University of Florida, College of Veterinary Medicine, Gainesville, Florida, USA.
North Carolina State University, College of Veterinary Medicine, Raleigh, North Carolina, USA.
J Vet Intern Med. 2021 Jan;35(1):51-57. doi: 10.1111/jvim.15998. Epub 2020 Dec 11.
Hypochloremia associated with congestive heart failure (CHF) in dogs is likely multifactorial. Loop diuretics cause 1:2 sodium [Na ]:chloride [Cl ] loss, whereas water retention causes a 1:1 [Na ]:[Cl ] dilution. Mathematical [Cl ] correction separates these effects on [Cl ].
We hypothesized that corrected [Cl ] (c[Cl ]) would not differ from measured [Cl ] (m[Cl ]) in dogs with controlled CHF because of loop diuretics, and dogs with refractory CHF would have higher c[Cl ] than m[Cl ], indicating relative water excess.
Seventy-one client-owned dogs with acquired heart disease, without CHF (NO-CHF), 76 with Stage C CHF and 24 with Stage D CHF.
Clinicopathological data from a previous study were retrospectively analyzed. Corrected [Cl ], m[Cl ], and differences were compared among NO-CHF, Stage C CHF, and Stage D CHF, using the formula: c[Cl ] = (mid-reference range [Na ]/measured [Na ]) × m[Cl ].
Corrected [Cl ] and m[Cl ] were lower in Stage D vs Stage C and NO-CHF (all P < .0001). The c[Cl ] was higher than m[Cl ] in Stage D (P < .0001) but not Stage C or NO-CHF. Median difference between c[Cl ] and m[Cl ] was higher for Stage D vs Stage C (P = .0003). No hypochloremic Stage D dogs had normal c[Cl ], but 11/24 had [Cl ] that was increased by >2 mmol/L.
Serum [Cl ] increased after mathematical correction in Stage D CHF dogs but not in Stage C and NO-CHF dogs. Although c[Cl ] was higher than m[Cl ] in Stage D dogs supportive of relative water excess, hypochloremia persisted, consistent with concurrent loop diuretic effects on electrolytes. Future study correlating c[Cl ] to antidiuretic hormone concentrations is warranted.
与充血性心力衰竭（CHF）相关的低氯血症在犬中可能是多因素的。袢利尿剂导致 1:2 钠[Na]：氯[Cl]丢失，而水潴留导致 1:1 [Na]：[Cl]稀释。数学[Cl]校正可将这些对[Cl]的影响分开。
我们假设由于袢利尿剂，患有控制良好的 CHF 的犬的校正[Cl]（c[Cl]）与测量[Cl]（m[Cl]）之间不会有所不同，而患有难治性 CHF 的犬的 c[Cl]将高于 m[Cl]，表明存在相对水过剩。
71 只患有获得性心脏病且无 CHF（NO-CHF）的患犬，76 只患有 C 期 CHF 的犬和 24 只患有 D 期 CHF 的犬。
回顾性分析了先前研究的临床病理数据。使用公式 c[Cl] =（中参考范围[Na] /测量[Na]）×m[Cl]，比较 NO-CHF、C 期 CHF 和 D 期 CHF 之间的校正[Cl]、m[Cl]和差异。
与 C 期 CHF 和 NO-CHF 相比，D 期的校正[Cl]和 m[Cl]均较低（均 P <.0001）。与 C 期和 NO-CHF 相比，D 期的 c[Cl]高于 m[Cl]（均 P <.0001）。与 C 期相比，D 期 c[Cl]和 m[Cl]之间的差异更高（P =.0003）。没有低氯血症的 D 期犬的 c[Cl]正常，但 24 只犬中有 11 只的[Cl]增加了> 2 mmol/L。
在 D 期 CHF 犬中，血清[Cl]在数学校正后增加，但在 C 期和 NO-CHF 犬中则没有。尽管 D 期犬的 c[Cl]高于 m[Cl]，支持相对水过剩，但低氯血症仍然存在，这与电解质同时存在的袢利尿剂作用一致。未来研究需要将 c[Cl]与抗利尿激素浓度相关联。
