Veterinary Medicine - January 2008 - (Page 17)

in inadequate water intake, pure water loss, or water loss in excess of sodium.6 Hypernatremia may also develop as the result of excessive intake of sodium (e.g. large amounts of sorbitol and glycol products such as paintball pellets, homemade play dough, salt water) or decreased renal excretion.5,7 The high concentrations of both sodium and chloride in the bleach coupled with dehydration likely resulted in the moderate to marked serum elevations of these electrolytes in our patients. The elevated anion gap hyperchloremic metabolic acidosis identiﬁed in the dogs was likely caused by multiple factors. It was partially attributed to a developing lactic acidosis, which is also observed in people who have consumed large quantities of sodium hypochlorite bleach.1 The accumulation of uremic acids from developing renal insufﬁciency may also have contributed to the elevated anion gap metabolic acidosis in these dogs. In addition to supplying large amounts of sodium and chloride, ingested sodium hypochlorite initiates chemical reactions that result in the perpetuation of hyperchloremia, consumption of bicarbonate, and development of a hyperchloremic metabolic acidosis (Figure 1).1 Further, the high serum chloride concentrations may promote urinary excretion of bicarbonate through direct ion exchange mechanisms in the kidney.1,8 The high chloride content in the intestinal ﬂuid may also interfere with exchange mechanisms at the intestinal luminal membrane, resulting in bicarbonate loss,1,9 which is further exacerbated by diarrhea. Additional biochemical abnormalities. The dogs’ elevated BUN, creatinine, phosphorus, and magnesium concentrations were all consistent with renal insufﬁciency, particularly given the development of oliguria in the male dog despite aggressive ﬂuid therapy. However, urine was not obtained for a complete urinalysis, and a combination of renal azotemia with a prerenal component due to dehydration was likely. The elevated BUN concentrations may have also partially been the result of hemorrhage into the gastrointestinal tract since bleach ingestion has been associated with erosive lesions in the oropharynx, esophagus, and stomach from the product’s caustic nature and alkalinity (pH of about 11.4).2 The female’s hyperglycemia was attributed to a stress response. The alterations in the calcium concentrations in the dogs were particularly perplexing (i.e. hypercalcemia in the female and hypocalcemia in the male). The underlying cause for these abnormalities was not readily apparent, and alterations of calcium concentrations are VETERINARY MEDICINE January 2008 17 http://www.wedgewoodpharmacy.com/refresh http://www.wedgewoodpharmacy.com/refresh http://healthcare.goarmy.com/info/vclpar http://healthcare.goarmy.com/info/vclpar

Table of Contents Feed for the Digital Edition of Veterinary Medicine - January 2008

Veterinary Medicine - January 2008 Contents Digital Extra Letters Toxicology Brief Idea Exchange A Challenging Case: Phimosis in a Young Adult Dog The Indications and Technique for Continuous Ambulatory Electrocardiographic Recording in Dogs A Review of Selected Systemic Antifungal Drugs for Use in Dogs and Cats CE Form Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - January 2008

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