Providing the right fluids in patients with hypernatremia
In the January 2008 issue, the article "Toxicology Brief: Sodium hypochlorite bleach ingestion in two dogs" states that lactated Ringer's solution was used to treat hypernatremia and hyperchloremia. It seems that a fluid such as dextrose 5% in water may be more appropriate, as well as something without sodium to replenish bicarbonate.
James A. Noll, DVM
Florence Animal Clinic
Dr. Chapman responds: Thank you for this comment as this addresses an important aspect of fluid therapy in the management of this case. As mentioned in the article, these animals were initially treated with lactated Ringer's solution on admission to the intensive care unit. Fluid therapy was later changed to dextrose 5% in water when the results of the serum chemistry profiles were available, which is a more appropriate choice given the presence of hypernatremia. While the full treatment regimen was not provided in this brief report, Dr. Noll brings up a valid point that should have been included in the discussion. Unfortunately, because of the rapid deterioration of these animals, it was difficult to fully appreciate the effect of fluid therapy on the electrolyte abnormalities.
Seth Chapman, DVM
Department of Veterinary Pathobiology
College of Veterinary Medicine and Biomedical Sciences
Texas A&M University
College Station, Texas