Quantitative Physicochemical Analysis of Acid-Base Balance and Clinical Utility of Anion Gap and Strong Ion Gap in 806 Neonatal Calves with Diarrhea

BackgroundAcid-base abnormalities in neonatal diarrheic calves can be assessed by using the Henderson-Hasselbalch equation or the simplified strong ion approach which use the anion gap (AG) or the strong ion gap (SIG) to quantify the concentration of unmeasured strong anions such as d-lactate. Hypothesis/ObjectivesTo determine and compare the clinical utility of AG and SIG in quantifying the unmeasured strong anion charge in neonatal diarrheic calves, and to examine the associations between biochemical findings and acid-base variables by using the simplified strong ion approach. We hypothesized that the SIG provides a more accurate prediction of unmeasured strong anions than the AG. AnimalsEight hundred and six neonatal diarrheic calves admitted to a veterinary teaching hospital. MethodsRetrospective study utilizing clinicopathologic findings extracted from medical records. ResultsHyperphosphatemia was an important predictor of venous blood pH. Serum inorganic phosphorus and plasma d-lactate concentrations accounted for 58% of the variation in venous blood pH and 77% of the variation in AG and SIG. Plasma d- and total lactate concentrations were slightly better correlated with SIG (r(s)=-0.69;-0.78) than to AG (r(s)=0.63;0.74). Conclusions and Clinical ImportanceStrong ion gap is slightly better at quantifying the unmeasured strong anion concentration in neonatal diarrheic calves than AG. Phosphorus concentrations should be included as part of the calculation of A(tot) when applying the simplified strong ion approach to acid-base balance to critically ill animals with hyperphosphatemia

Quantitative Physicochemical Analysis of Acid-Base Balance and Clinical Utility of Anion Gap and Strong Ion Gap in 806 Neonatal Calves with Diarrhea

BackgroundAcid-base abnormalities in neonatal diarrheic calves can be assessed by using the Henderson-Hasselbalch equation or the simplified strong ion approach which use the anion gap (AG) or the strong ion gap (SIG) to quantify the concentration of unmeasured strong anions such as d-lactate. Hypothesis/ObjectivesTo determine and compare the clinical utility of AG and SIG in quantifying the unmeasured strong anion charge in neonatal diarrheic calves, and to examine the associations between biochemical findings and acid-base variables by using the simplified strong ion approach. We hypothesized that the SIG provides a more accurate prediction of unmeasured strong anions than the AG. AnimalsEight hundred and six neonatal diarrheic calves admitted to a veterinary teaching hospital. MethodsRetrospective study utilizing clinicopathologic findings extracted from medical records. ResultsHyperphosphatemia was an important predictor of venous blood pH. Serum inorganic phosphorus and plasma d-lactate concentrations accounted for 58% of the variation in venous blood pH and 77% of the variation in AG and SIG. Plasma d- and total lactate concentrations were slightly better correlated with SIG (r(s)=-0.69;-0.78) than to AG (r(s)=0.63;0.74). Conclusions and Clinical ImportanceStrong ion gap is slightly better at quantifying the unmeasured strong anion concentration in neonatal diarrheic calves than AG. Phosphorus concentrations should be included as part of the calculation of A(tot) when applying the simplified strong ion approach to acid-base balance to critically ill animals with hyperphosphatemia

Additive prognostic value of preoperative plasma glucose concentrations in calves undergoing abdominal surgery.

Surgical abdominal emergencies in calves are associated with a guarded prognosis, especially if neonates are affected. Because hypoglycemia has been associated with sepsis and endotoxemia, this study aimed to assess the prognostic relevance of preoperative plasma glucose concentrations (GLUC) in calves requiring surgery for an acute abdominal disorder. For this purpose, data from retrospective and prospective case series were analyzed, consisting of 586 and 83 hospitalized calves, respectively. The outcomes of calves were evaluated until hospital discharge (both study populations) and for 3 mo following discharge by a phone call to the farmer (prospective study population). For the retrospective study population, the overall survival rate was 31.2%. Calves with a negative outcome (NO) had significantly lower median GLUC (4.3 mmol/L) than calves with a positive outcome (PO; 5.0 mmol/L). The survival rates of calves with GLUC 8.84 mmol/L), and GLUC <4.4 mmol/L (age 7-20 d) and <3.3 mmol/L (age ≥21 d), respectively. The area under the receiver operating characteristic curve of this model was 0.79 (95% confidence interval: 0.76-0.83) and the resulting sensitivity and specificity for NO at the optimal probability cut-point of 0.69 were 66.7 and 85.8%, respectively. For the prospective study population, the established model had sensitivity and specificity for predicting NO after 3 mo (proportion 24%) of 61.9 and 85%, respectively. In both study populations, hypoglycemia was significantly associated with intraoperative evidence of a septic process within the abdominal cavity. The present analyses show that hypoglycemia was highly indicative of a poor prognosis and serious intraoperative findings such as peritonitis. Determination of GLUC should therefore be part of the diagnostic work-up in calves suffering from an acute abdominal emergency

Risk Factors for the Development of Hypokalemia in Neonatal Diarrheic Calves

BackgroundNeonatal diarrheic calves have a clear negative potassium balance because of intestinal losses and decreased milk intake but in the presence of acidemia, they usually show normokalemic or hyperkalemic plasma concentrations. ObjectivesTo assess whether marked hypokalemia occurs in response to the correction of acidemia and dehydration and to identify factors that are associated with this condition. AnimalsEighty-three calves with a clinical diagnosis of neonatal diarrhea. MethodsProspective cohort study. Calves were treated according to a clinical protocol using an oral electrolyte solution and commercially available packages of 8.4% sodium bicarbonate, 0.9% saline and 40% dextrose infusion solutions. ResultsThe proportion of hypokalemic calves after 24hours of treatment (19.3%) was twice as great as it was on admission to the hospital. Plasma K+ after 24hours of treatment was not significantly correlated to venous blood pH values at the same time but positively correlated to venous blood pH values on admission (r=0.51, P<.001). Base excess on admission (Odds ratio [OR]=0.81, 95% confidence interval [CI]=0.70-0.94),duration of diarrhea (OR=1.37, 95% CI=1.05-1.80),milk intake during hospitalization (OR=0.54, 95% CI=0.37-0.79) and plasma sodium concentrations after 24hours (OR=1.12, 95% CI=1.01-1.25) were identified to be independently associated (P<.05) with a hypokalemic state after 24hours of treatment. Conclusions and Clinical ImportanceFindings of this study suggest that marked depletion of body potassium stores is evident in diarrheic calves that suffered from marked metabolic acidosis, have a low milk intake and a long history of diarrhea

Effects of Alkalinization and Rehydration on Plasma Potassium Concentrations in Neonatal Calves with Diarrhea

BackgroundIncreased plasma potassium concentrations (K+) in neonatal calves with diarrhea are associated with acidemia and severe clinical dehydration and are therefore usually corrected by intravenous administration of fluids containing sodium bicarbonate. ObjectivesTo identify clinical and laboratory variables that are associated with changes of plasma K+ during the course of treatment and to document the plasma potassium-lowering effect of hypertonic (8.4%) sodium bicarbonate solutions. AnimalsSeventy-one neonatal diarrheic calves. MethodsProspective cohort study. Calves were treated according to a clinical protocol using an oral electrolyte solution and commercially available packages of 8.4% sodium bicarbonate (250-750mmol),0.9% saline (5-10L),and 40% dextrose (0.5L) infusion solutions. ResultsInfusions with 8.4% sodium bicarbonate solutions in an amount of 250-750mmol had an immediate and sustained plasma potassium-lowering effect. One hour after the end of such infusions or the start of a sodium bicarbonate containing constant drip infusion, changes of plasma K+ were most closely correlated to changes of venous blood pH, plasma sodium concentrations and plasma volume (r=-0.73,-0.57,-0.53;P<.001). Changes of plasma K+ during the subsequent 23hours were associated with changes of venous blood pH, clinical hydration status (enophthalmos) and serum creatinine concentrations (r=-0.71, 0.63, 0.62;P<.001). Conclusions and Clinical ImportanceThis study emphasizes the importance of alkalinization and the correction of dehydration in the treatment of hyperkalemia in neonatal calves with diarrhea

Effects of Alkalinization and Rehydration on Plasma Potassium Concentrations in Neonatal Calves with Diarrhea

BackgroundIncreased plasma potassium concentrations (K+) in neonatal calves with diarrhea are associated with acidemia and severe clinical dehydration and are therefore usually corrected by intravenous administration of fluids containing sodium bicarbonate. ObjectivesTo identify clinical and laboratory variables that are associated with changes of plasma K+ during the course of treatment and to document the plasma potassium-lowering effect of hypertonic (8.4%) sodium bicarbonate solutions. AnimalsSeventy-one neonatal diarrheic calves. MethodsProspective cohort study. Calves were treated according to a clinical protocol using an oral electrolyte solution and commercially available packages of 8.4% sodium bicarbonate (250-750mmol),0.9% saline (5-10L),and 40% dextrose (0.5L) infusion solutions. ResultsInfusions with 8.4% sodium bicarbonate solutions in an amount of 250-750mmol had an immediate and sustained plasma potassium-lowering effect. One hour after the end of such infusions or the start of a sodium bicarbonate containing constant drip infusion, changes of plasma K+ were most closely correlated to changes of venous blood pH, plasma sodium concentrations and plasma volume (r=-0.73,-0.57,-0.53;P<.001). Changes of plasma K+ during the subsequent 23hours were associated with changes of venous blood pH, clinical hydration status (enophthalmos) and serum creatinine concentrations (r=-0.71, 0.63, 0.62;P<.001). Conclusions and Clinical ImportanceThis study emphasizes the importance of alkalinization and the correction of dehydration in the treatment of hyperkalemia in neonatal calves with diarrhea

Electrocardiographic findings in 130 hospitalized neonatal calves with diarrhea and associated potassium balance disorders

Background: Hyperkalemia in neonatal diarrheic calves can potentially result in serious cardiac conduction abnormalities and arrhythmias. Objective: To document electrocardiographic (ECG) findings and the sequence of ECG changes that are associated with increasing plasma potassium concentrations (cK(+)) in a large population of neonatal diarrheic calves. Animals: One hundred and thirty neonatal diarrheic calves (age 21 days). Methods: Prospective observational study involving calves admitted to a veterinary teaching hospital. Results: Hyperkalemic calves (cK(+): 5.8-10.2, blood pH: 6.55-7.47) had significantly (P6.5 mmol/L, S wave amplitude voltage decreased when cK(+) >7.4 mmol/L, QRS duration increased when cK(+) >7.8 mmol/L, J point amplitude increased when cK(+) >7.9 mmol/L, and ST segment angle increased when cK(+) >9.1 mmol/L. P wave amplitude was characterized by a second common break point at cK(+)=8.2 mmol/L, above which value the amplitude was 0. Conclusions and Clinical Importance: Hyperkalemia in neonatal diarrheic calves is associated with serious cardiac conduction abnormalities. In addition to increased S and T wave amplitude voltages, alterations of P and Ta wave amplitudes are early signs of hyperkalemia, which is consistent with the known sensitivity of atrial myocytes to increased cK(+)

Advances in prevention and therapy of neonatal dairy calf diarrhoea : a systematical review with emphasis on colostrum management and fluid therapy

Neonatal calf diarrhoea remains the most common cause of morbidity and mortality in preweaned dairy calves worldwide. This complex disease can be triggered by both infectious and non-infectious causes. The four most important enteropathogens leading to neonatal dairy calf diarrhoea are Escherichia coli, rota-and coronavirus, and Cryptosporidium parvum. Besides treating diarrhoeic neonatal dairy calves, the veterinarian is the most obvious person to advise the dairy farmer on prevention and treatment of this disease. This review deals with prevention and treatment of neonatal dairy calf diarrhoea focusing on the importance of a good colostrum management and a correct fluid therapy