Goggs Robert, Myers Marc, De Rosa Sage, Zager Erik, Fletcher Daniel J
Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States.
MedVet Columbus, Worthington, OH, United States.
Front Vet Sci. 2017 Aug 2;4:122. doi: 10.3389/fvets.2017.00122. eCollection 2017.
Disorders of chloride and mixed acid-base disturbances are common in veterinary emergency medicine. Rapid identification of these alterations and the presence of unmeasured anions aid prompt patient assessment and management. This study aimed to determine in dogs and cats if site-specific reference values for [Cl]:[Na] ratio and [Na] - [Cl] difference accurately identify corrected chloride abnormalities and to evaluate the predictive ability of the [Cl]:[Na] ratio for the identification of unmeasured anions. A database containing 33,117 canine, and 7,604 feline blood gas and electrolyte profiles was generated. Institution reference intervals were used to calculate site-specific reference values for the [Cl]:[Na] ratio and the [Na] - [Cl] difference. Contingency tables were used to assess the ability of these values to correctly identify corrected chloride disorders. Unmeasured anions were estimated by calculating strong ion gap (SIG). Continuous variables were compared using the Mann-Whitney test. Correlations between continuous variables were assessed using Spearman's rho (). In dogs, site-specific reference values for the [Cl]:[Na] ratio correctly identified 94.6% of profiles as hyper-, normo-, or hypochloremic. For dogs with normal sodium concentrations, site-specific reference values for the [Na] - [Cl] difference correctly identified 97.0% of profiles. In dogs with metabolic acidosis (base deficit > 4.0), [Cl]:[Na] ratio and SIG were moderately but significantly negatively correlated ( -0.592, < 0.0001). SIG was significantly greater in dogs with metabolic acidosis and hypochloremia compared to those without hypochloremia ( < 0.0001). In cats, site-specific reference values for the [Cl]:[Na] ratio correctly identified 93.3% of profiles as hyper-, normo-, or hypochloremic, while site-specific reference values for [Na] - [Cl] difference correctly identified 95.1% of profiles. In cats with metabolic acidosis [Cl]:[Na] ratio and SIG were moderately significantly negatively correlated ( -0.730, < 0.0001). SIG was significantly greater in cats with metabolic acidosis and hypochloremia compared to those without hypochloremia ( < 0.0001). Site-specific values for [Cl]:[Na] ratio and [Na] - [Cl] difference accurately identify corrected chloride disorders in both dogs and cats and may aid identification of the presence of unmeasured anions.
氯紊乱和混合性酸碱紊乱在兽医急诊医学中很常见。快速识别这些变化以及未测定阴离子的存在有助于对患者进行及时评估和管理。本研究旨在确定犬猫中 [Cl]:[Na] 比值和 [Na] - [Cl] 差值的特定部位参考值是否能准确识别校正后的氯异常，并评估 [Cl]:[Na] 比值对识别未测定阴离子的预测能力。生成了一个包含33117份犬类和7604份猫类血气及电解质分析资料的数据库。使用机构参考区间来计算 [Cl]:[Na] 比值和 [Na] - [Cl] 差值的特定部位参考值。列联表用于评估这些值正确识别校正后氯紊乱的能力。通过计算强离子间隙（SIG）来估计未测定阴离子。连续变量使用曼-惠特尼检验进行比较。连续变量之间的相关性使用斯皮尔曼等级相关系数（）进行评估。在犬中，[Cl]:[Na] 比值的特定部位参考值正确识别了94.6%的分析资料为高氯血症、正常氯血症或低氯血症。对于钠浓度正常的犬，[Na] - [Cl] 差值的特定部位参考值正确识别了97.0%的分析资料。在代谢性酸中毒（碱缺失 > 4.0）的犬中，[Cl]:[Na] 比值与SIG呈中度但显著的负相关（ = -0.592， < 0.0001）。与无低氯血症的犬相比，代谢性酸中毒合并低氯血症的犬的SIG显著更高（ < 0.0001）。在猫中，[Cl]:[Na] 比值的特定部位参考值正确识别了93.3%的分析资料为高氯血症、正常氯血症或低氯血症，而 [Na] - [Cl] 差值的特定部位参考值正确识别了95.1%的分析资料。在代谢性酸中毒的猫中，[Cl]:[Na] 比值与SIG呈中度显著负相关（ = -0.730， < 0.0001）。与无低氯血症的猫相比，代谢性酸中毒合并低氯血症的猫的SIG显著更高（ < 0.0001）。[Cl]:[Na] 比值和 [Na] - [Cl] 差值的特定部位值能准确识别犬猫校正后的氯紊乱，并可能有助于识别未测定阴离子的存在。
