Veterinary Clinical Medicine-I (General and Systemic)

TREATMENT

• Depends on underlying condition
• PSVA—surgical correction

• Fluids—0.9% saline or Ringer with 2.5%–5.0% dextrose and 20–30 mEq of potassium chloride/L; do not use lactate with fulminant hepatic failure (rare); use sodium-restricted fluids with acquired liver disease with acquired portosystemic shunting and ascites.
• Colloids—may be essential with low albumin (< 1.5 g/dL); use fresh-frozen plasma rather than synthetic colloids.
• Minimize exposure to drugs that require hepatic biotransformation or elimination.

Diet

• Adequate calories—avoid catabolism
• Dietary protein restriction—cornerstone of medical management for chronic disease; only as needed to ameliorate signs; dairy and vegetable proteins best tolerated
• Good-quality vitamin supplement (without methionine)—vitamin metabolism often perturbed with liver dysfunction

Drugs of choice

• Antibiotics—spectrum against intestinal flora (aerobic and anaerobic); nonabsorbable (neomycin, 10–20 mg/kg PO q8–12h); local and systemic (metronidazole, 7.5–10 mg/kg q12h); used in combination with lactulose
• Nonabsorbable-fermented carbohydrates—lactulose, lactitol, or lactose (if lactase deficient); lactulose most commonly used (starting dose, 0.5–1 mL/kg given two or three times daily);
• Enemas—cleansing (warmed polyionic fluids) mechanically clean the colon (10–15 mL/kg);  lactulose, lactitol, or lactose diluted 1:2 in water; neomycin in water (do not exceed oral dose); diluted Betadine (1:10, rinse well after 15 min); diluted vinegar (diluted 1:10 in water)