Electrolyte/Acid-Base

Question 1

Rate of Na change should not exceed what mEq/day?

Answer 1

12 mEq/L per day

Question 2

acid-base parameters that could necessitate Na bicarb administration

Answer 2

pH less than 7.2 or HCO3 < 12 mEq/L - ensure patient is not dehydrated

Question 3

Water requirements for dogs can increase during exercise or hot days. T/F?

Answer 3

True - JVIM 2018

Question 4

Tetrastarch causes dilutional coagulopathy at similar volumes to LRS with similar severity. T/F?

Answer 4

False - tetrastarch causes similar dilutional coagulopathy as LRS but at lower volumes JVIM 2018

Question 5

Components of refeeding syndrome in cats?

Answer 5

Hypophosphatemia (8/11), HYPOKALEMIA (all cats), hypomagnesemia, altered glucose homeostasis (can be hi or lo); neurologic deficits (8/11) (JFMS 2021)

Question 6

Acidosis or alkalosis was more common in dogs with hypoadrenocorticism? What % of dogs had acid-base abnormalities as determined by semi-quantitative approach.

Answer 6

Acidosis (metabolic); 100% of dogs had acid-base abnormalities by semi-quantitative approach (more so than the traditional approach)- JVECC 2021. Acidosis due to free water deficit was present in all dogs.

Question 7

The semiquantitative approach evaluates which ions in determining acid base status?

Answer 7

Serum free water (marked by serum sodium concentration), chloride, albumin, phosphate, and plasma lactate concentrations
Hypoalbuminemia, hypochloridemia - alkalinizing
Hyperphosphatemia, hyponatremia, hyperlactemia - acidifying (JVECC 2021)

Question 8

Using traditional acid-base approach, which acid-base abnormality was most common in dogs with parvoviral enteritis?

Answer 8

Metabolic acidosis with compensatory respiratory alkalosis (JVIM 2020)

Question 9

What was specificity of TP > 3 in pleural fluid and abdominal fluid to determine exudate vs nonexudate?

Answer 9

100% (pleural), 94% (abdominal) - JAVMA 2016

sensitivity of refractometry was 77% for pleural fluid and 80% for abdominal fluid

Question 10

Hemodiluted samples are likely to have a falsely increased/decreased glucose on glucometer, and the opposite was true in hemoconcentrated samples in cats.

Answer 10

increased - JAVMA 2019

Question 11

Can you do an overnight fast for kittens > 8w without worrying about hypoglycemia?

Answer 11

Yes - JFMS 2018

Question 12

Did transmucosal oral corn syrup increase glucose in kittens?

Answer 12

No - JFMS 2018

Question 13

What were incidences of coagulopathy and peritoneal effusion in severe anaphylaxis?

Answer 13

85.2% and 65.5% - not indicative of survival (JAVMA 2020)

Question 14

A dilutional hyponatremia may still occur in a hypovolemic animal. T/F? Why / why not?

Answer 14

True - through secretion of ADH and angiotensin II (JVECC 2019 review) [in this case the fractional excretion of Na in urine would be very low]

Question 15

Urine [Na] of euvolemic patients is expected to be over how much?

Answer 15

> 30 mmol/L (JVECC 2019 review)

Question 16

Mechanisms of hyponatremia in hypoadrenocorticism:

Answer 16

Cortisol deficiency leading to uninhibited release of ADH NOT aldosterone deficiency alone (or maybe even at all)- JVECCS 2019 review (also gives some good sources to back up)

Question 17

Ddx for hypervolemic hyponatremia?

Answer 17

CHF, kidney disease, hepatic cirrhosis

Question 18

Can fractional excretion of Na be used in patients with intrinsic renal disease?

Answer 18

No

Question 19

Timeline for osmotic demyelination?

Answer 19

Initial neurologic improvement, followed by progressive/irreversible deficits 1-several days later

Question 20

How to calculate sodium deficit?

Answer 20

Sodium deficit = TBW * (Normal [Na] - Patient [Na]), TBW = 0.6 * lean body weight in kg

Question 21

K supplementation with Na supplementation will do what to Na levels?

Answer 21

Increase them (faster?, unsure) - because administration of K will result in intracellular intake of K with EXTRAcellular output of Na. Thus this needs to be considered when you are correcting Na and also administering K. (there is an equation for this but I feel like we shouldn’t need to know it…?)

Question 22

Norm-R and Plasmalyte will generally do what changes to plasma pH?

Answer 22

Increase (but likely not significant unless large volumes) - JVIM 2017

Question 23

The ability of sodium bicarbonate solution administration to produce CNS and intracellular acidosis is dose and rate related. T/F?

Answer 23

True - JVIM 2017

Question 24

Rough equation to calculate strong ion difference?

Answer 24

Na-Cl. Should be about 20 meq/L normally. High = metabolic alkalosis, low = metabolic acidosis

Question 25

Reduction of plasma bicarbonate is consistent with proximal or distal RTA?

Answer 25

Proximal RTA

Question 26

Alkali therapy worsens hypokalemia with which RTA?

Answer 26

Proximal RTA

Question 27

Why is sodium bicarb not recommended for respiratory acidosis?

Answer 27

Exacerbates hypercapnia by donating substrate for the carbonic acid equation

Question 28

Main differentials for hyperchloremic metabolic acidosis?

Answer 28

RTA, severe diarrhea, loss of intestinal bicarb, admin of alkali-free chloride containing IV solution

Question 29

Equation for bicarb admin

Answer 29

mEq = 0.3 x BW in kgs x base deficit OR 0.6 x BW (kg) x (desired bicarb - measured bicarb))

Question 30

Main differentials for metabolic alkalosis

Answer 30

Loss of extracellular fluid (upper GI fluid loss or sequestration); thiazide diuretic; hyperaldosteronism; NaBicarb admin (excessive)

Question 31

Hypertonic saline should not be administered faster than 1 ml/kg/min to avoid what consequence?

Answer 31

Vagally mediated bradycardia (and potential cardiopulmonary arrest)

Question 32

Is vitamin B complex enough for an animal with documented thiamine or cobalamin deficiency?

Answer 32

No

Question 33

Magnesium is not compatible with solutions containing

Answer 33

Sodium bicarb or calcium