Trefz F M, Constable P D, Lorenz I
Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, LMU Munich, Oberschleißheim, Germany.
College of Veterinary Medicine, University of Illinois, Urbana-Champaign, IL.
J Vet Intern Med. 2017 May;31(3):907-921. doi: 10.1111/jvim.14709. Epub 2017 Apr 13.
Hyperkalemia is a frequently observed electrolyte imbalance in dehydrated neonatal diarrheic calves that can result in skeletal muscle weakness and life-threatening cardiac conduction abnormalities and arrhythmias.
Intravenous administration of a small-volume hypertonic NaHCO solution is clinically more effective in decreasing the plasma potassium concentration (cK) in hyperkalemic diarrheic calves than hypertonic NaCl or glucose solutions.
Twenty-two neonatal diarrheic calves with cK >5.8 mmol/L.
Prospective randomized clinical trial. Calves randomly received either 8.4% NaHCO (6.4 mL/kg BW; n = 7), 7.5% NaCl (5 mL/kg BW; n = 8), or 46.2% glucose (5 mL/kg BW; n = 7) IV over 5 minutes and were subsequently allowed to suckle 2 L of an electrolyte solution. Infusions with NaHCO and NaCl provided an identical sodium load of 6.4 mmol/kg BW.
Hypertonic NaHCO infusions produced an immediate and sustained decrease in plasma cK. Hypertonic glucose infusions resulted in marked hyperglycemia and hyperinsulinemia, but cK remained unchanged for 20 minutes. Between 30 and 120 minutes after initiation of treatment, the most marked decrements in cK from baseline occurred in group NaHCO , which were significantly (P < .05) larger during this period of time than in calves in group NaCl, but not group glucose. After 120 minutes, the mean decrease in cK from baseline was -26 ± 10%, -9 ± 8%, and -22 ± 6% in groups NaHCO , NaCl, and glucose, respectively.
CONCLUSIONS/CLINICAL IMPORTANCE: Small-volume hypertonic NaHCO infusions appear to have clinical advantages for the rapid resuscitation of hyperkalemic diarrheic calves, compared to hypertonic NaCl or glucose solutions.
高钾血症是脱水的新生腹泻犊牛中常见的电解质失衡，可导致骨骼肌无力以及危及生命的心脏传导异常和心律失常。
静脉注射小剂量高渗碳酸氢钠溶液在降低高钾血症腹泻犊牛的血浆钾浓度（cK）方面比高渗氯化钠或葡萄糖溶液在临床上更有效。
22头cK>5.8 mmol/L的新生腹泻犊牛。
前瞻性随机临床试验。犊牛随机接受8.4%碳酸氢钠（6.4 mL/kg体重；n = 7）、7.5%氯化钠（5 mL/kg体重；n = 8）或46.2%葡萄糖（5 mL/kg体重；n = 7）静脉注射5分钟，随后允许其吸吮2 L电解质溶液。注射碳酸氢钠和氯化钠提供相同的钠负荷6.4 mmol/kg体重。
高渗碳酸氢钠注射使血浆cK立即且持续下降。高渗葡萄糖注射导致明显的高血糖和高胰岛素血症，但cK在20分钟内保持不变。在治疗开始后30至120分钟之间，cK从基线的最大降幅出现在碳酸氢钠组，在此时间段内该降幅显著（P <.05）大于氯化钠组犊牛，但不大于葡萄糖组。120分钟后，碳酸氢钠组、氯化钠组和葡萄糖组cK从基线的平均降幅分别为-26±10%、-9±8%和-22±6%。
结论/临床意义：与高渗氯化钠或葡萄糖溶液相比，小剂量高渗碳酸氢钠注射在高钾血症腹泻犊牛的快速复苏方面似乎具有临床优势。
