Philp Helen S, Epstein Steven E, Hopper Kate
Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States.
Front Vet Sci. 2025 May 19;12:1563031. doi: 10.3389/fvets.2025.1563031. eCollection 2025.
To describe and compare the traditional and semiquantitative acid-base status of dogs with immune-mediated hemolytic anemia (IMHA) and hypokalemia to those with normokalemia.
Medical records of dogs with IMHA from a single institution over a 10-year period from January 1st, 2012 to December 31st, 2021 were retrospectively reviewed. Dogs were included if they met diagnostic criteria for IMHA based on the 2019 ACVIM consensus guidelines and had at least 1 blood potassium concentration measurement performed within 24 h of initial presentation. The dogs were divided into normokalemic and hypokalemic groups. Hypokalemia was categorized as mild (3-3.5 mEq/L [3-3.5 mmmol/L]), moderate (2-2.9 mEq/L [2-2.9 mmol/L]), or severe (<2 mEq/L [<2 mmol/L]). Population data, clinicopathologic data, and outcome were collected and recorded. Traditional and semiquantitative acid-base diagnoses were attributed to patients with sufficient data.
305 client-owned dogs with IMHA met the inclusion criteria. 186 dogs (61.0%) were normokalemic and 119 (39.0%) were hypokalemic (blood potassium concentration ≤ 3.5 mEq/L [≤ 3.5 mmol/L]) on presentation. The median blood potassium concentration in the hypokalemic group was 3.2 mEq/L (3.2 mmol/L) (interquartile range: 2.8-3.4 mEq/L [2.8-3.4 mmol/L]). Hypokalemia was mild in 78/119 (65.5%) dogs, moderate in 40/119 (33.6%) and severe in 1/119 (0.84%) cases. Metabolic acidosis was the most common traditional acid-base disorder identified in both normokalemic (26/82, 31.7%) and hypokalemic (44/92, 47.8%) dogs but the proportion was significantly higher in the hypokalemic group ( = 0.03). The semiquantitative approach identified acid-base abnormalities in 82/83 (98.8%) hypokalemic dogs. The most common abnormalities among the hypokalemic group were an unmeasured ion effect (74/83, 89.2%) and an alkalotic albumin effect (69/83, 83.1%). In the normokalemic group, the semiquantitative approach identified acid-base abnormalities in 62/63 (98.4%) dogs with unmeasured ions (55/63, 87.3%) and an alkalotic albumin effect (42/63, 66.7%) being the most common. Survival to discharge was significantly lower in the hypokalemic dogs (85/119, 71.4%) compared to the normokalemic population (163/186, 87.6%) ( = 0.02).
Hypokalemia is common in dogs with IMHA within the first 24 h of presentation and is associated with a variety of acid-base abnormalities. Hypokalemic dogs with IMHA appear more likely to develop metabolic acidosis and less likely to survive to hospital discharge.
描述并比较免疫介导性溶血性贫血（IMHA）伴低钾血症的犬与血钾正常犬的传统酸碱状态和半定量酸碱状态。
回顾性分析2012年1月1日至2021年12月31日期间一家机构10年内患有IMHA的犬的病历。若犬符合基于2019年美国兽医内科学会（ACVIM）共识指南的IMHA诊断标准，且在初次就诊后24小时内至少进行过1次血钾浓度测量，则纳入研究。将犬分为血钾正常组和低钾血症组。低钾血症分为轻度（3 - 3.5 mEq/L [3 - 3.5 mmol/L]）、中度（2 - 2.9 mEq/L [2 - 2.9 mmol/L]）或重度（<2 mEq/L [<2 mmol/L]）。收集并记录总体数据、临床病理数据及转归情况。为有足够数据的患者进行传统和半定量酸碱诊断。
305只客户拥有的患有IMHA的犬符合纳入标准。就诊时，186只犬（61.0%）血钾正常，119只犬（39.0%）低钾血症（血钾浓度≤3.5 mEq/L [≤3.5 mmol/L]）。低钾血症组血钾浓度中位数为3.2 mEq/L（3.2 mmol/L）（四分位间距：2.8 - 3.4 mEq/L [2.8 - 3.4 mmol/L]）。119只犬中78只（65.5%）为轻度低钾血症，40只（33.6%）为中度，1只（0.84%）为重度。代谢性酸中毒是血钾正常犬（26/82，31.7%）和低钾血症犬（44/92，47.8%）中最常见的传统酸碱紊乱，但低钾血症组比例显著更高（P = 0.03）。半定量方法在82/83只（98.8%）低钾血症犬中识别出酸碱异常。低钾血症组最常见的异常是未测定离子效应（74/83，89.2%）和碱性白蛋白效应（69/83，83.1%）。在血钾正常组，半定量方法在62/63只（98.4%）犬中识别出酸碱异常，未测定离子（55/63，87.3%）和碱性白蛋白效应（42/63，66.7%）最为常见。与血钾正常犬（163/186，87.6%）相比，低钾血症犬出院存活率（85/119，71.4%）显著降低（P = 0.02）。
低钾血症在IMHA犬初次就诊的前24小时内很常见，且与多种酸碱异常相关。患有IMHA的低钾血症犬似乎更易发生代谢性酸中毒，且出院存活率较低。
