Cover
Title Page
List of Contributors
Foreword
About the Companion Website
CHAPTER 1: Introduction to Acid‐Base and Electrolytes
1. Introduction to acid‐base
2. What is acidity?
3. Introduction to electrolytes
4. Osmolality and osmolarity
5. The anion gap
6. Conclusion
7. References
CHAPTER 2: Disorders of Sodium
1. Physiology
2. Clinical assessment of sodium derangements
3. Hyponatremia
4. Hypernatremia
5. References
CHAPTER 3: Disorders of Chloride
1. Physiology of chloride
2. Hyperchloremia
3. Hypochloremia
4. References
CHAPTER 4: Disorders of Potassium
1. Regulation of potassium
2. Hypokalemia
3. Hyperkalemia
4. Acid‐/Base disturbances and potassium
5. Summary
6. References
7. Further reading
CHAPTER 5: Disorders of Magnesium
1. Disorders of magnesium
2. Hypomagnesemia
3. Hypermagnesemia
4. References
CHAPTER 6: Disorders of Phosphorus
1. Disorders of phosphorus
2. Regulation of phosphorus
3. Measurement of phosphorus
4. Hypophosphatemia
5. Hyperphosphatemia
6. Hypoparathyroidism
7. References
CHAPTER 7: Disorders of Calcium
1. Physiology of calcium
2. Hypocalcemia
3. Hypercalcemia
4. References
CHAPTER 8: Traditional Acid‐Base Physiology and Approach to Blood Gas
1. Introduction
2. Overview of acid‐base
3. Buffer systems
4. Respiratory acidosis
5. Respiratory alkalosis
6. The anion gap
7. Base excess
8. Tips and tricks for acid‐base
9. Summary
10. References
CHAPTER 9: Metabolic Blood Gas Disorders
1. Acid‐base review pertaining to metabolic blood gas disorders
2. Simple versus mixed acid‐base disorders
3. Compensatory responses
4. Metabolic alkalosis
5. Metabolic acidosis
6. Prognosis of metabolic acid‐base derangements
7. References
CHAPTER 10: Respiratory Acid‐Base Disorders
1. The respiratory system
2. Disorders of oxygenation
3. References
CHAPTER 11: Mixed Acid‐Base Disorders
1. Review and overview of mixed disorders (Figure 11.1)
2. Compensation (Table 11.1)
3. Compensatory responses of respiratory disorders
4. Compensatory responses of metabolic disorders
5. The anion gap and chloride’s role (Box 11.1)
6. Steps in evaluating for mixed acid‐base disorders
7. Effects of mixed disorders on pH
8. Specific diseases known to cause mixed disorders (Box 11.2)
9. Treatment
10. Sampling errors
11. Conclusion
12. References
CHAPTER 12: Strong Ion Approach to Acid‐Base
1. Henderson–Hasselbalch: Overview of traditional approach to acid‐base
2. Stewart’s strong ion approach to acid‐base
3. Strong ion difference [SID]
4. Affects of [A_TOT]
5. Carbon dioxide and strong ion approach
6. Compensation
7. Simplified approaches to strong ion?
8. Strong ion gap (SIG)
9. References
CHAPTER 13: Companion Exotic Animal Electrolyte and Acid‐Base
1. Sample collection methods
2. Sample collection storage
3. Basic blood gas analysis of exotic species
4. Alternatives to blood gas analysis
5. Exotic small mammals
6. Birds
7. Reptiles
8. Amphibians
9. Fish
10. Conclusion
11. References
Index
End User License Agreement

List of Tables

Chapter 01
1. Table 1.1 Common electrolytes and their charges
2. Table 1.2 Average intracellular/extracellular electrolyte concentrations
3. Table 1.3 Units of measurement of electrolytes
Chapter 02
1. Table 2.1 Distribution of sodium and potassium in the intra‐extracellular fluid
2. Table 2.2 Treatment recommendations for hyponatremia based on clinical signs
Chapter 04
1. Table 4.1 Recommended potassium supplementation
Chapter 05
1. Table 5.1 Normal magnesium levels in dogs and cats
2. Table 5.2 Causes of magnesium deficit
Chapter 06
1. Table 6.1 Causes of hypophosphatemia
Chapter 07
1. Table 7.1 Factors affecting calcium analysis when sampling
2. Table 7.2 Common cancers and incidence of hypercalcemia
Chapter 08
1. Table 8.1 Percentages of buffering provided by each buffer type
2. Table 8.2 Normal arterial and venous acid‐base values for cats and dogs
Chapter 09
1. Table 9.1 Laboratory characteristics of metabolic alkalosis
2. Table 9.2 Laboratory characteristics of metabolic acidosis
Chapter 10
1. Table 10.1 Pros and cons of oxygen therapy techniques
Chapter 11
1. Table 11.1 Expected compensatory response to acid‐base disorders
2. Table 11.2 Example cases
Chapter 12
1. Table 12.1 SID and effect on acid‐base status
2. Table 12.2 List of major cations and anions
3. Table 12.3 Strong ion effect on SID and acid‐base status
Chapter 13
1. Table 13.1 Catheterization sites for common exotic animals
2. Table 13.2 The relationship between pCO₂ and pH when various metabolic disturbances are present
3. Table 13.3 Normal electrolyte ranges for common exotic animal
4. Table 13.4 Common causes of electrolyte abnormalities

List of Illustrations

Chapter 01
1. Figure 1.1 Arterial blood gases chart.
2. Figure 1.2 Effective and ineffective osmoles.
Chapter 02
1. Figure 2.1 Distribution of water by total bodyweight.
2. Figure 2.2 Transport of sodium across the luminal membrane of the renal tubule through the use of membrane co‐transporter proteins.
3. Figure 2.3 Renin‐angiotensin‐aldosterone system (RAAS).
Chapter 03
1. Figure 3.1 Corrected chloride.
2. Figure 3.2 Chloride gap.
3. Figure 3.3 Sodium chloride ratio.
Chapter 04
1. Figure 4.1 The Na⁺/K⁺‐ATPase pump.
2. Figure 4.2 ECG changes due to hyperkalemia, tall, spiked T‐waves.
3. Figure 4.3 ECG changes related to increasing hyperkalemia.
Chapter 05
1. Figure 5.1 Patient with tetanus receiving a constant rate infusion of intravenous magnesium.
Chapter 07
1. Figure 7.1 Body systems responsible for calcium regulation.
2. Figure 7.2 Initial response to hypocalcemia.
Chapter 08
1. Figure 8.1 Process of acid‐base balance in relation to pCO₂ and pH changes.
2. Figure 8.2 Acid‐base balance in the kidneys.
3. Figure 8.3 The anion gap.
4. Figure 8.4 Arterial blood gases chart.
5. Figure 8.5 Tic‐tac‐toe method of determining acid‐base imbalance.
6. Figure 8.6 How to use the tic‐tac‐toe method to determine acid‐base imbalance.
Chapter 09
1. Figure 9.1 Bicarbonate ion ().
2. Figure 9.2 Flowchart indicating normal versus compensated acid‐base disturbances and alkalemia versus acidemia.
3. Figure 9.3 Flowchart indicating when primary and compensatory alkalosis or acidosis is not present.
4. Figure 9.4 Abaxis I‐Stat point‐of‐care blood gas analyzer and a CG8+ cartridge, which is a common device for obtaining quick and reliable blood gas values.
5. Figure 9.5 Calcium oxalate crystals form as a result of glycolic acid formation from ingesting ethylene glycol.
6. Figure 9.6 Image of an 8.4% sodium bicarbonate () injectable solution bottle.
Chapter 10
1. Figure 10.1 Alveoli pulmonary cross‐section.
2. Figure 10.2 Oxygen hemoglobin disassociation curve.
3. Figure 10.3 Dyspneic cat.
4. Figure 10.4 Respiratory bulldog.
5. Figure 10.5 Nasal cannula.
6. Figure 10.6 Dyspneic cat with oxygen hood.
7. Figure 10.7 Nasal prongs.
Chapter 11
1. Figure 11.1 Mixed acid‐base disorder with a high anion gap acidosis and inappropriate compensation as shown on a cage side chemistry analyzer.
Chapter 12
1. Figure 12.1 Variables in A‐B evaluation.
Chapter 13
1. Figure 13.1 The pinna of the rabbit is quite vascular. The blue arrow is pointing to the marginal auricular vein while the black arrow is pointing to the auricular artery.
2. Figure 13.2 The auricular artery is used for blood gas sampling in exotic mammals such as rabbits. The artery is numbed prior to sampling by applying a thin layer of local anesthetic cream to the surface and then covering it with a semi‐occlusive bandage.
3. Figure 13.3 Venipuncture in small rodents can be difficult. To help keep the vessel from collapsing, a small‐gauge needle can be inserted into the vessel and blood can be collected using several hematocrit tubes.
4. Figure 13.4 The femoral vein and artery can be used to obtain larger samples of blood from small rodents. A 27‐ or 25‐gauge needle attached to a 1 cc syringe works well for sample collection.
5. Figure 13.5 The black arrow is pointing to the medial metatarsal vein in an avian patient. The person restraining the bird holds off the vessel by placing a finger or thumb across the leg similar to what is done in a canine or feline patient. The syringe and needle size used will be based on the size of the patient. In general a 1 or 3 cc syringe attached to a 27‐ or 25‐gauge needle is used for sample collection.
6. Figure 13.6 The jugular vein can be used for sample collection in most species of birds. The right jugular vein is often larger than the left, but either vessel can be cannulated.
7. Figure 13.7 The syringe and needle size used will be based on the size of the patient. In general a 1 or 3 cc syringe attached to a 27‐ or 25‐gauge needle is used for sample collection.
8. Figure 13.8 Collecting blood via the jugular vein in chelonians.
9. Figure 13.9 Using the subcarapacial venous sinus when the jugular venipuncture is not an option.
10. Figure 13.10 Cardiocentesis is commonly used for blood collection in the snake.
11. Figure 13.11 Fish are anesthetized for basic physical examinations and diagnostic procedures including blood collection. The most common anesthetic used is tricaine methanesulfonate (MS‐222).
12. Figure 13.12 Blood collection in fish is very similar to that in the lizard.

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Library of Congress Cataloging‐in‐Publication Data

Names: Randels‐Thorp, Angela, 1971– editor. | Liss, David, 1985– editor.
Title: Acid‐base and electrolyte handbook for veterinary technicians / edited by Angela Randels‐Thorp, David Liss.
Description: Ames, Iowa : John Wiley & Sons Inc., 2017. | Includes bibliographical references and index.
Identifiers: LCCN 2016035702| ISBN 9781118646540 (pbk.) | ISBN 9781118922880 (Adobe PDF)
Subjects: LCSH: Veterinary pathophysiology. | Acid‐base imbalances. | Water‐electrolyte imbalances. | MESH: Acid‐Base Imbalance–veterinary | Acid‐Base Equilibrium | Water‐Electrolyte Imbalance–veterinary | Water‐Electrolyte Balance | Animal Technicians
Classification: LCC SF910.W38 A25 2017 | NLM SF 910.W38 | DDC 636.089/607–dc23
LC record available at https://lccn.loc.gov/2016035702

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Foreword

It is gratifying for me to see Blackwell‐Wiley’s publication of this Acid‐Base and Electrolyte Handbook for Veterinary Technicians by Angela Randels‐Thorp and David Liss. This work clearly is more than a “handbook” in that the authors have taken care to explain the physiology and pathophysiology underlying disturbances in acid‐base and electrolyte homeostasis. Their love of the subject shows in their treatment of it. As I previously said in the preface to my own textbook, Fluid, Electrolyte, and Acid Base Disorders in Small Animal Practice, a sound foundation in physiology and pathophysiology enables the clinician to best understand the abnormalities he or she encounters: “Thoughtful evaluation of laboratory results provides valuable insight into the fluid, electrolyte and acid base status of the animal and can only improve the veterinary care provided.” The same can be said for veterinary technicians. If they understand the basis for the abnormal laboratory findings, they will be better able to take an informed approach to care for their veterinary patients. This type of in‐depth understanding allows veterinarians and veterinary technicians to make the best decisions when treating their patients. A favorite example of mine is understanding why chloride is the critical electrolyte needed to restore acid base balance in a dog or cat with metabolic alkalosis caused by protracted vomiting of stomach contents (HINT: it involves the vital need of the kidneys to reabsorb sodium in the volume‐depleted patient). Understanding the pathophysiology allows the clinician to make the logical choice of 0.9% NaCl as the crystalloid fluid of choice in this situation.

Randels‐Thorp and Liss have taken an in‐depth approach in their book, and indicate that they hope they are “providing an easy to understand approach to this detailed material, while not neglecting to incorporate the advanced nature of the topic.” They have delivered on this promise in their book, which takes considerable care to explain the physiology behind the laboratory abnormalities. Their approach will be useful not only to veterinary technicians pursuing specialty certification but also to veterinary students and veterinarians too. Their book provides valuable information about disorders of sodium, chloride, potassium, calcium, magnesium, and phosphorus as well as acid base disorders. The authors have not shied away from complexity, and have included a chapter on mixed acid base disturbances as well as a chapter on the non‐traditional approach to acid base balance, along with case examples to illustrate the value of the non‐traditional approach in complicated cases. The final chapter (Companion Exotic Animal Electrolytes and Acid‐Base) provides in one place hard‐to‐find valuable information not only about exotic mammalian species but also about birds, reptiles, and fish. I hope the community of veterinary technicians welcomes the challenge the authors have given them and uses this book as a foundation for advanced studies and specialty certification.

Stephen P. DiBartola,
DVM, ACVIM (internal medicine)
Emeritus Professor
Department of Veterinary Clinical Sciences
College of Veterinary Medicine
Ohio State University
Columbus, OH 43210