stepwise approach to categorize and stabilize these cases is outlined, along with helpful tips to optimize the referral experience, if indicated. Results: Having a strong methodical approach to animals in respiratory distress optimizes treatment. Similarly, achieving cessation of seizures, along with having a good understanding of the causes of seizures, allows for patient stabilization. Conclusion and clinical relevance: Do NOT refer emergent cases before completing basic stabilization. Many emergency cases do not require emergent referral and can be worked up by the primary veterinarian or sent to a referral clinic on an appointment basis after appropriate stabilization steps are completed.

Basic triage in dogs and cats: Part II.

PubMed · 2024-03-01

Background: Emergency cases can be presented at any time of the day or night. All small animal practitioners need to have the skills to triage and stabilize common emergency cases, even if cases are ultimately referred to another facility. Objective and procedure: The second part of this 3-part review article series discusses animals that collapse at home as well as dogs and cats with bleeding. A stepwise approach to categorize and stabilize these cases is outlined, along with helpful tips to optimize the referral experience, if indicated. Results: Having a robust and methodical approach to animals that collapse is important for many emergency cases, as the causes and treatment methods vary. Bleeding can lead to acute death if left untreated and knowing the steps to stop bleeding is important for patient stabilization. Conclusion and clinical relevance: Do not refer emergent cases before completing basic stabilization. Many emergency cases do not require emergent referral and can be worked up by the primary veterinarian or sent to a referral clinic on an appointment basis after appropriate stabilization steps have occurred.

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.

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.