Veterinary Clinical Medicine-I (General and Systemic)

MANAGEMENT

• Inpatient management
• Eliminate inciting insults
• Discontinue nephrotoxic drugs
• Establish and maintain hemodynamic stability
• Ameliorate life-threatening fluid imbalance
• Biochemical abnormalities, and uremic toxicities
• Induce emesis
• Institute gastric lavage
• Administer activated charcoal
• Cathartics
• Specific antidotes to patients with acute poisoning
• Early haemodialysis can eliminate dialyzable toxins.

Fluids

• Normal (0.9%) saline or balanced polyionic solution within 4–6 h; replace blood losses by whole blood transfusion; once the patient is hydrated, ongoing fluid requirements are provided by 5% dextrose for insensible requirements (approximately 20–25 mL/kg/day) and balanced electrolyte solution equal to urinary and other losses (i.e., vomiting and diarrhea).
• Hypervolemia—stop fluid administration and eliminate excess fluid by diuretic administration or dialysis

• Failure to induce diuresis by fluid replacement indicates severe parenchymal damage or underestimation of fluid deficit; if fluid-replete, administer diuretics and/or dopamine.
• Hypertonic mannitol (10–20%)—0.5–1.0 g/kg IV over 15–30 min; if effective, continue as intermittent IV bolus q4–6h or 1.0–2.0 mg/kg/min IV continuous-rate infusion (CRI);
• Furosemide (alternative or subsequent to mannitol)—2–6 mg/kg IV; 
• Dopamine—1–5 m g/kg/min IV in 5% dextrose as CRI; If these treatments fail to induce diuresis within 4–6 h, consider dialysis.

• Acid–Base Disorders
  • Administer bicarbonate if serum bicarbonate < 15 mEq/L; bicarbonate replacement: mEq = bicarbonate deficit × body weight (kg) × 0.3; give half IV over 30 min and the remainder over 4–6 h; then reassess

• Vomiting
  • NPO until vomiting subsides
  • Reduce gastric acid production—cimetidine (2.5–5.0 mg/kg IV q8–12h) or ranitidine (2 mg/kg IV q8–12h) or omeprazole (0.7–2.0 mg/kg PO q24h [dogs])
  • Mucosal protectant—sucralfate (0.5–1.0 g PO q6–8h)
  • Antiemetics—metoclopramide (0.2–0.5 mg/kg IV or IM q6–8h)
  • Control of vomiting—chlorpromazine (0.5 mg/kg IM q6–12h), prochlorperazine (0.1–0.2 mg/kg IM q6–8h), or trimethobenzamide (3.0 mg/kg IM q6–8h) can be used to treat vomiting but is associated with CNS depression, vasodilatation, and hypotension.

• Peritoneal or Hemodialysis
  • Dialysis can stabilize the patient until renal function is restored; without dialysis, most oliguric patients die before renal repair can occur.