Angelos S M, Smith B P, George L W, House J K, Van Metre D C, Fecteau G, Thacker V C, Angelos J A
Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan 66506, USA.
J Am Vet Med Assoc. 1999 May 1;214(9):1364-7, 1335.
A 7-day-old Jersey calf was evaluated because of diarrhea and pneumonia. The calf was hypernatremic, hypoproteinemic, and acidemic, and was treated initially with i.v. administration of fluids with sodium concentration (175 mEq/L) similar to the calf's serum sodium concentration. Sodium concentration of the administered fluids was gradually decreased over the following days, but the calf's serum sodium concentration decreased too rapidly, and the calf developed neurologic signs attributed to cerebral edema. Treatment with mannitol and i.v. administration of fluids with a higher concentration of sodium resulted in abatement of clinical signs. In calves, hypernatremia may develop over several days. Prescribing traditional isotonic or hypotonic fluids in such cases will be harmful, because during chronic hypernatremia, the brain's adaptive mechanisms involve accumulation of organic osmoles that may take several days to equilibrate across cell membranes, and cerebral edema may result. Administration of fluids containing sodium concentration approximately equal to the patient's measured serum sodium concentration is required to decrease serum sodium concentration more slowly than is possible with traditional isotonic fluids.
一头7日龄的泽西犊牛因腹泻和肺炎接受评估。该犊牛出现高钠血症、低蛋白血症和酸血症，最初通过静脉输注钠浓度（175 mEq/L）与犊牛血清钠浓度相似的液体进行治疗。在接下来的几天里，所输注液体的钠浓度逐渐降低，但犊牛的血清钠浓度下降过快，犊牛出现了归因于脑水肿的神经学症状。使用甘露醇治疗并静脉输注钠浓度更高的液体后，临床症状得到缓解。在犊牛中，高钠血症可能在数天内发展。在这种情况下开具传统的等渗或低渗液体是有害的，因为在慢性高钠血症期间，大脑的适应性机制涉及有机渗透溶质的积累，这可能需要数天时间才能在细胞膜间达到平衡，进而可能导致脑水肿。需要输注钠浓度大致等于患者测得的血清钠浓度的液体，以使血清钠浓度下降的速度比使用传统等渗液体时更慢。
